Ortho Part 3

Question 1

what are the four most common types of spinal surgeries

Answer 1

fusion, laminectomy, decompression, and discectomy

Question 2

describe approach techniques for spinal fusions

Answer 2

anterior more common in c spine, posterior more common in L spine

Question 3

what type of fusion materials can be used in spinal surgeries

Answer 3

harrington rods, pedicle screws, cages, and bone

Question 4

what are harrington rods?

Answer 4

distraction-type fixation that immobilizes multisegmental spine in certain planes

Question 5

what is the purpose of a pedicle screw

Answer 5

provides a rigid stable structure to which rods may be attached

Question 6

how does a cage work?

Answer 6

filled with autogenous bone, it is inserted between bodies in order to fuse the segments

Question 7

how are cages implanted?

Answer 7

between vertebral bodies via anterior approach

Question 8

from where is bone graft material harvested?

Answer 8

iliac crest - painful ambulation post op

Question 9

what is a spinal decompression

Answer 9

removal of posterior column (including lamina) and the foramen is widened to relieve pressure on the neural structures

Question 10

what is a discectomy

Answer 10

excision of herniated material, can be combined with other procedures

Question 11

minimally invasive spinal surgery should be considered for which conditions?

Answer 11

disc hernation, scoliosis, fusion

Question 12

how can you classify cervical orthoses?

Answer 12

rigid, semi-rigid, and soft

Question 13

when is a rigid cervical orthosis indicated? what’s it called?

Answer 13

unstable fractures; halo

Question 14

what is a PT implication for patients with a halo?

Answer 14

don’t tug on the vest

Question 15

when is a semi-rigid cervical orthosis indicated? what are two types?

Answer 15

stable fractures post op; philadelphia and miami-j

Question 16

when is a soft cervical orthosis indicated? what is an example?

Answer 16

symptom mgmt and pain control; foam with velcro

Question 17

how can you classify thoracolumbar and sacral orthoses?

Answer 17

rigid, semi-rigid, and soft

Question 18

when is a rigid TLSO indicated? what are two types

Answer 18

stable fractures post op; TLSO and Jewitt

Question 19

when is a semi-rigid TLSO indicated? what is an example?

Answer 19

symptom mgmt and pain control; corset

Question 20

when is a soft TLSO indicated? what is an example?

Answer 20

symptom mgmt and pain control; abdominal binder

Question 21

what tests and measures would you consider for a patient who has had spinal surgery?

Answer 21

Neuro exam
functional mobility
balance
vitals
cognition

Question 22

what are spinal precautions

Answer 22

no BLT - bending, lifting, and twisting

Question 23

how long do you expect a spinal patient to be hospitalized?

Answer 23

1-2 days unless they have a surgical complication, then usually 3 days

Question 24

how often should PT services be provided to spinal surgery patients?

Answer 24

1-2x/day beginning the day after surgery

Question 25

what are the four general precautions following a spinal surgery

Answer 25

1. use log rolling for bed mobility 2. avoid spinal flexion in sitting 3. wear brace per orders (usu OOB or upright) 4. limit prolonged sitting 5. no BLT

Question 26

what is the lumbar specific post op spinal precaution for lifiting objects?

Answer 26

no lifting anything heavier than 10 lbs (gallon of milk)

Question 27

what are two cervical specific post op spinal precautions

Answer 27

1. no lifting over 5 pounds | 2. UE movement <90

Question 28

what are important exercises to prescribe post op for spinal patients

Answer 28

activities to reduce CVP risks - ankle pumps and incentive spirometry

Question 29

briefly comment on post op spinal surgery strength and flexibility training

Answer 29

inappropriate in acute care

Question 30

if strength and flexibility is contraindicated, and we already mentioned CVP exercises, what else can you work on with spinal surgery patients?

Answer 30

1. spinal precaution education 2. bracing 3. aerobic capacity

Question 31

what five factors must be considered for a traumatic fracture

Answer 31

1. skin integrity 2. site of fracture 3. type 4. extent 5. position of fragments

Question 32

how can you classify a fracture based on skin integrity

Answer 32

open v closed

Question 33

how can you classify a fracture based on its site?

Answer 33

articular, epiphyseal, midbone, etc

Question 34

how can you classify a fracture based on type

Answer 34

linear, transverse, oblique, spiral, comminuted, segmental

Question 35

how can you classify a fracture based on extent

Answer 35

complete v incomplete

Question 36

how can you classify a fracture based on relative position of fragments

Answer 36

nondisplaced v displaced

Question 37

what are the four strata of spinal fracture classification

Answer 37

1. location (transverse/spinous/body) 2. compression (wedge or burst) 3. dislocation present or not 4. stable or unstable

Question 38

what are the three phases of fracture healing and what are their relative times

Answer 38

1. inflammatory (days) 2. reparative (up to 6-12 weeks post inflammation) 3. remodeling (6 mo to years)

Question 39

what happens in the inflammatory phase

Answer 39

hematoma formation and inflammatory mediators

Question 40

what happens in the reparative phase

Answer 40

granulation tissue and fibrocartilage form a soft callus to be replaced by a fibroosseus, bony callus

Question 41

what happens in the remodeling phase

Answer 41

complete restoration of the medullary canal

Question 42

how long does it take fractures to heal in peds? adolescents? adults?

Answer 42

4-6 wks 6-8 wks 10-18 wks

Question 43

what do you do if you suspect compartment syndrome?

Answer 43

contact the doc right away - medical emergency

Question 44

how does a fat embolism occur?

Answer 44

large bones may release fat globules from the marrow that can clot causing a PE or stroke

Question 45

what are some types of immobilization strategies?

Answer 45

external fixation (spints, braces, casts) or internal fixation (grafts and hardware)

Question 46

when is an external fixator typically indicated?

Answer 46

comminuted and open fxs with massive soft tissue injury (eg. pelvic fxs)

Question 47

when is an external cast typically indicated?

Answer 47

stable, closed fracture

Question 48

what are the four PT considerations for patients with hip fracture external fixators

Answer 48

1. maintain ROM above/below site 2. no pulling on the cage 3. minimized contact with the cage 4. discuss WB status with medical staff

Question 49

what is an ilizarov frame?

Answer 49

pediatric external fixator to extend bone length

Question 50

how long do you expect a patient to be hospitalized following a fracture?

Answer 50

1-3 days depending on the fracture site (hips usually warrant longer stays)

Question 51

how often should PT see fx patients?

Answer 51

1x per day

Question 52

what are some PT considerations for mobilizing a patient with an immobilized limb fracture?

Answer 52

mobilize the patient, although the effected limb will be NWB for 6-8 weeks

Question 53

what are elevation considerations for fracture patients?

Answer 53

4-5 in above the hear to assist venous return

Question 54

comment on strength and flexiblity training for fracture patients

Answer 54

strengthen around the fx and wb extremitity, core should be trained, AAROM/ROM within the context of the order

Question 55

how do you transfer a patient with a fractured lower extremity

Answer 55

towards strong limb, away from weak

Question 56

where is the incision made for a TSA?

Answer 56

between pec major and anterior deltoid

Question 57

what are post TSA precautions? (5)

Answer 57

1. ROM restricted per orders 2. no lifting/pushing/pulling with involved for 6 weeks 3. no behind the back/IR 4. no excessive stretching into ER 5. NWB 6. hand to mouth feeding with elbow at side

Question 58

what is considered proper bed positioning for a patient post TSA

Answer 58

1. towel roll under the elbow in supine | 2. avoid lying on involved extremity

Question 59

what are three therex implications in acute care for post op TSA

Answer 59

1. supine passive fwd flx w elbow flexed 2. supine passive ER with arm at side/elbow flexed 3. pendulums

Question 60

what is the weight limit for a straight cane? bariatric cane?

Answer 60

250; 500

Question 61

what is the weight limit for axillary crutches? bariatric crutches?

Answer 61

250; 550

Question 62

what is the weight limit for an adult wheeled walker? bariatric wheeled walker?

Answer 62

300; 500

Question 63

what is the weight limit for a standard adult wheelchair? bariatric extra wide?

Answer 63

250; 450

Question 64

what is the weight limit for a sliding board

Answer 64

400

Question 65

what is the weight limit for a tilt table

Answer 65

400