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Bringman class fall 2015 > Exam 1: Thursday 8/20/15 > Flashcards

Exam 1: Thursday 8/20/15 Flashcards

1
Q

How does a hip fracture manifest clinically?

A

~Pain in groin (the neck of the femur is located in the groin)
~Loss of the mobility in whole LE
~Visible deformity if displaced- shorten leg
~Can have a dislocated hip (will look similar to a displacement)- internal rotation, flexion, adduction

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2
Q

How can the health care team diagnosis a hip fracture?

A

~Radiograph

~MRI

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3
Q

Is a radiograph or MRI more definitive when diagnosing a hip fracture?

A

MRI

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4
Q

What will be done after a hip fracture is diagnosed?

A

Fix it or not fit

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5
Q

Don’t WB through the hip fracture if there is a fracture through….

A

Intertrochantric and intracapsular

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6
Q

Won’t fix a hip fracture if…

A 
~bone density decreased
~Older
~nursing home (?)
~immobile
~dementia
~decrease cardiac health
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7
Q

How to fix the hip fracture?

A

Surgery!!

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8
Q

Different types of surgery for a hip fracture

A 
~Nailing
~Compression screws
~THR
~Subtrochantic fracture nailing
~Oblique subtrochantic and intertrochantric- Locking plate
~Intracapsular- a few screws
~Intracapsular- compression screws
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9
Q

Details on Subtrochantic fracture nailing

A

~Usually performs this when there is a fracture somewhere on the subthrochatric (on the shaft)
~Has intramedullary canal in the shaft of the femur
~We can put the “pipe”/ nail through the intramedullary canal
~Physician drills in and all the medullary material is drained out
~measures how big the canal is; too small- moves; too big- more little fracture
~Will put large screw down the canal and then a screw through the neck of the femur
~There is distal screw to keep it from moving

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10
Q

Details on oblique subtrochantic and intertrochantric- Locking plate

A

~Long hardware that is bendable
~Sits on the outside of the bone
~Compression screws through the bone

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11
Q

Details on Intracapsular- a few screws

A

~Put 2 screws through the neck with washers
~Washers in place so that the screws cant be pulled through
~This is done so that a new neck is made

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12
Q

Details on Intracapsular- compression screws

A

~Has a plate attached to it that has a curve shape to shape to the femur with a few little screws to keep it in place
~A long compression screw through neck to help compress everything down

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13
Q

In oblique subtrochantic and intertrochantric- Locking plate, If the pt started to feel like there is a catch and/or loss of ROM, what do you do? (why?)

A

Take it seriously!!
~Body does a good job at move the screws in more or out of place
~The longest screw is the most important one to make sure it stays in place

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14
Q

Doctors may forget to give us a WB status. If this happens…

A

Default to NWB if there is not a WB status from the doc

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15
Q

Why do we have to get pts up (directly after surgery, etc)?

A

to prevent pneumonia/ DVTs

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16
Q

When would you not get a pt up?

A

~If there is dementia bc they do not remember not to WB
~also if they cannot maintain the WB status
**rely on nursing to help

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17
Q

TTWB stand for

A

toe touch weight bearing

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18
Q

WBAT stand for

A

weight bearing as tolerated

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19
Q

PWB stand for

A

partial weight bearing

*Bringman tells them that you can walk on it, but don’t bear too much weight through it

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20
Q

___ can be more stress on the joint bc …..; ____ is less because

A

NWB can be more stress on the joint bc you are holding up the LE; TTWB is less because the muscles can relax

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21
Q

What are some good tricks to help pts have feedback on the amount of force being put through the LE?

A

Packet of saltines, plastic plate, our foot

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22
Q

Fracture that has not been fixed: restrictions?

A

~No- only if the doc gives you some

~Pain is the only limiting factor

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23
Q

What are some possible cause of a pt passing out?

A

~Meds!
~Prolong bed rest
~Lack of food
~loss of blood

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24
Q

More details on how the meds can cause a pt to pass out

A

~Pain med can make them loopy

~Meds are off- hyper or hypo tension

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25
More details on how prolong bed rest can make a pt pass out
Being in bed for too long can lead to orthostatic hypotension
26
More details on how lac of food can make a pt pass out
the pt hasn’t eaten since before the surgery the night before!
27
More details on how blood loss can make a pt pass out
the pt has just had surgery which can lead to loss of blood; the loss of lead can lead to a decrease of Hgb
28
What do you need to talk to the pt about before they go home?
~Prior level of function ~What is their house like? ~Equipment ~Level of ind- do you have people to help
29
Details on the surgical site
~Some places will not let you look at the surgical site (nursing/ docs job) ~Coverderm is the normal bandage used ~Look on bandage for strike through ~Need to make sure that there is no infections
30
Do hip repairs normally have drains?
no
31
hip replacements: can have 2 different types
~Hemi arthroplasty | ~total
32
Hemi arthroplasty: details
~Replace half ~Get rid of the bone and replace it with the arthroplasty down into the intramedullary canal with bone cement ~Screw on a new femoral head ~Keep acetabulum
33
Which half is normally replaced?
~Typically replacing head and neck (not acetabulum)
34
A hemi arthroplasty is typically preformed on what type of fractures
Typically an higher intertrochantic or intracapsular
35
What are the benefits of having a hemi arthoplasty?
~Benefit is less trauma and there is not much bone to work with ~Want to keep as much of the acetabulum for as long as possible; if you have to have another hip replacement- can eventually have no bone to work with in this area
36
Precautions for a hemi arthoplasty
~Depends on the approach | ~If done correctly, should be WBAT
37
Approaches for a hip replacement
~posterior/ lateral | ~anterior
38
Posterior/ lateral hip precautions
~flexion 90 ~no adduction past neutral ~no IR
39
Posterior/ lateral hip precautions
These because the capsule has been cut, which normally would have kept the hip from dislocating
40
What are some everyday tasks that can cause a posterior/ lateral displacement?
~Flexion- Siting up, tying shoes, shaving legs, bathing, picking up something, getting into a chair that is low, don’t lead forward ~IR- don’t point toe in, turning to the hip that wasn’t worked on ~Adduction- getting in and out of bed, sleeping
41
Anterior hip precautions
~extreme extension (lunges)
42
Bringman stated anterior is better than posterior/ lateral bc
~Less pain because you are cutting through less arteries | ~Physician is cutting through/ moving around more important stuff
43
Implant criteria for a THA/ TKA
~Resistant to wear (durable) ~Approximate normal anatomy ~Biocompatibility ~High standard of production (no recalls)
44
Be able to describe the process of a THA to the pt!
~2 main component- the acetabular and the neck/head ~Will lay on your back and your feet in boots attached to the table so that the surgeon can manipulate the pt easier ~3-6 in incision near the groin ~Move aside muscles (no muscles are cut during the procedure) ~Will dislocate the hip ~Remove any OA, etc bone in the acetabulum and shape the acetabulum for the prosthesis ~Insert prosthesis to the acetabulum ~Remove the head and part of the inner neck/shaft for the neck ~Insert the prosthesis ~Relocate the hip with the new components ~The surgeon will test out the hip to make sure that it moves correctly and will take radiographs to make sure there is proper placements ~Close the incision after moving muscles in place
45
How long is it going to last?
Should last 10- 15 years (it is getting longer)
46
What will eventually fail?
~the boney attachment is the part that fails bc of forces and impact (over time it acts as a wedge and wears down) ~acetabular component and the top of the femur (greater trochanter) are the 2 parts that are most likely to cause the failure over time
47
activity precautions for THA
~causes the wear and tear | ~high impact activities: running, jumping, tennis, basketball, when feet leave the ground
48
rehab for a THA
~strengthen ~stretching ~get them up day of surgery and walk them ~ant- 4 way hip, ankle pump, gluts set, SAQ, LAQ, ~post- have to make sure that they don’t do flex ex about 90* on a 4 way hip ~out pt- WALK!, continue exercises
49
Who are you more worried about having a dislocation: someone doing really well or a little old lady that is scared to get up?
Person doing well- can do too well and push too hard
50
What happens after a dislocation?
need to put it back in (physician)
51
What can to prevent a hip dislocation (or what do you do after)?
~can put a knee immobilizer on ~hip spika ~locking hip
52
Details on a hip spika
~can have skin breakdown ~will have to wear this for months ~hard to put on without dislocating hip again ~never fits well
53
Details on a locking hip
~reducing the amount of ROM that the hip can move ~locks hip in place ~hardware you place into the joint
54
What are the two main types of total knee arthroplasty?
~unicompartmental/ partial | ~full
55
Details on unicompartmental/ partial
~if you only have problems with one side of the knee ~get to keep ACL/PCL can keep either MCL or LCL ~not very common ~ROM easier to get ~Exercises, therapy very similar ~Usually less swelling
56
Do you normally see a unicompartmental/ partial or a full TKA?
Typically see full compared to unicompartmental
57
Details on TKA
~Replace all ligaments; sometimes can save MCL/LCL ~BE able to draw this!! ~don’t do a SLR with a knee extension lag- you are reinforcing it!
58
Therapy for a TKA
``` ~a lot more therapy then total hip ~check strength and ROM (knee flex/ ext) ~walking ~take BP ~exercises (ankle pumps, quad sets, heel slides, SLR, SAQ/ LAQ, 4 way hip) ```
59
TKA- what meds, what is normally attached, etc right after surgery
~will have a drain ~some will sometimes use a recirculator ~nerve block to help with pain (sensory block) ~can still lose a little motor (need to assess if they will be able to WB through the leg)
60
What is a recirculator?
large drain that takes the blood that drained and put is back into you
61
What can you do if the leg is wobby?
put a knee immobilizer
62
TKA- measurements
~you care more about extension more than flexion | ~it’s harder to get extension and will walk funny if you do not get it
63
TKA- gait training
~need to educate and training their gait | ~they have been compensating for many years, trying to get back to pre injury/ pre OA gait
64
TKA- out pt therapy
~all the same ex from the hospital should be done at home (check the exercise to make sure they are doing right) ~gait training ~ROM ~balance ~functional activities ~increase mobility ~scar mobilization and patella mobilizations
65
what is something that can go wrong?
``` ~decrease ROM ~infection ~falls ~problems with the arteries and nerves ~death ```
66
Something that can go wrong details: decrease ROM
have to go in to mobilize under anesthesia
67
Something that can go wrong details: infection
~everything becomes more difficult (ROM, strength, etc) ~Can get in during surgery or get in from strike through ~dangerous b/c of the bone (bone now has hole) ~pump them full of antibiotics- hard to get antibiotic to the bone ~at a higher risk of osteomyelitis
68
What happens if an infections become bad enough?
~Will go in and do a IND (irrigation and debridement) ~can wash it out first; can go in and take out the joint ~take bone cement and antibiotic paste- shape into and put in where the prosthetic used to be ~can put in antibiotic beads through the hole (will not be doing ROM, etc with pt) ~when the infection is gone, put in a new prosthetics
69
What happens if an infection gets bad enough that an IND will not fix it?
~fuse bone or amputation
70
Something that can go wrong details: falls
~impacts the ground/ too much flexion- swelling and pops open the wound ~can lead to infection
71
Something that can go wrong details: problems with the arteries and nerves
~need to check if there are nerve/ blood supply damage post surgery ~cant move/ sensation issues/ increase pain/ N/T/ blood supply issues ~can loss a limb due to the lack of blood supply
72
Something that can go wrong details: death
~caused by a DVT | ~most likely going happen on the ortho floor
73
What are two things that a DVT can lead to?
~stroke (usually ischemic stroke; if we find it in time, we can give them TPA) ~PE (SOB quickly)

Bringman class fall 2015 (32 decks)

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