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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
Q

More details on how prolong bed rest can make a pt pass out

A

Being in bed for too long can lead to orthostatic hypotension

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26
Q

More details on how lac of food can make a pt pass out

A

the pt hasn’t eaten since before the surgery the night before!

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27
Q

More details on how blood loss can make a pt pass out

A

the pt has just had surgery which can lead to loss of blood; the loss of lead can lead to a decrease of Hgb

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28
Q

What do you need to talk to the pt about before they go home?

A

~Prior level of function
~What is their house like?
~Equipment
~Level of ind- do you have people to help

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29
Q

Details on the surgical site

A

~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

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30
Q

Do hip repairs normally have drains?

A

no

31
Q

hip replacements: can have 2 different types

A

~Hemi arthroplasty

~total

32
Q

Hemi arthroplasty: details

A

~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
Q

Which half is normally replaced?

A

~Typically replacing head and neck (not acetabulum)

34
Q

A hemi arthroplasty is typically preformed on what type of fractures

A

Typically an higher intertrochantic or intracapsular

35
Q

What are the benefits of having a hemi arthoplasty?

A

~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
Q

Precautions for a hemi arthoplasty

A

~Depends on the approach

~If done correctly, should be WBAT

37
Q

Approaches for a hip replacement

A

~posterior/ lateral

~anterior

38
Q

Posterior/ lateral hip precautions

A

~flexion 90
~no adduction past neutral
~no IR

39
Q

Posterior/ lateral hip precautions

A

These because the capsule has been cut, which normally would have kept the hip from dislocating

40
Q

What are some everyday tasks that can cause a posterior/ lateral displacement?

A

~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
Q

Anterior hip precautions

A

~extreme extension (lunges)

42
Q

Bringman stated anterior is better than posterior/ lateral bc

A

~Less pain because you are cutting through less arteries

~Physician is cutting through/ moving around more important stuff

43
Q

Implant criteria for a THA/ TKA

A

~Resistant to wear (durable)
~Approximate normal anatomy
~Biocompatibility
~High standard of production (no recalls)

44
Q

Be able to describe the process of a THA to the pt!

A

~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
Q

How long is it going to last?

A

Should last 10- 15 years (it is getting longer)

46
Q

What will eventually fail?

A

~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
Q

activity precautions for THA

A

~causes the wear and tear

~high impact activities: running, jumping, tennis, basketball, when feet leave the ground

48
Q

rehab for a THA

A

~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
Q

Who are you more worried about having a dislocation: someone doing really well or a little old lady that is scared to get up?

A

Person doing well- can do too well and push too hard

50
Q

What happens after a dislocation?

A

need to put it back in (physician)

51
Q

What can to prevent a hip dislocation (or what do you do after)?

A

~can put a knee immobilizer on
~hip spika
~locking hip

52
Q

Details on a hip spika

A

~can have skin breakdown
~will have to wear this for months
~hard to put on without dislocating hip again
~never fits well

53
Q

Details on a locking hip

A

~reducing the amount of ROM that the hip can move
~locks hip in place
~hardware you place into the joint

54
Q

What are the two main types of total knee arthroplasty?

A

~unicompartmental/ partial

~full

55
Q

Details on unicompartmental/ partial

A

~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
Q

Do you normally see a unicompartmental/ partial or a full TKA?

A

Typically see full compared to unicompartmental

57
Q

Details on TKA

A

~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
Q

Therapy for a TKA

A 
~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
Q

TKA- what meds, what is normally attached, etc right after surgery

A

~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
Q

What is a recirculator?

A

large drain that takes the blood that drained and put is back into you

61
Q

What can you do if the leg is wobby?

A

put a knee immobilizer

62
Q

TKA- measurements

A

~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
Q

TKA- gait training

A

~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
Q

TKA- out pt therapy

A

~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
Q

what is something that can go wrong?

A 
~decrease ROM
~infection
~falls 
~problems with the arteries and nerves
~death
66
Q

Something that can go wrong details: decrease ROM

A

have to go in to mobilize under anesthesia

67
Q

Something that can go wrong details: infection

A

~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
Q

What happens if an infections become bad enough?

A

~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
Q

What happens if an infection gets bad enough that an IND will not fix it?

A

~fuse bone or amputation

70
Q

Something that can go wrong details: falls

A

~impacts the ground/ too much flexion- swelling and pops open the wound
~can lead to infection

71
Q

Something that can go wrong details: problems with the arteries and nerves

A

~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
Q

Something that can go wrong details: death

A

~caused by a DVT

~most likely going happen on the ortho floor

73
Q

What are two things that a DVT can lead to?

A

~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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