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PTRS 746 Exam 1 Combined and Randomized > Extremity&Hip Fx > Flashcards

Extremity&Hip Fx Flashcards

1
Q

Q: What type of Salter-Harris Classification is not often recognized at the time of injury?

A

Type 5

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1
Q

T/F: ORIF appears to have better outcomes than HA.

A

False, flip it

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2
Q

Q: Greater initial displacement = ?

A

More extensive

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3
Q

Q: What is the femoral shaft healing time for the following ages? Birth, 8 yo, 12 yo, 20 yo

A

3 wks, 8 wks, 12 wks, 20 wks

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3
Q

Q: What are the 3 signs of acute compartment syndrome?

A
  1. Painful
  2. Edematous, tight
  3. Absent or significantly diminished pulse
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3
Q

Q: Which stages of the Garden Staging System require surgery?

A

2-4, however, by the time we see them all the stages will look the same to us

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3
Q

Q: What population is ORIF suggested for?

A

Younger, highly active pts

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4
Q

Content: 3 types of intracapsular fractures

A
  1. Subcapital 2. Transcervical 3. Basicervical
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5
Q

Q: What is the approx. incidence of hip fractures per year?

A

329,000`

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5
Q

Q: Acute delirium occurs in _________% of post-op pts.

A

30-50

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6
Q

Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.

A

26-75

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7
Q

Content: 4 factors of bone healing

A
  1. Age
  2. Location and configuration
  3. Extent of initial displacement
  4. Blood supply
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8
Q

Content: DVT (3)

A
  1. Very common complication of hip fracture
  2. Incidence of up to 60% w/o prophylaxis
  3. Incidence of 20-30% w/prophylaxis
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10
Q

Q: What can cause an avulsion fracture?

A

Musculature is stronger than the developing bone can handle

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10
Q

Q: What is the failure rate of ORIF?

A

20-36%

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11
Q

Q: What can be seen radiographically during the reparative phase?

A

Fracture line diminishes

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12
Q

Content: 3 indications for a conservative treatment plan for fracture management

A
  1. Unstable medical status
  2. Non-displaced fractures
  3. Risk of surgery vs. risk of immobility
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13
Q

T/F: THA is never used to revise a failed ORIF or HA.

A

False, often

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14
Q

Content: 6 ways fractures are described

A
  1. Anatomic location
  2. Fracture location
  3. Direction
  4. Alignment
  5. Articular involvement
  6. Open/Closed
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14
Q

Content: 4 Stages of the Garden Staging System

A

1 = incomplete, may be impacted

2 = complete, non-displaced

3 = complete, partially displaced

4 = complete, fully displaced

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15
Q

Q: Remodeling is _____ ________ in children and _____________ _____________ after early adulthood.

A

Very, rapid, relatively, constant

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15
Q

Q: Non-displaced fractures with ________ periosteal sleave heal _______ as fast as displaced fractures.

A

Intact, twice

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15
Q

Q: Presence of a comorbidity increases mortality by ~____%.

A

16

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16
Q

Diagram: Identify the type of fracture

A

Spiral

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16
Q

Q: What Salter-Harris classification is an injury to perichondrial ring may cause physis to tether to bone, hindering growth?

A

Type 6

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17
Q

Q: Which type of Salter-Harris classification is most common?

A

Type 2

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17
Q

Content: 2 types of fracture reduction

A
  1. Open
  2. Closed
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19
Q

Content: Late complications - joint (2)

A
  1. Persistent pain or stiffness
  2. Post-traumatic DJD
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21
Q

Q: What occurs during the reparative phase?

A

Cell differentiation - chondroblasts are mineralized by osteoblasts to form a soft callus

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21
Q

Q: Who is cortical bone more flexible in?

A

Children

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21
Q

Q: Delayed mobilizaiton is associated with… (5)

A
  1. Delirium
  2. Pneumonia
  3. Increased length of stay
  4. Greater 6 mo. mortality
  5. Poorer 2 mo functional performance
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22
Q

Q: What is the risk during the reparative phase?

A

Delayed union or non-union

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23
Q

Q: What is the risk of dislocation with HA?

A

~5%

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24
Q

Content: Early complications - local (3)

A
  1. Infection, gangrene, septic arthritis
  2. Compartment syndrome
  3. Osteomyelitis, avascular necrosis
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24
Q

Q: What is the single best predictor of operative mortality following hip fracture?

A

Delirium

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25
Q

Q: What 5 things does a PT fracture intervention entail?

A
  1. Preserve/Improve ROM
  2. Increase mobility
  3. ADL training
  4. Education
  5. Wound care
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26
Q

Q: What 4 things should be considered for a PT fracture intervention?

A
  1. MOI
  2. Age
  3. Functional needs/demands
  4. Type of immobilizaiton/orthopedic plan of care
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26
Q

Q: What is the risk of dislocation for a THA?

A

5-10%

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27
Q

Content: 4 goals of fracture management

A
  1. Pain control
  2. Reduction and fixation in good position
  3. Return to function
  4. Prevent complications
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28
Q

Term: Femoral head articulates with acetabulum, but is fixed to the stem

A

Unipolar

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29
Q

T/F: Long oblique and spiral fractures heal faster than transverse fractures

A

True

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29
Q

Q: What percent of hip fractures occur in women?

A

76

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30
Q

Content: 5 risk factors for heterotropic ossification

A
  1. Neurologic involvement
  2. Open wounds/burns
  3. Sepsis
  4. Prolonged critical illness
  5. Aggressive ROM
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31
Q

Q: What are the two main types of fracture management?

A

Reduction and immobilization

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32
Q

Content: Salter Harris Classification - Type 1 (Description, Tx, Px)

A

D: run directly along the growth plates, vital portions of growth plate remain attached to the epiphysis

Tx: Rarely reduced, immobilization to fully heal

Px: Excellent if blood supply is intact

33
Q

T/F: Avulsion fractures are more common in children, esp. at growth plates.

34
Q

Q: What are the 3 risks associated with posterior THAs?

A
  1. Dislocation
  2. Infection
  3. DVT
35
Q

Q: A cortical bone fracture caused by an angulatory tension force (in children) is called a?

A

Greenstick fracture

37
Q

Content: Late complications - bony (5)

A
  1. Abnormal healing
  2. Growth disturbance
  3. Persistent ostemyelitis
  4. Osteoporosis
  5. Complex regional pain syndrome (CRPS)
38
Q

Q: What occurs during the remodeling phase?

A

Reformation of the medullary canal

39
Q

Q: 1 in ____ individuals die within 1 year of a hip fracture.

39
Q

T/F: Bipolar replacements are better than unipolar replacements.

A

False, no evidence that one is better than the other

41
Q

Content: 3 phases of bone healing (with time frame)

A
  1. Inflammatory phase, 1-2 wkls
  2. Reparative phase, months
  3. Remodeling phase, mo-yrs
41
Q

Q: What is the key to rehab for hip fractures?

A

Early mobilization

43
Q

Content: Salter Harris Classification - Type 3 (Description, Tx, Px)

A

D: Run along part of growth plate and turn perpendicularly into the joint

Tx: Surgery to restore joint surface

Px: Good if blood supply to separated portion is intact

45
Q

Diagram: Identify the type of fracture

A

Transverse

46
Q

Diagram: Identify the type of fracture

48
Q

Content: Salter Harris Classification - Type 4 (Description, Tx, Px)

A

D: Run from epiphysis across the growth plate and into the metaphysis

Tx: Surgery to restore joint surface and align growth plate

Px: May cause premature focal fusion and joint deformity

49
Q

Content: Extracapsular Hip Fracture (2)

A
  1. Involve trochanteric region
  2. Types trochanteric, intertrochanteric, subtrochanteric
50
Q

Diagram: Identify the type of fracture

52
Q

Q: Periosteal sleeve disruption = ?

A

Prolonged healing time

53
Q

T/F: It is unclear whether cemented or uncemented is the superior approach.

55
Q

Q: What is the healing prognosis is all fracture fragments have blood supply?

55
Q

Q: ORIF or pinning is thought as _______ ___________.

A

bone conserving

56
Q

Content: PE (3)

A
  1. Incidence ~10-15%
  2. Mortality ~2-10%
  3. Account for 14% of deaths due to hip fracture
58
Q

Q: If only some fragments have blood supply, what is the course of action?

A

Rigid immoblization to allow for vascularized fragments to serve as “hosts” to unvascularized fragments

59
Q

Q: What is the failure rate of HA?

60
Q

Q: Hemiarthroplasty is considered for ______________ fracture.

A

Intracapsular

61
Q

Q: Delirium is usually observed within POD _____, resolved by POD ___.

63
Q

Q: Fractures surrounded by __________ heal faster

64
Q

Defn: Increased pressure with fasical compartment (esp. anterior LE) due to edema or hematoma within closed space

A

Acute Compartment syndrome

65
Q

Q: What occurs during the inflammatory phase?

A

Increased vascularity and formation of fracture hematoma

67
Q

Diagram: Fill in the following table

68
Q

T/F: THA has better outcomes than HA beyond 3 years.

70
Q

Q: How is chronic compartment syndrome different than acute?

A

Chronic is due to muscular expansion or decreased size of anatomical compartment

70
Q

Content: Salter Harris Classification - Type 2 (Description, Tx, Px)

A

D: Runs along the grwoth plate and includes a triangular metaphyseal fragment

Tx: Reduction and immobilization

Px: Good

71
Q

Content: Late complications - muscular (2)

A
  1. Myositis ossificans
  2. tendon rupture
72
Q

Diagram: Identify the type of fracture

74
Q

Content: Initial complications due to local injuries to… (5)

A
  1. Skin
  2. Vascular
  3. Neurologic
  4. Muscular
  5. Visceral
74
Q

Content: Early complications - remote (3)

A
  1. Thrombus/embolus formation
  2. Pneumonia
  3. Tetanus
74
Q

Diagram: Identify the type of fracture

A

Longitudinal

75
Q

Q: With HA you see a deterioration of function after ______ years

77
Q

Content: 4 types of immobilization

A
  1. Casting
  2. Splinting
  3. External fixation
  4. Internal fixation
78
Q

Q: What are the 3 risks associated with anterior THAs?

A
  1. Increased operative time
  2. Increased blood loss
  3. Infection
79
Q

T/F: Falls are the leading cause of death in individuals greater than 65 years old.

81
Q

Diagram: Identify the type of fracture

A

Comminuted

82
Q

T/F: The vast majority (90%) of hip fractures occur due to trauma.

A

False: falls

83
Q

Diagram: Risk factors for falls

84
Q

Content: 3 Surgical treatments for hip fracture

A
  1. ORIF
  2. HA
  3. THA
85
Q

Q: 1 in _____ require nursing home care for at least 1 year.

87
Q

Q: What percent of hip fractures result from falls?

88
Q

T/F: Cortical bone heals faster than cancellous bone

A

False, flip it

90
Q

Q: What is the cellular response during the inflammatory phase? (4)

A
  1. Neutrophils 2. Macrophages 3. Phagocytes 4. Osteoclasts
91
Q

Content: Salter Harris Classification - Type 5 (Description, Px)

A

D: Compression of growth plate results in a growth disturbance

Px: Poor

92
Q

Q: The risk of fracture ____________ every 5 years after the age of 50.

93
Q

Content: Anterior THA precautions (3)

A
  1. No ABD
  2. No (excessive) extension
  3. No ER
94
Q

Q: What are the steps in fracture management and which step involves PTs?

A

Steps: reduction, fixation, restoration of function PT = restoration of function

95
Q

Diagram: Salter-harris classificaiton of growth plate injuries

96
Q

Content: Complications of hip surgery (8)

A
  1. CV
  2. Pneumonia
  3. Pressure ulcers
  4. Delirium
  5. UTI
  6. Wound infection
  7. Depression
  8. Malnutrition
98
Q

Content: Intracapsular Hip Fracture (2)

A
  1. Involve femoral head or neck
  2. Higher rate of non-union and AVN
99
Q

Content: Heterotropic ossification (3)

A
  1. Soft tissue ossification, usually periarticular
  2. most commonly involves hip or knee
  3. unknown etiology
101
Q

Q: ORIF is the treatment of choice for _______________ fracture.

A

Extracapsular

103
Q

Q: THA is considered for _______________ fracture

A

intracapsular

104
Q

Q: The fracture rate of institutionalized individuals is _____x greater than those in the community.

105
Q

Content: Posterior THA precautions (3)

A
  1. No ADD past neutral
  2. No flexion past 90
  3. No IR
106
Q

T/F: With HA only the femoral component is replaced.

107
Q

Term: Femoral head articulates with both acetabulum and stem

108
Q

Content: Fracture mechanics - cortical bone (2)

A
  1. Tolerant to compression and shear forces
  2. Fractures due ot tension - bending, twisting, pulling
109
Q

Q: What 4 factors should be considered when hip surgery is an option?

A
  1. Age
  2. Mobility status
  3. Mental state
  4. Pre-existing bone and joint pathology
110
Q

Q: What type of forces are cancellous bone susceptible to?

A

Compression forces

111
Q

Diagram: Identify the type of fracture

PTRS 746 Exam 1 Combined and Randomized (7 decks)

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