Fractures (ch9) Joint Arthroplasty (ch10) Flashcards
What are classification of fractures?
Linear Oblique Compression Avulsion Impaction Stress
What type of fracture occurs when one fragment is driven into another?
Impaction
Common in tibial plateau fractures
What type of fracture is caused by a sudden muscle contraction or pulling by a ligament in which the area of a bone where the ligament attaches is pulled away from the rest of the bone?
Avulsion
common in fifth metatarsal during inversion
What type of fracture occurs when the bone is compressed beyond its limits of tolerance? Where is this type of fracture mostly found?
Compression
Found in the vertebral bodies as a result of a flexion injury
What type of fracture runs parallel to the bone?
Linear
What type of fracture runs perpendicular to the long axis of a bone? What causes them?
Transverse
Caused by tensile/ bending forces
What causes a stress fracture?
repeated low force trauma
Common in athletes and military personnel
What is an open fracture?
fractures that are exposed to the external environment
What is a closed fracture? what usually accompanies a closed fracture?
Does not break the skin
What accounts for the largest number of fractures among the elderly? What are they associated with?
Osteoporosis
Poor balance & falls
What is the most common cause of fractures?
trauma
Greenstick and torus fractures are most common in?
Children
Primary healing will occur if?
Intramedullary vasculature is intact
There is cortical contact
Fracture fixation provides compression across the fracture, reduces the interfragmentary gap to less than 1 mm, and eliminates motion at the fracture site
When does secondary healing start?
with formation of a fibrous callus around the fracture site and ends with its conversion to bone
What occurs during the inflammatory stage of bone healing?
Formation of a hematoma at the injury site
Inflammatory cells invade the area
What occurs during the repair stage of bone healing?
Characterized by the differentiation of mesenchymal stem cells into the cell types necessary for tissue restoration
Soft callus is formed, then mineralized by osteoblasts, forming hard callus
ends when the fracture is clinically stable
What occurs during the remodeling stage of bone healing?
Osteoblasts and osteoclasts replace the immature bone with mature, organized bone
Fully healed fracture is often stronger than the surrounding bone
What risk factors can delayed healing?
Mellitus Smoking Long-term steroid use NSAIDs and other medications Poor nutrition
How can e-stim help w/ bone healing?
Improve tissue healing
Transcutaneous electrical nerve stimulation (TENS) – noninvasive, well tolerated pain reliever
Electrical stimulation - high voltage pulsed current (HVPC) used to control edema
Neuromuscular electrical stimulation (NMES) is often used to improve strength and to retard the effects of disuse atrophy
Stimulate the biological processes involved in osteogenesis
Weight bearing progressions during bone healing &
Assistive devices to be used
Gait Training - start with non-weight bearing (NWB), advance through toe-touch weight bearing (TTWB), to partial weight bearing (PWB), to full weight bearing as tolerated
Assistive devices - wheelchairs, walkers, and crutches to assist with mobility to reachers who enable a person to grasp something that is placed beyond his or her reach
ROM progressions
Gravity progressions
PROM> AAROM> AROM
Gravity eliminated> Gravity assisted > Against Gravity
What is arthrofibrosis?
increased fibrous tissue in a joint that limits ROM
What is arthropathy?
any disease or abnormal condition affecting a joint
What is arthrodesis?
The surgical fusion of the bony surfaces of a joint w/ internal fixation such as pins, plates, nails, or bone graft
What is arthroplasty?
any reconstructive joint procedure with or without an implant that is designed to relieve pain and restore motion
What is a hemiarthroplasty?
involves removing and replacing only one side of the joint
What can be used to treat fractures on or around the femoral neck that can not be treated by open reduction internal fixation ?
Bipolar or unipolar hemiarthroplasty
Resection arthroplasty and fascial arthroplasty
do not involve replacement of the joint with an implant
What are indications for Arthrodesis?
Painful, degenerative arthritis or RA that can not be helped by arthroplasty
Avascular necrosis or osteonecrosis
Neurological disease that resulted in an unstable joint
Neuropathic joints
Infection ie chronic osteomyelitis
Failed total joint arthroplasty cause by infection
Deltoid or quadriceps femoris paralysis
What are the two main surgical approaches to a THA?
Anterior and posterolateral
What are the indications for THA?
Pain and disability
Decreased muscle strength, limited hip ROM, and flexibility
Gait abnormalities
What should patients with THA be educated on?
Weight-bearing & ROM restrictions
How to use of assistive devices such as walkers, crutches, and canes
Follow tissue healing parameters and the postsurgical precautions
Goals of TKA interventions
Achieving knee flexion early in rehabilitation allows patients more independence
Improve balance and proprioception since they can impact the frequency of falls and subsequent injury
Constrained Total shoulder arthroplasty
ball and socket design that reduces humeral motion
Using NMES for TKA
potentially more effective than exercise alone b/c it recruits a greater proportion of type II fibers
Exercise interventions for TKA
Pool therapy for gait training, ROM, strengthening, and recreation
Deep squats should be avoided
Stationary cycling and a walking program may be added to achieve optimal function
Nonconstrained TSA
Nonconstrained TSA: resembles the normal anatomical motion of the shoulder joint
Shoulder arthroplasties - prognosis
Over 70% of patients with shoulder fractures do have complete or near-complete relief of pain after TSA
Functional results vary, depending largely on the underlying cause
Outcome is best with a well-reduced fracture, a motivated patient, and an appropriate rehabilitation program maximum recovery of function usually occurring within 6-12 months of the surgery
Strength after TSA is generally sufficient to allow ADLs and light recreational fitness activities
TSA also significantly improves quality of life for patients with OA
Goal of TSA interventions
Stability
The goal of inpatient therapy is to teach patients ROM activities that they can do at home
Reason to have Total Elbow Arthroplasty
Useful when conservative management of a painful or unstable elbow is unsuccessful
Four main designs of Total elbow arthroplasty
Constrained
Semiconstrained
Unconstrained
Resurfacing
Total elbow arthroplasty – prognosis
TEA is generally effective for relieving pain but often results in loss of ROM and strength
Following TEA what is recommended to decrease swelling
Compressive cryotherapy shown to decrease postoperative swelling
Early icing and compression are recommended
outcome is determined by surgeon preference
What type of patient gets a total wrist arthroplasty?
Generally used to treat patients with RA that affects the wrist and low functional demands
Total wrist arthroplasty – intervention
Rehabilitation after wrist arthroplasty requires balancing ROM and stability needs
Active ROM program should include active flexion, extension, pronation, and supination of the wrist
Finger arthroplasty
Used to treat a wide variety of painful conditions that limit hand function
Metacarpophalangeal arthroplasty
Implants may have a single- or two-piece hinge design, be constrained or nonconstrained, and be fixed with or without cement
Metacarpophalangeal arthroplasty goal and typical outcome
Goal is to decrease pain, enhance joint stability, and ultimately improve hand function
Metacarpophalangeal arthroplasty - intervention
Therapy should protect the joint, improve ROM, and safely progress the patient back to activity
Based on the principles of tissue healing and scar formation
Reason to have Interphalangeal joint arthroplasty
Treatment of pain, stiffness, deformity, instability, and loss of cartilage in the joint
Goal of Interphalangeal joint arthroplasty?
Relieve pain and to improve hand function
Less flexion of the interphalangeal joints is needed for functional use of the index and middle finger than for the fourth and fifth fingers
Continuous passive motion machine
Continuous passive motion (CPM) machine provides a slow and controlled passive mechanical force to move a joint through a prescribed or preset ROM
What is the most common post-THA complication? What could it lead to?
Thrombosis
could lead to death if thrombi move to lungs
Following a THA, when does the risk of dislocation level off?
between 10 and 13 weeks after surgery
Following TSA, what is the hardest/ most painful motion to regain?
External rotation but it is important to achieve good ROM
What activity is done immediately after or the day after TSA surgery?
PROM of GH joint
In a TSA, what has been implicated as a risk factor for not regaining flexion ROM?
Muscle weakness
In what position should exercises be performed following a TSA?
In the supine position and progressed to sitting
Following a TSA, when can outpatient therapy & AROM activities begin?
10 to 14 days postoperatively
What complex is important to strengthen but not overstress in a TSA patient?
rotator cuff
What is used to decrease pain and swelling following a TKA?
Cold and compression
When should ROM activities begin following TKA surgery? What motions should be stressed?
ROM should be initiated soon after surgery
ROM activities that address both flexion and extension
What is essential for a normal gait pattern?
Full knee extension ROM is essential for a normal gait pattern and for efficient quadriceps function to stabilize the knee
Why is patellar mobilization important in TKA patients?
Patellar mobilization is very important because the suprapatellar pouch is often where adhesions that limit ROM develop
What ROM activities are beneficial following a TEA?
AAROM exercises include flexion-extension, pronation and supination at 90 degrees of elbow flexion
What will help return strength and function following a TEA?
Routine performance of ADLs
