Fractures Pt.2

Question 1

Typical history of a tibial plateau fracture

Answer 1

• high energy trauma
• ensure no symptoms of compartment syndrome
• beware 50% of closed tibial plateau fractures have menisci & collateral ligament tears

Question 2

Symptoms of a tibial plateau fracture

Answer 2

• pain especially with weight bearing
• swelling
• decreased flexion ROM

Question 3

Diagnosis of a tibial plateau fracture

Answer 3

• anterior posterior & oblique X ray
• CT may be used after diagnosis to determine surgical approach

Question 4

Describe post op protocol (phase I) for a tibial plateau fracture

Answer 4

• max protection (0-1 weeks)
• RICE
• begin patellar mobilization
• quad setting
• single leg raise (open chain)

Question 5

Describe phase II post-op protocol for a tibial plateau fracture

Answer 5

• 1-6 weeks
• non-weight bearing
• brace in full extension
• stationary bike, pool (after incision has healed)
• manual LE PNF patterns

Question 6

Describe phase III post-op protocol for a tibial plateau fracture

Answer 6

• weeks 6-8
• partial weight bearing: up to 25% week 6, 50% week 7, 75% week 8
• may progress to one crutch
• begin proprioception activities within weight bearing tolerance
• weeks 9-10
• full weight bearing week 10
• normalize gait
• begin treadmill walking/elliptical
• no running or high impact activity
• CKC exercises
• progress proprioception & balance

Question 7

Describe phase IV post-op protocol for a tibial plateau fracture

Answer 7

• weeks 10-20
• advanced strengthening & plyometrics
• begin gym exercises
• week 20+: sport specific drills & plyometrics

Question 8

MOI of ankle fractures

Answer 8

• Sprain with fracture: usually fracture = avulsion or compression, avulsion same side as ligament, and compression opposite side as ligament
• Direct trauma: talus fractures

Question 9

Intervention for ankle fractures

Answer 9

• immobilization (brace, boot, or cast)
• surgical: open reduction internal fixation (ORIF)
• post-immobilization manual therapy: mobilization and massage

Question 10

Describe medial tibial stress syndrome

Answer 10

• shin splints used interchangeably
• cluster of tendinopathy, periostitis, remodeling, post/ant tib. problems
• mechanism: poor plyometric and shock absorbing ability
• examination: tenderness 5-10 cmm proximal to medial malleolus, may be tender proximally along muscle belly

Question 11

Intervention for medial tibial stress syndrome

Answer 11

• look for functional/biomechanical cause
• correct imbalances
• consider orthotics
• plyometric progression

Question 12

Describe metatarsal stress fractures

Answer 12

• rhythmic overload
• females > males
• contributing factors: skeletal malalignment (caves feet/high arch) and improper footwear

Question 13

Where are stress fractures common

Answer 13

• 2nd or 3rd metatarsal shaft (march fracture) from running & jumping
• 5th metatarsal shaft
• navicular from pronation

Question 14

Progressive symptoms of stress fractures

Answer 14

• stiffness/soreness after activity
• mild soreness/pain during activity that persists afterward
• pain during activity that alters performance
• pain during & after, does not subside with complete rest

Question 15

Intervention for stress fractures

Answer 15

• immobilization (4-6 weeks)
• maintain CV fitness
• comprehensive rehab program