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Year 1- Acute and community rehab > Introduction into acute orthopaedic assessment > Flashcards

Introduction into acute orthopaedic assessment Flashcards

1
Q

Types of bones (6)

A
  • Flat (frontal)
  • Short
  • Sesamoid
  • Sutural bone
  • Irregular
  • Long
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2
Q

What are some factors impacting bone remodelling? (6)

A
  • Parathyroid gland
  • Calcium levels in the blood
  • Mechanical stress (wolf’s law)
  • Vitamin D
  • Blood supply
  • Nutritional status
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3
Q

Fracture definition

A

An interruption in the continuity of bone

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4
Q

Classification of fractures

A
  1. Skin damage
  2. Displaced, undisplaced or impacted
  3. Shape or appearance on X-ray
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5
Q

Skin damage- two types?

A
  1. Open or compound fracture is when either the end of the bone has pierced through the skin or a foreign object pierces the skin
  2. Closed is when the skin remains intact
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6
Q

What is a major risk factor of an open fracture compared to a closed fracture?

A

Infection

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7
Q

What are displaced, undisplaced or impacted when classifying fractures?

A

Displaced- fragments are not in an anatomical position and require manipulation to restore normal alignment
Undisplaced= fragments are in anatomical alignment and do not require manipulation
Impacted= bone fragments are forced into one another

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8
Q

Shape or appearance on x-ray when classifying fractures

A
  • Closed
  • Open
  • Transverse= bone is broken perpendicular to its length
  • Spiral= bone is broken in a twisting motion
  • Comminuted= bone is broken in at least two places
  • Greenstick= crack on one side of bone and doesn’t extend all the way through
  • Oblique= bone is broken at an angle
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9
Q

What can fractures be caused by? (3)

A
  1. Trauma
  2. Pathological
  3. Stress/fatigue
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10
Q

What are the different types of trauma that can cause fractures? (4)

A
  1. Direct= direct blow to a limb or an object falling
  2. Indirect= falling onto an outstretch hand, fixed foot in the ground and upper body twisting
  3. High-energy= road traffic crash
  4. Low-energy= a fall
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11
Q

What is a pathological cause of a fracture?

A

When a disease weakens the underlying integrity of the bone due to either: infection, cysts, osteoporosis but more commonly tumours

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12
Q

How does stress/fatigue cause a fracture to occur?

A

Occurs due to repeated abnormal forces being applied to a bone

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13
Q

What are the common signs and symptoms of a fracture?

A
  • Pain= from the local inflammatory reaction and trauma or unknown
  • Deformity= more noticeable where there is displacement of bone.
  • Oedema= localised immediately after the injury and becomes more intensive with time.
  • Muscle spasm= is an attempt by the body to stop things from moving.
  • Abnormal movement= there may be grating between broken ends of the bone
  • Loss of function= following severe fractures but also stress, impacted or crack.
  • Shock= Hypovolaemic shock is a possibility
  • Limitation of joint movement= adhesion formation, tight muscles, pain, spasm, fear, weak muscles or swelling
  • Muscle atrophy= loss of strength in disused muscle groups
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14
Q

Series of events in bone fracture healing

A
  • Bone breaks
  • Blood vessels break therefore bleeding leading to a blood clot forming
  • Area swells
  • Phagocytes remove any unwanted debris
  • Osteoclasts remove dead bone fragments
  • Chrondroblasts form fibrocartilaginous tissue (soft callus) holding broken ends together
  • Soft callus hardens to a bony callus
  • Osteoclasts reabsorb some excessive bone tissue
  • Lump remains at the fracture site
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15
Q

What factors impact on both the quality and speed of bone healing? (5)

A
  • Type of bone fractured
  • Type of fracture
  • Blood supply
  • Age
  • Nutritional status
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16
Q

What is an immediate complication? Examples?

A
  • A complication that happens within the first hour
  • Haemorrhage, life threatening visceral injuries, damage to neurovascular structures
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17
Q

What is an early complication?

A
  • A complication in the first few weeks
  • Wound infection, pneumonia, compartment syndrome, pressure sores, deep vein thrombosis
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18
Q

What is a late complication?

A
  • A complication after months to years following the fracture
  • Delayed union, Non-union, Mal-union, Deformity, Avascular necrosis, Complex regional pain syndrome
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19
Q

What is delayed union?

A

When a fracture takes longer than usual to heal

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20
Q

What is non union?

A

Failure of a fractured bone to heal and mend after an extended period of time

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21
Q

What is mal union?

A

Broken bone that heals abnormally

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22
Q

What is avascular necrosis?

A

The death of bone tissue due to a lack of blood supply

23
Q

Which arteries are the main blood supply to the femur head?

A

Medial and lateral circumflex

24
Q

What are the 3 stages to managing a fracture?

A
  1. Reduction (realignment back into the normal anatomical position)
  2. Immobilisation (aim is to maintain the reduction to allow union at the fracture site)
  3. Rehabilitation (regain and return to ‘normal’ function)
25
Q

What is fracture reduction? What two approaches are used?

A
  • Realignment back into the normal anatomical position
    1. Closed reduction= without surgical intervention
    2. Open reduction= with surgical intervention
26
Q

What is fracture immobilisation? What methods are used?

A

The aim of immobilisation is to maintain the reduction achieved in order to allow the fracture site to unite and heal
1. Closed methods= Cast, functional bracing, slings, collar and cuff or splints, traction
2. Open methods= Open reduction and internal fixation

27
Q

What is arthroplasty?

A

Where the articular surface of a joint is replaced surgically

28
Q

What are the two different types of arthroplasty used for hip fractures?

A
  1. Hemiarthroplasty= when the femoral head is replaced with a prosthesis (false part)
  2. Total hip replacement= involves replacement of both the femoral head and the acetabulum with prostheses.
29
Q

Define what a fractured neck of femur is:

A

A hip fracture that occurs in the neck. The ball is disconnected from the rest of the femur

30
Q

What is a trochanteric fracture

A

Involves the proximal femur between the neck of femur and the shaft

31
Q

What is extracapsular fracture

A

Fractures of the neck of the femur which occur outside the capsule of the hip joint

32
Q

What is a subtrochanteric fracture

A

A break between the lesser trochanter and the area approximately 5 centimetres below the lesser trochanter.

33
Q

Intracapsular neck fracture (3 types)

A
  1. Subcapital= immediately below the femoral head
  2. Transcervical= across the mid‐femoral neck
  3. Basicervical= across the base of the femoral neck
34
Q

What is the epidemiology (how often diseases occur) of fractured neck femur in the UK?

A

Around 70,000 patients suffer neck of femur fractures annually

35
Q

What is the aetiology (causes) of fractured neck of femur?

A
  • Ageing
  • Osteoporosis
  • Repetitive loading of bone and sudden increase in training volume or activity
  • Low energy injuries e.g falls in older patients or high energy injuries e.g road traffic collision or fall from height
36
Q

What is clinical presentation of the patient who has a fractured neck of femur?

A
  • Dull ache
  • Inability to put weight on injured leg
  • Shorter leg on the side of the injured hip
  • External rotation of the injured hip
  • Stiffness, bruising and swelling in and around the hip
37
Q

How does a fractured femur get diagnosed?

A

Based on patient history, physical examination and radiography

38
Q

What are the non-operative (conservative) management options for a fractured neck of femur?

A

Long period of bed rest

39
Q

What are the operative (surgical) management options for a fractured neck of femur?

A
  • Garden stage 1 and 2 are stable fractures and can be treated with internal fixation
  • Stage 3 and 4 are unstable fractures and can be treated with arthroplasty or THR
40
Q

What are the potential immediate/ short term complications which can arise from a fractured neck of femur?

A

Avascular necrosis, early immobility

41
Q

What are the longer term complications which can arise from a fractured neck of femur?

A

Avascular necrosis, non-union, joint dislocation, aseptic loosening, deep infection

42
Q

What is the prognosis for fractured neck of femur?

A
  • It depends on the health status of the patient and the type of fracture
  • Healthy, young and fit individuals with uncomplicated fractures with will have a good prognosis
  • Whereas frail elderly patients are unlikely to fully recover from a neck of femur fracture
43
Q

What do you look for in the observation section of initial assessment for a hip replacement?

A
  • Discolouration
  • Pain
  • Reduced movement
  • Swelling
  • Odour
  • Atrophy
  • Chest pain
  • SOB
  • Unilateral calf pain
  • New onset confusion
44
Q

What do you feel for in the palpation section of the initial observation of a hip replacement?

A
  • Swelling
  • Heat
  • Sensation
  • Pulses
  • Tenderness
  • Muscle spasm
45
Q

What to do in the movement section in the initial assessment after hip replacement?

A
  • AROM
  • PROM
  • Transfers
  • Gait
  • Stairs/ steps
  • Test joint above and below
46
Q

Fractured neck of femur key messages (what to look out for)

A
  • Look for laterally rotated and shortened limbs
  • Be aware of avascular necrosis
  • Understand the type of surgery performed and the local post-operative protocol following this
  • Check weight bearing status
47
Q

Problem list for fractured neck fo femur

A
  • Pain
  • Reduced ROM
  • Reduced strength
  • Loss of function
48
Q

Post op of hip replacement: How to protect the joint/ what to avoid

A
  • Do not cross your operated leg across the midline of your body for the first 6 weeks after your operation.
  • Avoid the extremes of hip bending until you have seen your surgeon.
49
Q

Key points to remember are that elective orthopaedic patients…

A
  1. Have been referred for a planned total hip replacement often due to osteoarthritis and have not had any trauma
  2. Have had a thorough pre-op assessment
  3. Have a planned admission to hospital
  4. Are medically optimised and well pre-op
  5. Have very clear and measurable post-op milestones.
50
Q

Post op: exercises for in bed converse chuck taylor lift hi platform trainers in white

A
  1. Ankle pumps= repeat 10 times every waking hour
  2. Quad crontractions= Hold for 5, repeat 10 times, 3 times a day
  3. Glute contractions= hold for 5, repeat for 10, 3 times a day
  4. Hip flexion= repeat 10 times, 3 times a day
  5. Hip adbuction= repeat 10 times, 3 times a day
51
Q

Post op: exercises for sitting down

A

Quadriceps exercise= Try straighten your leg by lifting your foot up off the floor
Hold for 3 secs and relax.
Repeat 10 times

52
Q

Post op: exercises for standing up

A

(hold onto a firm support if needed)
1. Hip flexion= achieve a 90 degree angle. Repeat 1o times
2. Hip abduction= repeat 10 times
3. Hip extension= repeat 10 times

53
Q

What is Wolf’s Law?

A

The idea that natural healthy bones will adapt and change to adapt to the stress that is it subjected to

Year 1- Acute and community rehab (2 decks)

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