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Orthopaedic Physiotherapy > Knee Surgery & Rehab > Flashcards

Knee Surgery & Rehab Flashcards

1
Q

What are the indications for surgery for knee fractures?

A
  • Critical size defect of shaft of tibia 12 +/- 1mm, 50% cortex
  • Infection/open injury
  • Complex case (older, other pathology etc)
  • Need to reconstruct the joint
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2
Q

How is a spiral fracture fixed surgically?

A

Intramedullary nailing - rod goes along the shaft of the bone & is nailed in place

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3
Q

What are the 3 types of extra articular distal femur fractures (type A)?

A

Simple
Metaphyseal wedge
Metaphyseal complex (comminution)

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4
Q

What is considered for a extra articular distal femur simple fracture & what are the surgical options?

A
  • Apophyseal or metaphyseal
  • Oblique or spiral
  • Sx: traction, external fixation or plate & screws
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5
Q

What are the surgical options for metaphyseal articular wedge & comminution fractures?

A

Traction
External fixation
Plate & screws

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6
Q

What are the 3 types of partial articular distal femur fractures (type B)?

A

Lateral sagittal
Medial sagittal
Frontal

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7
Q

What occurs during medial and lateral sagittal fractures and what are the surgical options?

A
  • Simple
  • Through notch/condylar load bearing surface
  • Rx: Plate & screws, external fixation
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8
Q

What is the aim for partial articular distal femur fractures?

A
  • Anatomical restoration of the articular surface

- Early active mobilisation of the joint

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9
Q

What are the 3 types of complete articular distal femur fractures (type C)?

A

Simple
Metaphyseal comminution
Multifragmentary

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10
Q

What occurs during a simple complete articular fracture?

A

No part of the articular surface is in continuity with the diaphysis

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11
Q

What occurs during a metaphyseal complete articular fracture?

A

No part of the articular surface is in continuity with the diaphysis
Comminution of metaphysis

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12
Q

What occurs during a multifragmentary complete articular fracture?

A

No part of the articular surface is in continuity with the diaphysis
Comminution of metaphysis
Comminution of articular surface

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13
Q

What is the phase 1 principle for knee fracture rehabilitation?

A

Protect & maintain

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14
Q

How is the knee maintained?

A
  • Restrictions on joint ROM
  • Restrictions on muscle contraction/weight bearing
  • Management of oedema (compression, elevation)
  • Consider other joints
  • Educate patient
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15
Q

What is the mechanism of tibial plateau fractures?

A
  • Direct fall (20%)
  • Car vs pedestrian (50%)
  • Axial compression & rotation force (30%)
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16
Q

What types of tibial plateau fractures are associated with axial compression & rotation force?

A
  • Lateral plateau (abduction force)
  • Medial plateau (adduction)
  • Anterior (extended knee)
  • Posterior (flexed knee)
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17
Q

What are the indications for surgery for tibial plateau fractures?

A
  • Type of fracture
  • Age of patient (younger = less likely)
  • Degree of displacement/articular surface
  • Compromised knee stability
18
Q

What are the types of proximal tibial fractures?

A

Extra-articular:

  • Avulsion
  • Metaphyseal simple
  • Metaphyseal multifragmentary

Partial articular:

  • Pure split
  • Pure depression
  • Split-depression

Complete articular:

  • Simple, metaphyseal simple
  • Simple metaphyseal multifragmentary
  • Multifragmentary
19
Q

What is the mechanism of patella fracture?

A
  • Direct trauma/fall on knee
  • Big pull of quad muscles
  • Displaced or non-displaced
20
Q

What are the indications for surgery for patella fractures?

A
  • Displacement >3-4mm

- Loss of active knee extension

21
Q

What is the rehabilitation for patella fractures post surgery?

A 
Protect
- Weight bear as tolerated (in a splint)
Maintain
- ROM
- Quads/hamstrings (wasting is rapid)
22
Q

What does patella fracture surgery involve?

A

Reduction with K-wires & tension band

23
Q

What needs to be considered during patella rehabilitation?

A
  • Preoperative history/impairments
  • Surgical procedure/tecnhique
  • Surgeon’s assessment of the tissue status
24
Q

What are the common restrictions associated with patella rehabilitation?

A
  • Active/passive ROM
  • ROM limits
  • Weight bearing status
  • OA, pre-existing problems
  • Tendinopathy, bursitis, quads strength
25
Q

What is another name for a total knee replacement (TKR)

A

Total knee arthroplasty (TKA)

26
Q

What are the main reasons for TKR (in order)?

A
  • OA
  • Rheumatoid arthritis
  • Other inflammatory arthritis
  • Osteonecrosis
  • Other
27
Q

What are the indications for TKR?

A
  • Pain
  • Loss of function
  • Other treatments no longer sufficient
28
Q

What is the relationship between age and TKR?

A

More likely to need another TKR sooner if under 55 years old (more likely to last longer with increased age)

29
Q

What are the contraindications for TKR?

A
  • Active infection
  • Significant genu recurvatum (hyper extension)
  • Excessive obesity
  • High impact sports/occupation
  • Arterial insufficiency
  • Neuropathic joint
  • Mental illness
30
Q

What structures are cut in a TKR?

A
  • Skin (longitudinal incision)
  • Joint (quads tendon to tib tuberosity)
  • Patella subluxed laterally
  • Quads & hamstrings left intact
  • ACL, tibial plateau
31
Q

What are the complications associated with TKR?

A
  • DVT
  • Fat embolism
  • Poor wound healing
  • Infection
  • Fractures
  • Neuro problems
  • Vascular injuries
  • Arthrofibrosis
  • Disruption of extensor mechanism
32
Q

What exercises are allowed ‘as tolerated’ post TKR?

A
  • ROM 0-90 deg
  • Static/inner range quads
  • FWB (WBAT)
33
Q

What are the precautions for exercise post TKR?

A
  • DVT
  • Pain
  • Bleeding
  • Quads activation
34
Q

What is the pathology of ACL injury?

A
  • Rupture

- Avulsion

35
Q

What are the indications for surgery for ACL?

A
  • Competitive sports
  • Functional deficits
  • Other injuries
36
Q

What are the pre-op goals for ACL?

A
  • Full extension
  • Able to do SLR without lag (good quads)
  • Minimal to no swelling
37
Q

What are the issues with BPTB graft compared to hamstring autograft for ACL recon?

A

BPTB:

  • Patella pain
  • VMO wasting
  • Kneeling pain

Hamstring:

  • Hamstring donor site
  • Loss of ACL protection
38
Q

What are the stages of maturation of the ACL graft post surgery?

A
  • Necrosis (1-2 weeks)
  • Revascularisation (6-8 weeks)
  • Cellular proliferation
  • Collagen formation, remodelling, maturation (1-2 years)
39
Q

What are the ACLR treatment protocols for weeks 1-4?

A
  • Protect healing graft
  • Decrease swelling & inflammation
  • Attain full extension
  • Increase quads strength
40
Q

What are the ACLR walking aid guidelines?

A
  • Brace for 1-4 days until SLR

- Crutches 1-7 days until confident

Orthopaedic Physiotherapy (11 decks)

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