Lecture 1 Flashcards
Fracture
structural separation in continuity of a bone, an epiphyseal plate or a cartilaginous joint surface
When should PTs detect fractures?
PT provide initial screening after traumatic event
PT provide initial screening for repetitive traumas
possibility of fracture during PT session
there is possibility of fracture occurring after surgery
Signs and symptoms of fracture
localized/specific pain aggravated by movement
muscle guarding with passive movement
pain w/weightbearing
decreased function of body part
swelling, deformity, abnormal movement
sharp, specific, excruciating pain
crepitus
Risk factors for fractures
evidence or history of high energy trauma or sudden impact
osteoporosis
history of falls w/increasing age, low body mass index, low levels of PA
Soft tissues & fractures
soft tissue may be injured as well
potentially serious if near artery/nerve
fractures in center of body–> internal organs, spinal cord, brain injured
Fracture blister
shear forces on skin
possible wound and infection
Adherent scar
bone poking through skin
Fracture causes
bending
twisting
straight pull
crushing
repetitive microtrauma
normal force on abnormal bone
Bending
long bone bends, fracture on convex side
type: transverse, oblique, greenstick
Twisting
spiral tension failure
type: spiral
Straight pull
tension failure from pull of ligament or muscle
type: avulsion
Crushing
compacts or bursts bone
type: compression, burst, buckle
Repetitive microtrauma
small crack in bone unaccustomed to stress
type: fatigue, stress
Normal force on abnormal bone
osteoporosis, tumor, other disease
type: pathological fracture
How to identify fractures
site
extent
configuration
relationship of fragments
relationship to environment
complications
Position of fracture
described by how distal fragment displaces in relationship to the proximal fragment
Comminuted
more than 2 fragments
Bone healing stages
inflammation (swelling)
reparative (osteocytes working)
remodeling (returning to normal)
Clinical union
fracture site is firm enough that it doesn’t move, motion of limb is permissible but be VERY CAREFUL not to stress the site of the fracture
Radiological union
fracture callus is replaced by mature bone, meaning bone is healed
4-6 wks = kids
6-8 wks = adults
10-12 wks = elderly, complications
cortical vs cancellous bone healing
spongy bone typically heals faster than cortical
Epiphyseal plate fractures
can lead to growth disturbances, bone deformity. bone is not the length it should be
Stress sharing device
permits some transmission of load across fracture site
cast, rods, pins, wires
Stress shielding device
protects the fx completely from mechanical stress, transfers stress to the fixation device
surgical plates, external fixators
usually for more fragile bone, longer healing process
Tissue response to immobilization
connective tissue weakens
articular cartilage degenerates
muscle atrophy
circulation slows
scar, contractures, shortening
Post-immobilization impairments
decreased ROM, joint play, flexibility
atrophy
pain
scar
motor control
balance
Stretching with fx
proximal to fracture site ONLY until radiological healing has occurred
Muscle performance w/fx
begin proximal to fx ONLY
don’t traumatize tissues
provide scar mobilization as possible
correct movements asap
Complications with fractures
compartment syndromes
infection
fat embolism
refracture
fixation device failure
delayed or malunion
Requirements for ex for fx
dynamic
high bone strains
apply load rapidly
short bouts separated by periods of rest
mod to high, >2x body weight
4-7 days/wk
Low-risk for fx exercises
normal BMD
no clinical risk factors (falls, fracture)
Mod-risk for fx exercises
low bone mass
certain clinical risk factors
High-risk for fx exercises
very low bone mass
number of risks
Some of the clinical risks factors
BMD
age
sarcopenia
loss of height
cancer
RA
hx of fractures/falls
excessive alcohol
smoking
Frailty
geriatric syndrome based on deficit count by population prevalence
weakness, low PA, slow walk speed, exhaustion, unintended weight loss
0 = non frail
1-2 = pre frail
3+ = frail
Increasing risk w/exercise
you will decrease the intensity from high impact 4x body weight to moderate impact 2-3x body weight
and you also decrease sets
High impact exercises
> 4 BW
drop landing
star jump
vertical jump
tuck jump
Moderate impact activities
2-3 BW
jump rope
running
bounding
jump take offs and hops
side hops
Exercise modifications Osteoarthritis
reduce or eliminate high ground reaction forces
sub power training contraction against mod to high load
goal is rapid onset of high muscle contraction forces but with NO impact landing
Exercise Modifications for fragility
start with heel drops instead of jumps
supervision
use support system
exercise Modifications for cardio/pulm disease
keep training intensity below level that causes ischemia or severe dyspnea
deep throbbing pain that is bilateral or symmetrical
load modifications OA
correct form
limit range
weight machines
alter intensity
consult PCP
load mod for frailty
decrease intensity
modify impact
supervision for safety
load mod for cardio/pulm
keep intensity below angina or ischemia
seated exercises
avoid breath holding
