Lecture 1

Question 1

Fracture

Answer 1

structural separation in continuity of a bone, an epiphyseal plate or a cartilaginous joint surface

Question 2

When should PTs detect fractures?

Answer 2

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

Question 3

Signs and symptoms of fracture

Answer 3

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

Question 4

Risk factors for fractures

Answer 4

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

Question 5

Soft tissues & fractures

Answer 5

soft tissue may be injured as well
potentially serious if near artery/nerve
fractures in center of body–> internal organs, spinal cord, brain injured

Question 6

Fracture blister

Answer 6

shear forces on skin
possible wound and infection

Question 7

Adherent scar

Answer 7

bone poking through skin

Question 8

Fracture causes

Answer 8

bending
twisting
straight pull
crushing
repetitive microtrauma
normal force on abnormal bone

Question 9

Bending

Answer 9

long bone bends, fracture on convex side
type: transverse, oblique, greenstick

Question 10

Twisting

Answer 10

spiral tension failure
type: spiral

Question 11

Straight pull

Answer 11

tension failure from pull of ligament or muscle
type: avulsion

Question 12

Crushing

Answer 12

compacts or bursts bone
type: compression, burst, buckle

Question 13

Repetitive microtrauma

Answer 13

small crack in bone unaccustomed to stress
type: fatigue, stress

Question 14

Normal force on abnormal bone

Answer 14

osteoporosis, tumor, other disease
type: pathological fracture

Question 15

How to identify fractures

Answer 15

site
extent
configuration
relationship of fragments
relationship to environment
complications

Question 16

Position of fracture

Answer 16

described by how distal fragment displaces in relationship to the proximal fragment

Question 17

Comminuted

Answer 17

more than 2 fragments

Question 18

Bone healing stages

Answer 18

inflammation (swelling)
reparative (osteocytes working)
remodeling (returning to normal)

Question 19

Clinical union

Answer 19

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

Question 20

Radiological union

Answer 20

fracture callus is replaced by mature bone, meaning bone is healed

4-6 wks = kids
6-8 wks = adults
10-12 wks = elderly, complications

Question 21

cortical vs cancellous bone healing

Answer 21

spongy bone typically heals faster than cortical

Question 22

Epiphyseal plate fractures

Answer 22

can lead to growth disturbances, bone deformity. bone is not the length it should be

Question 23

Stress sharing device

Answer 23

permits some transmission of load across fracture site

cast, rods, pins, wires

Question 24

Stress shielding device

Answer 24

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

Question 25

Tissue response to immobilization

Answer 25

connective tissue weakens articular cartilage degenerates muscle atrophy circulation slows scar, contractures, shortening

Question 26

Post-immobilization impairments

Answer 26

decreased ROM, joint play, flexibility atrophy pain scar motor control balance

Question 27

Stretching with fx

Answer 27

proximal to fracture site ONLY until radiological healing has occurred

Question 28

Muscle performance w/fx

Answer 28

begin proximal to fx ONLY don't traumatize tissues provide scar mobilization as possible correct movements asap

Question 29

Complications with fractures

Answer 29

compartment syndromes infection fat embolism refracture fixation device failure delayed or malunion

Question 30

Requirements for ex for fx

Answer 30

dynamic high bone strains apply load rapidly short bouts separated by periods of rest mod to high, >2x body weight 4-7 days/wk

Question 31

Low-risk for fx exercises

Answer 31

normal BMD no clinical risk factors (falls, fracture)

Question 32

Mod-risk for fx exercises

Answer 32

low bone mass certain clinical risk factors

Question 33

High-risk for fx exercises

Answer 33

very low bone mass number of risks

Question 34

Some of the clinical risks factors

Answer 34

BMD age sarcopenia loss of height cancer RA hx of fractures/falls excessive alcohol smoking

Question 35

Frailty

Answer 35

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

Question 36

Increasing risk w/exercise

Answer 36

you will decrease the intensity from high impact 4x body weight to moderate impact 2-3x body weight and you also decrease sets

Question 37

High impact exercises

Answer 37

>4 BW drop landing star jump vertical jump tuck jump

Question 38

Moderate impact activities

Answer 38

2-3 BW jump rope running bounding jump take offs and hops side hops

Question 39

Exercise modifications Osteoarthritis

Answer 39

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

Question 40

Exercise Modifications for fragility

Answer 40

start with heel drops instead of jumps supervision use support system

Question 41

exercise Modifications for cardio/pulm disease

Answer 41

keep training intensity below level that causes ischemia or severe dyspnea deep throbbing pain that is bilateral or symmetrical

Question 42

load modifications OA

Answer 42

correct form limit range weight machines alter intensity consult PCP

Question 43

load mod for frailty

Answer 43

decrease intensity modify impact supervision for safety

Question 44

load mod for cardio/pulm

Answer 44

keep intensity below angina or ischemia seated exercises avoid breath holding