Lecture 11: Orthopaedic Management of Spasticity Flashcards
Functions of the skeleton
- Body structure & shape
- Movement (lever systems)
- Vital organ protection
- Physiological contributions
Blood cell production (via bone marrow)
Mineral storage
Endocrine regulation
What is the treatment for femur fracture
* what are the draw backs?
A metal rod forced into the medullary cavity of a bone (medullary rod). This will serve as a load sharing device allowing for early weight bearing and the facilitation of bone healing.
Removes mechanical barrier to movement anymore
- people who have not alot of fat may feel the screws which are uncomfy. screws can be removed overtime
Two types of bone healing
primary: use metal plates to piece together misaligned bones. no callus formation
secondary: bone forms a callus to bridge the gap between broken ends. eventually replaced with bone in 6 weeks. occurs when cast, external fixation, splints, or nails are used
arthrodesis
surgical immobilization of a joint by fusion of the adjacent bones.
often performed on the bones of the ankle and foot
usually accompanied by contracture release surgery for fuller correction of the joint deformity.
high tibial osteomy
* what is it
* when is it used
* give some statistics on surgical outcomes
- surgical procedure to correct varus malalignment and provide relief of unicompartmental osteoarthritis of the medial compartment of knee
- change weightbearing axis to back to straight down middle.
- used to prolong native joint lifespan. often performed to delay or prevent total knee replacement
- 10 years after the surgery, 80% people still like their joint.
small wedge of bone is removed to allow the bone to be repositioned or reshaped
total knee replacement
all knee compartments wear away. no cartilage
Surgical procedure to resurface a knee damaged by arthritis
typical patient for high tibial osteomy
40-60
- bowlegged (varus)
- osteoarthritis is isolated to medial compartment of knee joint
Tendon Transfer Principles
- Joints must be supple prior to transfer (full rom, free of pathology; otherwise you will lose function of transferred tendon)
- Soft tissue must be at equilibrium (timing) (can’t have local inflammation)
- Donor muscle must have adequate excursion (amount of movement of muscle tendon unit; example: wrist flexor has about 30mm of excursion while finger flexors have greater excursion. transferinging a wrist flexor to a finger flexor is bad but you can do the other way around due to excursion)
- Donor muscle must have adequate strength (strength scale of 0-5. 3 is antigravity; 5 is full power; 1 is a flicker. donor should be at least 4 or 5 since itll lose 1 grade of power when you transfer it. muscles that have been paralyzed you shouldn’t use bc it wont have full power)
- Expendable donor muscle (never transfer a quadricep tendon since you’ll lose extensor)
- Straight line of pull (the muscle will pull in a direct line from its origin to the insertion of the tendon being substituted.)
- Synergy
- muscle groups that work together. tendon transfer work more effectively when you use a synergist - Replace a single function per transfer
Types of Cerebral Palsy
Spastic Diplegia: Affects legs > arms
Spastic Quadriplegia: Affects the entire body
Dyskinetic Cerebral Palsy (Athetoid): Often affects entire body The baby often presents with perinatal asphyxia and/or kernicterus (bilirubin-induced brain dysfunction) that affects the basal ganglia, cerebellum and sometimes thalamus
Spastic Hemiplegia– Affects the arm and leg of one side. Imaging shows unilateral UMN abnormalities. perhaps only one side of the brain was lacking oxygen during pregnancy
Ataxic CP Involves the entire body
etiology of cerebral palsy
Intrauterine growth restriction (34%)
Intrauterine Infections (28%)
Prematurity (78%)
Perinatal asphyxia (10%)
cerebral palsy definition
Heterogeneous group of non-progressive disorders
characterized by motor and postural dysfunction
Range in severity due to abnormalities in developing brain
9% of the population is missing a
palmaris longus
tendon
Describe the following descriptors:
* athetoid/dystonic
* ataxic
- Athetoid/Dystonic – abnormal posture, involuntary movements
- Ataxic – Lack coordination
Orthopaedic
Classification
GMFCS
Gross, motor, function, classification scale
* level 1: children can walk and stairclimb without limitaiton
* level 2: climb stairs with railing; experiences limitations on uneven surfaces, inclines, or crowded spaces
* level 3: need assistive mobility devices; may be able to climb stairs; can push self in wheelchair
* level 4: can walk short distances with a walker and relies on wheeled mobility device
* level 5: all areas of motor function are limited. physical impairment restricts voluntary movement control and antigravity head and trunk control
CP Orthopaedic Manifestations (presentations)
- Upper extremity deformities
- Hip subluxation and dislocation
- Spine deformities
- Foot deformities
- Gait disorders
- Contractures and fractures
