Management of Fractures Flashcards
how does populations increasing life span increase fractures?
decreased coordination
weakened bones
who is at risk for fractures?
elderly for hip
children for forearm and leg
what are characteristics of primary fracture?
direct or contact healing
vasculature is intact
cortical contact
what does fraction fixation provide?
compression
how long does it take for a primary fracture to heal?
5-6 weeks for bone to close
what are the characteristics of secondary fracture?
when motion across FX site is limited but not eliminated
callous or indirect healing
wires, rods, external fixation
what type of motion is required for secondary healing?
slight
difference between primary and secondary healing:
no compressive component for secondary
what does fracture healing prognosis depend upon?
location
nature of fracture
type of fixation
why do high impact fractures heal more slowly?
soft tissue and vascular damage
why do open fractures heal more slowly?
soft tissue and bone loss (infection)
what are risk factors for delayed healing?
DM
smoking
steroids
poor nutrition
what are the effects of immobilization of muscle?
decrease strength
increase fatigue
atrophy
what occurs after 5 weeks of immobilization?
5% decrease arm circumference
35% decrease elbow extension
atrophy due to immobilization begins in:
1-3 days
muscle mass loss most in 5 days
what to observe in fracture patient:
gross -> fine
guarding fractured limb
off-balance gait
ROM for fractured site:
A&PROM above/below the fracture
AROM of effected joints
How do you TX comminuted FX?
gentle tendon glide of isolated muscle
gentle A/P ROM
Closed method of reduction:
wait longer to begin AROM to prevent more injury
what are concerns for closed FX?
Long arm cast
need to move un-casted joints, active assisted
ORIF TX:
ROM initiated w/in 5 days
splint for external support
retrograde massage
tenodesis with wrist on wedge
Why are elderly bitches more likely have fractured hip if they had previous UE FX?
changed habits to avoid another UE FX
how will associated soft tissue damage affect TX?
vascularization of muscles, nerves (most affected), tendons
what are potential problem areas after FX?
Redness
Shiny skin
posture compensation
Contra-Indications to FX:
non-union due to bone infection (not healing together)
Acute fracture management of Edema:
Elevation
Retrograde massage
MEM (3 weeks)
Pressure wrap modalities AROM
Problems during acute FX management:
limited ROM
what splint position to use after acute FX:
safes postion
hand based protective splint
what is safes position?
60-70 degrees wrist extension
60 degree MP flexion fingers extended
Priority = IP
Lengthened collateral ligaments
what not to do during acute FX:
MMT
what to do during sub-acute phase of FX:
PROM to involved joints
passive stretching
gentle weight bearing through joint
late stage FX problems:
limited ROM (frozen shoulder)
treatment of a late stage FX:
joint mobilization PROM Stretching splinting (composite flexion)
How many penises comprise a Cornucopia?
5
Big boobies or small boobies?
little boobies, big nipples
