Management of Fractures

Question 1

how does populations increasing life span increase fractures?

Answer 1

decreased coordination

weakened bones

Question 2

who is at risk for fractures?

Answer 2

elderly for hip

children for forearm and leg

Question 3

what are characteristics of primary fracture?

Answer 3

direct or contact healing
vasculature is intact
cortical contact

Question 4

what does fraction fixation provide?

Answer 4

compression

Question 5

how long does it take for a primary fracture to heal?

Answer 5

5-6 weeks for bone to close

Question 6

what are the characteristics of secondary fracture?

Answer 6

when motion across FX site is limited but not eliminated
callous or indirect healing
wires, rods, external fixation

Question 7

what type of motion is required for secondary healing?

Answer 7

slight

Question 8

difference between primary and secondary healing:

Answer 8

no compressive component for secondary

Question 9

what does fracture healing prognosis depend upon?

Answer 9

location
nature of fracture
type of fixation

Question 10

why do high impact fractures heal more slowly?

Answer 10

soft tissue and vascular damage

Question 11

why do open fractures heal more slowly?

Answer 11

soft tissue and bone loss (infection)

Question 12

what are risk factors for delayed healing?

Answer 12

DM
smoking
steroids
poor nutrition

Question 13

what are the effects of immobilization of muscle?

Answer 13

decrease strength
increase fatigue
atrophy

Question 14

what occurs after 5 weeks of immobilization?

Answer 14

5% decrease arm circumference

35% decrease elbow extension

Question 15

atrophy due to immobilization begins in:

Answer 15

1-3 days

muscle mass loss most in 5 days

Question 16

what to observe in fracture patient:

Answer 16

gross -> fine
guarding fractured limb
off-balance gait

Question 17

ROM for fractured site:

Answer 17

A&PROM above/below the fracture

AROM of effected joints

Question 18

How do you TX comminuted FX?

Answer 18

gentle tendon glide of isolated muscle

gentle A/P ROM

Question 19

Closed method of reduction:

Answer 19

wait longer to begin AROM to prevent more injury

Question 20

what are concerns for closed FX?

Answer 20

Long arm cast

need to move un-casted joints, active assisted

Question 21

ORIF TX:

Answer 21

ROM initiated w/in 5 days
splint for external support
retrograde massage
tenodesis with wrist on wedge

Question 22

Why are elderly bitches more likely have fractured hip if they had previous UE FX?

Answer 22

changed habits to avoid another UE FX

Question 23

how will associated soft tissue damage affect TX?

Answer 23

vascularization of muscles, nerves (most affected), tendons

Question 24

what are potential problem areas after FX?

Answer 24

Redness
Shiny skin
posture compensation

Question 25

Contra-Indications to FX:

Answer 25

non-union due to bone infection (not healing together)

Question 26

Acute fracture management of Edema:

Answer 26

Elevation
Retrograde massage
MEM (3 weeks)
Pressure wrap modalities AROM

Question 27

Problems during acute FX management:

Answer 27

limited ROM

Question 28

what splint position to use after acute FX:

Answer 28

safes postion

hand based protective splint

Question 29

what is safes position?

Answer 29

60-70 degrees wrist extension
60 degree MP flexion fingers extended
Priority = IP
Lengthened collateral ligaments

Question 30

what not to do during acute FX:

Answer 30

MMT

Question 31

what to do during sub-acute phase of FX:

Answer 31

PROM to involved joints
passive stretching
gentle weight bearing through joint

Question 32

late stage FX problems:

Answer 32

limited ROM (frozen shoulder)

Question 33

treatment of a late stage FX:

Answer 33

joint mobilization PROM
Stretching
splinting (composite flexion)

Question 34

How many penises comprise a Cornucopia?

Answer 34

5

Question 35

Big boobies or small boobies?

Answer 35

little boobies, big nipples