Ortho Flashcards
CI cone calipers
CI on traction (cones calipers)
No movement of fracture site
Do not remove traction
No unilateral shoulder flexion>90°
No bilateral shoulder flexion>160°
No unilateral shoulder depression
Resisted arm exercises can only be done bilaterally
CI lumbar injuries on bedrest
CI on bedrest
No movement at fracture site
No weight bearing through the spine
No resisted hip flexion
No pelvic tilting
No hip abduction>40°
burst fracture mx - L4
L4 - unstable fracture
No turning, rolling (ADL testing limited to supine)
No spine lateral flexion
No unilateral hip abduction
Hip flex ROM can’t be tested
no movement (active and passive) > 20°due to psoas action, and posterior pelvic tilt
No resisted hip flexion (L2 myotome)
d/t anterior shear of iliopsoas
rest of myotomes and dermatomes done only in supine
polytrauma PT Mx
Main Bears are Red, Rest GRIm RRReaper
Maintain clear chest
Education , mobilisation ACBT
Bed mobility
Pressure sore relief, positioning and re-education
Reduction of pain and swelling
PRICE, electrotherapy, mobility and soft tissue release
Restore movement in a joint
Passive and active movements, PNF and mobilisations
Gait Re-education
Facilitation, assistive devices and education
Restore strength and flexibility in supporting muscles
Active exercises, weight training and stretching
Improvement in overall level of fitness
Endurance training
Restore balance/proprioception
Return to a level of independence before injury
Respect contra-indications of all injured sites
Complications of bed rest
- DVT – hard/swollen calf, pain
- Chest complications – ausc
- Bed sores
- Decreased ROM
- Decreased strength – atrophy
- infection (ex-fix)
Signs & Symptoms of Potts Disease
PPPPAST For Local Night
Progresses slowly
Paravertebral swelling
Pain and stiffness
Paralysis of the lower limbs.
Appetite loss-anorexia-weight loss
Spinal mass, sometimes associated with numbness, tingling, or muscle weakness of the legs
Tubercular arthritis is usually a monoarthritis affecting primarily the hip or knee and less commonly the ankle, elbow, wrist and shoulder.
fever
night sweats
Localised back pain
SYMPTOMS OF TB pulmonary
Productive cough which does not improve after 3 weeks
Haemoptysis
Weight loss
Appetite loss
Night sweats
Fever
Chest pain
Shortness of Breath
Isolated TB spine may not have a cough or other “typical” TB symptoms
Late complications of Potts
Seven Vertebras Sink & Spin
severe kyphosis
Vertebral collapse resulting in
kyphosis/Gibbus
Spinal cord compression (paraplegia (so
called Pott’s paraplegia))
sinus formation
PT Mx Potts
Mrs CORTs Bpm
Refer for braces
Core stability
Bed program
Optimize muscles that are working
Maintain ROM
Maintain strength
Bed mobility
Transfer
Depending on the prognosis either treatment as a spinal etc,
patient or rehabilitation back to previous functional level
primary vs secondary bone tumour
- primary bone tumors- start in the bones of the spine
- secondary bone tumors- spread into the bones of the spine from elsewhere in the body.
PT Mx w/ spinal tumour
optimize their functional level to keep them active
breathing techniques (DBE)
CI and precautions for ex-fix with or without traction - pelvic fracture tile C
- NWB on leg of traction side 6/52
- No sitting for 2/52 and then no sitting >45° for a further
2/52 - Hip flexion <30° for 3/52 and then <70° for a further 3/52.
After 4-6/52 bedrest commence mobilisation NWB for 6/52 (as per surgeon orders)
(bedrest precautions)
chest complications DVT
infection (ex-fix) pressure sores muscle atrophy
decreased flexibility and ROM
benign vs malignant
Contents
Margin
Extent
Periosteal
Benign
Homogenous
Well defined
Well circumscribed
Occasional reaction
Malignant
Disorgansied
Absent/ill-defined
Along medullary cavity or through the cortex/periosteum
Reaction often present
long term complications of pelvic fractures
BLIP ON PONS
- Bladder and bowel dysfunction – check involvement before removing catheter
- Pain
- Instability
- Leg length discrepancy
- Obstetric difficulties
- Pelvic obliquity with sitting difficulty
- Non union-uncommon
- Nerve damage
- Soft tissue
- OA hip-if acetabular #
CI & precautions for Type B
CI for ex-fix or plates
No excessive hip external rotation
No sitting higher than 45° (hip flexion) for 4/52 (post pelvic tilt)
B1 pelvic fracture definition
B1-‘open book’
* External rotation injury
* antero-posterior compression fractures
* causing separation of the pubic symphysis and widening of one or both sacroiliac joints.
* Sacrospinous& sacrotuberous lig torn
* Posterior SI & Interosseous lig intact
This is an open book injury. It is an external rotation injury and is causes due to an antero-posterior compression fracture. It causes separation of the pubis symphysis and widening of one or both of the sacro-iliac joints. The sacrospinous and sacrotuberous ligaments are torn but the posterior sacro-iliac and interosseous ligaments are still intact. As a result of these torn ligaments, vertical stability of the pelvis will be affected (dereased)
Grading of Spondylolisthesis
Spondylolisthesis
A spinal disorder in which one vertebra ‘slips’ forward (usually) onto the bone below it
Grade 1-vertebral body above subtends 1⁄4 of the AP diameter of the vertebral body below
Grade 2- vertebral body above subtends 1/2 of the AP diameter of the vertebral body below
Grade 3- vertebral body above subtends 3/4 of the AP diameter of the vertebral body below
Grade 4- vertebral body above subtends the full AP diameter of the vertebral body below
Spondylolisthesis definition
Spondylolisthesis
A spinal disorder in which one vertebra ‘slips’ forward (usually) onto the bone below it
Spondylolisthesis be identified on X-ray
L-spine-anterior oblique view -“Scotty Dog”.
A fracture of the par interarticularis (isthmus) results on the X-Ray as a dark “collar” on the neck of the dog
Grade 1-vertebral body above subtends 1⁄4 of the AP diameter of the vertebral body below
Grade 2- vertebral body above subtends 1/2 of the AP diameter of the vertebral body below
Grade 3- vertebral body above subtends 3/4 of the AP diameter of the vertebral body below
Grade 4- vertebral body above subtends the full AP diameter of the vertebral body below
Role of PT - spinal fractures & surgeries
PPREM
Prevention of complications of bedrest
Posture and soft tissue care
Restoration of musculoskeletal function
Educate on CI and care
Mobilized out of bed
