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Subacute rehabilitation > ORTHO > Flashcards

ORTHO Flashcards

1
Q

RISK FACTORS FOR ACL INJURY

A

Young age (peak at 16-18 yrs)
Earlier, more intense, and more frequent participation in sport
Variations in bone morphology
Neuromuscular control
Genetic
Hormonal

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2
Q

Different types of meniscal surgery

A

Arthroscopy + Meniscectomy
Arthroscopy + Meniscus repair

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3
Q

What is an arthroscopy + meniscectomy?

A

Damaged cartilage is trimmed away

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4
Q

Arthroscopy + Meniscus repair

A

Sutured together

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5
Q

Autograft

A

tissue from own body

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6
Q

Allograft

A

tissue from cadaver

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7
Q

Pros / cons of HS autograft

A

Easier Sx to perform
↓ knee pain/stiffness post-op,
↓ hamstring strength
↓ incision and faster recovery
↑ laxity/potential graft
lengthening

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8
Q

Pros / cons of Quad autograft

A

Middle 1/3 of quadriceps tendon
Fixation not as solid
↑ post-op knee pain
↑ laxity/potential graft
lengthening

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9
Q

Pros / cons Patella tendon

A

Middle 1/3 of tendon
↑ pF knee pain (kneecap, kneeling)
↑ post-op stiffness
↓ knee laxity compared to other methods

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10
Q

COMPARE TRIAL for surgical / conservative management of ACL tear

A

(IMMEDIATE V DELAYED SURGERY) - 50% of patients randomised to three-months of rehab did not need surgery

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11
Q

Cross bracing protocol findings

A

90% of patients had evidence of healing on 3-month MRI (continuity of the ACL).
More ACL healing on 3-month MRI was associated with better outcomes.

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12
Q

What does the evidence say for meniscus surgery v conservative management for degenerative meniscal injury

A

strong evidence in favour of conservative management

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13
Q

MOI of ACL injury

A

deceleration, change of direction combined with knee valgus load

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14
Q

Common symptoms of ACL

A

hearing a pop or haemoarthrosis

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15
Q

Presentation of meniscus injury

A

pain, stiffness, catching/locking and instability

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16
Q

Diff between WEBER FRACTURES

A

Weber A: # inferior/distal to syndesmosis
Syndesmosis intact
Deltoid ligament intact
+/- medial malleolus #
Usually stable and conservative Mx indicate

WEBER B: # at level of syndesmosis
Syndesmosis intact or partially torn
+/- medial malleolus #
+/- Deltoid ligament damage
Stability varies
May require ORIF
WB as tolerated wearing the CAM-boot

WEBER C: Above level of ankle joint
Syndesmosis damaged/ruptured with widening of joint
Usually Deltoid ligament injury and/or medial malleolus #
Unstable
ORIF required
Altered articulation of talus and the tibia worsening in weight bearing.

17
Q

Management of Weber A #

A

Typically don’t need to be casted
Treated in stabilising ankle orthoses
Early function and WBAT
ROM exercises as tolerated

18
Q

Management of Weber B #

A

CAM boot
Over 6/52, the patient WBAT in boot
Orthosis stays on at night.
ROM exercises as tolerated

19
Q

Management of Weber C: #

A

ORIF: open reduction internal fixation Fracture will be healed using nails of entire shaft.
Generally nails will stay in.
8+ weeks of rehab

20
Q

Describe the management of Weber B fractures (Kortekangas et al 2019)

A

80 received 3 weeks of orthosis, 84 received 6 weeks in a cast, 83 received 3 weeks in a cast.
A shorter 3 week period of immobilisation proved non-inferior to traditional 6 weeks in cast immobilisation

21
Q

What are the considerations, implications advantages and disadvantages of surgical vs conservative management for grade III achilles tendon tears?

A

Considerations → Early detection is really important.
- Put patient in plantarflexion i.e. boot with heel lifts or cast
- Must be detected within 5 days otherwise surgery is needed.

Conservative:
- Reduced risk of infection

Surgical
- Reduced risk of re-rupture
- Cost

Benefits:
- Unclear which is superior
- Most studies achieve similar results

22
Q

0-3 mo post achilles surgery

A

NWB: 8-12 weeks
Keep the leg elevated above heart level (leg straight & propped up on a pillow)

Wear a walking boot that lifts the heel to protect the tendon (ensures foot is in plantarflexion & prevents the tendon from being stretched to maximise healing. Overtime the heel inserts are gradually reduced in height).

Circulation exercises eg ankle pumps, stretching and strengthening of the ankle, hip, quads, etc

Gradually wear the boot less and increase the difficulty of the exercises

23
Q

3-6-9 months post surgery ACHILLES SURGERY

A

Advanced strengthening of the ankle and other leg muscles

Gradual return to work and/or sport

24
Q

Considerations for achilles surgery

A

Level of activity (may need to reduce non-essential work commitments)

Can the patient use crutches to navigate stairs, etc

Any other LE concerns eg hip pain may affect mobility & sleep

Ensure patient understands NWB

Teach patient to shower –> can’t get surgical site wet initially (plastic bag over the boot? Recommend a seat)

How to put on the boot

Ensure precautions are followed

Continue with upper body workouts

Consider social support ie do they have family/friends

How will patient clean wound alone + complete PROMS?

25
Q

DIFFERENCE POST-SURGERY ORIF AND THR

A
  • After THR, there are no weight bearing restrictions but there are for ORIF (WBAT)
  • After an ORIF, the patient will work up to full weight bearing unlike THR
26
Q

ACHILLES PROTOCOL

A

WK 0-2:
Heel lift 4-6cm and NWB; strengthen knee and hip.

WK 2-4:
Drop to heel lift 2-4cm and continue knee and hip strengthening. Ankle ROM but no DF.

Week 4-6:
Start bike cardio with boot (week 4).
Ankle ROM with dorsiflexion.
Crutches with PWB.

Week 6-12:
Discontinue heel lift.
WBAT
Banded exercises for ankle.
Bilateral concentric CR.
Balance

Week 8-12:
Full passive range.
Proprioception work

Week 12+:
Global strengthening
Eccentric heel drops

27
Q

RISK FACTORS FOR HIP OA

A

Age 40+
Heredity, congenital defects and disease
Joint morphology (FAI - CAM)
Joint trauma
Female > male
Excess weight

28
Q

Precautions following a THR

A
  • No Hip flexion >90
  • No rotation
  • No sitting with legs crosse
29
Q

Pathophysiology & symptoms of OA

A

Disease that affects the whole joint; meniscus, labrum, cartilage etc.

Use related pain
Functional limitations
morning symptoms
crepitus
Restricted movement
bony enlargement

30
Q

Indications for LSF

A

Painful degenerative disc disease
Unstable fractures
Progressive spondylolisthesis

31
Q

Indications for ACDF (absolute and contraindications)

A

Absolute
* Progressive cervical myelopathy
* Certain infections (TB, discitis)
* Traumatic instability, car crashes, fractures

Relative
* Radiculopathy (structure compressing nerves) that has failed to respond to conservative treatment for at least 6 weeks
* Recurrent radiculopathy
* Progressive neurological deficits
* Severe pain

32
Q

Precautions: 0-14 days post ACDF

A

Do not:
- pick up anything >1.5kg
- sleep on stomach or with arms above head
- lift anything > shoulder height
- perform strenuous exercise
- wet incision site
- Drive

33
Q

Patient education 0-14 days post ACDF?

A

Proper use of cervical support if required
Protection of surgical site
Daily walking program (progression of speed and duration)

34
Q

Describe the precautions and length of time of precautions following LSF

A
35
Q

Indications for rotator cuff repair

A

Acute trauma with full thickness tear and weakness
Failure of 3-6 month conservative management or acute full thickness tear in young person <50

Subacute rehabilitation (5 decks)

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