Orthopaedic Rehabilitation

Question 1

why is it important to know and understand the stages of tissue healing?

Answer 1

for avoidance of excessive stress and strain

Question 2

what are the stages of healing?

Answer 2

post-operative
regeneration
remodelling

Question 3

when is classed as the post-operative healing phase?

Answer 3

24-48hours post-op

Question 4

when is classed as the regeneration phase of healing?

Answer 4

day 5 - 3 weeks +

Question 5

when is classed as the remodelling phase of healing?

Answer 5

6 weeks - 1 year

Question 6

what occurs in the post-operative stage of healing?

Answer 6

pain
oedema
healing tissues

Question 7

what care should be provided during the post-op stage of healing?

Answer 7

reduce pain - multimodal analgesia
cryotherapy
rest
easy movement only - NWB/supported WB

Question 8

what happens in the regeneration stage of healing?

Answer 8

new collagen fibres are forming
still fragile so requires ‘relative rest’

Question 9

what care should be provided in the regeneration phase of healing?

Answer 9

controlled lead exercise
passive/active ROM exercises

Question 10

what happens in the remodelling phase of healing?

Answer 10

consolidation and maturation

Question 11

what occurs during the remodelling phase of bone healing?

Answer 11

regeneration and remodelling

Question 12

what occurs during consolidation of tissues?

Answer 12

cellular into fibrous tissue, increasing strength and alignment

Question 13

what occurs during maturation of tissues?

Answer 13

vascularity and metabolic rate returns to normal (between 10 weeks - 1 year)

Question 14

what occurs during the regeneration phase of bone healing?

Answer 14

bridging callus forms

Question 15

what occurs during the remodelling phase of bone healing?

Answer 15

clinical union of bone

Question 16

what can occur once the remodelling phase of bone healing is completed?

Answer 16

gradual return to normal exercise

Question 17

what is a common first intervention for cruciate disease cases?

Answer 17

weight loss programmes - obesity is common in patients with cruciate disease

Question 18

what does the recovery of fractures depend on?

Answer 18

degree of fractures and site
pre-existing disease
degree of soft tissue damage
presence of open wounds

Question 19

what should be involved in a rehabilitation plan for a fracture patient?

Answer 19

adequate analgesia

restricted exercise

cold compresses

encourage use of the limb

supportive dressing if applicable

Question 20

why should we encourage use of the limb with fracture patients?

Answer 20

will help to start regain ROM

Question 21

how can we encourage use of the limb in fracture patients?

Answer 21

can start doing PROM exercises - must be minimal to start to avoid further damage

Question 22

what is the main difficulty nursing patients with external fixators?

Answer 22

difficulty in applying treatments

Question 23

how can we aid recovery in patients with external fixators?

Answer 23

cryotherapy
passage/PROM
active exercises (physio)

Question 24

what type of physiotherapy is important in patients with external fixators?

Answer 24

extension of the distal limb to avoid contracture of the muscles - the limb is usually held in a flexed position

Question 25

what are the main aspects of managing patients after joint surgery?

Answer 25

main management - multimodal analgesia pressure dressing 12-24 hours cryotherapy PROM massage can reduce oedema

Question 26

what are the benefits of PROM after joint surgery?

Answer 26

maintenance of normal ROM stimulation of blood and lymphatic circulation stimulation of sensory awareness

Question 27

what specific management should be considered for patients who have had a THR?

Answer 27

management by experienced staff only - clear signage required walked slowly in a controlled manner must be kept settled and calm - mild sedation may be required

Question 28

when can PROM be started for tendon injuries?

Answer 28

after 3 weeks rest

Question 29

how long should exercise be limited for tendon injuries/rupture?

Answer 29

3-6 weeks

Question 30

what are the primary goals of rehabilitation for orthopaedic patients?

Answer 30

weight bearing regain active range of movement muscle building

Question 31

what is the most important aspect of the post-operative period after orthopaedic surgery?

Answer 31

multimodal pain relief - rehabilitation can cause stress on the tissues

Question 32

what is the function of rehabilitation?

Answer 32

assists with return to function, minimising stress on the surgical site

Question 33

how can we aid rehabilitation of orthopaedic injury pre-emptively/pre-surgical management?

Answer 33

cryotherapy support dressings weight bearing as much as possible good pain management assessment of other conditions/lifestyles which may affect treatment

Question 34

when is cryotherapy most effective?

Answer 34

initial 72hour period

Question 35

what are the advantages of cryotherapy?

Answer 35

vasoconstriction - reduced inflammation analgesic effect reduced tissue oedema

Question 36

what is the idea application of cryotherapy?

Answer 36

15 mins 3x daily

Question 37

what temperature is appropriate for heat therapy?

Answer 37

46 degrees C

Question 38

when might heat therapy be beneficial?

Answer 38

before exercise - increased blood flow = increased elasticity

Question 39

what are the advantages of massage as a rehabilitation technique?

Answer 39

increases blood flow --> improves oxygen supply and aids removal of waste products --> helps muscle work more efficiently good enrichment for patient stimulates venous and lymphatic return mobilises adhesions prepares muscles for exercise and aids recovery after

Question 40

when is the ideal time to perform massage as part of rehabilitation?

Answer 40

as a warm up for physiotherapy session

Question 41

what assisted therapeutic exercises might be done with orthopaedic patients?

Answer 41

assisted standing weight shifting side bending and cervical flexion/extension balance boards/swiss balls muscle stimulation (TENS, e-stim)

Question 42

which active therapeutic exercises might be done with orthopaedic patients?

Answer 42

slow walks stair climbing sit to stands, down to sits, treadmill walking advanced exercises - dancing, wheelbarrowing, hydrotherapy

Question 43

when should hydrotherapy be started for orthopaedic patients?

Answer 43

6-12 weeks post-op

Question 44

how can we best communicate when nursing orthopaedic patients?

Answer 44

record clear and precise details or progress andn any procedures take videos walking/of wound to show progress ensure rehab plans discussed as a team and communicated with all involved