Orthopaedics Flashcards
What is orthopaedic physiotherapy?
physiotherapy related to the preparation for and/or rehabilitation from orthopaedic surgery or related to an orthopaedic hospital admission
Why is it so important to be prepared before seeing a patient by reviewing their medical history etc?
a patients condition can change in seconds and the medical post operative orders are vital
What are some indicators of DVT?
swelling, redness, hot, sore calf
+/- positive Homan’s sign (passive dorsiflexion pain)
What is compartment syndrome?
bleeding into the space between muscles causing vascular occulsion due to an increase in pressure
What are the 5 P’s you are looking for in compartment syndrome?
palour, pain, parasthesia, pulses, paralysis
What does FWB stand for?
full weight bearing
What does WBAT stand for?
weight bear as tolerated
What does PWB stand for?
partial weight bearing
What does TWB stand for?
Touch weight bearing
What does HWB stand for?
heel weight bearing
What does NWB stand for?
non-weight bearing
True or false… as soon as a patient has instructions for anything less than FWB, they MUST use an aid device of some kind
true
True or false… at 6 weeks post internal fixation, the metal work is no longer the main stability and the bone is starting to take over
true
Are oral pain medications slow or fast acting?
slow
Are intravenous pain medications slow or fast acting?
fast
Are subcutaneous narcotic pain medications slow or fast acting?
slow
Are intramuscular narcotic pain medications slow or fast acting?
slow
PCA stands for patient-controlled analgesia, what does this refer to?
analgesia (pain killers) that can be administered by the patient
Why is it important to know about your patients timing, frequency and dose of pain medication?
because you need to time your treatments around these in order to get the most out of the sessions- a patient in pain is not going to want to participate
How long does it take for pain medication to kick in?
5-30 minutes depending on what/how the pain killers are administered
True or false… morphine can drop someone’s blood pressure
true
True or false… an epidural affects both sensory and motor function
true
When is arthroscopy indicated for arthritic knees?
only if mechanical locking is an issue… otherwise it is counter-indicated (old school train of thought that the knee needs ‘cleaning out’)
True or false… the ankle deltoid ligament should be surgically repaired after injury to improve ankle stability
false- makes little difference to ankle stability
The Enhanced Recovery After Surgery (ERAS) model aims to what?
aims to improve patient outcomes by optimising all elements of the patient’s journey through surgery
How many days do you expect a total knee/hip replacement to be in hospital post-surgery?
3-5 days
True or false… hip replacements are cemented generally when the patient has lower healing capacity
true
When is the most common time for dislocations post total hip replacement?
in the first 3 months
True or false… there is generally less functional complications in total hip replacements compared to total knee replacements
true
Patellar tendon grafts for ACL replacements are strong and are eventually replaced by new tissue… whats the disadvantage?
donor site pathology & anterior knee pain
Hamstring grafts for ACL replacement have good graft strength and have less donor site issues down the line… what’s the disadvantage?
there is evidence of elastic creep in graft due to poorly aligned collagen fibres and therefore may be more lax
Does a severed ACL HAVE to be replaced surgically?
no- about ⅓ of ACL injuries will cope without replacement, another ⅓ will cope with functional/movement changes, the last third of injuries must be surgically fixed
What muscle group is of particular focus post ACL reconstruction?
quads
What is involved in a 3 way patella realignment?
move the tibial tuberosity medially
release tightness of lateral retinaculum and vastus lateralis
tightening of medial retinaculum and vastus medalis oblique (VMO)
In what position do we want to immobilise a knee after a 3-way patellar alignment?
extension for 6 weeks
A high tibial osteotomy is used to avoid doing knee replacements too young in patients with OA. What does it entail?
realigning the tibia to distribute weight better away from the arthritic tissue
The Young-Burgess system is used to classify pelvis fractures, how does it classify them?
by direction of force
i.e. AP compression, lateral compression, vertical shear & combination
APC 1 (of the Young-Burgess system) refers to what kind of pelvic fracture?
an anterior/posterior compression resulting in disruption of the pubic symphysis
APC 2 (of the Young-Burgess system) refers to what kind of pelvic fracture?
an anterior/posterior compression resulting in disruption of the pubic symphysis with separation of more than 2.5cm, disruption of the posterior ligaments
APC 3 (of the Young-Burgess system) refers to what kind of pelvic fracture?
‘open book’ fracture
disruption of pubic symphysis, posterior ligaments & sacroiliac ligaments
LC 1 (of the Young-Burgess system) refers to what kind of pelvic fracture?
fracture of the pubic rami on ipsilateral side of force
LC 2 (of the Young-Burgess system) refers to what kind of pelvic fracture?
fracture of the pubic rami & iliac wing on the ipsilateral side of force
LC 3 (of the Young-Burgess system) refers to what kind of pelvic fracture?
fracture of the pubic rami & iliac wing on the ipsilateral side of force + injuries on contralateral side
True or false… vertical shear pelvic fractures are often referred to as parachute injuries
true
True or false… vertical shear injuries often vary in degree
false- often happen due to a fall on one leg with alot of force therefore the injuries are usually significant
True or false… stable pelvic fractures should be managed surgically
false
Are you more likely to fracture your posterior or anterior acetabulum in a car accident?
posterior- most of the force will go through the posterior as patient will be in a sitting position
True or false… someone who experiences an acetabular fracture will often require a total hip replacement down the line
true
When would surgical intervention be indicated for a clavicular fracture?
if it is displaced posterior and is threatening neurovascular structures
Are prolapsed discs often rehabilitated through conservative management or surgical?
conservative
What are some indications for surgical management of a prolapsed intervertebral disc?
no improvement with conservative treatment
increase in neurological deficit
bladder & bowel symptoms suggesting cauda equina damage
uncontrollable pain
What happens during a discectomy?
removal of the damaged portion of a herniated IV disc to relieve compression on a spinal nerve
this procedure has a low rate of return of physical signs of weakness or loss of reflexes
Why would a surgeon choose to do a microdiscectomy over a discectomy?
it is less invasion and the recovery time is often less with comparative success rates
True or false… the planned surgical procedure is always the procedure undertaken
false, things can go wrong or things may be different than expected once the patient gets on the table
this is why it is important to always read the surgical notes for what was actually undertaken
What is lumbar spine stenosis?
with age the IV disc loses fluid content and height and can bulge into the central canal, also spinal facet joints can thicken and enlarge with arthritis and bulge into the central canal
(aka OA of the spine)
resulting in compression of neural structures
What are the symptoms of lumbar spine stenosis?
central low back pain
pins & needles or numbness in the legs
cramping in the legs
leg weakness (more severe)
How does a laminectomy help with lumbar spine stenosis?
by removing a piece of the lamina (spinous process) to decrease the pressure on the spinal cord or nerve root
usually only done on 1-2 levels before the stability of the spine is in question and fusions need to be done in conjunction with the laminectomy
What are some possible complications of decompressive spinal surgery?
neural tissue damage
infection
error in diagnosis
inadequate decompression
What key things are we managing post operatively for patients who have undergone decompressive spinal surgery?
circulo-respiratory exercises daily neurological checks daily log roll (for comfort to mobilise) muscle activation exercises (i.e. multifidus) mobilisation education and advice
True or false… the rate of reinjury after a discectomy is quite high (within 2-3 months post surgery)
true
What is the discharge criteria for patients who have undergone decompression surgery?
independently mobile on stairs
independent home exercise program
outpatient appointment booked ~2 weeks to progress HEP
Why would spinal fusion surgery be considered for a patient?
instability (either due to trauma or disease)
scoliosis/kyphosis/spondylolisthesis
osteomyelitis, TB, primary or secondary neoplasms
Why are iliac crest bone grafts advantageous?
they have 3 cortical surfaces therefore are quite strong
on the downside can be a significant point of pain post surgery
5 stages of fracture healing & their times
- tissue damage & hematoma (initial injury)
- inflammation & cellular proliferation (8 hours to 2 weeks)
3: callus formation (woven bone) (2 to 4 weeks) - consolidation (8 weeks)
- remodeling (8 weeks to 2 years)
Description of 5 stages of fracture healing
- bleeding into the injury site resulting in an area of necrotic bone
- proliferation of osteogenic cells & inflammatory markers, osteoclasts remove necrotic bone & osteoblasts lay down collagen to bridge fracture site, hematoma absorbed & capillary infiltration
- collagen matrix becomes woven bone, fracture is united
- woven bone becomes lamellar bone, clinical & radiographic union
- bone resorption & formation, medullary canal reformed
What is the physiotherapist’s role in the second stage (inflammation & cellular proliferation) of fracture healing?
promote rest elevation, ice circulatory exercises teach how to use mobility aids DO NO HARM
What is the physiotherapist’s role in the third (callus formation) stage of fracture healing?
circulatory exercises
mobility aid education
DO NO HARM
What is the physiotherapist’s role in the fourth (consolidation) stage of fracture healing?
progress weight-bearing status
gait, balance & strength retraining
increase ROM
DO NO HARM
