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PHTY2101 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is orthopaedic physiotherapy?

A

physiotherapy related to the preparation for and/or rehabilitation from orthopaedic surgery or related to an orthopaedic hospital admission

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2
Q

Why is it so important to be prepared before seeing a patient by reviewing their medical history etc?

A

a patients condition can change in seconds and the medical post operative orders are vital

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3
Q

What are some indicators of DVT?

A

swelling, redness, hot, sore calf

+/- positive Homan’s sign (passive dorsiflexion pain)

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4
Q

What is compartment syndrome?

A

bleeding into the space between muscles causing vascular occulsion due to an increase in pressure

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5
Q

What are the 5 P’s you are looking for in compartment syndrome?

A

palour, pain, parasthesia, pulses, paralysis

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6
Q

What does FWB stand for?

A

full weight bearing

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7
Q

What does WBAT stand for?

A

weight bear as tolerated

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8
Q

What does PWB stand for?

A

partial weight bearing

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9
Q

What does TWB stand for?

A

Touch weight bearing

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10
Q

What does HWB stand for?

A

heel weight bearing

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11
Q

What does NWB stand for?

A

non-weight bearing

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12
Q

True or false… as soon as a patient has instructions for anything less than FWB, they MUST use an aid device of some kind

A

true

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13
Q

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

A

true

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14
Q

Are oral pain medications slow or fast acting?

A

slow

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15
Q

Are intravenous pain medications slow or fast acting?

A

fast

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16
Q

Are subcutaneous narcotic pain medications slow or fast acting?

A

slow

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17
Q

Are intramuscular narcotic pain medications slow or fast acting?

A

slow

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18
Q

PCA stands for patient-controlled analgesia, what does this refer to?

A

analgesia (pain killers) that can be administered by the patient

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19
Q

Why is it important to know about your patients timing, frequency and dose of pain medication?

A

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

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20
Q

How long does it take for pain medication to kick in?

A

5-30 minutes depending on what/how the pain killers are administered

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21
Q

True or false… morphine can drop someone’s blood pressure

A

true

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22
Q

True or false… an epidural affects both sensory and motor function

A

true

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23
Q

When is arthroscopy indicated for arthritic knees?

A

only if mechanical locking is an issue… otherwise it is counter-indicated (old school train of thought that the knee needs ‘cleaning out’)

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24
Q

True or false… the ankle deltoid ligament should be surgically repaired after injury to improve ankle stability

A

false- makes little difference to ankle stability

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25
Q

The Enhanced Recovery After Surgery (ERAS) model aims to what?

A

aims to improve patient outcomes by optimising all elements of the patient’s journey through surgery

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26
Q

How many days do you expect a total knee/hip replacement to be in hospital post-surgery?

A

3-5 days

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27
Q

True or false… hip replacements are cemented generally when the patient has lower healing capacity

A

true

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28
Q

When is the most common time for dislocations post total hip replacement?

A

in the first 3 months

29
Q

True or false… there is generally less functional complications in total hip replacements compared to total knee replacements

A

true

30
Q

Patellar tendon grafts for ACL replacements are strong and are eventually replaced by new tissue… whats the disadvantage?

A

donor site pathology & anterior knee pain

31
Q

Hamstring grafts for ACL replacement have good graft strength and have less donor site issues down the line… what’s the disadvantage?

A

there is evidence of elastic creep in graft due to poorly aligned collagen fibres and therefore may be more lax

32
Q

Does a severed ACL HAVE to be replaced surgically?

A

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

33
Q

What muscle group is of particular focus post ACL reconstruction?

A

quads

34
Q

What is involved in a 3 way patella realignment?

A

move the tibial tuberosity medially

release tightness of lateral retinaculum and vastus lateralis

tightening of medial retinaculum and vastus medalis oblique (VMO)

35
Q

In what position do we want to immobilise a knee after a 3-way patellar alignment?

A

extension for 6 weeks

36
Q

A high tibial osteotomy is used to avoid doing knee replacements too young in patients with OA. What does it entail?

A

realigning the tibia to distribute weight better away from the arthritic tissue

37
Q

The Young-Burgess system is used to classify pelvis fractures, how does it classify them?

A

by direction of force

i.e. AP compression, lateral compression, vertical shear & combination

38
Q

APC 1 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

an anterior/posterior compression resulting in disruption of the pubic symphysis

39
Q

APC 2 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

an anterior/posterior compression resulting in disruption of the pubic symphysis with separation of more than 2.5cm, disruption of the posterior ligaments

40
Q

APC 3 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

‘open book’ fracture

disruption of pubic symphysis, posterior ligaments & sacroiliac ligaments

41
Q

LC 1 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

fracture of the pubic rami on ipsilateral side of force

42
Q

LC 2 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

fracture of the pubic rami & iliac wing on the ipsilateral side of force

43
Q

LC 3 (of the Young-Burgess system) refers to what kind of pelvic fracture?

A

fracture of the pubic rami & iliac wing on the ipsilateral side of force + injuries on contralateral side

44
Q

True or false… vertical shear pelvic fractures are often referred to as parachute injuries

A

true

45
Q

True or false… vertical shear injuries often vary in degree

A

false- often happen due to a fall on one leg with alot of force therefore the injuries are usually significant

46
Q

True or false… stable pelvic fractures should be managed surgically

A

false

47
Q

Are you more likely to fracture your posterior or anterior acetabulum in a car accident?

A

posterior- most of the force will go through the posterior as patient will be in a sitting position

48
Q

True or false… someone who experiences an acetabular fracture will often require a total hip replacement down the line

A

true

49
Q

When would surgical intervention be indicated for a clavicular fracture?

A

if it is displaced posterior and is threatening neurovascular structures

50
Q

Are prolapsed discs often rehabilitated through conservative management or surgical?

A

conservative

51
Q

What are some indications for surgical management of a prolapsed intervertebral disc?

A

no improvement with conservative treatment
increase in neurological deficit
bladder & bowel symptoms suggesting cauda equina damage
uncontrollable pain

52
Q

What happens during a discectomy?

A

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

53
Q

Why would a surgeon choose to do a microdiscectomy over a discectomy?

A

it is less invasion and the recovery time is often less with comparative success rates

54
Q

True or false… the planned surgical procedure is always the procedure undertaken

A

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

55
Q

What is lumbar spine stenosis?

A

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

56
Q

What are the symptoms of lumbar spine stenosis?

A

central low back pain
pins & needles or numbness in the legs
cramping in the legs
leg weakness (more severe)

57
Q

How does a laminectomy help with lumbar spine stenosis?

A

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

58
Q

What are some possible complications of decompressive spinal surgery?

A

neural tissue damage
infection
error in diagnosis
inadequate decompression

59
Q

What key things are we managing post operatively for patients who have undergone decompressive spinal surgery?

A 
circulo-respiratory exercises daily
neurological checks daily 
log roll (for comfort to mobilise)
muscle activation exercises (i.e. multifidus)
mobilisation 
education and advice
60
Q

True or false… the rate of reinjury after a discectomy is quite high (within 2-3 months post surgery)

A

true

61
Q

What is the discharge criteria for patients who have undergone decompression surgery?

A

independently mobile on stairs
independent home exercise program
outpatient appointment booked ~2 weeks to progress HEP

62
Q

Why would spinal fusion surgery be considered for a patient?

A

instability (either due to trauma or disease)
scoliosis/kyphosis/spondylolisthesis
osteomyelitis, TB, primary or secondary neoplasms

63
Q

Why are iliac crest bone grafts advantageous?

A

they have 3 cortical surfaces therefore are quite strong

on the downside can be a significant point of pain post surgery

64
Q

5 stages of fracture healing & their times

A
  1. tissue damage & hematoma (initial injury)
  2. inflammation & cellular proliferation (8 hours to 2 weeks)
    3: callus formation (woven bone) (2 to 4 weeks)
  3. consolidation (8 weeks)
  4. remodeling (8 weeks to 2 years)
65
Q

Description of 5 stages of fracture healing

A
  1. bleeding into the injury site resulting in an area of necrotic bone
  2. proliferation of osteogenic cells & inflammatory markers, osteoclasts remove necrotic bone & osteoblasts lay down collagen to bridge fracture site, hematoma absorbed & capillary infiltration
  3. collagen matrix becomes woven bone, fracture is united
  4. woven bone becomes lamellar bone, clinical & radiographic union
  5. bone resorption & formation, medullary canal reformed
66
Q

What is the physiotherapist’s role in the second stage (inflammation & cellular proliferation) of fracture healing?

A 
promote rest
elevation, ice
circulatory exercises
teach how to use mobility aids 
DO NO HARM
67
Q

What is the physiotherapist’s role in the third (callus formation) stage of fracture healing?

A

circulatory exercises
mobility aid education
DO NO HARM

68
Q

What is the physiotherapist’s role in the fourth (consolidation) stage of fracture healing?

A

progress weight-bearing status
gait, balance & strength retraining
increase ROM
DO NO HARM

PHTY2101 (10 decks)

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