Orthopaedics

Question 1

Disc surgery

Answer 1

Discectomy:
-Discectomy is the surgical removal of the damaged portion of a herniated disk in the spine

Microdiscectomy
-Disc is excised through small incisions under endoscopic control. Surgical trauma minimised

Question 2

Laminectomy

Answer 2

• Involves removal of a piece of lamina to decrease the pressure on the spinal cord
• Used for spinal stenosis

Question 3

Post operative management of disc surgery

Answer 3

• Circulo-Respiratory Exercises commenced Day 0
• Neurological assessment
• Log Roll for comfort only
• Day 0- 1 exercises: Neural mobilisations, Transversus and Multifidus
• Mobilise Day 0-1 on Drs orders, initially on rollator and progress quickly to single stick or independent mobility.
• Back education and ergonomic advice
• Out of bed sitting
• OPD referral for muscle stability, neural mobilisation progression

Question 4

Spinal fusion surgery

Answer 4

Due to…

• Instability
• Congenital or acquired deformity
• Other conditions such as TB, osteomyelitis

Examples:

• Bone grafts
• Posterior lumbar fusion
• Anterior lumbar interbody

Question 5

Post operative management for spinal fusion surgery

Answer 5

• Circulo Respiratory maintenance commenced day 0
• Daily neurological checks
• May not tolerate sitting for long periods
• Log Roll
• Exercises to commence day 1 including UL and LL
• ROM exercises, neural mobilisation exercises
• Multifidus and Transversus activation
• Mobility commencing Day 1-2

Question 6

Post surgery management of scoliosis

Answer 6

One stage:

• Circulo-respiratory exercises
• Supportive cough
• Thoracic biomechanics
• Log roll
• UL and LL ROM exercises
• Neural mobility exercises
• TA and multifidus activation
• Mobilise on day 1-2 with doctors orders on a rollator with or without a brace

Question 7

MOI of spine fractures

Answer 7

• Flexion injury: crush fracture
• Vertical compression: burst fracture
• Flexion + rotation: fracture/dislocation (highly unstable)
• Hyperextension: vertebral arch fracture

Question 8

Classification of pelvic fractures

Answer 8

• Young-Burgess: focuses on the line of force and the degree on injury:
• Tile: Focuses on the resultant of pelvic stability

Question 9

Young-Burgess

Answer 9

Most commonly used

Lateral compression:

• Type 1: unilateral rami # and ipsilateral sacral compression #
• Type 2: Unilateral rami # and ipsilateral posterior iliac #
• Type 3: Type 1 + type 2 injury

A/P compression

• Type 1: stable SIJ pubic symphysis <2cm or rami #
• Type 2: >2cm of pubic symphysis and vertical rami #
• Type 3: complete disruption of symphysis and ligaments

Vertical shear injury
Complex injury
Ring sparing injury

Question 10

Tile classification

Answer 10

Type A: rotationally and vertically stable
Type B: rotationally unstable but vertically stable
Type C: rotationally and vertically unstable

Question 11

Physiotherapy management of pelvic fractures

Answer 11

• Falls assessment
• Ensure adequate and well timed pain relief
• Bed mobility and mobility with appropriate aid
• Discharge planning

Question 12

Post op management of pelvic fractures

Answer 12

• Bed rest 3-4 weeks until pelvis displayed signs of union
• Sit to 40 degrees
• PCA
• External fixation removed 4 weeks
• Commence mobilising with rollator
• Education
• Upper limb exercises
• Assessment of cardiorespiratory, circulatory and neurological