PAST PAPERS: JUNE 2015

Question 1

SECTION C:
QUESTION 1
1.1. Describe the Weber B and Weber C classifications of ankle fractures. (10)

Answer 1

Weber B
(supination-eversion)
1. Syndesmotic #
2. May have rupture of anterior syndesmosis & therefore tibio-fibular
ligament rupture (but the mortise is stable following reduction of the
fracture)
3. Rupture of the posterior syndesmosis
Type 1 – isolated fibular fracture
Type 2 – associated medial ligament rupture and/or avulsion #
Type 3 – associated medial ligament rupture and/or avulsion # as well
as fracture of the posterolateral tibia

Weber C
(pronation-eversion)
1. Suprasyndesmotic #
2. Syndesmosis is completely disrupted
3. Avulsion # or rupture of medial ligament
4. Fracture of the diaphysis of the fibula
5. Rupture of the posterior syndesmosis
Type 1 – fibular fracture is simple
Type 2 – fibular fracture is segmental/comminuted
Type 3 – fibular fracture is very proximal

Question 2

QUESTION 2
Mr Samuels sustained a fracture of his left lateral malleolus, with no talar shift, that was managed with a below knee plaster of Paris (POP). He is day one post surgery, his chest is clear and unaffected limbs are a grade 5 muscle strength.

Briefly outline the physiotherapy management for this patient, including the contraindications to be adhered to over the next seven days. (10)

Answer 2

TREATMENT
The treatment of ankle fractures is based on the stability and degree of displacement. This may be categorised as follows:

Fractures of one malleolus with no talar shift:
Below knee POP, then elevate for 2-5/7
Apply walking heel and mobilise PWB/FWB for 6/52

CONTRA-INDICATIONS AND PRECAUTIONS
Avoid isometric inversion and eversion for the first few weeks.
Do not use the foot or ankle as a point of resistance for hip and knee strengthening exercises.
General contra-indications.

Question 3

QUESTION 3
Miss Johnson has sustained an isolated fracture of her fibula and it being managed with analgesia. Her doctor confirmed that she can be discharged when physiotherapy is satisfied with her mobility.

Explain the contraindications and precautions the physiotherapist should adhere to during treatment sessions for the next six weeks (6)

Answer 3

CONTRA-INDICATIONS AND PRECAUTIONS
Avoid isometric inversion and eversion for the first few weeks.
Do not use the foot or ankle as a point of resistance for hip and knee
strengthening exercises.
General contra-indications.

Question 4

QUESTION 4
Mr Michael sustained an anterior dislocation following a horse riding accident. He was managed through light traction for four weeks.
Explain the aspect that the physiotherapist should assess in order to prevent complications of bed rest while treating MR Michael during traction. (6)

Answer 4

physiotherapy treatment for anterior dislocation
This injury requires urgent reduction under general anaesthetic. It is done by
applying strong traction, combined with internal rotation and adduction.
The patient is put on light traction for 3-6/52 and then mobilised NWB for a
further 3/52.

CONTRA-INDICATIONS AND PRECAUTIONS OF ANTERIOR DISLOCATION:
• Avoid excessive abduction, extension and external rotation, especially in combination.
• NWB for 3/52 after the traction has been removed.
• Maintain neutral position of hip when doing bed exercises.
• Modify bedpan use to avoid hip extension.
• General contra-indications for traction=
✓Check line of pull is parallel to shaft of fractured bone
✓Check that rope and weights are hanging freely
✓Check pin sites for signs of sepsis
✓Check that counter traction is applied if necessary
✓Check that the position of the patient relative to the traction is correct
✓Check pressure areas
✓Check for all complications of immobilization. A patient on traction is subject to all the usual complications of immobilization such as
DVT, chest complications, general deconditioning etc.

Question 5

QUESTION 5
Explain the physiotherapy management of an anterior dislocation of the shoulder for during the first six weeks following injury. (8)

Answer 5

Management:
Subluxation
Rest in a sling for 2/52. Start pendular exercises in the sling at 2/52 (1/52 in elderly).

Dislocation
Reduce ASAP, under anaesthetic if necessary. Maintain with arm sling for 2/52. Start pendular exercises at 2/52 (1/52 in elderly).

Post-Surgery:
Sling for 3 weeks before starting to wean.

Contra-indications and precautions:
Avoid abduction and external rotation positions for 6/52.
No contact sport for 6/52
No driving with a sling and only when pt can drive/handle steering wheel with control