Rehab Flashcards
What is the Wessex Head Injury Matrix and when is it used
To assess whether a patient is emerging from coma. Used in decisions to end or carry on treatment
What is a fragility fracture and where are the common sites?
What is the most common cause?
A pathological fracture that results from normal activity or a fall from a standard height or less. Commonly caused by osteoporosis
Sites:
Vertebrae
NoF
Wrist (Colles)
What is osteoporosis?
What are the symptoms?
What are the risk factors that should be illicited in a history?
Imbalance in osteoclast/osteoblast function causing a reduction in bone mass.
Symptoms - None until fracture
Risk factors -
- Female
- Alcohol M > 21 F >14 per week
- Smoking
- Steroids
- Previous fracture
- FH of fractures
What tools are used to investigate ?Osteoporosis
FRAX - estimates 10 year risk
Qfracture - does the same.
After this can consider DEXA scan
T -1 to +1 in normal
-1 to -2.5 osteopenia
Below -2.5 = osteoporosis
Who gets investigated for osteoporosis after a fracture?
Someone with risk factors
Men >75
Women >65, If over 75 then assume osteoporosis
What is the treament for osteoporosis?
When are they given?
What considerations are needed?
Check Vit D and calcium first - Bisphosphonates eg Alendronic acid are first line
- They can be given daily or weekly but:
- Need to be taken first thing, 30 mins before food and other meds with whole glass or water
- Need to stand for 30 minutes after as can cause reflux
What are the common side effects of bisphosphonates?
GI:
Abdo pain/Cons/diarrhoea/wind/indigestion
Other:
Dizziness, itching, headache
What are the features of hip fractures?
Pain
shortened and externally rotated
What are the two broad types of hip fracture and then their subdivisions?
Intracapsular
- From femoral head to femoral neck
Extracapsular
- Trochanteric - Trochanter avulsion
- Intertrochantric - between trochanters
- Subtrochanteric - inferior to trochanters
What type of fractures are more dangerous and why?
Intracapsular due to AVN of femoral head
What are the treatment options for an intracapsular fracture?
- Total hip replacement - if severe of comminuted
- Hemi arthroplasty
- Cannulated screws - If younger and no osteoporosis
What are the treatment options for an extracapsular fracture?
- Intramedullary nail
- Dynamic hip screw - allows movement and remodelling
What is this?
Total hip replacement
What is this
hemiarthoplasty
What is this?
Cannulated screws
What is this?
Intramedullary nail
What is this?
Dynamic hip screw
What are the most common causes of falls and what must you always do?
- Postural hypotension
- Syncope/arrythmias
- Medication
ALWAYS DO SITTING AND STANDING BLOOD PRESSURE AND ECG
What changes in BP indicated postural hypotension?
20 in systolic
10 in diastolic
What are some common causes of dizziness and therefore falls?
Drugs causing postural
Migraine
Stress/anxiety
Hypo
Dehydration
Arrythmias - if tachycardic and regular think ?Sepsis
