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
