Test 4- Prosthetics and Fractures

Question 1

Components of prosthesis

Answer 1

• Socket: suspension interface
• Components: elbow, wrist
• Terminal device: end of prosthesis- hand, hook, etc.

Question 2

Prosthetic options

Answer 2

• None
• Oppositional prosthesis
• Body Powered
• Externally powered
• Hybrid
• Activity specific
• Multiple

Question 3

No Prosthesis

Answer 3

Should NOT be do to lack of coverage or access, but should be an option per pt desire

• Focus on teaching compensation
• Reasons: limited functional benefit, comfort, reduce sensory input, hot/heavy
• Should have yearly follow up to make sure requirements are fulfilled

Question 4

Oppositional Prosthesis

Answer 4

Only allows grasp movements: opposition, holding objects

• light weight and simple, looks more aesthetic than others (may restore body image)
• Is high cost, not durable and allows no active prehension

Question 5

Body-Powered Prosthesis (Cable Driven)

Answer 5

Relies on gross body movements captured through harness

• Moderate cost, durability and weight, proprioception through harness
• Poor static and dynamic cosmesis, poor grip strength/ pinch force, uncomfortable

Question 6

Externally powered prosthesis (electric)

Answer 6

Powered by battery, works through myoelectrical signals or other inputs

• allows stronger grip/pinch strength, less body movement to operated, aesthetic and no harnessing
• heavy, limited sensory feedback, expensive and requires extensive therapy to learn

Question 7

Hybrid prosthesis

Answer 7

Two of more technologies combines (ie: externally powered hand and body powered elbow)
-Provides better grip than pully system and less weight than electric

Question 8

Activity specific prosthesis

Answer 8

Prosthesis developed for specific activity

-is an adaptation to an existing prosthesis (change out the terminal device)

Question 9

Classification of fractures

Answer 9

• Comminuted fracture: Involves shattering of bone into pieces; usually takes the LONGEST to heal
• Compound fracture: bone pierces through skin
• Incomplete facture: hairline or greenstick fracture (most common in children)
• Complete fracture

Question 10

Timeline for fracture healing- phase 1

Answer 10

Inflammatory phase: 1-2 weeks; hematoma forms on the fracture site, tissue comes together to begin framework for bone regrowth

Question 11

Timeline for fracture healing- phase 2

Answer 11

Regeneration phase: 2-6 weeks; healing takes place, regrowth of bone and vascular tissue.
-Soft callus turns into hard callus and direct union

Question 12

Timeline for fracture healing- phase 3

Answer 12

Remodeling phase: 6 weeks to a year; Strong bone tissue (ossification) at the fracture
-rigidity of callus drastically improves between weeks 6 and 8

Question 13

Growth plates

Answer 13

Growth plates do not close until 18-20 years

-DO NOT perform ultrasound over growth plates- can stunt growth

Question 14

Goals for fractures (in order)

Answer 14

• Protect fracture
• Edema and soft tissue healing
• ROM/ mobility
• Strength increase
• Ability to perform occupational tasks

Question 15

ORIF

Answer 15

Open Reduction Internal Fixation

-Internal devices used to restore close to normal anatomical position and joint surface

Question 16

FOOSH

Answer 16

Fall On Outstretched Hand

-one of the most common fracture causes, leads to distal radial fractures

Question 17

Colles fracture

Answer 17

Distal radial fracture at the dorsal angulation; extension fracture of radius

• can lead to issues with pronation, supination and ulnar/radial deviation if fracture crosses distal radial ulnar joint of involves the ulna
• Surgical goal: preserving length of radius

Question 18

Smith’s fracture

Answer 18

Distal radial fracture at the volar angulation; flexion fracture of radius
-less common than Colle’s

Question 19

Ulnar Abutment Syndrome

Answer 19

• Presents as ulnar side wrist pain; pain with supination, pain with weight bearing and grip
• not the normal 22 degrees of incline between ulna and radius causing more weight bearing at the ulna (usually only 20%)

Question 20

Kienbock’s disease

Answer 20

Avascular necrosis of the lunate

• Caused by compression on the TFCC
• Treatment: splinting to immobilize wrist and take pressure off of lunate. Surgery can be required in extreme cases

Question 21

When can you begin resistance after a fracture?`

Answer 21

No resistance for 8-10 weeks: nothing heavier than a toothbrush and no major gripping/pinching

Question 22

Time for strengthening after fractures based on location

Answer 22

• Proximal radius: 8 weeks
• Distal radius: 7 weeks
• Humerus: 9 weeks
• Scaphoid: 12 weeks or longer
• Digits: 4-5 weeks

Question 23

Sequence of motion progression after fracture

Answer 23

Gentle AROM> AAROM> PROM> stretching