Trauma/ortho Flashcards
The exam
IF TRAUMA -#1 priority make sure all spines are clear
Evaluation must be extra thorough
Be aware of the situation surrounding the accident
Decide if PT services/orders are appropriate
KNOW YOUR LINES
Hx/ chart review
Know patient’s significant PMHx (looking for stuff that will affect mobility)
Is the patient under an alias?
Know lab results, tests performed since patient’s admission to hospital and results of those tests
Order written by
Senior resident or attending.
Do not take anyone’s verbal word on anything
Make sure stuff is in the chart (ie. Chart says spine has been cleared)
Patient and family interview
Patient’s Previous Functional Level (PFL)
Who patient lives with at home and how much assistance the patient will have at discharge
Home environment/set up of home
Equipment needed
Eval - organization
Chart Review Diagnostic Tests Review Medication Review n Patient Interview Tests and Measures (Objective) *anything that will affect your ability to tx
Tests and measures
Mental Status Observation Cardiovascular/Pulmonary Integumentary Sensation Pain Range of Motion/Strength Posture Functional Mobility Balance
Prognosis
Problems that require “skilled” intervention
Impairments
Activity limitations
Goals (functional & measureable)
Fx - traction
involves the use of a distractive force on bone to restore alignment; maintained continuously therefore pt might be put on strict BED REST
Buck’s: provides distraction of lower extremity (eg. Hip fx)
90-90: peds femoral fx/adult femoral fx
Halo: for cervical fxs
Fix - 90-90 traction
Subtrochanteric and proximal 3rd femur fx
Especially in young children
Can cause Flexion contracture in adults
Fx - external fixation
device consisting of pins that insert at an oblique or right angle to the long axis of the bone that are connected externally to the skin by a frame
Intervention: maintain ROM above/below joint; elevate extremity; in some cases can use external fixator to carefully move extremity
Fracture management goal
bony union of fx without further bone or soft-tissue damage that enables early restoration of maximal function
Early restoration of function minimizes cardiopulmonary compromise, muscle atrophy (loss of functional ROM)
Fracture site must callous which requires bone approximation
Fx management reduction
process of aligning and approximating Fx fragments (Done by MD)
Closed: noninvasive and is accomplished by manual manipulation or traction
Open: treatment of choice when closed reduction cannot be achieved or when closed methods cannot maintain adequate fracture fixation throughout the healing phase
ORIF (open reduction internal fixation) requires surgery & fixation devices such as screws, rods, plates, etc.
Fx management- immobilization non invasive
Casts: check for spots that may cause irritation as well as ones that may be too tight
Splints
Traction - Buck’s
Fx management- immobilization invasive
Traction
Halo
External fixation
Fx - cast
Non invasive
elevate extremity 4-5 inches above heart;
avoid getting cast wet, NWB unless MD states otherwise; move joints above and below; do not put objects in cast
Complications: neurovascular compromise (report numbness/tingling to MD), skin breakdown
Halo
Spatial awareness needs to be improved
Teach them to scan the room before they get somewhere, cant look down
Coming loose - surprised look on their face, potentially blood track marks as pins are sliding. If not sure, don’t work w/ pt and let someone know
Pelvic fx
Stable — Functional mobility with possible WB precautions; AAROM exercises; LE strengthening
Unstable — Functional mobility (usually NWB); AAROM exercises
Discectomy
Spinal surgery
Least invasive
Partial or complete removal of the intervertebral disc
Typically accompanied by a laminectomy
Laminectomy
Spinal surgery
Removal of bone at the interlaminar space
Indicated for spinal stenosis and nerve root compression
Decompression
Spinal surgery
Procedure where the posterior elements are removed including the lamina and spinous process
The foramen are widened to relieve pressure on the neural elements
Spinal fusion
Spinal surgery
Fusion of the facet joints at a given vertebral level by either Iliac Crest Bone Graft (ICBG), cadaver bone and/or use of mechanical hardware
Indicated for segmental instability, fractures, facet joint arthritis
Pt interventions
Log roll – absolute for fusions
Bed Mobility, transfers & gait training
FWW at time of initial evaluation
Spinal Precautions: no bending, no twisting, no heavy lifting(>10 lbs) (NO BLT). Applies to cervical or lumbar
Extended sitting should be limited
Bracing when necessary (needs to be on in supine in bed- needs to be on for transfers)
Pt & family training
Ther ex should be started judiciously
