Trauma/ortho

Question 1

The exam

Answer 1

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

Question 2

Hx/ chart review

Answer 2

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

Question 3

Order written by

Answer 3

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)

Question 4

Patient and family interview

Answer 4

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

Question 5

Eval - organization

Answer 5

Chart Review 
Diagnostic Tests Review 
Medication Review n Patient Interview 
Tests and Measures (Objective)
*anything that will affect your ability to tx

Question 6

Tests and measures

Answer 6

Mental Status 
Observation 
Cardiovascular/Pulmonary 
Integumentary 
Sensation 
Pain
Range of Motion/Strength 
Posture 
Functional Mobility 
Balance

Question 7

Prognosis

Answer 7

Problems that require “skilled” intervention
Impairments
Activity limitations
Goals (functional & measureable)

Question 8

Fx - traction

Answer 8

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

Question 9

Fix - 90-90 traction

Answer 9

Subtrochanteric and proximal 3rd femur fx
Especially in young children
Can cause Flexion contracture in adults

Question 10

Fx - external fixation

Answer 10

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

Question 11

Fracture management goal

Answer 11

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

Question 12

Fx management reduction

Answer 12

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.

Question 13

Fx management- immobilization non invasive

Answer 13

Casts: check for spots that may cause irritation as well as ones that may be too tight

Splints

Traction - Buck’s

Question 14

Fx management- immobilization invasive

Answer 14

Traction

Halo

External fixation

Question 15

Fx - cast

Answer 15

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

Question 16

Halo

Answer 16

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

Question 17

Pelvic fx

Answer 17

Stable — Functional mobility with possible WB precautions; AAROM exercises; LE strengthening

Unstable — Functional mobility (usually NWB); AAROM exercises

Question 18

Discectomy

Answer 18

Spinal surgery

Least invasive
Partial or complete removal of the intervertebral disc
Typically accompanied by a laminectomy

Question 19

Laminectomy

Answer 19

Spinal surgery

Removal of bone at the interlaminar space

Indicated for spinal stenosis and nerve root compression

Question 20

Decompression

Answer 20

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

Question 21

Spinal fusion

Answer 21

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

Question 22

Pt interventions

Answer 22

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