Upper / Lower Extremity fractures Flashcards
what is considered functionally stable during a clinical examination in a bone region ?
50% ROM in active & painless manner
What is a fracture of the ulna + dislocation of radial head called ?
Monteggia Fracture Dislocation
What is a fracture of the radius + dislocation of distal radioulnar joint called ?
Galeazzi Fracture Dislocation
after surgery, forearm should be immobilized until sutures are removed. true or false
True
Phase 1 of forearm fracture rehabilitation (0-2 weeks)
- splint
- sutures removed at week 2
- elevation for edema control
- finger ROM
Phase 2 of forearm fracture rehabilitation (2-6 weeks)
- AROM & AAROM of elbow, forearm, wrist
- no pronation / supination (repetitive forearm rotation)
- light weight bearing (2-3KG) / NWB
Phase 3 of forearm fracture rehabilitation (6+ weeks), what do we have to keep in mind ?
lifting & twisting is restricted till union has been achieved
AROM, AAROM, PROM are encouraged in radial neck and head fractures, true or false
False, discouraged
What nerve is at risk of getting stretched or injured during surgery of radial head and neck fractures ?
(PIN) posterior interosseous nerve
NWB for 10-12 weeks until bony union is achieved in radial neck and head fractures is true or false
False, 6-8 weeks
Define the terrible triad
Elbow dislocation (olecranon) + fracture of radial head + fracture of coronoid process of the ulna
What is Phase 1 (0-2 weeks) of radial head fracture rehab protocol without associated ligamentous injury or repair ?
- splint (immobilization) for 1-2 weeks
- sling may be added for comfort
- elbow AROM & AAROM (flexion & extension)
- avoid stress in coronal plane (valgus & Varus)
- avoid flexion in pronation
What is Phase 2 (2-6 weeks) of radial head fracture rehab protocol without associated ligamentous injury or repair ?
- sutures removed at 2 weeks
- AROM & AAROM (supination & pronation)
- by end of 6 weeks, full ROM in flexion and extension should be obtained (elbow)
What is Phase 3 (6+ weeks) of radial head fracture rehab protocol without associated ligamentous injury or repair ?
by 8 weeks, full pre-operative ROM should be obtained (including pronation & supination)
Olecranon fractures that are minimally displaced and are stable may be treated with operative measures, true or false
False, non-operative measures
What is phase 1 (0-2 weeks) of olecranon fractures ?
- posterior splint for 1-2 weeks
- gentle PROM and AAROM start after splint removal
What is phase 2 (2-6weeks) of olecranon fractures ?
- sutures removed at week 2
- gentle movements continue of elbow (no resistance)
- maintain ROM of shoulder, wrist, and fingers
What is phase 3 (6+ weeks) of olecranon fractures ?
- gentle & progressive resistance exercises may be initiated once bony union has been achieved and confirmed
- weight bearing restrictions decrease as bony union is achieved
What nerve is found in proximal humerus fractures ?
Axillary nerve
When does healing begin for proximal humerus ?
6-8 weeks
What two regions of the proximal humerus are most likely to be fractured ?
anatomical neck & surgical neck
What nerve is found in diaphysial / shaft humerus fractures ?
Radial nerve
When does healing begin for diaphysial / shaft humerus fractures ?
8-12 weeks
What can be helpful in diaphysial / shaft humerus fractures ?
- functional sling
- velpeau
- intra medullary nail
- external fixation
What nerve is found in distal humerus fractures ?
Medial, ulnar, radial nerves
What artery is found in distal humerus fractures ?
Brachialis artery
What risks are found in distal humerus fractures ?
CRPS & Volkmann Ischemic Contracture
When does healing begin in distal humerus fractures ?
8-12 weeks
Shoulder internal & external rotation and wrist motions are allowed in distal humerus fractures, true or false
False, they are forbidden
In forearm fracture rehabilitation, what are things we should keep in mind during rehab ?
- NWB on the extremity until the bones heal (6-8 weeks)
- early edema control
- ROM of fingers, elbow, and wrist
- after the bone has sufficiently healed, strengthening exercises can be performed
- after surgery, forearm should be immobilized until sutures have been removed
Regarding olecranon fractures, the elbow is generally splinted or casted in ____ degrees _________ for _____ weeks with gentle active motion initiated
90 / flexion / 3-4
What can be worn in clavicular fractures ?
Figure of 8 splints / velpeau
In the case of ________ including avulsion fractures, the patient can be treated with bracing
Stable isolated malleolus fractures
When can the patient wean off bracing to full weight bearing in ankle fractures
4-6 weeks
In ankle fractures, strengthening of the foot and ankle musculature is important, in particle which muscle ?
Lateral Everters
After strengthening of the foot and ankle muscles, the patient can move on to _____________ training, analogous to the therapy regimen used for severe ankle sprains.
Proprioceptive training
What are some important ankle fracture protocols ?
- managing swelling and edema
- returning ankle ROM to pre injury levels
- WBAT initially
- Stability plays a crucial role in the protocol of these injuries
I’m unstable ankle fractures, post operatively, the patient is immobilized in a splint / cast for how many days to allow wound healing ?
10-14 days
In a patient with good bone quality and stable anatomical fixation, what can be applied once the wound has healed ?
Removable fracture boot
Ankle fracture protocols
- once the wound has healed and a removable fracture boot has been applied
-gentle ankle active and passive ROM exercises within pain tolerance may begin - Restoration of full ROM
- Restore strength
In ankle fractures, NWB for _______ postoperatively until there is hard callus, after 6 weeks, patients may progressively _______
4-6 weeks / WBAT
Ankle fractures requiring syndesmosis fixation, require how many weeks of NWB
8 weeks
Which fracture involves the weight bearing distal tibial articular surface ?
Pilon Fractures
Pilon fractures typically occur as a result of ?
High energy mechanism
Pilon fractures can also occur in combination with typical ankle fracture patterns as a result of lower energy rotational mechanism as with a sporting injury, true or false
True
In rehabilitation of non operative pilon fractures, patients are NWB and immobilized in a long leg cast for how long
6-8 weeks
In rehabilitation of non operative pilon fractures, after a fracture boot is used, NWB and WB can be done, depending on surgeon’s preference based on stable fracture fixation and degree of healing. True or False
False, PWB AND WBAT
For operative pilon fractures, NWB is done for _________, patients are immobilized in a well padded splint with the foot in ___________ position. After _______ weeks, sutures are removed and a __________ is worn.
10-12 weeks
neutral
2-3 weeks
removable fracture boot
for operative pilon fractures, once the sutures are out and the incision has healed, ankle and subtalar ROM exercises are started (AROM, AAROM, gentle PROM), true or false
true
ankle and subtalar ROM are instituted as soon as feasibly possible in operative or non operative pilon fractures
non operative
_________ are the most common fractures of the talus, followed by _________ fractures. Fractures of the __________ of the talus are common in snowboarding injuries about the foot and ankle.
chip and avulsion fractures
talar neck
lateral process
gentle isometric strengthening is done before PWT in operative pilon fracture rehab, true or false
false, WB
after fracture union in operative pilon fractures, which takes _______ weeks, _________ bearing in the fracture boot is done, progressing to _______ bearing.
10-12 weeks
PWB
WBAT
Fractures of the talus lateral process are managed with immobilization in a short leg cast / brace, NWB for _________ weeks, and then progressive mobilization on ankle and subtalar ROM and strengthening.
4-6 weeks
non operative talar neck fractures require immobilization and NWB up to __________ (until radiographic evidence of union is present)
3 months
operative talus fractures (reduction and fixation) are immobilized in a NWB splint / cast for at least _______
1 month
After incisions have healed and sutures have been removed in operative talus fractures, gentle ROM exercises can begin. Also with rigid fixation, early ankle and subtalar motion are acceptable, as is gentle isotonic ankle stretching. True or False
False, gentle isometric ankle strengthening
in operative talus fractures, NWB for about _________ postoperatively to protect the talus during the revascularization phase.
3 months
After evidence of union in operative talus fractures, what can we do ?
- progressive mobilization
- restoration of full ROM
- Strengthening
- gait training
- proprioceptive training
generally in olecranon fractures, the elbow is splinted or casted at ______ degrees flexion for _____ weeks with gentle active motion initiated.
90 degrees / 3-4 weeks
Olecranon fractures in the elderly are not able to repair, may be treated with what instead ?
excision and advancement of triceps
in olecranon fractures in the elderly, postoperative therapy mirrors triceps repair. True or False
True
In olecranon fractures, resistance exercises should not be initiated until ______ weeks (union) after surgery.
6-8 weeks
in olecranon fractures, depending on surgeon’s preference for soft tissue healing therapy, it may be initiated a week after surgery and also gentle AROM is encouraged. true or false
true
What are the protocols for rehab of non operative calcaneus fractures
- supportive well padded splint to allow resolution of the initial fracture edema
- fracture boot / cast within 2 weeks with ankle in neutral flexion
- early subtalar and ankle joint gentle AROM
- NWB for 6-8 weeks
regular shoe wear is not recommended for about _________ weeks to minimize the stress across the calcaneocuboid joint in non operative calcaneus fractures.
10-12 weeks
postoperatively, ___________ fractures may initially be splinted in a bit of plantarflexion to minimize the tension of the gastrocnemius and soleus complex on the fracture.
posterior tuberosity fractures
in operative calcaneus fractures, the fracture boot is worn and gentle early AROM exercises are done if incisions have adequately healed. At what week
2 weeks
operatively treated calcaneus fractures are placed into a short leg splint or cast in a _______ position post operatively and because of greater concern about post operative wound problems with calcaneus fractures, immobilization is continued until the wound is well healed, typically for ________ weeks.
neutral / 2-3 weeks
what are some protocols for operative calcaneus fractures
- isometric strengthening exercises before WB
- NWB for 8-10 weeks
- when WB begins, therapy may address restoration of full ROM, strengthening, gait training, and balance training in progressive fashion.
