W3 Flashcards
Where is the most common area of the femur for a fracture to occur?
Middle 1/3 of femur
What are some of the serious complications of an acute femoral shaft fracture?
- Severe shock
- Fat embolism leading to PE
What should be included in an X-ray of a femoral shaft fracture
Inclusion of hip and knee joints
Considerations of IF vs traction for femoral shaft fractures
Time in hospital:
- 3 days for IF, >12 weeks traction
Infection risk:
- Increased risk with IF due to metal, especially if open fracture
Level of fracture:
- Lower femoral fractures less stable with IF
Age:
- Older IF
- Very young traction/cast
Other:
- Other fractures IF
- Tumors IF
What is the IF technique for adults with shaft of femur fracture?
Intramedullary rod, with cross bolts to prevent rotation.
Inserted with closed approach (small incision, rod hammered down shaft).
WB status post femoral shaft fracture
PWB if stable (commonly transverse #) and IF
NWB if unstable
What are some possible complications post femoral shaft fracture
- Mal-union (prevent rotation of leg)
- Non-union
- Joint stiffness above and below
- Myositis ossificans (only a problem if inhibiting function)
What are the goals of physiotherapy in an acute shaft of femur fracture (in hospital)?
Avoid acute complications:
- PPC
- DVT + compartment syndrome
- Infection
Discharge:
- Safe and indep transfers (quads control and knee flexion 90)
- Safe and indep gait (steps)
- Educate on positioning (no rotation)
What are important considerations of tibia and fibula fractures?
- Commonly open fractures (25%) (infection risk)
- Poor blood supply (slow healing, risk of non-union)
What is the acute management post GAMP for tibia and fibula #?
- Above knee cast for stability
- Min 6 weeks NWB
- Slow union, 3-4 months
What are the indications for IF for tibia and fibula #?
- Unstable # (oblique, spiral)
- Shorter recovery than GAMP
- PWB instead of NWB
What are the indications for external fixiation for tibia and fibula #?
- Open fracture (don’t want to introduce metal rod as increased risk of infections)
- Comminuted # (hard to threat intramedullary rod)
What are some common complications post tibia and fibula #?
- Skin issues (ulcers, infections, compartment syndrome)
- Delayed or non-union
- Mal-union
- Ankle/foot/knee activity limitation
What is a Pott’s fracture?
Fracture of medial or lateral malleolus, most common ankle fracture, often associated with dislocation. Talar shift must be corrected.
What are the Ottawa ankle rules?
Indication for X-ray post ankle injury. X-ray necessary if;
- Tender on palpation of posterior edge of lateral or medial malleolus, navicular, or base of 5th met
OR - Unable to WB for 4 steps
98% sensitive for ruling out fracture
