Week 12 (Fractures, Dislocations and OA)

Question 1

Define pathological fracture

Answer 1

Fracture caused by normal forces in abnormal bone

Question 2

Define stress fracture

Answer 2

Fracture caused by repetitive normal forces

Question 3

What are the signs and symptoms of a fracture

Answer 3

• Localised tenderness
• Deformity
• Pain
• Noise
• Swelling

Question 4

How to manage a new fracture

Answer 4

• Refer to GP +/- orthopaedics
• POLICE
• Check neurovascular status
• Cast/plaster if appropiate

Question 5

What are the management options of a fracture

Answer 5

• Observation without immob
• Closed management by splint or plaster
• Closed reduction and immobilisation
• Open reduction and internal fixation
• External fixation

Question 6

When would you want to immobilised a fracture

Answer 6

When the need for stability outweighs the detrimental effects of immobilisation

Question 7

If you are in an non-immobilised fracture, what do you want to maintain

Answer 7

• Maintain/regain ROM of both involved and uninvolved joints
• Maintain/regain muscle strength
• Assist with pain and swelling

Question 8

Stages of cortical bone healing

Answer 8

1. Inflammatory: haemotoma formation
2. Soft callus formation: cellular proliferation (2-3 weeks)
3. Hard callous formation: osteoblasts produce cancellous bone (1-2 months)
4. Bone remodelling: conversion to cortical bone

Question 9

Stages of cancellous bone healing

Answer 9

Key differences compared to cortical bone healing

• Minimal callus formation
• Direct bridging of gap
• Requires direct contact

Question 10

How long does bone healing take

Answer 10

4 to 12 weeks + depending on bone location

Question 11

What is a physiotherapist’s role in the remodelling phase

Answer 11

• Removing immobilisation
• Treatment impairments and activity limitations
• Regain ROM and strength
• Treat pain and swelling
• Retrain motor control and function

Question 12

How to manage a stress fracture

Answer 12

• Reduction/modification of activity
• Majority heal within 6 weeks of initiation of rest
• Assess and treat predisposing factors: training/equipment, technique, muscle length and strength
• Maintain skill fitness and ROM

Question 13

How to manage dislocations

Answer 13

• Get it back in: may not be our job
• Method of reduction
• Length of time dislocated
• Associated injury

Question 14

What is OA

Answer 14

Not a normal state of ageing MSK tissue: 50% people aged between 45 and 64

• Traumatic or idiopathic (not wear and tear of cartilage)
• Generally progressive but can remain stable over long periods

Question 15

OA is characterised by

Answer 15

Breakdown of subchondral bone and cartilage
- Osteophytes at joint margins
- Joint space narrowing
- Subchondral sclerosis
- Subchondral cyst formation
- Chondrocalcinosis
Systemic inflammation

Question 16

Treatment of OA

Answer 16

• Conservative management: non- pharmacological or pharmacological e.g. anti-inflammatories, steroid injections, hyaluronic acid injections, chondroitin sulphate
• Surgical: joint preservation surgery, total or partial arthroplasty

Question 17

Non-pharmalogical treatment of OA include

Answer 17

Reducing mechanical loads:
- Weight loss
- Temporospatial
- Equipment
- Gait retraining
Symptom management
- Strength training and CVD
- Heat therapy and cryotherapy
- TENS
- Manual therapy