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Ortho Eval > Week 5 - Fracture Management > Flashcards

Week 5 - Fracture Management Flashcards

1
Q

name the most common type of fracture for all ages.

A

distal radius fracture

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2
Q

name 5 risk factors of fractures.

A
  • trauma
  • increasing life span
  • race
  • comorbidities -osteoporosis
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3
Q

loss of bone continuity; force exceeds tissue strength

A

fracture

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4
Q

____ begins at time of injury.

A

inflammation

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5
Q

vascular disruption can lead to ____.

A

necrosis

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6
Q
  • caused by immobility
  • starts with uncorrected skeletal deformities, acute pain and persistent edema
  • leads to progressive stiffness, tendon adhesions, muscle atrophy, pain, loss of function
A

fracture disease

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7
Q

Energy sufficient to fracture bone must pass through ___ ___.

A

soft tissue

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8
Q

name 4 examples of soft tissue that energy must pass through to fracture bone.

A
  • ligament
  • volar plate (fingers)
  • tendons
  • skin
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9
Q

what are the most common complication of hand fractures?

A

joint contracture and tendon adhesions

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10
Q

t/f - soft tissue can be severely damaged in both open and closed fractures.

A

true

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11
Q

-site protection and clearance
-healing process begins
0-2 weeks

A

inflammation stage of fracture healing

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12
Q

-scaffold for new bone
-soft to hard
-fluffy opacity on x-ray
2-3 weeks

A

callus formation of fracture healing

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13
Q
  • bridging by cartilage/immature bone
  • fracture stable but weak
  • 4-6 weeks
A

union stage of fracture healing

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14
Q
  • all callus replaced by bone
  • immature bone becomes lamellar bone
  • bone secure
  • 6-8 weeks
A

consolidation stage of fracture healing

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15
Q
  • continued osteoblast/osteoclast activity
  • reshaping to best density and shape
  • 1-2 years
A

remodeling stage of fracture healing

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16
Q

what is the first soft tissue that protects PIP joints? (very important to look at in finger fractures)

A

volar plate

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17
Q
  • direct or contact healing
  • when vasculature is intact
  • cortical contact
  • fracture fixation provides compression
  • bone grows directly across compression and heals without callus
  • 5-6 weeks for bone to close
A

primary method of fracture healing

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18
Q

describe the main components of the primary method of healing.

A
  • there is compression

- no callus

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19
Q
  • when motion across fracture site is limited but not eliminated
  • callus or indirect healing
  • motion is required for secondary healing and promotes callus
  • wires, rods, external fixation
  • they do not compress fracture gap
A

secondary method of fracture healing

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20
Q

name 3 main components of the secondary method of healing.

A
  • callus
  • does not compress fracture gap
  • motion is limited but not eliminated
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21
Q

name 3 factors that contribute to predictable variability of fracture healing.

A
  • location
  • nature of fracture
  • type of fixation
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22
Q

fractures from high impact/force heal more slowly due to what?

A

soft tissue and vascular damage

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23
Q

open fractures heal slower due to what?

A

soft tissue and bone loss

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24
Q

chronic bone infection

A

osteomyelitis

25
Q

name 5 risk factors for delayed fracture healing.

A
  • diabetes
  • smoking
  • long term steroid use
  • NSAID
  • poor nutrition
26
Q

name 3 effects of immobilization on muscle

A
  • decrease of muscle strength
  • increase fatigue during work
  • atrophy begins in 1-3 days
27
Q

once atrophy begins, when is loss of muscle mass greatest?

A

within next 5 days

28
Q

what % of decrease in muscle fiber size (atrophy) occurs 72 hours after immobilization?

A

14-17% decrease

29
Q

which method of healing is ORIF plate and screws?

A

primary (compresses)

30
Q

OTs must remember what 3 things with fracture management?

A
  • bone
  • soft tissue
  • scar healing
31
Q

overall goal to restore functional abilities of pt.

A

rehabilitation

32
Q

with most fractures there will be a period of ____.

A

immobility

33
Q

name 6 components of OT evals for fractures.

A
  • wound, skin, scar
  • pain
  • ROM
  • strength - MMT, grip, pinch
  • hand function (dexterity)
  • ADLs/work
34
Q

what type of ROM should you use for pts affected joint(s)?

A

AROM

35
Q

which types of ROM should you use for joints above and below fracture?

A

AROM and PROM

36
Q

name 5 OT fracture guiding principles/considerations.

A
  1. is fracture stable?
  2. is fracture healing
  3. closed or open reduction?
  4. is edema under control?
  5. are tendons gliding?
37
Q

describe the goals of the immobilization phase of fracture treatment.

A
  • protect healing structures
  • control pain and edema
  • ROM uninvolved parts
  • complications
  • NO thermal modalities during inflammatory phase
38
Q

how long is the immobilization phase?

A

4-6 weeks (may be shorter)

39
Q

should thermal modalities be used during the inflammatory phase?

A

NO

40
Q

describe the goals of the motion phase of fracture treatment.

A
  • manage pain, edema, wound, skin, scar
  • controlled motion (AROM to PROM)
  • light functional activities
  • monitor tissue response
  • wean from orthosis
41
Q

describe the goals of the strengthening phase of fracture treatment.

A
  • increase ROM to functional levels - add PROM, stretch, joint mobilization, orthosis to mobilize joint.
  • increase muscle strength and endurance
  • moderate to heave tasks
42
Q

describe the goals of the late phase of fracture treatment.

A
  • work conditioning
  • functional capacity eval if necessary
  • return to play, sports, leisure
43
Q

what should be part of treatment in all phases of fracture treatment?

A

pt. education!

44
Q

name a protection rehab intervention for fractures.

A
  • orthotics: plaster, fiberglass, thermoplastics
  • immobilize NECESSARY joint
  • prescribed by MD
45
Q

name 3 pain rehab interventions for fracture treatment.

A
  • PAMs - cold, heat, e-stim
  • myofascial release
  • massage
46
Q

name 5 edema rehab interventions for fracture treatment.

A
  • elevation
  • compression
  • ACTIVE exercise
  • MEM
  • cryotherapy
47
Q

name 2 wound/scar rehab interventions for fracture healing.

A
  • at pin sites or incision site.

- scar remodeling - manual mobilization, ultrasound, elastomer

48
Q

name 4 ROM rehab interventions for fracture treatment.

A
  • AROM, AAROM, PROM
  • full arc of motion - not partial
  • isolate target joint(s)
  • may be combined with - heat, stretch and AROM
49
Q

name 2 orthotics rehab interventions for fracture treatment.

A
  • once healing sufficient to apply stress to improve certain motions with MD ok!
  • orthosis usually dynamic or static progressive
50
Q

motion before ___.

A

strength

51
Q

for closed reduction fractures, you will wait longer to begin ___.

A

AROM

52
Q

name the 3 progressive steps of strength interventions.

A
  1. motion
  2. strength
  3. endurance
53
Q

name 4 factors that may delay healing.

A
  • infection
  • continued edema
  • other comorbidities
  • pain
54
Q

name 2 modalities that are used in edema treatments.

A
  • NMES

- cold

55
Q

name 3 different types of fists used to determine if tendons are gliding.

A
  • full fist
  • hook fist
  • flat fist
56
Q

which method of healing is a cast?

A

secondary (slight movement on fracture sight)

57
Q

In closed reduction cases, you will wait longer to begin ___.

A

AROM

58
Q

name 3 factors to consider in the sub-acute phase of a healed fracture.

A
  • edema - now may be brawny
  • limited ROM - PROM to involved joints, careful passive stretching
  • decreased strength
59
Q

name the 4 steps of the “treatment hour” during a session.

A
  1. warm up - heat, massage, getting ready for treatment session
  2. hands-on period - using your hands to help pt., passive range, stretching, massage, helping them move
  3. independent period - pt. works on their own
  4. cool down - Q&A, cold packs, going over home program

Ortho Eval (24 decks)

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