wk 9- bone healing/ complications

Question 1

timelines for rehab (stage 1)

Answer 1

stage 1 (<3 weeks)
-pain control
-wound protection
-maintaining correction/alignment
-restricted activities

Question 2

timelines for rehab (stage 2)

Answer 2

stage 2 (3-12 weeks)
-return to footwear
-reduced levels of activity
-low level rehab to maintain structures (proprioception/strengthening, etc)

Question 3

timelines for rehab (stage 3)

Answer 3

stage 3 (3-18 months)
- rehab/ return to activity

Question 4

complications with rehab/healing process

Answer 4

-infection

-scar

deep scars -compress on nerves and alter tendon function

superficial scars -compress on superficial nerves and comestically unappealing

-non union/malunion

Question 5

medical complications are what

Answer 5

complications that occur within 30 days post op

Question 6

when do pulmonary complications mostly occur

Answer 6

1 day post op

Question 7

when do urinary complications occur

Answer 7

2 days post op

Question 8

when do wound complications occur

Answer 8

3 days post op

Question 9

when do DVT complications occur

Answer 9

4 days post op

Question 10

what is dehiscence

Answer 10

a gapping of the wound resulting in increased scarring

caused by infection, absorbable sutures if alot of inflammatory process occurring, moving around and opening up a wound, etc

Question 11

treatment of dehiscence

Answer 11

remove affected sutures
debride sloughy tissue
antiseptic dressing
steri strips/taping to reduce pressure on wound
resuture

Question 12

what type of sutures typically have a reaction on the skin

Answer 12

absorbable

Question 13

how do absorbale sutures dissolve

Answer 13

a low grade inflammatory process breaks them down

if its exaggerated, then they break down quicker

Question 14

if theres a superficial suture reaction how to treat

Answer 14

remove sutures
antisptic dressing
allow to heal by secondary intention
hydrocortisone cream

Question 15

what is a seroma

Answer 15

collection of serious fluid between epidermis and dermis

Question 16

how to treat seroma

Answer 16

basically like a blister

treat with aspiration and compression dressings

Question 17

what is a hypertrophic scar

Answer 17

excessive granulation tissue and deposition of collagen within wound margins

Question 18

keloid scar

Answer 18

excessive deposition of dermal collagen well beyond wound margins

people with darker skin tones are more susceptible

Question 19

scar treatment during operation

Answer 19

radiation therapy
avoid absorbable sutures
steroid injection under suture line

Question 20

post op scar treatment

Answer 20

steroid injection/hydrocortisone cream- slows down collagen formation and scar formation

US
silicine gel sheeting
excision
cryotherapy
laser
interferon

Question 21

why is it so important to assess someones imumune status and prior surgeries when about to conduct another?

Answer 21

infection at a different site (eg nail surgery caused an infection) can result in an infection through haemtomous spread to an area of high vascularity like where a joint replacement has occurred

Question 22

DVT causes

Answer 22

virchows triad

1. stasis
2. endolethieal trauma/abnormality
3. hypercoaguable state

can cause pulmonary embolism or venous insufficiency

Question 23

risk stratification- DVT

Answer 23

high-
surgery
fracture
clotting factors
previous DVT/family history

mod-
pregnancy, stroke, CHF

low-
bed rest/immobility
obesity
female/oral contraception
varicose veins
smoking

Question 24

osseous post op complications

Answer 24

union problems
infection
metal work irritation
AVN

Question 25

delayed union is what

Answer 25

fracture not healed or signs of union in reasonable time approx 4 months, can take longer than this but need to monitor

Question 26

what can cause delayed union

Answer 26

smoking local ischaemia/lack of blood supply inappropriate mobilisation

Question 27

non union

Answer 27

after approx 8-9month will often form a false joint - fibrocartilaginous interface this isnt a bad thing if its still rigid, no pain, complications

Question 28

contraindications of immobilisation

Answer 28

previous DVT neuromuscular disease inability to use crutches lack of blood supply

Question 29

aims of immobilistion after surgery

Answer 29

1. maintain aseptic environment 2. maintain alignment of surgery 3. provide compression in the first 48-72 hours

Question 30

jones compression application

Answer 30

surgical dressing if required cast padding (2 layers) elastic bandage for compression cast padding elastic bandage for more compression thin layer of taping/cast padding material then synethic or plaster material designed for swelling in first 3 days before a rigid cast or mobilisation

Question 31

post foot surgery immobilisation

Answer 31

1. jones compression cast (short term first 3-4days) 2. back slab, below knee cast 3. aircast boot 10-12 weeks post op

Question 32

post trauma/injury immobilisation

Answer 32

1. jones compression cast (short term 3-4days) 2. below knee cast, backslab, soft cast, moon boot

Question 33

rigid cast types

Answer 33

fibreglass cast or back slab

Question 34

how long should you apply a rigid cast for after 2-3 day compression - surgical setting

Answer 34

no signs of swelling or infection rigid cast is on for about 6 week period for immobilisation and alignment

Question 35

fracture types

Answer 35

comminuted non comminuted (oblique, spiral, traverse, partial) avulsion impaction incomplete (greenstick or torus) infartion chip stress pathologic bone bruise

Question 36

stability of fractures from most stable to least

Answer 36

tranverse, oblique, spiral, comminuted

Question 37

transverse and oblique fractures can be what

Answer 37

stable fractures and can be closed, reduced and immobilised as treatment

Question 38

spiral and comminuted fractures are

Answer 38

unstable fractures that are difficult to reduce without open reduction and internal fixation of the bone

Question 39

if a fracture is in a joint what treatment is best

Answer 39

surgery- open reduction and internal fixation

Question 40

how to do reductions for fracture

Answer 40

increase the deformity distract reverse the deformity and realign maintain correction with immobilisation can be performed open or closed

Question 41

digital fractures occur mostly through what MOA

Answer 41

stub or crush injury

Question 42

treatment for digital fractures

Answer 42

buddy splints and post op shoe or surgery if intrarticular or large unstable fragments