GenO OP-Fractures

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Author:
agatton
ID:
11271
Filename:
GenO OP-Fractures
Updated:
2010-03-27 18:18:56
Tags:
General Orthopedics OP
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Description:
OP study cards
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  1. Definition + Etiology
    A disruption of the continuity of bone, usually caused by trauma. Direct violence, indirect violence, MM contraction, pathological #

    • Simple/Closed: No external wound
    • Compound/Open: Protruding through skin or into body cavity
    • Complicated: Often infected
    • Comminuted: Bone slintered into pieces
    • Incomplete: Not entire diameter
    • Impacted: Bones wedged into one another
    • Greenstick: Bent+broken (kids)
  2. CIs and Precautions
    • Hydro+ Casts
    • Too, much too soon
    • Fragile Tissue post-cast (jt mobes, frictions)
    • Extreme Heat/Cold
    • Hydro + Plates/pins (maybe)
    • Confirm Unionization and consolidation
    • ***Testing immobilized MM***
  3. S&S
    • Shock
    • P w/ Acute tenderness over Fx site
    • MM spasm
    • Loss of ARoM and/or PRoM
    • Deformity
    • Fatigue
  4. H
    • X-RAY EVIDENCE OF COMPLETE UNIONIZATION/CONSOLIDATION
    • Type of Fx
    • Other Tx
    • Meds
    • Immobilized Time/Device
    • Plates/Pins/Screws
    • Predisposing factors
    • Smoking
  5. O
    • Edema, Girth
    • Deformity
    • Gait/Posture

    • Post-cast:
    • Pressure sores, cast dermitits
  6. P
    • ***DO NOT CHALLENGE # SITE UNTIL MD/X-RAY CONFIRMED UNION***
    • Bony deformity
    • Size/location/shape of bone callus
    • MM spasm TrP, HT
    • Friable skin post-cast
  7. M
    • ***Testing imoobilized MMs is CI'd***
    • ARoM to prox+distal jts
    • ***No weight bearing until MD OK***
    • PRoM done with care, Pain-free
    • ***No POP until MD OK***
    • RRoM wait until unionization
  8. N
    If NN damage suspected, test area/MM for motor/sensory
  9. R
    • Sclerotomic
    • Possible jt, visceral, deep fascial Pain
    • TrP, MM spasm pain referral
    • In chronic, fascial adhesions and plane of restriction referring pain
  10. S
    • As per injury
    • Homan's for DVT
  11. Tx Goals
    • Initial Casting
    • Decr comps
    • pt edu
    • Decr P and SNS firing
    • Prevent swelling, MM spasm, atrophy, contractures
    • Maintain RoM of all jts

    • Post Casting
    • Mobilize hypomobile jts
    • Decr adhesions
    • Increase venous return and tissue health
    • Increase tissue extensibility
    • Decr comps
    • Maintain/increase RoM
  12. Tx
    • Initial Casting
    • Elevate limbs, support
    • Vibrations and MLD-like techniques PROX
    • PRoM to PROX+DIST jts for lymph drainage
    • Tx associated injuries

    • Post Casting
    • Frictions
    • Stretching
    • Jt mobes
    • Massage and PRoM
  13. Hydro
    • Initial Casting
    • Contrast to contralateral side
    • Heat PROX to casting, pref on trunk

    • Post Casting
    • DMH if no edema
    • Skin brushing (start w/ cloth, progress to brush)
    • Contrasts (mild at first)
  14. RemEx
    • Initial Casting
    • Aerobic (eliptical/recumbant bike)
    • Submax Iso Contractions
    • Postural
    • Post Casting
    • STR, graded return to function

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