Orthopedic Conditions: Fractures

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mariamandrussow
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283960
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Orthopedic Conditions: Fractures
Updated:
2014-09-23 20:57:48
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Orthopedic Conditions Fractures
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Orthopedic Conditions: Fractures
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  1. Most important treatment goals for fractures
    • Alternative Techniques
    • Educate in potential need for assistance
    • Reintegration!
  2. Fracture Healing times
    UE & LE: Callus & Union
    • UE: Callus 2-3 wks, Union 4-6 wks
    • LE: Callus 2-3 wks, Union 8-12 wks
  3. Surgical Procedures:
    ORIF
    External Fixation
    Osteotomy
    Arthrodesis/Arthroplasty vs. Hemiarthroplasty
    Carpectomy
    • ORIF: open reduction internal fixation
    • External Fixation: don't open skin
    • Osteotomy: remove piece of bone
    • Arthrodesis/Arthroplasty vs. Hemiarthroplasty: total hip replacement vs. partial (just head usually)
    • Carpectomy: removal of carpal bone
  4. Factors affecting fracture healing
    • Periosteum intact
    • Closed vs. Open
    • Displaced vs. Nondisplaced
    • Delayed union
    • Excessive movement (fracture to wrist-you move this a lot)
    • Severe soft tissue damage
    • Age
    • Nutrition (Calcium, vit C & D)
  5. Concerns as a result of prolonged immobility:
    • Pain
    • Stiffness
    • Edema
    • Loss of ROM
    • Muscle atrophy
    • Sudomotor changes(hair, nails, skin)
    • Compression-vascular, nerve (from Edema)
  6. Focus of evaluation for ortho client:
    • Clint's perspective of injury
    • Edema
    • Pain
    • Wounds
    • ADL/IADL, work, leisure
    • Posture
    • Sympathetic: texture, color, temp
    • Sensation
    • ROM, strength
  7. What might impair an ortho patient's abilities? (we can measure these with assessment tools)
    • Pain
    • Edema
    • ROM (begin immediately or 3-4 weeks after stabilization)
    • Strength/MMT
    • Endurance
  8. What does the OT do? What are the main/general focus areas for Tx?
    • Educate onprecautions, risks, time frame
    • ADL, IADL, work, leisure
    • Protection vs. Use (compensate, adapt, integrate?)
    • Splinting
    • Modalities (ultrasound, thermotherapy, etc)

    • General Tx Focus:
    • *Exercise/Activity (adjunct/enabling activities, *PROM vs. AROM, isometric strengthening, etc)
    • *Edema management
    • Wound care
  9. Non-surgical: external immobilization
    Clavicular fracture?
    Cervical fracture?
    Thoracic/Lumbar fracture?
    • Figure 8 sling
    • Hard/soft collar
    • Corset
  10. Surgical (displaced fracture)
    Cervical fracture?
    Thoracic/Lumbar fracture?
    • Aspen & Philidelphia
    • TLSO & Jewitt
  11. What would OT do for clavicular, cervical, lumbar/thoracic fractures?
    • Educate- log rolling
    • Modify tasks- no twisting, reaching, bending so provide rise on toilet, long show horn, reacher
    • Adaptive Equipment
    • Don/Doff bracing
    • Caregiver education
    • Strengthening
  12. Fracture healing process can also be affected by:
    • Type, location, Severity & PREmorbid status
    • Complex Regional Pain Syndrome (CRPS) Type 1 limb, Type 2 nerve
    • Infection
    • Corticosteroids
    • Hematoma (bruising ecchymosis which causes pressure)
    • Poor nutrition
  13. Most common UE Fractures:
    Colle's
    Smith's
    Boxer's
    Finger (phalangeal)
    Elbow (olecranon)
    • Colle's: distal radius, due to extension of wrist, dorsal displacement, median nerve damage)
    • Smith's: distal radius, due to flexion of wrist, volar displacement)
    • Boxer's: 4 & 5th metacarpals
  14. Midshaft Humeral fracture could cause damage to which nerve?
    Radial: affects wrist & finger extension
  15. Signs of Colle's fracture
    • Finger stiffness
    • hand swelling
    • median nerve compression (carpal tunnel)
    • limited forearm supination
  16. Elbow fracture complications/outcomes:
    • Radial nerve damage
    • Decreased flexion or extension
    • Decreased forearm supination or pronation
    • Volkmann's Ishemia
  17. Volkmann's Ishemia
    • cause by elbow fracture: lack of blood flow to arm from swelling
    • Pale, Bluish skin color
    • No forearm radial pulse
    • Decreased hand sensation
    • Severe pain
  18. OT Intervention/Focus for LE & UE
    • Immobilization of fx (splint, brace)
    • ROM/Strengthening
    • EARLY MOBILIZATION
    • Edema mgmt
    • Education
    • Home EXERCISE program (HEP)
    • Caregiver education
  19. Hip surgery can be due to:
    • Osteoarthritis: wear & tear
    • Rheumatoid arthritis: autoimmune
    • Congenital HIp Dysplasia
    • Osteoporosis
    • Pathological Fracgure
    • Osteomyelitis (infection)
    • Avascular nevrosis
  20. HIP PRECAUTIONS:
    Posterior approach:
    Anterior approach:
    • BOTH: no aDduction (no crossing legs/passing midline)
    • Posterior approach:no hip flexion, no internal rotation
    • Anterior approach: no hip extension, no external rotation, no aBduction
  21. OT focus for hip fractures:
    • Energy Conservation
    • UE Strengthening
    • Education about precautions
    • Adaptations/Compensations (positioning)
    • Adaptive Equipment (reacher, sock aid, shower seat, commode)
    • Pain mgmt
    • Caregiver education
  22. What to do for a knee replacement
    • CPM: continuous passive motion machine
    • weight precautions
    • encourace knee FLEXION (need to start using, or they will stop!)
    • Fx mobility & transfer training to support occupatoins

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