Podcast
Questions and Answers
Which of the following statements accurately describes a condition indicating no healing occurs in fractures?
Which of the following statements accurately describes a condition indicating no healing occurs in fractures?
What is primarily responsible for the formation of new bone after rigid fixation?
What is primarily responsible for the formation of new bone after rigid fixation?
Which factor does NOT influence the union of fractures?
Which factor does NOT influence the union of fractures?
How does greater motion at the fracture site affect the callus formation during the healing process?
How does greater motion at the fracture site affect the callus formation during the healing process?
Signup and view all the answers
Which complication of fractures is characterized by the deformity of shortening?
Which complication of fractures is characterized by the deformity of shortening?
Signup and view all the answers
What is the primary characteristic of stress-sharing devices in fracture fixation?
What is the primary characteristic of stress-sharing devices in fracture fixation?
Signup and view all the answers
Which method results in primary bone healing without callus formation?
Which method results in primary bone healing without callus formation?
Signup and view all the answers
What is the expected rate of bone healing with stress shielding devices?
What is the expected rate of bone healing with stress shielding devices?
Signup and view all the answers
What complication can be prevented by performing breathing exercises?
What complication can be prevented by performing breathing exercises?
Signup and view all the answers
How long does compression plate fixation typically require for non-weight bearing?
How long does compression plate fixation typically require for non-weight bearing?
Signup and view all the answers
What is a common feature of stress-sharing devices and their impact on fracture healing?
What is a common feature of stress-sharing devices and their impact on fracture healing?
Signup and view all the answers
Which of these is NOT a method to prevent circulatory complications?
Which of these is NOT a method to prevent circulatory complications?
Signup and view all the answers
What happens during early loading before fracture healing with a compression plate?
What happens during early loading before fracture healing with a compression plate?
Signup and view all the answers
What is the primary purpose of using a semi reclined position after 24 hours postoperatively?
What is the primary purpose of using a semi reclined position after 24 hours postoperatively?
Signup and view all the answers
Which exercise is appropriate for Day 1 of rehabilitation following ORIF of hip fractures?
Which exercise is appropriate for Day 1 of rehabilitation following ORIF of hip fractures?
Signup and view all the answers
What advantage does side lying position provide in early rehabilitation post hip fracture?
What advantage does side lying position provide in early rehabilitation post hip fracture?
Signup and view all the answers
Which of the following factors is NOT considered when determining the progression of gait training?
Which of the following factors is NOT considered when determining the progression of gait training?
Signup and view all the answers
What level of hip flexion is required to sit down on a chair according to the rehabilitation guidelines?
What level of hip flexion is required to sit down on a chair according to the rehabilitation guidelines?
Signup and view all the answers
On which day postoperatively does ambulation with TDWB using a walker typically begin?
On which day postoperatively does ambulation with TDWB using a walker typically begin?
Signup and view all the answers
What is the significance of using an overhead trapeze during the initial postoperative days?
What is the significance of using an overhead trapeze during the initial postoperative days?
Signup and view all the answers
Which of the following is NOT included in the discharge criteria after hip fracture rehabilitation?
Which of the following is NOT included in the discharge criteria after hip fracture rehabilitation?
Signup and view all the answers
What is the primary goal of performing ROM exercises post-injury?
What is the primary goal of performing ROM exercises post-injury?
Signup and view all the answers
Which type of fracture is categorized as a complete fracture without displacement?
Which type of fracture is categorized as a complete fracture without displacement?
Signup and view all the answers
In Garden classification, which stages are considered stable fractures?
In Garden classification, which stages are considered stable fractures?
Signup and view all the answers
For displaced femoral neck fractures, when is weight bearing allowed?
For displaced femoral neck fractures, when is weight bearing allowed?
Signup and view all the answers
Active or static contraction exercises are important for what purpose in rehabilitation?
Active or static contraction exercises are important for what purpose in rehabilitation?
Signup and view all the answers
What is the primary purpose of reducing edema after a fracture?
What is the primary purpose of reducing edema after a fracture?
Signup and view all the answers
Which of the following best describes the rehabilitation principles for operatively treated fractures?
Which of the following best describes the rehabilitation principles for operatively treated fractures?
Signup and view all the answers
What type of exercises should be used to prevent weakness in immobilized parts during rehabilitation?
What type of exercises should be used to prevent weakness in immobilized parts during rehabilitation?
Signup and view all the answers
Which characteristic defines a Type I open fracture according to the Gustilo-Anderson Classification?
Which characteristic defines a Type I open fracture according to the Gustilo-Anderson Classification?
Signup and view all the answers
What is the primary disadvantage associated with internal fixation methods?
What is the primary disadvantage associated with internal fixation methods?
Signup and view all the answers
Which of the following is NOT one of the three stages of fracture management?
Which of the following is NOT one of the three stages of fracture management?
Signup and view all the answers
In which scenario is open reduction typically required?
In which scenario is open reduction typically required?
Signup and view all the answers
What type of fracture is characterized by extensive wound and soft tissue damage, including neurovascular structures?
What type of fracture is characterized by extensive wound and soft tissue damage, including neurovascular structures?
Signup and view all the answers
Which method of fixation is NOT considered an internal fixation method?
Which method of fixation is NOT considered an internal fixation method?
Signup and view all the answers
What is the purpose of sustained traction in fracture management?
What is the purpose of sustained traction in fracture management?
Signup and view all the answers
Which of the following describes a characteristic of Type II open fractures?
Which of the following describes a characteristic of Type II open fractures?
Signup and view all the answers
What is a major factor affecting the prognosis of open fractures compared to closed fractures?
What is a major factor affecting the prognosis of open fractures compared to closed fractures?
Signup and view all the answers
What should be considered if bone loss is more than 50% of the cortical surface?
What should be considered if bone loss is more than 50% of the cortical surface?
Signup and view all the answers
Which condition can lead to delayed fracture healing?
Which condition can lead to delayed fracture healing?
Signup and view all the answers
What is the goal of Phase 3 in the rehabilitation process?
What is the goal of Phase 3 in the rehabilitation process?
Signup and view all the answers
How does early stabilization of fractures in patients with multiple injuries benefit them?
How does early stabilization of fractures in patients with multiple injuries benefit them?
Signup and view all the answers
Which rehabilitation phase focuses on strengthening and endurance exercises?
Which rehabilitation phase focuses on strengthening and endurance exercises?
Signup and view all the answers
What is recommended to prevent knee flexion contracture during rehabilitation?
What is recommended to prevent knee flexion contracture during rehabilitation?
Signup and view all the answers
What is indicated to be the average time for soft tissue healing in type III fractures?
What is indicated to be the average time for soft tissue healing in type III fractures?
Signup and view all the answers
Study Notes
Management of Lower Limb Fractures
- The objectives of the lecture are to define fracture management principles, explain fracture handling techniques, describe bone healing processes, differentiate internal fixation types, and compare lower limb fracture rehabilitation protocols.
Complications of Fractures
- Potential fracture complications include: infection, avascular necrosis, malunion (deformity from shortening), joint disruption, adhesions, injury to large vessels, muscle, nerves, viscera, and contractures.
Bone Healing
- Fracture union depends on bone type, fracture classification, blood supply, and fixation.
- Age affects healing time; delay union indicates slower-than-normal healing, malunion indicates healing with deformity, and nonunion indicates no healing.
Bone Healing Stages
- Bone healing involves four phases: hematoma formation (0-2 weeks), soft callus formation (2-3 weeks), hard callus formation (3-6 weeks), and bone remodeling (8 weeks-2 years).
Primary Bone Healing
- Involves very slow healing in rigid fixation.
- New bone grows directly across fracture ends, with no bridging callus formation.
- This is dependent upon osteoclast resorption prior to osteoblast formation.
Secondary Bone Healing
- The most common type of bone healing, occurring in the absence of rigid fixation.
- Characterized by bridging callus formation which increases fracture site stability.
- Occurs with casting, external fixation, and intramedullary nails.
Gustilo-Anderson Classification of Soft Tissue Injury in Open Fractures
- Classifies soft tissue injury severity in open fractures.
- Type I: Wound < 1cm, minimal soft tissue damage.
- Type II: Wound > 1cm, slight-moderate soft tissue damage.
- Type III: Extensive soft tissue damage, including muscle, skin, and/or neurovascular structures.
Fracture Management Stages
- Three stages for fracture management: deal with any open wounds, attend to the fracture until united, mobilize the joint and rehabilitate the limb.
Principles of Fracture Management
- First aid: Do not move the patient.
- Definitive treatment steps: reduction, fixation, rehabilitation.
Reduction Techniques
- Closed reduction (manipulation): Usually involves anesthesia.
- Open reduction: Used when closed reduction fails; allows highly accurate reduction with increased risk of infection.
Fixation Methods
- External fixation (plaster casting, frame fixation).
- Internal fixation (intramedullary nails, compression plates, screws, wire sutures).
- Sustained traction
Advantages of Internal Fixation
- No casts.
- Prevents skin pressure complications and bed rest complications.
- Is important for the elderly needing early motion.
- Avoids stiffness.
- Enhances fracture healing.
- Prevents muscle atrophy.
Disadvantages of Internal Fixation
- Increased risk of infection during surgery.
- Additional surgical trauma.
- Need for a wide surgical exposure.
Stress-sharing Devices
- Do not provide rigid fixation and permit partial stress transmission across the fracture site.
- Micro motion at the fracture site induces secondary healing with callus formation.
- Materials include casts, intramedullary nails, and external fixators.
Stress-shielding Devices
- Shield the fracture site, transfer stress to the device, and compress fractured ends with no motion occurring at the site.
- Result in primary bone healing and no callus formation.
- Examples include compression plating and static locked intramedullary nails.
Principles of Fixation Devices Comparison
- The table compares external fixators, pins, screws, plates, rods, and casts in terms of biomechanics, type of bone healing, rate of healing, and weight bearing protocols.
Physical Therapy During Immobilization
- Prevent respiratory complications (breathing exercises).
- Prevent circulatory complications (active exercises, position changes).
- Maintain joint range (ROM exercises).
- Reduce edema (bandaging, elevation).
- Maintain muscle function (active/static contractions).
- Prevents weakness in immobilized limbs (static/isometric exercises.)
- Maintaining function (based on injury and fixation type).
- Teaching patient appliance use and care (as needed).
Physical Therapy After Fixation Removal
- Reducing swelling.
- Regaining joint range of motion.
- Regaining muscle power.
- Re-educating full function
Hip Fractures
- Include intracapsular fractures (neck, subcapital, transcervical, basicervical) and extracapsular fractures (intertrochanteric, subtrochanteric).
- These can be classified by the Garden classification. Garden stage I & II are stable, treatable by internal fixation, III & IV are unstable requiring hemi or total hip replacement.
Rehabilitation After ORIF of Hip Fractures
- Initial immobilization with bed mobility, maintaining proper operative limb alignment.
- Avoiding hip flexion for the first 7-10 days postoperatively.
- Starting semi-reclined positioning 24 hours after surgery.
- Encouraging side-lying positioning for toiletry, pulmonary functions and prevention of pressure ulcers.
- Using over head trapeze.
- Gait training with walker or crutches.
Gait Training
- Begins when balance and mobility are sufficient.
- Over 12-16 weeks gait patterns should evolve into complete weight bearing.
- Surgical procedure, fracture area, and patient comfort are factors in transitioning to full weight bearing.
Active Exercises (e.g., pool therapy)
- Active exercises can be used to regain strength, proprioception, and mobility through immersed exercise.
- Immersion provides 75% off-loading to the xiphoid process or 50% off-loading to the umbilicus.
- Hip flexion exercises, such as tying a shoe, ascending stairs, and sitting on a chair, require varied amounts of hip flexion.
Hospitalization Phase of Upper End of Femur Fractures
- During the hospitalization period, exercises such as quadrucep sets, hamstring sets, gluteal sets, and ankle pumps are routinely performed.
- Active assisted hip abduction and adduction and supine leg slides increase hip and knee flexion.
- Day two includes ambulation with TDWB, with walker.
Discharge Criteria
- Discharge typically occurs one to two weeks after surgery.
- The criteria involves independence of ambulating and going to the bathroom.
- Activities such as standing hip exercises (abduction, flexion), stationary bicycles, pool exercises, and treadmills, are essential components of the rehabilitation process.
General Principles of Rehabilitation
- Phase 1 (0-6 weeks): Joint mobilization, protected weight bearing.
- Phase 2 (6 weeks-3 months): Strength & endurance exercises, progressive weight bearing.
- Phase 3 (3-6 months): Progression to full weight bearing, agility training, and return to activities.
- Phase 4 (>6 months): Resumption of normal activities.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers the principles and techniques of managing lower limb fractures, including handling approaches and rehabilitation protocols. It also explores the bone healing process and potential complications that may arise after a fracture. Test your knowledge on the stages of bone healing and the impact of various factors on recovery.
