Orthopedics Midterm Review PDF

Orthopedics Bone anatomy - Periosteum: outside layer. - Membrane - Attachment for mm. tendons n.endings - Compact bone layer: mineralized part - Strength and integrity of the bone - Spongy bone: bone marrow- fat deposits - Keeps bones light - Conta...

Orthopedics Bone anatomy - Periosteum: outside layer. - Membrane - Attachment for mm. tendons n.endings - Compact bone layer: mineralized part - Strength and integrity of the bone - Spongy bone: bone marrow- fat deposits - Keeps bones light - Contains blood vessels Bone growth [osteogenesis or ossification] - Starts at 8 wks after conception - Dynamic process that never stops** - 3 cell types involved in growth: - Osteoblasts- bone forming cells - Osteocytes: mature bone cells - Osteoclasts: break down and reabsorb bone- excess bone is removed **we don't want to see over growth in bones ** OA= excess bone, osteoclasts are not working well Common disorders - Congenital - Arthritic - Soft tissue - bursa inflamed, n injury - Autoimmune [leukemia, OA, OP] - Osteoporosis - Degeneration [OA] - Tumor- cancerous or benign - Fractures - Bone growth post fracture 1. Reactive phase: inflammation and granulation forming.[2/4wks] The main questions in the hospital at this stage are- do they need to be immobilized? Is there an adequate blood supply? Are they getting enough sleep/nutrition? 2. Reparative phase: periosteum forms osteoblasts resulting in new tissue formation [4/8 weeks-6/8 mo] 3. Remodelling phase: 3-5 yrs depending on ones age and health Treatment What can negatively influence the outcome? - Displacement - Infection - Bone loss  - Medical conditions [diabetes, hormone illnesses, vascular illness] - Medications [steroids, immunosuppressants] - Poor general health - Non compliance w wb orders Non surgical fractures Undisplaced: - If stable→ may be managed by protection alone w/o the need for reduction or immobilization e.g minor spinal fracture - If unstable → do not need reduction but req positioning/immobilization e.g. casting a radius fracture Surgical treatment Reduce a fracture which cannot be approximated in a closed manner - ORIF , pins, wires, screws, plates, external fixation - External fixation: a device that encircles or sits adjacent to the limb and is attached by screws or wires to the bone  - Used to treat fractures and reconstruct bones [deformed or damaged] Ilizarov: a leg lengthening procedure, cut the bone surgically and insert wires through the skin, muscle and bone and out the other side. Attach the wires to a cage. - 1 mm of bone distraction per day - Req to wb thru the bone to stimulate osteogenesis - - OT role: fabricate foot place [high risk for foot drop], wound care, skin assessment, pin sites, compression to manage edema, practice ADLs and home equipment, assist w pain and anxiety, body image - Clothing modifications often needed for dressing , built up shoes to accomodate for mods in leg length Arthroscopy: small cameras to investigate or assist in Sx repair Arthroplasty: joint replacements - Req when conservative Tx fail, and pt continues to have pain, sti ness, and functional impairments bc of the compromised joint - Common with OA, RA, trauma, avascular necrosis - Total arthroplasty: both articular surfaces replaced [high revision rate]  - Hemiarthroplasty: only one articular surface replaced [lower revision rate] Diseased hip [needing arthroplasty] Implant fixation: - Cemented: for osteoporosis or osteopenia usually. It is more stable, can wb earlier, WBAT post Sx - Cementless: decr rejection rates, better option if possible, depends on the growth of porous bone for stability [possibly initially NWB post Sx]  - Hybrid: femoral position cemented, acetabulum uncemented [4-6 wks PWB] Levels of Weight bearing 1. NWB→ cannot touch floor at all 2. FeWB→ touch floor for balance only [bilateral gait aid req] 3. PWB→ small amt of weight permitted [determined by surgeon in % of wb] 4. WBAT→ as tolerated Patient education - Wb precautions, movement precautions, activity restrictions Posterolateral approach to hip replacement - Most common approach bc it does not interfere w the hip abductors [more simple] - High rate of hip dislocation - Glut max, min, piriformis, gemeli, obturator externus and quad femoris are all incised [weakened external and internal rotation] - THUS, hip precautions are as follows to limit posterior hip dislocation 1. 2.  3. OT role for hip and knee care Pre-op: educate the client precautions and functional implications, take environmental Hx, arrange equipment/homecare needs, discuss hip/knee kit and provide info for purchase POD 0: pt sts at the edge of bed and attempts to stand/walk as early as 4 hrs post op [consider pain meds], don catheter once walking, reinforce precautions POD 1: teach correct transfers, confirm home support and env, ADL practice, up in chair for all meals, encourage walking POD 2: ADL practice w equipment [if needed] , shower if able POD 3: independent w self care, dressing, transfers, ensure they are maintaining their wb and movement precautions during functional tasks , discharge from acute Chair/toilet transfer 1. Backs up until they feel the chair at the back of their legs 2. Slide operated leg frwd 3. Reach back twrd armrests and use them for support as knees bend to sit 4. Reverse to stand **do not use walker Slipped Capital femoral epiphysis -capital femoral epiphysis slips o the femoral neck bc of a shearing failure of the cartilaginous growth plate in the proximal femur - growth spurt [weakening of the growth plate] + body weight = mechanical failure of the physis [growth plate fracture] - occurs often in obese adolescents - typically in boys aged 10-16 - usually unilateral - incr risk of avasc necrosis -Sx req, pins into the neck of the femoral head OT role: environmental hx [school, home, leisure] discuss safety in the home, eliminate throw rugs, clutter, small pets, - Discuss back to school strategies - Assess safety w bed mobility and transfers - ADL assessment - Arrange necessary equipment Knee Arthroplasty ‘Happy knee’ Diseased Knee Knee replacement: patella moved out of the way - Damaged cartilage surfaces at the end of the femur and the tibia are removed - Metal components cemented or press fit into the bone - Patella may or may not be resurfaced - Plastic spare inserted between the metal components for a smooth gliding surface Ankle fractions/fusions - Presents with symptoms similar to an ankle sprain - Higher risk if have a PMH which includes - diabetes, peripheral vascular disease, metabolic bone disease, chronic use of corticosteroids - Indicators suggesting fracture: gross deformity, swelling, bony tenderness, discoloration, ecchymosis and inability to wb Ankle Fracture Types  - Structure of the ankle forms a ring - Fracture of a single part = stable - Fracture of more than one part = unstable Weber Classification Weber A: fracture inferior to syndesmosis [lateral malleolus] - Syndesmosis between tib and fib is intact - Medial malleolus may be fractured - Usually stable if medial malleolus is intact - Reduction and cast - ORIF occasionally needed - Weber B: fracture as a level of syndesmosis - Syndesmosis is intact or partly torn - Possible medial malleolus # or deltoid ligament damage - Stability is variable - Reduction and cast - May req ORIF Weber C: fracture above level of ankle joint - Tibiofibular syndesmosis damaged→ widening of the joint - Medial malleolus # and deltoid ligament damage - Very unstable - ORIF req Pilon Fracture: fracture of the distal tib metaphysis combined w disruption of the talar dome - Common MOI: skiers coming to an unexpected stop, free fall from heights - Males are 3x more likely vs females - Maisonneuve Fracture: proximal fib fracture coexisting w a medial malleolar fracture or disruption of the deltoid ligament - Partial or complete disruption of the syndesmosis  - Most req Sx repair - Can be treated by immobilization w cast for 6-8 wks - Tillaux Fracture: caused by extreme eversion and lateral rotation of the ankle - Incidence highest in adolescents - those aged 12-14, bc the fracture occurs after the medial epiphyseal plate of the tibia closes but before the lateral aspect closes \ Tx- closed reduction - if displacement is >2mm long leg cast for 4wks, short leg cast for 2-3 wks - Open reduction - if displacement