Orthopedics quiz

Chapter 25

What are the common causes of fractures?

• Trauma

• Disease of the bone or joint

What are the two primary factors that determine whether a fracture will occur?

• Amount of force applied to the bone

• The strength and toughness of the bone

Pathological fracture

• Osteoarthritis and osteoporosis 

• When a bone fracture is caused by insufficiency of the bone due to low density, in a task such as bending over or getting out of bed

What is osteoarthritis

Most common form of joint disease involving destruction and loss of articular cartilage

Osteoporosis

Low bone density and the deterioration of bone

Osteopenia

reversable weakening of the bone that increases the risk of developing osteoporosis

Heterotopic ossification (HO)

• Orthopedic condition resuling in abnormal bone formation in extra skeletal soft tissues

Injuries associated with heterotopic ossification

• Traumatic injuries including severe burns, spinal cord injuries, head injuries, as well as other bone forming diseases such as ankylosing spondylitis

Hip fracture incidence

289000 by 2030, 12% increase

Hip fracture outcomes

1 year post hip fracture 28.6 mortality rate

• Primary causes of disability and mortality in the older adult

• Many people do not return to premorbid functional level and rely o adaptive equipment and adaptations

Common signs and symptoms of fractures

• Edema

• Injury to surrounding soft tissue

• Hematoma

• Ecchymosis (discoloration of skin caused by bleeding)

Intracapsular hip fracture

• INvolves the femoral neck such as a sub capital or transervical fracture

Extracapsular hip fracture

• involve the trochanters such as a subtrochanteric or intertrochanteric fracture

What functional impairments are associated with hip fractures

• Pain

• Decreased proprioception

• limited ability to bear weight on the involved lower extremity impacting gait, decreased muscle strngth, impaired balance, and decreased ADL performance

Delayed union

When a bone takes longer time to heal than is typical

Malunion

When the fracture heals in a nonanatomic or deformed position

Nonunion

When there is a failure of the fracture ends to unite

Describe the stages of bone healing

• Blood vessels constrict to prevent further bleeding and platelets provide clotting

• Inflammatory stage where phagocytosis occurs and osteoclasts resorb devitalized bone to prepare for repair to the site

• Callus formation occurs where fibrous cartilage forms a soft callus around week 2 post fracture

• Cartilage is mineralized forming a hard callus from week 4-6 post fracture

• Remodeling occurs where immature bone is replaced with mature lamellar bone between 8-12 weeks post fracture

What medical and surgical interventions are used for hip fractures

• Joint arthroplasty (replacement)

• Hemiarthroplasty (femmoral head replacement)

• Open reduction and internal fixation

Three standard hip precautions following total hip arthroplasty

• Avoiding hip adduction

• Avoiding hip rotation

• No hip flexion beyond 90 degress

• Avoid hip extension if anterior approach is used

NWB

0%, foot and toes do not touch the ground

TTWB (toe-touch weight bearing) or TDWB

foot may rest on the floor but the extremity is not bearing weight. The patient may touch toes to the ground for balance assist only

PWB (partial weight bearing)

• Prescribed amount as a percentage of the patients body weight, usually 20-50% although interpretations vary greatly

Weight bearing as tolerated

limited only by the patients tolerance, usually 50%-100%

FWB (full weight bearing)

100% no limitation

OT role in hip precaustion

• Educating clients about precautions

• Teaching adaptations that will help them follow precautions