Orthopedics

When looking at PT orders, you should always refer to

orthopedic guidelines

Exam and evaluation should include

screening joint ROM and strength, including above and below, screen sensation, assess edema/swelling, assess bed mobility and transfers, assess balance, gait, and stairs

You should always explain

WB status to the patient

Considerations for eval in acute care

PLOF, compliance with WB status and equipment use/safety, ability to self monitor, risk for falls, insight/judgment, speed of functional movement, onset of fatigue, body mechanics

If a fracture is present… is almost always indicated

an orthopedic consult

Categories of management

non-urgent or elective, urgent, emergent

non-urgent management

stable fracture, intact neuromuscular system

Elective management

failed conservative treatment

Urgent management

time frame for management is 24-72 hours, closed, unstable fractures, intact neuromuscular system

Emergent management

requires immediate attention, open fractures, fracture/dislocation with impaired neurovascular system, spinal injuries with deteriorating neurological deficits

external fixation is used for

severely comminuted or open fractures

Therapy implications of external fixation

maintain full ROM for joints above and below the fixation, avoid any vibration, clear drainage, slight bleeding, redness, and swelling at pin sites to be expected

clear drainage, slight bleeding, redness, and swelling at pin sites of external fixators is

normal

external fixators can be for

until a candidate for internal fixation or a certain degree of healing is reached

A pt getting a total joint athroplasty may have failed conservative measures such as

pain meds, AD, activity/lifestyle modification, cortisone and lubrication injections

Highest risk of dislocating hip after arthroplasty is with

posterolateral approach

Most common TJA

cemented

TJA that allows early WB

cemented

Posterolateral hip precautions

No hip FLX past 90°, No IR, No ADD past neutral

anterolateral hip precautions

No hip EXT beyond neutral, no ER, no ADD

Acute care PT must cover… for TJA

stairs, car, and bed transfers

After LE procedure you should always check

DF to ensure no foot drop

PT for THA

POD0/1, check sensations and strength, gross mobility in regard to hip precautions, focus on gait and stairs, AD, avoiding pivoting, gentle HEP of AROM/PROM/AAROM within precautions, DME recommendations, car transfers and rolling

After THA you can/cannot roll on the affected side

CANNOT

Tricompartmental TKA

replacement of both condyles, tibial plateau, dorsal surface of patella

Unicompartmental (partial) knee arthroplasty

replacement of the worn femoral and tibial articulating surfaces (medial or lateral compartment)

Rehab for partial knee arthroplasty (unicompartmental) rehab is like

a scope

Acute care PT for TKA

ROM, strengthening, functional mobility, gait training, stair training, car transfers, AD safety, fall reduction, education on positioning while supine, family/caregiver training as indicated, pain education, pain management education, and rehab expectations

CPM

continuous passive motion machine

TKA CPG regarding CPM

should not use CPM after primary uncomplicated TKA

CPM gives at most

2° greater AROM FLX @ 6 weeks, no meaningful improvement in pain, function, QOL, or clear impact on manipulation rates

Rapid recovery programs

3-6 hours after operation, sitting EOB to 100 ft amp, performed in recovery room with close monitoring of vitals and tolerance

Benefits of rapid recovery

improved ROM, gait, balance, muscle strength, decreased LOS, may decrease pain?

Drops in BP may manifest as

nausea

Sleep apnea means a pt

is not eligible for rapid recovery programs, because they will need to spend a night in the hospital to ensure respiration is good

skeletal traction

pins and needles through bone, strict bed rest

skin traction

boots, slings, belts applied directly to skin, can be removed intermittently

For Bucks traction units note

change in positioning of HOB, FOB, placement of blankets, etc., keep weights hanging freely, isometric or active exercise of uninvolved extremities is possible