2.1: Fractures and Orthotics

what type of fracture is this?

open

what type of fracture is this?

closed

what type of fracture is this?

non-displaced

what type of fracture is this?

displaced 

what type of fracture is this?

simple

what type of fracture is this?

comminuted

what are the types of linear fracture?

transverse, oblique, spiral

describe a transverse fracture

-typically long bones
-force on each side of bone
-from trauma
-<30 degress

describe an oblique fracture

-twisting
-from landing at an angle
->30 degrees 

describe a spiral fracture

-from a twisting motion
-sharp edges

what type of fracture is this?

spiral

what type of fracture is this?

oblique

what type of fracture is this?

transverse

what is a comminuted fracture?

-3 or more fractured parts

what is a segmental fracture?

-bone breaks in at least two places
-commonly seen in trauma
-can be further divided into two level, three level, longitudinal split, comminuted

what is bone lose in reference to a fracture?

portion of the bone is lost due to the break

when do you use a dynamic hip screw?

-intertrochanteric fractures

what are the beneftis of a hip screw?

-allows for sparing of the femoral head

-keep normal hip mechanics

what is a dynamic hip screw?

large screw with side plate and several small screws

what is an intramedullary hip screw?

-a longitudinal rod in the medullary canal of the femur

-aka IM nail

when do you use an intramedullary hip screw

-long bone diaphyseal fractures
-may be combine with dynamic screw for intertrochanteric fractures 

what is a percutaneous pin?

pin inserted through the skin

when do you use a percutaneous pin?

-to stabilize a bone, fracture, or joint

-corrects alignment of the bone 

-particularly in small long bones such as phalanx, metatarsals, metacarpals

what is an open reduction internal fixation (ORIF)?

-when skin must be opened and hardware is placed for a fracture reduction and stabilization

what is an external fixation?

-structure of pins and bars that are inserted externally through the skin for fixation of fractures 

-typically followed by an ORIF after integument integrity is improved 

why would you use an external fixation rather than an ORIF?

-integument integrity is compromised

-local edema

benefits and risks of external fixation

benefits:
-allows access for wound care
-helps control pain and alignment 
allows swelling to go down and tissue healing

risks:
-need to be repositioned frequently because they cannot lay on that side
-watch for infection and pressure injury 

common post-op complications for fractures

-persistent infection
-poor healing
-non-union
-osteomyelitis (bone infection)

common post-op management for fractures

-hospital admission for antibiotics
-hardware removal/exchange
-joint fusions
-osteotomies
-repeat operative debridements

what is the name, type, and purpose of this cervical orthotic?

name: halo

type: rigid

purpose: unstable C1-2 fractures

what is the name, type, and purpose of this cervical orthotic?

name: miami-j

type: semi-rigid

purpose: stable fractures, non-operative ligamentous injuries, sometimes used post-op

what is the name, type, and purpose of this cervical orthotic?

name: CTLSO

type: semi-rigid

purpose: multiple level fracture

what is the name, type, and purpose of this CERVICAL orthotic?

name: sternal occipital mandibular immobilizer 

type: semi-rigid

purpose: jaw issues with cervical spine involvement 

what is the name and type of this cervical orthotic?

name: Philadelphia collar

type: semi-rigid

what is the name, type, and purpose of this thoracic orthotic?

name: TLSO

type: rigid

purpose: stable fractures, non-operative ligamentous injury, post-operatively 

what is the name, type, and purpose of this thoracic orthotic?

name: boston overlap

type: rigid

purpose: stable fractures, non-operative ligamentous injury, post-operatively 

what is the name, type, and purpose of this THORACIC orthotic?

name: sternal occipital mandibular immobilizer

type: rigid

purpose: stable fractures, non-operative ligamentous injury, post-operatively

what is the name, type, and purpose of this thoracic orthotic?

name: jewett brace

type: rigid

purpose: commpression fractures, keeps you in good postural alignment

what is the name, type, and purpose of this thoracic orthotic?

name: cloth TSO

type: semi-rigid

purpose: pain control in absence of instability, symptom management 

what is the name, type, and purpose of this thoracic orthotic?

name: lumbar corset

type: semi-rigid

purpose: pain control in absence of instability, symptom management 

what is the name, type, and purpose of this thoracic orthotic?

name: LSO

type: semi-rigid

purpose: pain control in absence of instability, symptom management 

what is the name, type, and purpose of this thoracic orthotic?

name: abdominal binder

type: soft

purpose: pain control in absence of instability, symptom management 

what is the name, type and purpose of this UE orthotic?

name: sarmiento brace

type: rigid

purpose: humeral fractures

what is the name, type and purpose of this UE orthotic?

name: ulnar gutter splinting 

type: rigid

purpose: 4th or 5th metacarpal fracture

what is the name, type and purpose of this UE orthotic?

name: custom splints

type: rigid

purpose: maintain functional position of joint in static position

what is the name and type of this UE orthotic?

name: hinged elbow brace

type: semi-rigid

what is the name, type and purpose of this UE orthotic?

name: figure 8 brace

type: soft

purpose: clavicle fractures

what type of UE orthotic is this?

soft

what type of UE orthotic is this?

soft

what is the name, type, and purpose of this LE orthotic?

name: hip abduction brace, hip spica

type: rigid

purpose: used in pts with recurrent dislocations, particularly after a post THR

what is the name, type, and purpose of this LE orthotic?

name: fracture brace

type: rigid

purpose: non-union and non-healing fractures, custom molded 

what is the name, type, and purpose of this ankle orthotic?

name: AFO

type: rigid

purpose: used to prevent/treat foot drop, custom or prefab

what is the name, type, and purpose of this ankle orthotic?

name: PRAFO

type: semi-rigid

purpose: for long-term, low functioning pts, helps keep them in neutral ankle position and prevents pressure injuries

what is the name, type, and purpose of this foot orthotic?

name: toe wedge

type: rigid

purpose: keeps all weight off of the toes after foot surgery (have to use a step to gait)

what is the name, type, and purpose of this foot orthotic?

name: cast shoe

type: rigid

purpose: used post-op if foot can’t fit in shoe

what is the name and type of this ankle orthotic?

name: boot 

type: semi-rigid

what is the name, type, and purpose of this LE orthotic?

name: locking-hinged knee brace

type: semi-rigid

purpose: stabilize non-op fracture or ligamentous injury

what is the name, type, and purpose of this LE orthotic?

name: knee immobilizer 

type: semi-rigid

purpose: stabilizes distal femoral or proximal tibial fractures, provides knee stability for weight bearing when quads are weak, can be used for post-op patellar fracture 

what is the name, type, and purpose of this orthotic

name: ace wrap

type: soft

purpose: controls swelling and pain (provides no stability)