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joint replacement

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Arthroplasty

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refers to a fracture that has not broken though the skin.

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closed fracture

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Fracture resulting in dorsal displacement, dorsal comminuting, and radius shortening; Often referred to as a dinner fork deformity given its resemblance to an upside down dinner fork.

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Colles' fracture

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Fracture in which a bone is broken, splintered, or crushed in to a number of pieces. Applied to fractures that have tow or more fragments. Often requires ORIF

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comminuted fracture

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Also referred to as reflex sympathetic distrophy (RSD) is a chronic pain condition in which high levels of nerve impulses are sent to an affected site. Intense pain may hinder work and life roles.

answer

Complex regional pain syndrome (CRPS)

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aka open fracture. Fractured bone breaks through the skin surface and are more prone to infection.

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Compound fracture

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When bone takes more time than expected to heal; it heals slowly. Suspected after pain and tenderness persist at the site 3 months to 1 year after injury.

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Delayed union

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Skin discoloration caused by escape of blood in to the tissues from ruptured blood vessel; bruising

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Ecchymosis

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often seen in children with soft growing bones. rather than snapping into two, the bone breaks on one side and bends on the other.

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Greenstick fracture

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an orthopedic condition resulting in abnormal bone formation in extraskeletal soft tissues. Associated with traumatic inures including severe burns, SCI and head injures

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Heterotopic ossification (HO)

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fracture heals in an abnormal or deformed position. significant functional implications. Person will often suffer limited ROM, strength, and coordination.

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Malunion

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fracture in which the bone is not healing. May be caused by vascular and tissue damage, poor alignment, stress to the fracture sites and infection. (Scaphoid bone has a high risk for site due to its limited blood supply)

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Nonunion

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Surgical procedure, involves opening of and reducing the fracture site. OR involves reduction to secure fracture, IR involves securing the fracture site with pins, rods, plates, and screws. HO may occur after this type of fracture.

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Open reduction internal fixation (ORIF)

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may cause orthopedic conditions. aka degenerative joint disease (DJD). noninflammatory joint disease that results in deterioration of articular cartilage and the formation of new bone or osteophytes on the joint surface.

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Osteoarthritis

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low bone mass. a reversible weakening of the bone that may be diagnosed through bone density scan

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Osteopenia

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Disease characterized by low bone density and deterioration of bone. Common in postmenopausal women, due to cessation of estrogen production. may cause orthopedic conditions

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Osteoporosis

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a weakening of bone that may result in it being unable to sustain normal forces experienced during daily activities. often caused by diseases like osteoporosis/arthritis. Thus, the bone may fracture while the person simply bends over or gets out of bed.

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Pathologic fracture

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The fifth stage of the healing process. also known as consolidation. occurs between 6 weeks and 1 year. bone is ideally reshaped to original form and able to resume its intended function.

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Remodeling

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Opposite of Colle's Fracture. Displacement from the break is positioned toward the volar or palmar aspect of the wrist rather than the dorsal aspect.

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Smith's fracture

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Orthopedic deformity that results from severe damage to tissues and muscles caused by increased pressure in the forearm compartments. (elbow fracture)

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Volkmann's deformity

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a procedure to set (reduce) a broken bone without surgery. This allows the bone to grow back together. It works best when it is done as soon as possible after the bone breaks

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Closed reduction

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nerve compartment syndrome of forearm (following elbow fracture)

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Volkmann's Ischemia

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external appliances used to support a paralyzed muscle, promote specific motion, or correct musculoskeletal deformity.

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Orthotics

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position of the hand that allows for finger and thumb contact and facilitates manipulation of objects

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prehension

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injury and disease of the bones, joints, and their related structures which include ligaments, tendons, and muscles.

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Orthopedic Conditions Involve

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Fractures, Arthroplasty, Osteoporosis, Osteopenia.

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Name 4 of the most common ortho conditions.

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Rheumatic diseases such as osteoarthritis and osteoporosis.

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Orthopedic Conditions may also be caused by...

question

integrity of the bone Lead to impairments in joints and soft tissue

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Rheumatic Disease Effects

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Arthroplasty, or joint replacement.

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As a result of rheumatic diseases people may need _____ .

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Noticeable aches with movement especially after inactivity. Joint pain Inflammation Stiffness Tenderness Limited ROM Crepitus

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Osteoarthritis signs and symptoms:

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audible or palpable crunching or popping in the joint

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Crepitus

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Pathologic, Closed, Open/Compound, Greenstick, Complete, Incomplete/Hairline, Transverse, Oblique, Spiral

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Name the 9 types of fractures

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Open wound at fracture

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Open/Compound fracture

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Clean break through entire bone

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Complete fracture

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Partial break

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Incomplete/Hairline fracture

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Break at right angle to bone

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Transverse fracture

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Diagonal/Slanted fracture

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Oblique fracture

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twisting fracture line

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Spiral fracture

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localized pain at fracture site deformity edema ecchymosis

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General Signs and Symptoms of Fractures:

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Unintentional Falls FOOSH

answer

What is the #1 cause of fractures?

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In older adults; humerus, wrist, pelvis, and hip

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Where are fractures common?

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Repair and immobilization

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What are two types of treatment for fractures?

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6-12 weeks

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How long is the normal healing time for a fracture?

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Closed Reduction Open Reduction Internal Fixation (ORIF) Open Reduction External Fixation Hemiarthroplasty Arthroplasty

answer

What are the five types of fracture repair?

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Proximal end (shoulder), Distal end (elbow), bone shaft; May effect radial nerve function.

answer

Where are humeral fracture locations possible?

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Wrist fracture

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What is another name for distal radial fractures?

question

Loss of... sensation, strength, movement Limited functional use of hand and possibly the arm

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Distal radial fracture symptoms:

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↓ Functional use of affected hand ↓ Functional use of entire affected UE ↓ Sensation ↓ Strength

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What are some limitations during the repair of a distal radial fracture?

question

scaphoid (often related to sports injuries)

answer

What is the most commonly fractured bone in the wrist?

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Falls and MVA(motor vehicle accidents)

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In what situation are pelvic fractures most common?

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fracture

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fx

question

inability to weight bear on the involved lower extremity referred pain to the knee

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Hip fx symptoms:

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surgical

answer

Most Hip fractures require ______ intervention.

question

mortality/functional

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Hip fractures are the leading cause of _____/_____ decline in the elderly.

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ORIF Hemiarthroplasty

answer

Most common hip fracture repairs

question

Avoid bending past 90 degrees. Avoid twisting leg in or out. Avoid crossing legs

answer

General Weight Bearing Precautions

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Total Hip Replacement

answer

THR

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Total Hip Precautions

answer

THP

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Total Knee Replacement

answer

TKR

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Early Mobilization

answer

What is important for inc outcome in TKRs?

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Bone spurs; Bouchard's Nodes & Herberden's Nodes

answer

What are osteophytes?

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PAIN Relief PAIN Prevention Incision Care Fall Prevention Precautions Complication prevention

answer

Medical Management for fractures includes:

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(non-weight bearing): no weight at all placed on involved extremity

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NWB

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(toe-touch weight bearing: only toe of involved extremity can be placed on ground for balance, 90% of weight still on uninvolved extremity

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TTWB

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(partial weight bearing): 50% of body weight can be placed on involved extremity

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PWB

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(weight bearing at tolerance): clients are allowed to judge how much weight they are able to put on the affected extremity

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WBAT

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(full weight bearing): 100% of weight on involved extremity w/o damage to fracture site

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FWB

question

common in adults over 60, especially women weight bearing restrictions may be necessary, w/ the aid of a walker or crutches, for at least 6 to 8 weeks if there is a severe displacement or the femoral head has a poor blood supply or nonunion the femoral head is surgically removed and replaced by an endoprosthesis (hemipolar arthroplasty)

answer

Femoral Neck Fractures

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-occur mostly in women but in a slightly older age group -usually caused by direct trauma or force over the trochanter (falls) -preferred treatment = ORIF (open reduction and internal fixation) -weight bearing restrictions must be observed according to surgeon's orders for up to 4 months

answer

Intertrochanteric Fractures

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fracture 1-2 inches below the lesser trochanter usually from direct trauma, falls, motor vehicle accident, etc. most often seen in in persons younger than 60 treatment = skeletal traction followed by ORIF

answer

Subtrochanteric Fractures

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*no hip flexion greater than 90 degrees *no internal rotation *no adduction (crossing legs or feet) precautions in place for 6-12 weeks

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Hip Precautions - Posterolateral Approach

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*no external rotation *no adduction (crossing legs or feet) *no extension precautions in place for 6-12 weeks

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Hip Precautions - Anterolateral Approach

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injuries, diseases, and deformities of bones, joints and their related soft tissue structures: muscles, tendons, ligaments and nerves musculoskeletal injuries and conditions result in long term chronic pain

answer

Orthopedic conditions Include

question

help relieve pain, decrease swelling and inflammation, assist in wound care, maintain joint or limb alignment restore function at the injury site retrains the client in ADLs

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Role of OT during Acute Stage

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evidence of bony callus on radiographic examination, although the fracture line is still apparent

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Clinical Union

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Active or passive movement with a predetermined safe arc. allowed movement begins in the middle of the range and is gradually upgraded toward the full arc as healing occurs

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Controlled Range of Motion:

question

achieve a precise and effective stabilization for optimal recovery and resolution of function

answer

The goal of fracture tx:

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Open Reduction Internal Fixation surgically reduces open fractures and those closed fractures that are unstable and where the bone fragments cannot be approximated accurately by closed manual reduction alone

answer

ORIF

question

1.Inflammation Phase - up to 10% of healing time 2.) Reparative/Fibroblastic Phase - up to 40% of healing time 3.) Remodeling Phase - can account for up to 70% of healing time

answer

3 Phases of Fracture Healing

question

Immobilization/Early Mobilization Identify tasks and activities client needs to learn an adaptation or obtain assistance during period of time when movement is restricted so that fracture site remains undisturbed Measurements of ROM & circumference on adjacent joints according to surgeon's protocol

answer

Specialized Focus for fracture from 0-6 wks

question

Early Consolidation Continually assess the client's ability to use the injured limb for functional tasks to correspond with clinical progress Initially measure AROM of the involved joints (shoulder fractures are measured for AA/PROM) Assess edema and sensibility Rate pain on visual analog scale Observe for signs of infection

answer

Specialized Focus for fracture from 6-8 wks

question

follow specific and focused protocols indicating the timing, type and quantity of desired movement in gravity-assisted or gravity-eliminated plane movement may be restricted to midrange and gradually upgraded to full ROM Under careful guidance and manual handling, isometric contraction of the muscles whose bellies extend across the fracture site is encouraged to facilitate circulation and bone healing

answer

Tx during Immobilization/Early Mobilization

question

focused, active use of the limb Direct client in a graduated program to resolve presenting impairments and reintegrate the limb into normal and customary use for functional tasks and role performance edema massage, compression gloves/sleeves and gentle lymph massage Introduce modalities to ameliorate stiffness and/or pain Dynamic splinting, static progressive splinting or the use of continuous passive motion (CPM) to increase passive mobility over time To prevent adherent or hypertrophic scar formation (teach patient deep pressure tissue massage)

answer

Tx during Early Consolidation

question

glenohumeral joint, scapulothoracic joint, sternoclavicular joint & acromioclavicular joint

answer

the shoulder complex is composed which joints?

question

the shoulder

answer

what is Considered the most challenging portion of the body to rehabilitate?

question

stiffness and pain (that is why nonoperative and postoperative therapy programs call for a specific regimen of PROM, AAROM, or AROM within a controlled, guarded range. shoulder motion begins as soon as the acute pain diminishes in the stable shoulder fractures)

answer

Immobilization of the shoulder results in:

question

movement of the limb by an external force to its available or prescribed end range

answer

PROM

question

movement of the limb by an external force to its available end range and then applying overpressure **Passive stretching is contraindicated in the early stage of fracture healing

answer

Passive stretching

question

used post-surgery to mobilize shoulder bend 90' w/ back parallel to floor and support with unaffected arm on a stable surface rock body to swing affected arm in small circles

answer

Codman's pendulum exercises

question

humeral head replacement

answer

Hemiarthroplasty

question

within first 1-2 days after surgery

answer

Rehab program begins for total shoulder arthroplasty

question

Phase I: positioning, Codman's pendulum exercises, and passive assistive exercises (risk of contracture and nerve damage) Phase II: therapist encourages active assisted concentric and eccentric exercises, progressing to AROM and lightly resistive exercises Phase III: addresses both stretching and strengthening

answer

What are the 3 stages to Management of Humeral Shaft or Humeral Neck Fractures?

question

Intercondylar and supracondylar fractures (the extension type) are the most common of the distal humerus fractures that impact elbow function nondisplaced or minimally displaced supracondylar fractures complex elbow fractures (displaced supracondylar fractures and intercondylar fractures), radial head fractures

answer

What are the types of Elbow Fractures?

question

Intertrochanteric hip fractures and femoral neck fractures are the most common fractures in adults older than 50 years of age

answer

What are the most common types of Hip Fractures?

question

open reduction with internal fixation (ORIF)

answer

what is the most common treatment for hip fracture?

question

partial joint replacement in which the femoral head and neck are placed by a prosthesis

answer

Hemiarthroplasty

question

Total Hip Arthroplasty

answer

THA

question

PT teaches patient to use a walker or crutches - focus on GAIT

answer

What is the role of PT following A Hip Fracture & Surgery?

question

OT teaches the patient to complete ADL safely, corresponding to the medical orders and the PT progression for postoperative weight bearing

answer

What is the role of OT following A Hip Fracture & Surgery?

question

evaluation of the patient's ability to perform basic and instrumental ADL safely and independently and the need for adapted equipment and/or assistance of others. educate HIP PRECAUTIONS

answer

What input does OT have on Pt discharge?

question

osteotomy, arthrodesis, hip fusion, hip resurfacing, and partial or total hip arthroplasty

answer

Surgical procedures for Elective Hip Surgery Resulting from Disease

question

procedure to correct the alignment of the femur to relieve weight bearing on the hip joint Not the treatment of choice for treating hip pain as a result of arthritis

answer

Osteotomy

question

fuses the acetabulum with the femoral head at about 25-30 degrees of flexion and in neutral abduction and rotation Not as common as other hip surgeries

answer

Hip Joint Arthrodesis

question

surgically replaces the entire hip joint destroyed by disease or trauma Posterolateral most common approach (vs. anterolateral)

answer

Total Hip Arthroplasty

question

Postoperative education on hip precautions, demonstration of long-handled equipment and medically necessary durable equipment to protect the prosthesis. the OT instructs the patient in adaptive procedures and methods to modify the environment to allow for safe performance of ADL, IADL, and homemaking

answer

What is the first phase of OT Tx for Pt receiving THA?

question

physical findings of injury/disease it is proportional to the diagnosis

answer

Acute low back pain is caused by:

question

pain that extends beyond 3 months post-injury

answer

Chronic pain is defined as:

question

Postural stress and disc degeneration

answer

most common causes of LBP

question

low back pain

answer

LBP

question

spinal stenosis, vertebral fracture, tumor, infection, spondylolisthesis, arthritis

answer

Other causes of LBP:

question

to prevent the patient from developing chronic pain that leads to occupational dysfunction

answer

What is the primary goal in medically managed back care?

question

malingering, symptom magnification, and disease conviction or factitious disorder

answer

What psychological distress disorders and non-physiological behaviors are associated with Chronic LBP?

question

exercise

answer

What can significantly reduce sick leave in patients with LBP?

question

directs the patient in performance of activities in a neutral lumbosacral position teaches the patient to understand, manage and protect the low back by using proper body mechanics and alternative techniques to perform activities at home or at work how to perform activities safely Emphasis on both cognitive and motor learning to develop the patient's understanding and ability to self-regulate motor activity safely

answer

What does OT do to treat LBP?

question

interview about: the pain history and pain reaction during activity in relation to -location -intensity (using a 0-10 pain scale) -quality (sharp, throbbing, burning, etc) -duration

answer

Evaluation of the Patient with LBP involves:

question

performance skills (coordination and strength) client factors (sensory, neuromusculoskeletal and movement related functions)

answer

What client factors are important to include and consider when treating a client?

question

it is used to select appropriate and effective intervention's for client priorities

answer

why is the occupational profile important?

question

Mobilization (first 5-10 days) intermediate or strengthening (1-8 weeks post-op) late or strengthening stage (6-8 weeks post-op)

answer

The rehabilitation process is generally divided into what 3 stages post fx?

question

massage compression active ROM elevation

answer

edema control methods

question

manual edema mobilization

answer

MEM

question

thermal modalities joint mobilization ultrasound e-stim dynamic splinting serial casting AROM PROM

answer

treatments for joint stiffness

question

soft-tissue trauma, edema, and bruising that occur around the fracture site

answer

What types of coexisting conditions should you be aware of for joint replacement?

question

alleviate pain, increase motion, and maintain alignment and stability of the knee joint when conservative treatment has failed

answer

What is the reasoning for a surgical knee replacement?

question

total knee arthroplasty

answer

TKA

question

when two or more compartments of the knee are damaged

answer

When is TKA indicated?

question

if there is medial or lateral compartmental damage between the femur and tibia

answer

When is partial/unicompartmental knee arthroplasty (UKA) indicated?

question

-complications or special procedures that occurred during surgery -additional precautions and risks

answer

Special Considerations for LE Joint Replacements

question

dislocation degeneration of parts fracture of bone next to implanted parts loosening of parts infection after surgery

answer

common complications for LE joint replacement:

question

-chronic disability or consequences of the aging process -one or all of the following: disease of a body part, fear, anxiety, change in body image, decreased functional ability, joint deformity, and pain -without the opportunity to confront these issue the client is likely to become depressed, filled w/ guilt and anxiety, and fear. these emotions inhibit the client's progress and further damage the client's self-image

answer

Psychological Factors

question

primary physician, nursing staff, OT or OTA, PT or PTA, dietician, pharmacist, and social worker/case coordinator

answer

Who makes up a Rehabilitation healthcare team?

question

informs the team of the client's medical status

answer

What is the physician's role in rehab?

question

responsible for physical care of the client during hospitalization, including care and monitoring of the surgical incision

answer

What is the nursing staff's role in rehab?

question

responsible for evaluation and intervention in the areas of musculoskeletal status, LE sensation, pain, skin integrity, and mobility (especially gait)

answer

What is the PT's role in rehab?

question

consults w/ each client to ensure adequate nutrition is received to aid healing process

answer

What is the dietitian's role in rehab?

question

ensures that each client is being discharged to the appropriate living situation or facility

answer

What is the case coordinator's role in rehab?

question

client is ready to start getting out of bed, 1-3 days post surgery

answer

OT typically begins when post surgery?

question

home modifications, safe transfer techniques, use of public transportation, and community mobility tips

answer

topics covered in client education

question

dressing stick, sock aid, long-handled sponge, long-handled shoehorn, reacher, elastic shoelaces, leg lifter, elevated toilet seat, three-in-one commode, and shower chair or bench

answer

common assistive devices for clients w/ hip fractures and joint replacement

question

*supine position w/ an abduction wedge or pillow in place is the recommended sleeping position *side-lying sleeping: sleeping on the operated side is recommended if tolerable, if sleeping on non-operated side the client must keep legs abducted w/ an abduction wedge or pillow

answer

Bed Mobility procedure for Persons w/ Hip Surgery

question

*Standing to sitting: back up to chair, extend the operated leg forward, reach back for the armrests, and slowly lower to the sitting position *Sitting to standing: extend operated leg, push up from the armrests, once standing client can reach for an ambulatory aid *Low chairs, soft chairs, reclining chairs, and rocking chairs should be avoided

answer

Chair Transfers for persons w/ hip surgery

question

three-in-one commode chairs w/ armrests can be used in the hospital or at home

answer

Commode Chair Transfers for persons w/ hip surgery

question

*client is prohibited from taking a bath sitting on the floor of the tub *nonskid strips/stickers recommended *when entering crutches or walker go first, then the operated leg, and then the non-operated leg *shower chair w/ adjustable legs or a stool and grab bars strongly recommended

answer

Shower/bath Transfers for persons w/ hip surgery

question

sit in a chair w/ arms or on the edge of the bed for dressing, maintain hip precautions, use assistive devices

answer

Lower-Body Dressing instructions

question

sponge bathing at the sink is indicated until the physician designates that it is safe for the client to shower, usually 7-10 days post surgery

answer

Lower-Body Bathing instructions

question

until able to shower the client is instructed to obtain assistance for shampooing hair

answer

Hair Shampoo instructions

question

a plastic drainage tube inserted at the surgical site to assist w/ postoperative drainage of blood, should not be disconnected for any activity b/c this would create a blockage in the system

answer

Hemovac

question

large and small triangular foam wedges used when the client is supine to maintain the LE's in abduction

answer

Abduction Wedge

question

fabricated and set up by an orthopedic technician and can be used for 3 days post surgery; it balances the weight of the elevated leg; purpose is to supported the affected LE; client's leg can be taken out of the devices for exercise only

answer

Balanced Suspension

question

used for clients who have hip flexion precautions while sitting

answer

Reclining Wheelchair

question

Sequential Compression Devices

answer

SCDs

question

inflatable, external leggings that provide intermittent pneumatic compression of the legs, used postoperatively to reduce the risk of deep vein thrombosis

answer

SCDs

question

thigh high hosiery that are worn 24 hours a day and removed only during bathing, purpose is to assist circulation, prevent edema, and thus reduce the risk of deep vein thrombosis

answer

Antiembolus Hose

question

an IV

answer

PCA is delivered through

question

patient-controlled analgesia

answer

PCA

question

patient-controlled epidural analgesia is delivered through an epidural line

answer

PCEA

question

portable breathing apparatus used to encourage deep breathing and prevent the development of postoperative pneumonia

answer

Incentive Spirometer

question

Continuous passive motion machine

answer

CPM

question

mechanical device that supports a joint and can be set to move slowly through a designated ROM to promote controlled movement in the operated joint

answer

A Continuous passive motion machine does what?

question

A force system designed to control, correct, or compensate for a bone deformity, deforming forces, or forces absent from the body and often involves the use of special braces

answer

Orthosis

question

Orthotic device for immobilization, restraint, or support of any part of the body

answer

Splint

question

Mobility of the hand is directly related to the type and condition of the skin

answer

Skin considerations

question

no movable parts and immobilizes a joint of part; used to rest or protect, to reduce pain, or to prevent muscle shortening or contracture

answer

Static splint

question

achieves a slow, progressive increase in ROM by repeated remolding of the splint or cast

answer

Serial static splint

question

includes a static mechanism that adjusts the amount or angle of traction acting on a part.

answer

Static progressive splint

question

limit joint ROM but don't completely stop joint motion

answer

Restriction splints

question

may be fit for protection to prevent injury, rest to reduce inflammation or pain, or for positioning to facilitate proper healing after surgery

answer

Immobilization splints

question

are designed to increase limited ROM or to restore or augment function

answer

Mobilization splints

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