question

Hip Fracture ORIF Indications

answer

Femoral head & neck fx When closed methods cannot maintain adequate fixation

question

ORIF Components

answer

Screws Plates Rods Pins Wires

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Hip ORIF WB Status

answer

WBAT Might be PWB or NWB if surgeon states precautions

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Hip Fracture

answer

Intracapsular: subcapital Extracapsular: intertrochanteric, subtrochanteric

question

Gait Speed and Hip Fx

answer

Prediction of hip fx: SSWS < 0.69 m/s SSWS post hip fx: meaningful change = 0.11 - 0.25 m/s, MDC = 0.8 - 0.82 m/s, MCID = 0.1 m/s, ICC = 0.82 - 0.97 Prediction of gait speed post hip fx: LE strength best predicts walking speed

question

Types of Hip Arthroplasty

answer

Hemiarthroplasty: replacement of the femoral component only Total hip arthroplasty (THA): both femoral head and acetabulum replaced

question

Hip Hemiarthroplasty Types

answer

Unipolar hemiarthroplasty (UH): cup articulates directly with hip socket Bipolar hemiarthroplasty (BH): additional inner bearing (lining) between the stem and endoproesthetic head component (metallic acetabular cup)

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Hip Arthroplasty Indications

answer

OA Fracture: femoral neck, acetabular, trochanteric RA Bone tumors Avascular necrosis

question

Lateral Hip Arthroplasty

answer

Elevation of hip abductors Lower risk of dislocation

question

Anterior-lateral Hip Arthroplasty

answer

Interval between TFL and gluteus medius Risk of injury to lateral femoral cutaneous nerve

question

Posterior-lateral Hip Arthroplasty

answer

Most common Does not compromise abductor mechanism of the hip Higher risk of dislocation

question

Signs of Dislocation of Hip

answer

Shorter hip Interntal rotation Pain

question

Posterior Approach Precautions

answer

No hip flexion > 90 degrees No hip IR beyond neutral No hip adduction past neutral Can use an abductor pillow

question

Anterior Approach Precautions

answer

No hip extension past neutral No hip ER

question

Trochanteric Osteotomy

answer

May be performed in difficult primary THA or in THA revisions Additional precaution: no active abduction

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PT After THA

answer

BID If possible, time tx with pain medication Pt to be up in chair for meals Compression mechanisms always on the patient, to prevent DVT while they eat, etc.

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PT After THA DOS

answer

If PM sx: dangle at bedside, ankle pumps, encourage incentive spirometer If AM sx: OOB transfers, instruct in hip precautions, gait training, ankle pumps, encourage incentive spirometer

question

PT After THA POD #1

answer

Ther ex Transfer Gait training Review hip precautions Encourage incentive spirometer

question

PT After THA POD #2

answer

Same as #1 but add curb/stair training Some may be discharged home, if so, car transfer training

question

PT After THA POD #3

answer

Same as POD #1 & 2 Most are discharged home and to another level of care

question

Mobility After THA

answer

Supine sit: usually do not go side lying Bed chair: use of walker, surgery LE extended in sit stand, may need pillow or raised

question

Post THA Therapeutic Exercise

answer

Ankle pumps Quad sets Gluteal squeezes Heel slides SAQ Hip abduction/adduction (unless trochanteric osteotomy was done) Standing heel raises Partial knee bends Standing hip flexion Standing hip abduction (unless trochanteric osteotomy was done) Standing hip extension

question

Adaptive Device Use After THA

answer

Reachers/grabbers Dressing stick Long-handled sponge Toilet seat riser Sock aid

question

Direction the Patient Should Turn When Walking Post Anterior Approach THA

answer

Toward the affected leg (b/c no ER past neutral)

question

Total Knee Arthroplasty (TKA)

answer

Tibial, femoral, and patellar components Metal, plastic, ceramic Unilateral or bilateral Partial

question

TKA Indications

answer

OA RA Post-traumatic arthritis

question

PT After TKA

answer

BID Is possible, time tx with pain medication Pt to be up in chair for meals

question

PT After TKA DOS

answer

If PM sx: dangle at bedside, ther ex, measure ROM, encourage incentive spirometer, continuous passive motion machine (if ordered by physician) If AM sx: OOB transfers, ther ex, gait training, measure ROM, encourage incentive spirometer, continuous passive motion machine (if ordered by physician)

question

PT After TKA POD #1

answer

Ther ex Transfer training Gait training (get the reciprocal ASAP) Measure ROM BID (want 0-90, do not put pillows under knees because want them in extension) Instruct in HEP Encourage inceptive spirometer CPM (if ordered by physician)

question

PT After TKA POD #2

answer

Ther ex Transfer training Gait training (stairs, curbs) Measure ROM BID Review HEP Encourage incentive spirometer CPM (if ordered by physician) Some may be discharged home, and if so, car transfer training and confirm appropriate gait AD for home

question

PT After TKA POD #3

answer

Same as POD day 1 & 2, and most are discharged home

question

TKA Considerations

answer

No pillows under knee Push knee ROM Goal is to have at least 0 degrees ext and 90 degrees flexion before leaving hospital

question

Continuous Passive Motion (CPM)

answer

Pt controls Fitted to pt's size Sheepskin padding Foot plate Check for pressure! Increased daily per MD orders

question

Mobility After TKA

answer

Supine sit: slow lowering of foot to floor (when stand to sit, keep leg forward, sit down w/ other leg) Bed chair: might use AD, stand pivot transfer

question

Post TKA Therapeutic Exercise

answer

Ankle pumps Quad sets Heel slides SAQ SLR Hip abduction/adduction Seated hip flexion LAQ Seated knee flexion Standing heel raises Partial knee bends Standing knee flexion Standing hip abduction

question

Adaptive Device Use After TKA

answer

Reachers/grabbers Dressing stick Long handled sponge Sock aid

question

External Fixators

answer

Aluminum or titanium percutaneous pins inserted at oblique or right angles to the long axis of a bone that connect externally to a frame

question

External Fixators WB Status

answer

Could be NWB

question

External Fixators Precautions

answer

Look for pin loosening and infection Clean discharge 2x a day & put antiseptic on it

question

Types of Shoulder Arthroplasty

answer

Total shoulder arthroplasty: both the HH and glenoid replaced Shoulder hemiarthroplasty: just the HH is replaced Reverse total shoulder arthroplasty: both the HH and glenoid replaced and switched

question

TSA Indications

answer

OA RA Post traumatic arthritis Severe fx Avascular necrosis Rotator cuff arthropathy

question

Precautions After TSA

answer

Proper positioning in bed (support humerus) Use sling for upright activities initially Initially: no AROM No extension past neutral No ER past neutral No WB No pushing, pulling, or lifting No driving for at least 4 weeks

question

Reverse TSA

answer

Socket and ball are switched Allows use of the deltoid instead of he RC for elevation

question

Reverse TSA Indications

answer

Completely torn RC with severe UE weakness RC arthropathy Failure of previous TSA

question

Precautions Post rTSA

answer

No IR past neutral No extension past neutral No adduction past neurtral

question

Post TSA Therapeutic Exercises

answer

Joint protection, sling Pendulum exercises PROM shoulder (flexion to 90 degrees, preferably in scapular plane, ER to 30 degrees) Shoulder shrugs AROM elbow, wrist, hand

question

Spine Surgeries

answer

Discectomy: removal of all or part of disc that has herniated Laminectomy: portion of the lamina is removed to relieve pressure/compression Vertebroplasty/kyphoplasty: cement mixture injected into bone for compression fracture Fusions

question

Spine Immobilization

answer

Cervical collars and braces Thoracolumbosacral orthosis (TLSO) Lumbar support

question

Cervical braces/collars

answer

Soft cervical collar Philadelphia collar Halo

question

Types of Braces

answer

Cervicothoracolumbar orthosis (CTLO) Thoracolumbosacral orthosis (TLSO) Lumbosacral orthosis (LSO) Lumbar support/corset Abdominal binder (for people who are orthostatic HTN post abdominal surgery)

question

Post Spine Surgery Precautions

answer

No bending, lifting, twisting Restrict rotation Restrict flexion and extension Lifting limited to 5-10# (per MD) No pushing or pulling

question

Mobility After Spine Surgery

answer

Supine sit: log roll Bed chair: may have restricted sitting time

question

Therapeutic Exercise After Spine Surgery

answer

Quad sets Glute sets Ankle pumps Partial heel slides Hip abduction SAQ TA pelvic stabilization (just tightening the core in place) Standing heel raises Partial squats Standing hip abduction

question

Chest Surgery/Post Sternotomy Risks

answer

Dehiscence: separation of the tissue Mediastinitis: infection in wound, need excessive debriedment Sternal instability: pops or clicks

question

Sternal Precaustions

answer

Depends on patient "Move in the tube"

question

Sternum Support Harness

answer

Provides circumferential resistance to increase intrathoracic pressure during forceful activity

question

Sternal Instability: Clinical Features

answer

Pain/discomfort Excessive motion/clicking of sternal segments Disruption of ADLs

question

Activities Post Sternotomy

answer

Deep breathing and cough as exercise: NO Deep breathing and cough as needed: YES Trunk exercise: YES Mobility: YES Cycling: YES Supportive devices: YES Gait aid if needed: YES

question

Pacemaker Function

answer

Uses electrical pulses to prompt the heart to beat at a set rate or demand Usually on L, but not always if there are special precautions

question

Pacemaker Indications

answer

Symptomatic bradycardia Sinus node dysfunction AV block Neurally mediated syncope or carotid sinus hypersensitive Cardiac transplantation Sleep apnea syndrome Tachycardia Arrythmias

question

Post Pacemaker Implantation Precautions

answer

Arm in sling No lifting > 10# L UE to remain below shoulder height for 4-6 weeks Avoid activities that stretch pectoralis Lead is sutured to the pectoralis muscle and the pacemaker is placed in a pre-pectoral pocket

question

Implantable Cardioverter-Defibrillator (ICD) Function

answer

Delivers electric shock to restore normal heart rhythm when an abnormal/life threatening rhythm is detected

question

ICD Indications

answer

Primary and secondary prevention of sudden cardiac arrest

question

Post ICD Precautions

answer

Avoid driving for at least 7 days to allow healing has been recommended

question

Gait Speed & Cardiac Sx

answer

Slow gait speed (<0.83 m/s) associated with an increased risk of in hospital complication in elderly population Increased readmission risk <0.8 m/s in patients with heart failure

question

Mobility Post Abdominal Sx

answer

Abdominal binder Log roll No "sit up" type of motion Secure surgical drain during mobility Instruct to exhale with effort Lifting restrictions per MD

question

Gait Speed

answer

The "6th Vital Sign" Easy to measure Can be a predictor of mortality, assistance levels Documents progress For acute care (not diagnosis specific): MDC = 0.16 m/s

Physical Therapy Management of the Surgical Patient – Flashcards

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