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Treatment of femoral shaft fracture
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Section 1
(50 cards)
Treatment of femoral shaft fracture
Almost always with surgery Most common procedure is to insert intramuscular your rod through center of femur
magnetic resonance imaging (MRI)
A noninvasive medical test that aids and diagnosis and treatment of medical conditions. Utilized to distinguish pathological tissue from normal tissue
What ligament is normally injured when the lateral side of the knee is struck?
MCL Susceptible to tearing when it has been stretched too far
Treatment for ITT
Foot orthotics during the day, Dennis brown bar at night.
Treatment for osteoarthritis
Drugs to slow prevention Pain relievers Hyaluronate injuries PRP injections Stem cell injections Bone marrow aspirate
MRI indications
Head: tumors and aneurysms Chest: blood vessels of heart and lungs Blood vessels: finds blockage in veins and arteries Abdomen and pelvis: tumors, bleeding, infection, and blockage of abdominal organs Bones and joints: cartilage, ligaments, tendons, muscle dysfunctions Spine: discs and nerves of the spinal column
Colles Fracture
fracture of the distal radius at the wrist
This stress injury is caused by repeated flexion of the elbow
Golfers elbow
How can the patella be tracked back into place?
Extension of the leg
Common causes for ACL injury
Sports injury Rough play Motor vehicle accidents Falls
CT scan indications
Muscle and bone disorders such as bone tumors and fractures Utilized to pinpoint the location of a tumor infection or blood clot Guide procedures such as surgery biopsy and radiation therapy Utilize to detect and monitor diseases such as cancer or heart disease Utilized to detect internal injuries and internal bleeding Pregnancy is CONTRAINDICATION
Degradation of the articulations cartilage, increased viscosity of synovial fluid and thickening of joint capsule decreased range of motion are all signs of what?
Osteoarthritis Also see exposure of subchondral bone-> vascularization->eburnation->subchondral cysts
This stress injury is caused by kneeling or leaning forward for a long period of time
Housemaids knee
Patellar subluxation is commonly seen in (young/elderly) (males/females)
Young females Usually chronic condition Poorly conditioned vastus medialis
Grade 4 muscle testing
Patient can hold the position against strong to moderate resistance has full range of motion
Orthotic bracing for OA
Knee orthosis Unloading knee brace
Bursitis
Inflammation of bursa Caused by: injury, infection, overuse, underlying rheumatic condition, leg length discrepancy Tx: ice, rest, aspiration if swelling continues, canes walkers, PT
What braces are used for patellar subluxation?
BREG PTO Palumbo knee brace Lateral J brace
Patient assessment
Take a comprehensive patient history Perform diagnosis specific functional examination Consult with other healthcare professionals Provide patient education Document assessment in patient chart Make patient referrals
Contractures
Pathological abnormal shortening of muscle. Can lead to atrophy of muscle Piece of bone or other tissue blocking movement. Being in wheelchair. Knee replacement components in wrong position Tx: stretching, release of hamstrings in knee flexion contracture
X-ray imaging is used for
Bone disturbances: fractures, tumors, etc. The denser the material, the whiter the image will appear
Describe pain in osteoarthritis
No nerve ending in articulations cartilage Intraosseous pressure Synovitis Muscle fatigue and spasm Pathophysiological Changes to surrounding ligaments bursa and menisci
Is genu Valgum more often seen in men or women?
Women
Roles and responsibilities of a CPO
Patient assessment Formulation of a treatment Implementation of a treatment plan Follow-up treatment plan Practice management Promotion of competency and enhancement of professional practice
Causes of osteoarthritis
Previous knee injury Repetitive strain on the knee Age Genetics Obesity Bone disorders
Primary symptoms of knee osteoarthritis
Pain Tenderness Grafting sensation Stiffness of knee joint Limited ROM Localized edema
Where does a tibial plateau fracture occur?
Just distal to the knee joint Can lead to knee arthritis
This stress injury is caused by repetitive extension of the wrist
Tennis elbow
MRI contraindications
Brain aneurism clip Implanted neural stimulator Implanted cardiac pacemaker or defibrillator Cochlear implant Ocular foreign body Other implanted medical devices Insulin pump Metal shrapnel or bullet
At what degree is surgery required to treat ITT for patients greater than what age?
10 degrees after ages 6-8
What are the grades for PCL/ACL injuries?
Grade 1: stretched, mild damage Grade 2: partial tear Grade 3: complete tear of ACL/PCL along with another ligamentous injury
Pigeon toed refers to what condition common in early childhood?
Internal tibial torsion Considered normal until 18-24 months of age Possible genetic factors and in utero position (exact cause unknown)
Where does a tibial plafond fracture occur?
Just above the ankle joint and often involves the Cartlidge surface of the ankle joint at the ankle mortise.
Grade 2 muscle testing
Patient has all or partial range of motion in the gravity eliminated position
What ligament is damaged in a "dashboard injury"
PCL
Where does an intertrochanteric hip fracture occur?
Just distal to femoral neck Surgical treatment involves placement of screw and plate at site of fracture
What is the most common type of tibial fracture?
Shaft of tibia Can be treated with usually with long leg cast If too much displacement or angulation, surgery may be required to realign the bones
Grade 5 muscle testing
patient can hold the position against maximum assistance and through complete range of motion
Most common cause of disability in the United States?
Osteoarthritis
What ligament is damaged when the tibia is translated too far anteriorly in relation to the femur?
ACL
What are areas most affected by repetitive stress injuries?
Elbows Shoulders Knees Heels
Grade 1 muscle testing
The muscle can be palpated while the patient is performing the action in the gravity eliminated position
Computed Tomography (CT Scan)
Produce cross sectional images of the body using x-ray. Provides detailed image of internal structures.
Grade 3 muscle testing
Patient can tolerate no resistance but can perform the movement throughfull range of motion
What are common causes for femoral shaft fractures?
High speed motor vehicle collisions and falls in the elderly Often one of several injuries suffered by patient
What are possible causes of genu varum?
Intrauterine positions Rickets Various bone disorders Obesity
What is the most common form of osteoarthritis?
OA of the knee
Which direction does the patella usually slide when subluxated?
Laterally
Grade 0 muscle testing
No contractile activity can be felt in the gravity eliminated position
Where do overuse injuries most often occur in teenagers
Growth plates
Section 2
(50 cards)
What tests or examinations are used to diagnose a disk herniation?
Tendon reflexes straight leg test or bowstring test x-rays for degeneration of the spine MRI electromyogram maybe utilized to document which nerves are being irritated by the disc herniation
What is the difference between rigid and flexible pes planus?
Rigid occurs when the longitudinal arch is absent both and nonweightbearing and weight-bearing positions Flexible occurs when the launch to an arch is present when the patient is nonweightbearing but is absent during weight-bearing. this is commonly seen in children
Common orthotic treatment for plantar fasciitis
Anti-inflammatories corticosteroids physical therapy for stretching night splints custom molded foot orthotics surgery as last intervention
Convex pes valgus treatment
Provide functional, stable, pain free foot Non-surgical- stretching, physiotherapy, serial casting and manipulation 6-8 weeks Surgery (9-12months)- correct bone position, soft tissue release, tendon balancing
This injury occurs when there is a dislocation or fracture and dislocation is between the 4 foot and mid foot joints
Lisfranc fx
Treatment options for metatarsus adductus
Orthopedic shoes stretching or passive manipulation exercises casts surgery Occurs in approximately one out of 1000 to 2000 live births and affects girls and boys equall Majority are flexible and resolves by 3 to 4 years of age 10% are stiff and may benefit from casting
Non surgical interventions for hallux rigidis include
Shoe modifications with high toe box and rocker bottom soles Orthotic devices custom molded foot orthotics Medications, injection therapy, and physical therapy
What are common treatments for Morton's neuroma?
Icing orthotic devices medications activity modifications shoe modifications injection therapy
What is the term for a fracture at the base of the fifth metatarsal bone?
Jones fracture Pain along outer side of foot, swelling and difficulty walking
Sanders classification for calcaneal fractures
1: non-displaced posterior facet (talocrural articulation) 2: two-part fracture 3: three-part fracture with depression of posterior facet 4: severely comminuted fracture
This condition involves an abnormal bony cartilaginous or fibrous connection that develops between two bones in the tarsal portion of the foot
Tarsal coalition Calcaneonavicular Talocalcaneal The connection can be composed of bone cartilage or fibrous tissue and may lead to decreased motion and pain in one or both feet
What condition is described by an osseous formation at the insertion of the Achilles tendon at the calcaneus?
Haglund's deformity (pump bump) Protrusion at the back of heel leads to bone spur that puts pressure on the bursa. Treatment is aimed to reduce swelling and irritation but will not shrink the bony protrusion
This condition usually sees a benign tumor between third and fourth metatarsal's. Pain develops between the third and fourth metatarsal's because of the union of the plantar nerves.
Morton's neuroma
Signs and symptoms of pes planus
Absent arch Tired feet Complaints of pain after weight gain Heel tilts away from midline when viewed on the coronal plane
Orthotic intervention for rear foot varus
Medial rearfoot varus posting with custom foot orthotics
What condition involves the first metatarsal in a neutral position being below the plane of the metatarsals two through five?
Plantar flexed first ray Flexible and rigid deformities treated with custom molded foot orthotics with a first Ray relief surgical intervention if needed will be an osteotomy
What condition causes the distal portion of the foot to turn inward?
Metatarsus adductus Also termed metatarsus varus Can be flexible which means the foot can be corrected by hand or rigid meaning it cannot be straightened
Clinical tests for pes planus
Wet footprint
A condition in which the rear of the foot tends to curve inward at the ankle due to inversion
Rear foot varus Vegas ankle is present. Patients are susceptible to ankle strains and sprains due to the position of the hind foot perhaps the most common foot disorder seen.
Common treatment for Lisfranc fracture
Commonly treated surgically with either internal or External fixator's
Herniated disc treatment includes
Physical therapy muscle relaxant medication pain medications anti-inflammatory medications local injection of steroids orthotic management decompression of disc surgical operations: discectomy, laminectomy Only 10% of people with herniated disc problems eventually have surgery Lumbosacral orthosis are used post-op
Posterior tibial tendon dysfunction
Caused by elastic changes in the posterior tibial tendon impairing its ability to support launch to an arch of the foot. This results in flattening of a longitudinal arch with front of foot sliding to the outside.
What fracture does the term "aviators astragalus" refer to?
Talus fracture: high speed motor vehicle accident or high fall Most require surgery
What are causes and treatments of tarsal coalition's?
Causes Most often occurs during fetal development resulting in the bones not developing properly less common causes of tarsal coalition include infection arthritis previous injury to the area Nonsurgical treatments include oral medications physical therapy orthotic devices such as custom AFO's immobilization surgical management involves osteomy and removal of hole coalition in the space is filled with soft tissue
Degenerative disorder of the joint located at the base of the first metatarsal
Hallux rigidus: causes pain and stiffness in the MTP joint Overtime it is increasingly more difficult to flex/extend the great toe
Misaligned metatarsals and everted foot can be seen in what condition?
Forefoot valgus: first two metatarsals are plantarflexed Patient supinate and may lead to calcaneal varus. Compensation may result in stretched peroneal muscles
Orthotic management for pes planus
Flexible - calf stretching. Not effected by inserts or special shoes or braces. No treatment under age of 3 Rigid- Appropriate footwear, customer and arch supports, scaffold pad, UCBL, surgery in extreme cases
What is a treatment for metatarsalgia?
Custom Foot orthotics with metatarsal pad
What are classifications for vertebral fractures?
Minor - spinous processes and facet joints Major- vertebral body, pedicles and lamina Stable- no spinal deformity or neurological problems Unstable- Weight bearing is a problem and can cause deformity and further damage
What can be seen with a disc herniation at the L5 S one level
Pain over sacroiliac joint hip posterior lateral thigh and leg to heel Numbness on back of calf, lateral heel, foot to toe Weakness and plantar flexion of foot in great toe , difficulty walking on toes Atrophy and gastrocnemius and Soleus Ankle jerk diminished or absent
This stress fracture in the foot can often be seen and athletes that use explosive movement or sudden directional change
Navicular stress fracture Tx: CAM walker or crutches
Orthotic management for first day insufficiency
Custom FO Cluffy wedge
What are red flags for cauda equina syndrome?
Bladder or bowel incontinence saddle paresthesia sexual problems
Morton's toe is also called
First ray insufficiency: short 1st metatarsal (hypermobile) Callus under second and third metatarsal Metatarsals 2-5 take on most of the stress
This condition shows over pronation and a foot pointing up. Fairly common foot deformity at birth.
Talipes Calcaneovalgus Resolves spontaneously or with stretching exercises may be associated with hip dysplasia uterine positions are thought to be responsible unilateral or bilateral differential diagnosis is vertical talus which require surgery
This condition can be seen as extreme supination in infants.
Talipes equinovarus One or both feet turned in word. More common in boys than girls. Incidence one in 1000 Risk factors may sometimes be genetic or smoking during pregnancy
What are common orthotic interventions for posterior tibial tendon dysfunction?
Custom molded foot orthotics ankle foot orthosis Arizona orthosis Richie brace
Condition where the longitudinal arch collapses and is in contact with the ground during weight bearing
Pes planus: all infants have it, most children have it, 15% of adults have it
Dislocation of the talonavicular joint and dorsal dislocation of the navicular does ally are signs of what continental condition?
Convex pes valgus Occur in less than 1% of live births 71% of the time in it bilateral
What are four different toe deformities and how are they treated?
Claw toe Hammer toe Mallet toe Curly toe Treated with stretching or foot orthosis with met pad rocker bottom shoe with deep toebox Typically does not resolve, flexible deformities become rigid with age
What can be seen with a herniation at the L4 L5 level
Pain over sacroiliac joint hip lateral thigh and leg Numbness of the lateral leg and first three toes Weakness in dorsiflexion of great toe and foot difficulty walking on heels foot drop may occur
What is the most destructive abnormality to the lower extremity?
Forefoot varus: A congenital osseous deformity in which the forefoot is inverted in neutral position of subtalar joint Calcaneus is everted to compensate and navicular can collapse to allow forefoot to contact surface
What is plantar fasciitis?
Inflammation of the plantar fascia leading to heel pain. risk factors include age sex type of activities occupation pes cavus planus over pronation of the foot overweight ill fitting shoes tight Achilles' tendon
Signs and symptoms of disc herniation
Common herniation between L4 L5 or L5 S1 Pain numbness tingling diminished reflexes muscle weakness MSK spasm
What are common symptoms of posterior tibial tendon dysfunction
The most common symptom is pain after activity. Swelling on inside of ankle weakness or inability to stand on toes tenderness over Midfoot
Treatment of Talipes Equinovarus or club foot
Stretching and casting stretching and taping Dennis brown splint/bar reversed last shoes 90% of routine club foot response may need to lengthen the Achilles' tendon
What can lead to compression fractures of the vertebrae?
Osteoporosis bone cancers abnormal load in normal spine vehicle accidents fall from height diving in shallow water
This condition leads to bunions
Hallux valgus Custom foot orthotics, custom night splint, or bunionectomy if severe
This is a condition where the nucleus pulposis of the vertebral body leaks into the nucleus fibrosis
Disk herniation
Condition marked by pain and inflammation in the ball of the foot
Metatarsalgia Often located under the second third and fourth metatarsal heads One or more of the metatarsal heads become inflamed and painful
Section 3
(50 cards)
What disorders can lead to neuromuscular scoliosis
Cerebral palsy polio muscular dystrophy spina bifida Progressive and worsens during growth continues into adulthood may be unable to sit lung function may be severely affected quality-of-life affected
Causes of non-structural (reversible) idiopathic scoliosis
Poor posture pain and muscle spasms spinal lesion leg length discrepancy
What are causes of spinal fractures-dislocations?
Vehicular accidents- rotational and sometimes lateral force superimposed on a flexion injury Fracture with dislocation unstable: PLL is torn facet joints may be fractured superior portion of vertebral body sheared off and spinal column is dislocated Neurological injury common
What motion can cause transverse process fractures?
Extreme twisting or extreme side bending, direct impact this is uncommon
At what age is spinal stenosis more common?
60 and older
What cranial deformity is present when the ear and possibly forehead or displaced anteriorly on the side of posterior flattening?
Positional plagiocephaly or occipital flattening Sutures are not fused head appears to have parallelogram shape flattened occipital region due to laying on their back without changing position torticollis can also contribute Occurs after birth often confused with lambdoid craniosynostosis
Treatment of round back
Strengthening exercises and body bracing Scheurmann's disease is treated with TLSO and PT Surgery- spinal fusion
Prevention and treatment of plagiocephaly
Carrie frequently instead of putting down limit car seat/bouncy seat/carrier use special pillow or mattress encourage child to look in different directions Cranial remolding helmets
Symptoms and diagnosis of round back
Mild back pain: dowager's hump Tenderness and stiffness in the spine difficulty breathing muscle fatigue diagnosis x-rays CT MRI lung function test
What ages are involved in juvenile idiopathic scoliosis?
4 to 9 years old
Clinical feature in diagnosis of osteomyelitis of the vertebra
Back pain and reluctance to burn forward irritability and loss of appetite elevated ESR with normal white blood cells radiography demonstrates decreased disk space and ostial lysis differential diagnosis maybe spinal TB punch biopsy may be necessary
Complications with plagiocephaly
Delayed milestones of learning or development increased need for special services when the child reaches school-age orthodontic and TMJ issues scoliosis visual disturbances including visual field defect and astigmatism auditory problems psychological/social issues torticollis often associated
85% of spondylolisthesis occur at which vertebrae?
L5
What is kyphosis
The anterior posterior curving of spine scene and cervical spine Round back or hunchback can be caused by developmental problems (scheurmann"s disease) degenerative disease or trauma
What percent of cerebral palsy patients have scoliosis?
20%
Orthotic treatment for scoliosis
Boston brace for 18 hours or more per day Charlston bending brace for nighttime wear Kabbalist brace and Wilmington brace also used
What percent of idiopathic scoliosis is structural?
85% Neuromuscular disorders birth defects injury, infections, tumors
What symptoms can be seen in physical examination of adolescent idiopathic scoliosis?
One shoulder higher uneven hips symptoms include back ache tiredness abnormal gait visible curving clothes don't fit properly
Treatment for vertebral osteomyelitis
Bedrest body cast operative drainage In children disk space for me is permanently narrowed In adults spontaneous fusion occurs occasionally back pain persists and requires spinal fusion
Possible causes for acquired torticollis
Infections or tumor of neck malfunction of nervous system arthritis of neck acid reflux in infants injury occasionally infants with torticollis have a higher risk for plagiocephaly
What is the most common type of idiopathic scoliosis?
Adolescent idiopathic scoliosis greater than 10 years old and greater in females
Where is vertebral osteomyelitis most commonly found?
Lower thoracic and upper lumbar spine route may be via Batsons plexus or paravertebral vans
Predisposing factors for craniosynostosis
Genetic disorders white males advanced maternal age maternal thyroid disease fertility medications just before or during early pregnancy Teratogan- smoking drugs and environmental effects
At what angle is scoliosis usually treated?
Greater than 25° or progressing by 10° use of TLSO is utilized for progressive curves if curve reaches 50° it will be expected to worsen and surgical intervention will be required
What is the forward slipping of the vertebral body in the spinal column superior to it typically occurs between L5 and S1
Spondylolisthesis Most common type of secondary to bilateral pars interarticularis defect or spondylolysis degenerative types occur due to degenerative disc disease leading to osteopythic compression of nerve roots Pathological weakness or trauma can also lead to spondylolisthesis
Diagnosis for scoliosis
Cobb method of angle measurement from scoliosis radiographs Less than 10° is normal Idiopathic if there is no underlying cause greater than 40° is severe X-RAY MRI
Possible causes for congenital torticollis
Birth trauma intrauterine position shortening or spasm of SCM hip dysplasia may be present along side differential diagnosis Klippel-Feil syndrome (malformation of the cervical spine)
What condition is characterized by the head tilting to one side with chin pointing to opposite side?
Torticollis (wry neck) Discovered 6 to 8 weeks congenital: hyper trophy and contracture acquired: spasmodic torticollis
Burst fractures in the vertebra can be caused by
Severe trauma axial loading of spine multiple fractures of vertebral body anterior and middle columns involved with unstable fracture displacement of fragments more severe than compression fractures
Risk factors of osteoarthritis
Aging more than women after 45 repetitive trauma to the spine genetic defect of cartilage overweight family history of osteoarthritis in association with other diseases such as rheumatoid arthritis, gout, diabetes and infections
At what age does De Novo scoliosis occur
After 40 Arthritis or degeneration of spine
Orthotic intervention for torticollis
TOT collar- 4 months or more with a tilt of 5 degrees or more Physical therapy surgery in extreme cases TMJ involvement
Degeneration of disks and cartilage that affects neck and lower back and is more common in women after 45
Osteoarthritis
What vertebra is affected in a hangman's fracture?
C2 Bilateral pedicle fracture involving the C2 vertebrae anterior subluxation of C2 over C3 result from now hyperextension when face hits a hard surface lethal in most cases (phrenic nerve)
Flat head syndrome refers to which cranial deformity
Brachycephaly Sutures are not fused wide head increased height at back of head prolonged pressure at back of head
Diagnosis and treatment of osteoporosis
Postural distortion radiography DEXA scan Treatment prevention of further bone loss estrogen anabolic hormones calcitonin vitamin D
What are some treatments of spinal fractures?
Medication - anti-inflammatory, muscle relaxants, activity control Physical therapy braces surgery - Restore spinal alignment, spinal stability, reduce neurological complications, rehabilitation
The seatbelt fracture refers to which fracture?
Chance fracture hyperflexion injury anterior column compressed transverse fracture through post column intra-abdominal injuries common commonly seen between T 12 and L2
Vertebral osteomyelitis is most common in what age group?
Can occur at any age but is more common in young children
What condition occurs when osteoblastic activity is decreased and osteoclastic activity is increased?
Osteoporosis Vertebral bodies become wedge shaped due to microfractures resulting in dorsal kyphosis pressure from the resilient intervertebral disc eventually result in biconcave vertebral bodies
Treatment for spondylolisthesis
Approximately 5 to 6% of males in 2 to 3% of females have a spondylolisthesis Treatment ranges from observation to surgical stabilization of the spine Treatment plan depends on the age of the patient type of slippage and the symptoms experience by the patient
Signs symptoms and diagnosis of osteoarthritis
Neck or back stiffness weakness or numbness of arms or legs depression Diagnosis History or exam evaluation of symptoms x-rays or MRI blood test to exclude other conditions
Preventing and treating positional plagiocephaly or brachiocephaly includes
Start early Tummy time to strengthen neck muscles and encourage movement as well as hand and motor development alternate head positions while sleeping or carrying baby use visual stimuli
Clinical features and treatments of spondylolisthesis
Typically patient presents with no signs or symptoms, happens after injury or chronic strain pain may persist and require bracing
What condition involves a premature closure of one or more sutures?
Craniosynostosis Abnormal shaped skull can be associated with microcephaly can lead to increased intracranial pressure early intervention reduces possible adverse effects on brain development scaphocephaly greater than 50% sagittal suture leads to boat shaped head
Signs and symptoms of spinal stenosis
Pain numbness muscle weakness Bowel/ bladder function problems treatment pain relief physical therapy lumbar traction surgery if above do not help (laminectomy)
What is the grading system for spondylolisthesis?
Grade 1 is 0 to 25 grade 2 is 25 to 50 grade 3 is 50 to 75 grade 4 is 75 to 100 Numbers refer to percent translated upon its articulating vertebrae
What is the narrowing of open spaces in the vertebral column?
Spinal stenosis Congenital lumbar stenosis is relatively rare and usually present between 30 and 40
Treatments to help relieve symptoms and increase function of joints in osteoarthritis patients
Physical therapy exercise heat or cold therapy hydrotherapy massage acupuncture tens unit to the affected joint bracing surgery if spinal stenosis results
What percent of muscular dystrophy patients have scoliosis
60 to 90%
Section 4
(42 cards)