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Clinical Management of acute orthopedic injuries. Kylie Miller Starr, PT, DPT, ATC Lafene Health Center Kansas State University. objectives.

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clinical management of acute orthopedic injuries

Clinical Management of acute orthopedic injuries

Kylie Miller Starr, PT, DPT, ATC

Lafene Health Center

Kansas State University

objectives
objectives
  • Participants will understand and be able to correctly utilize clinical prediction rules to determine necessity of radiographs in acute knee and ankle injuries.
  • Participants will have a basic understanding of appropriate exercises for foot/ankle, knee, and shoulder in order to facilitate earlier mobilization following injury.
  • Participants will be comfortable selecting and applying appropriate braces for foot/ankle, knee, and shoulder injuries.
slide3

ICE

or

SURGERY??

common foot ankle injuries
Common Foot & Ankle Injuries
  • Ankle sprains
  • Ankle fractures
  • Midfoot sprains
  • 5th metatarsal fractures
foot ankle injuries
FOOT & ankle injuries
  • Estimates: 80-98% of ankle or foot injuries in the ER undergo x-rays.
  • <15% have fractures
  • Resources
    • Time
    • Healthcare costs

Jenkins, 2010

foot ankle exercises
Foot & ankle exercises
  • Early mobilization
    • Improved comfort
    • Earlier return to work
    • Active population

Eiff, 1994

foot ankle exercises1
Foot & Ankle exercises

Visual Health information

bracing crutches
Bracing & crutches
  • When do you use crutches?
    • How long?
  • Application of ankle brace, Aircast, compression wrap, Cam walker
    • Stability
    • Compression
    • Function
common knee injuries
Common KNEE Injuries
  • ACL sprain/tear
  • MCL sprain/tear
  • Meniscus tear
  • Patellar dislocation

weblogs.baltimoresun.com

ottawa knee decision rule
Ottawa Knee Decision Rule
  • Criteria:
    • Age ≥ 55 years
    • Tenderness at the head of the fibula
    • Isolated tenderness of the patella
    • Inability to flex the knee to at least 90 degrees
    • Inability by the patient to bear weight both immediately and in the ER for four steps
  • Positive test: any of the five criteria ORDER X-RAYS

Cook, 2008

pittsburgh knee decision rule
Pittsburgh Knee Decision Rule
  • Criteria
    • Pt hx of blunt trauma or fall
    • Inability by pt to bear weight both immediately and in the ER for four steps
    • Age <12 or >50 years
  • Positive test: blunt trauma/fall and either item 2 or 3

ORDER X-RAYS

Cook, 2008; www.emra.org

ottawa knee decision rule or pittsburgh knee decision rule
Ottawa Knee Decision Rule or Pittsburgh Knee Decision Rule
  • So... Which one do we use?
  • Sensitivity: 85-100 vs 99-100
  • Specificity: 27-50 vs 60-79
  • LR+: 1.7-1.9 vs 2.5
  • LR-: .11-.30 vs .02
  • Our primary population

Cook, 2008; www.emra.org

knee exercises
Knee exercises
  • Early mobilization
    • Improved ROM
    • Decreased effusion
    • Less quadriceps atrophy
knee exercises1
KNEE exercises

visual health information

bracing crutches1
Bracing & crutches
  • Crutches
  • Braces
    • Immobilization vs stabilization vs compression
common shoulder injuries
Common SHOULDER Injuries
  • AC jt sprain/separation
  • Clavicle fractures
  • Shoulder dislocation
  • Subluxation
  • Rotator cuff strain
  • Labral tear
shoulder exercises
Shoulder exercises
  • Early mobilization
    • Decreased pain/stiffness
    • Improved ROM
    • ADLs
shoulder exercises1
Shoulder exercises

visual health information

bracing
Bracing
  • Sling
  • Sling and swath
works cited
Works Cited

Bachmann LM, Kolb E, Koller MT, Steurer J. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003; 326(7386): 417.

Cook CE , Hegedus EJ. Orthopedic Physical Examination Tests: An Evidence-Based Approach. Upper Saddle River, New Jersey: Pearson Prentice Hall, 2008.

Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med. 1994 Jan-Feb; 22(1):83-8.

Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003;1 39:575-588.

Jenkins M et al. Clinical usefulness of the Ottawa ankle rules for detecting fractures of the ankle and midfoot. JATA. 2010; 45(5): 480-482.

Pittsburgh Decision Rules and Ottawa Knee Rules. Emergency Medicine Residents Association. http://www.emra.org/students/advising/_to_sort/pittsburgh-decision-rules-and-ottawa-knee-rules

Visual Health Information (VHI) PC-Kits. www.vhikits.com

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