Clinical management of acute orthopedic injuries
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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

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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.


Clinical management of acute orthopedic injuries

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


Ottawa ankle rules

Ottawa ankle rules

Cook, 2008


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


Clinical management of acute orthopedic injuries

QUESTIONS?


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