Clinical Management of acute orthopedic injuries

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

2. 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.

3. ICE or SURGERY??

4. Common Foot & Ankle Injuries • Ankle sprains • Ankle fractures • Midfoot sprains • 5th metatarsal fractures

5. 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

6. Ottawa ankle rules Cook, 2008

8. Foot & ankle exercises • Early mobilization • Improved comfort • Earlier return to work • Active population Eiff, 1994

9. Foot & Ankle exercises Visual Health information

10. Bracing & crutches • When do you use crutches? • How long? • Application of ankle brace, Aircast, compression wrap, Cam walker • Stability • Compression • Function

11. Common KNEE Injuries • ACL sprain/tear • MCL sprain/tear • Meniscus tear • Patellar dislocation weblogs.baltimoresun.com

12. 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

13. 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

14. 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

15. Knee exercises • Early mobilization • Improved ROM • Decreased effusion • Less quadriceps atrophy

16. KNEE exercises visual health information

17. Bracing & crutches • Crutches • Braces • Immobilization vs stabilization vs compression

18. Common SHOULDER Injuries • AC jt sprain/separation • Clavicle fractures • Shoulder dislocation • Subluxation • Rotator cuff strain • Labral tear

19. Shoulder exercises • Early mobilization • Decreased pain/stiffness • Improved ROM • ADLs

20. Shoulder exercises visual health information

21. Bracing • Sling • Sling and swath

22. 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

23. QUESTIONS?