Clinical Management of acute orthopedic injuries. Kylie Miller Starr, PT, DPT, ATC Lafene Health Center Kansas State University. objectives.
Clinical Management of acute orthopedic injuries Kylie Miller Starr, PT, DPT, ATC Lafene Health Center Kansas State University
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.
ICE or SURGERY??
Common Foot & Ankle Injuries • Ankle sprains • Ankle fractures • Midfoot sprains • 5th metatarsal fractures
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 Cook, 2008
Foot & ankle exercises • Early mobilization • Improved comfort • Earlier return to work • Active population Eiff, 1994
Foot & Ankle exercises Visual Health information
Bracing & crutches • When do you use crutches? • How long? • Application of ankle brace, Aircast, compression wrap, Cam walker • Stability • Compression • Function
Common KNEE Injuries • ACL sprain/tear • MCL sprain/tear • Meniscus tear • Patellar dislocation weblogs.baltimoresun.com
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 • 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 • 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 • Early mobilization • Improved ROM • Decreased effusion • Less quadriceps atrophy
KNEE exercises visual health information
Bracing & crutches • Crutches • Braces • Immobilization vs stabilization vs compression
Common SHOULDER Injuries • AC jt sprain/separation • Clavicle fractures • Shoulder dislocation • Subluxation • Rotator cuff strain • Labral tear
Shoulder exercises • Early mobilization • Decreased pain/stiffness • Improved ROM • ADLs
Shoulder exercises visual health information
Bracing • Sling • Sling and swath
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