Who is most at risk for a hip fracture?
Elderly men
Elderly women
Young children
Adolescents
How often should falls risks screenings and assessments be completed?
At least yearly, but optimally quarterly.
Every 6 months, or at least twice yearly.
Once every two years.
Every five years.
Why do patients not stay on fosamax for long periods of time?
It is not the best medication option.
They will form an allergy to the medication.
There will be a reverse effect.
It stops working.
What are the types of fractures?
Extracapsular, trochanteric, femoral neck, subcapital
Extracapsular, femoral neck, crush, subcapital
Femoral neck, subcapital, bony fracture, osteocytic
An appropriate exercise for the maximum protective phase of an ORIF is an active straight leg raise.
True
False
Pick the following goals of the maximum protective phase of an ORIF.
Decrease pain and swelling
Ability to WBAT.
Isometric exercises of the hip and knee
Gentle, protected ROM
Heel slides
Supine hip abduction/adduction
Upper extremity strengthening
Prone knee flexion
Weight shifting
Prone hip extension
How long are patient's who have undergone a hip ORIF under weight bearing precautions?
4-6 weeks
8 weeks
2 weeks
3-4 weeks
ORIF patients have a quicker recovery period than a total hip replacement.
What are the goals of the moderate protective phase of an ORIF?
CKC activities are initiated once patient is FWB
Standing abduction, flexion, extension
Decreased use of assistive devices
PROM
Reduction of swelling
The minimum protective phase occurs from weeks 6-8.
Why is a hemiarthroplasty of the hip done?
Arthritic degeneration of the acetabulum.
Avascular necrosis or femoral head fractures.
Arthritic degeneration of the the femoral head.
Legg-Calve Perthes disease.
What is a total hip replacement?
Both the femoral head and the acetabulum are replaced.
A pin is placed in the joint for stabilization.
The femoral head is replaced
The acetabulum is replaced.
There are no weight bearing restrictions for non-cemented hip replacements.
Which of the following is a reason someone would have a non-elective hip replacement?
Pain
Declined ambulatory capacity
Decreased range of motion
Osteonecrosis
How long can antalgic gait last with a total hip replacement?
1-2 years
6 weeks
6 months
8-12 months
Complications associated with a THR include antalgic gait for 1-2 years, thromboembolic disease, dislocation.
What are the precautions for the posterior or lateral approach for a THR?
Avoid Hip Adduction
Avoid Internal Rotation
Avoid Hip Flexion greater than 90 degrees.
All of the above.
What are the precautions for an Anterior approach?
Avoid combined hip extension and external rotation.
Avoid combined hip flexion and internal rotation.
Avoid Abduction and external rotation.
Avoid Adduction past neutral and internal rotation.
What exercises are appropriate for the max protective phase of a total hip replacement?
Ankle pumps
Isometrics
Active knee flexion
Abduction against gravity
Patient education of precautions
Use of crutches/Walker for ambulation
Bed mobility - Rolling to affected side.
When does the moderate protective phase begin?
Good quad control
Decreased pain
Independent with bed mobility and transfers
All of the above
What is the main difference in the max protective phase of a THR and ORIF?
Total hip replacements are WBAT and ORIFs are TDWB
THRs are TDWB and ORIFs are WBAT.
There are no differences.
What does the moderate protective phase focus on?
Open chain strengthening
CKC standing hip activities
Theraband Activities
What occurs in the minimum protective phase?
Precautions may be discharged.
Normalize gait with/without AD
Balance, proprioceptive, and stabilization activities
Increased CKC activities
The new anterior approach does not cut the muscle, but it moves the musculature out of the way to assist in strength return at a much quicker pace.
Who is more at risk for Legg-Calve-Perthes Disease?
Children between 2-12 years of age.
Children and adolescents between 0-18
Geriatric population, 65+
Geriatric women, 65+
What does the treatment for Legge-Calve-Perthes disease consist of?
Approximation of the femoral head in the acetabulum.
Abduction braces and pillows.
Abduction, hip extension, and internal rotation strengthening activities.
Trochanteric bursitis is caused by irritation, compression, and repeated friction as the IT band snaps over the bursar lying superior to the greater trochanter.
What special test would be positive with trochanteric bursitis?
RFIL
FABER's
OBER's
REIL
Ischial bursitis is caused by direct contusion and extended standing activities.
Iliopectineal bursitis exhibits local tenderness over the iliopsoas muscle and tendon as well as diffuse radiating pain into the anterior thigh.
A hamstring train is caused by sudden contraction of the hamstrings or deceleration of the lower leg against concentric contraction of the quads.
An iliopsoas strain occurs from sudden hip flexion or forced hip extension against resistance.
A hip pointer is a contusion of the ischial tuberosity.
A stable pelvic fracture can be treated conservatively with rest and protected weight bearing, or an ORIF with fractures of the ischial tuberosities.
An unstable fracture of the pelvis/acetabulum is rotationally unstable or rotationally and vertically unstable.
