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When is a plevic fracture to be non-weightbearing
If the fracture disrupts the pelvic ring
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Clinical Presentation of a pelvic fracture
- significant pain and discomfort
- transitional movements are difficuld and painful to perform
- will want to remain in bed, reluctant to move - can lead to respirtatory and circulatory compromise
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Clincial management for pelvic fracture for a stable fracture
- acute care
- out of bed asap
- 1st week- pain med before Rx, amubation with walker, funcation activites, gente strengthening , isometrics, closed chain
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Important Rehab considerations for Pelvic Fractures
- Strengthening - stable avoid SLR Empasis on abducation
- Unstable - no open chain exericses
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Clinical managment for a unstable pelvic fracture
- limited weight bearing for 3 monts
- isometric exercises
- wheelchair management / gait training
- Functional activties
- week 12 increase aggressiveness of strengtheing
- may need to go skilled
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Intracapsular hip fracture
- femoral head
- 47% of all fractures
- usual caused by trauma
- can be displaced or non displaced
- risk of avascular nercosis - leads in THA
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Extracapsular Hip Fracture
- Trochanteric or intertrochanteric
- usual cause is trauma
- 49% of fractures
- stable or unstable
- very little risk of avascular necrosis
- .4%
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Clinical Presentation with a hip fracture
- most likely surgically reduced and fixated
- will have dressing and staples
- may have drain
- may have ted hose
- may have compression pumps
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Acute managemnet for hip fractures
- isometric exercise
- ankle pumps
- AAROM
- bed mobility training
- begin gait skills from side of bed following weight bearing precautions
- transfers
- standing balance activities
- establish discharge parameters
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Subacute management for hip fractures
- increase gait independence
- advance asst device
- increase standing balance ex
- standing exercises -flex, abduction, toe raises, partial squats, extension, knee flexion
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Typical discharge parameters for hip fractures
- independent in all bed mobility
- Able to amb 100ft
- independtent transfers or family trained
- able to do stairs and curbs
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Reasons for total hip replacement
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THA pre-op planning
- class
- PT consult
- home assessment
- blood donations
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Anterior THA
- TFL, Glut Med
- Precautions - hip ext, ER
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Lateral THA
- Glut Med, Greater Trochanter
- Precautions - IR, ADD, FLEX
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Posteriorlateral THA
- most common
- TFL, GLUT med, ER
- IR, ADD, FLEX
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