Surgical Protocols Flashcards by Owen Honroth

explain general routine of soft-tissue procedures

auto or allograft tissue to create new ligament

typically knee ligaments or AFTFL/CFL, UCL

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explain PCL reconstruction acute phase

immobilized in extension
– 6 weeks

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explain lateral ankle reconstruction acute phase

immobilized 4-6wks
cast / rigid walking boot

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hamstring vs patellar grafts
- pros

HS
- fewer symptoms post-op
- greater return to preinjury level of activity
- earlier rehabilitation

PT
- maintains graft tension early
- less expensive
- faster healing time

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hamstring vs patellar graft
- cons

HS
- more expensive
- technically difficult procedure
- rehab can be more problematic

PT
- increased risk of anterior knee pain/patellofemoral osteoarthrosis
- knee extension deficit possible
- quad atrophy

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common locations of tendon surgery

hand
rotator cuff
achilles
patella

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main rehab issue post-op tendon surgery

mobility impairment prevention balanced with optimal tendon loading

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common tendon repairs in hand

flexor tendon
distal repairs
proximal repairs

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flexor tendon repair acute phase

immobilized 3-4wks
wrist and digits flexed

can do resisted extension
passive flexion
– both within splint limits

AROM tolerance at 4 wks

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distal wrist repair acute phase

immobilized 6-8wks
- DIP in neutral

AROM initiated at 6
- PIP in neutral with extension initiated first then flexion

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proximal wrist repair acute phase

immobilized in ext 4wks

A/PROM into flexion with MCP in extension early

active extension/flexion at 6 weeks

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RTC repair acute phase

generally:
- immobilized 4-6wks
- no active shoulder motion/weight bearing

isometrics at 6 wks

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what are soft-tissue stabilization procedures for

joint instability via capsular laxity
– ST to ST rather than bony stability

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explain loading in acute phases of soft-tissue stabilization procedures

controlled for lengthy time, more than other repairs
- no bony fixation paired with decreased ST healing times

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explain ROM limits with soft-tissue stabilization surgery

ST is non-contractile, AROM allowed within ROM limits

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explain provocation positions of knee hip and shoulder labrum

knee = WB and flexion (meniscus)

hip = unilateral hip extension, excessive hip flex/AB/ER

shoulder = ER (specifically ant/inf labrum and bankart lesion)

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involvement of articular cartilage typically includes involvement of the

bony processes

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lavage/debridement surgery

used for bone
- removes loose fragments / mechanical or chemical irritants

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explain prognosis of debridement surgery

will not address underlying pathology

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microfracture surgery

creation of small fractures within the bone to stimulate healing responses/local fibrocartilage growth

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acute phase protocol microfracture surgery

WB limited up to 8 wks
– PROM for 6 weeks

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OAT surgery

osteochondral autograft transplantation

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OAT surgery procedure

articular cartilage from areas of low loading to areas of high loading

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ACI surgery

autologous chondrocyte implantation

ACI surgery procedure

healthy articular cartilage taken and injected under periosteal flap

ACI and OAT surgery indication

restore/preservation of articular cartilage

articular cartilage surgery acute phase

early NWB - gradual progress to WBAT - high impact typically delayed 6 months

ORIF

open reduction internal fixation

indication of ORIF

if closed reduction not possible fracture healing would be protracted

ORIF acute phase rehab

WB/ROM restrictions -- relative to what was fixed

osteotomy

cutting of bone to correct alignment

common osteotomy surgeries

knee = genu valgum/varum

osteotomy acute phase

WB limited 6-8 weeks

indication of total joint arthroplasty

severe joint degeneration - all conservative/surgical treatment failed

primary goal of jt replacement

pain reduction

cemented vs non-cemented jt replacement WB status

c = tolerate FWB post-op

considerations for cemented vs non-cemented jt replacement

c = fragile bones/those who benefit from immediate WB (think bed rest damage > joint replacement damage) nc = younger/more active individuals --> more stressful on bones during surgery

explain what is replaced during THA

femoral and acetabular articular surfaces

what is replaced during TKA

medial/lataeral femoral condyle tibial plateau patellar articular surfaces

UKA

unicompartmental knee arthroplasty

UKA procedure

articular surface either medially or laterally

TSA

total shoulder arthroplasty -- humeral head and glenoid articular surfaces

shoulder hemiarthroplasty

replacement of only humeral head

hemiarthroplasty of hip

replacement of femoral head articular surface only

interventions related to TKA

motor function training - balance, walking, movement symmetry - supervised therapy with strength training - NO CPM machine

prognostic factors related to TKA

worse post-op outcomes if - higher BMI - depression - severly decreased pre-op PROM/strength - greater amounts of comorbidities

posterior THA precuations

flexion/adduction/IR no flex >90 no pivot on leg (IR) sleep on back

anterior THA precautions

no extension/ER - no stepping backward - no pivot outward on surgical side - no crossing legs - sleep on surgical side in SL

foundational intervention for lumbar/cervical procedures

solid walking program

pre-op spine surgery PT involvement

mm strength/stabilization program with early mobilization

explain acute therapy following scoliosis correction surgery

early mobilization in bed/effective coughing ambulation (4-7 days post)

spinal precautions

BLT bend lift twist

lumbar non-fusion surgery

laminectomy discectomy micro-discectomy

precautions of lumbar non-fusion injuries

avoid end-range rotation/flexion no jt mob for 3 mo

explain prognosis of microdiscectomies

rehab time decreased - fibers of annulus fibrosis not damaged

acute phase post-op fusion surgery

possible pain below/above fusion due to hypomobility at fusion mm retrained

acute phase laminectomy/discectomy

early movement activation of spinal mm

lumbar vs cervical interventions post fusion

L = core stabilization C = deep neck flexor strength/stability

lumbar precautions

avoid - end range rotation/extension - no intensive abdominal ex - no impact loading (3mo)

cervical precautions

no lifting >5-10 lbs 4wks

total disc replacement goal

preserve normal spine motion with pain relief

Surgical Protocols Flashcards

(63 cards)