Case Presentation

Block 1
  Importance of post-op physiotherapy
 When someone goes under general anesthesia, their lung function
can be reduced post operatively. Atelectasis is also a common post
operative complication of anesthesia. Chest physiotherapy aims at
Learning Issue improving and maintaining cardiorespiratory health after the
surgery and improve oxygen saturation levels (Manzano et al.,
2008). Some techniques that can be done are thoracic expansion
exercises, incentive spirometry, diaphragmatic breathing, SMI and
early mobilization (Ahmad, 2018).
  Sub capital femur fracture:
 Is one of the most common types of neck of femur fracture where
the fracture line extends through the junction of the head and neck
of femur. Femoral neck fractures are considered intracapsular i.e.
within the capsule. Femoral fractures are more common in the
elderly but can occur in younger people. A risk with femoral
fractures is that blood supply to the femoral neck can be cut off
resulting in avascular necrosis.

Pathophysiology
  Distal radius fracture:
 Are commonly caused by FOOSH (falling on outstretched arm).
Depending on the type and extent of the fracture, neurological
dysfunction can also occur so it is important to check for median,
radial and ulnar nerve function. If a malunion occurs, nerve
function may be disrupted which is why it is important that the
bone heals well.
Pathophysiology
(continued)
  Sub capital femur fracture:
 Most femur fractures require surgery to stabilize the fracture. The
fracture can either be internally fixated or if the hip joint is not
able to be repaired then a partial or complete hip replacement is
done. This is common in the elderly. The patient will also be given
pain relief such as Morphine and antibiotics to prevent infections.
Deep vein thrombosis can be a complication as a result of a major
fracture or immobilization which can then lead to a pulmonary
embolism if not caught early

Medical
management
  Distal radius fracture:
 Depending on the extent of the fracture, a closed or open
reduction can be done. For an open reduction, the surgeon will
either use plates or k wire to stabilize the fracture. The arm will
then be placed in a cast to allow for the bones to fuse.

Medical
management
(continued)
  Pre operative:
 Maintenance of muscle strength and range of motion .
Mobilization within limit to prevent cardiorespiratory health
decline.
 Post operative:
Physiotherapy  Chest physiotherapy to maintain lung function and prevent post
management -op complications (diaphragmatic breathing, SMI).
 Bed mobility exercises to enable the patient to mobilize
independently as well as maintain cardiorespiratory function.
 Maintenance of range of motion as well as strengthening
exercises (Mariana et al., 2015).
  Risk of:
- reduced lung function
- reduced strength of muscle
- muscle atrophy
Problem List -joint stiffness
-frozen shoulder because right arm is in sling
 Patient was also mobilizing without using an assistive device
which is a risk for fall because he wont be able to stabilize himself
if he falls.
  Mobilizing with assistance.
Short Term  Prevention of loss of muscle strength and atrophy

Goals  Prevention of joint stiffness

 Maintaining cardiorespiratory fitness
  Able to fully weight bear mobilize independently
Long Term  Able to climb stairs independently

Goals  Able to run

 Able to play soccer
  Maintain good lung function
 Teach him how to mobilize using gutter frame
 Maintain muscle power in left lower and upper limbs
Aims of  Prevent joint stiffness

treatment  Prevent muscle atrophy and weakness of affected limbs

 Prevent right frozen shoulder
 Maintain good blood circulation
  Diaphragmatic breathing and SMI to prevent post-op
complications
 Ankle pumps to prevent DVT
 Make a fist (15-30 per hour) to prevent joint stiffness
 Teach him how to mobilize using a gutter frame to provide
stability
Probable  Right shoulder abduction, adduction, flexion and extension (10
treatment reps x 3sets) [preventing frozen shoulder]
 Straight leg lifts (10 reps x 3sets)
Strengthening
 Heel slides (10 reps x 3sets) exercises
 Single leg bridge (10 reps x 3sets)
 Static quads (10 reps x 3sets)
  The following things should be reassessed to ensure progress is
being made:
-Gait
- Muscle power of lower limb as well as wrist and elbow if the cast is
Reassessment removed
- ROM of right hip, knee, fingers, right shoulder and right wrist and
elbow if the cast has been removed
- observe swelling to see if it has decreased
- cardiorespiratory fitness
  Ahmad, A. (2018). Essentials of Physiotherapy after Thoracic Surgery: What
Physiotherapists Need to Know. A Narrative Review. The Korean Journal Of Thoracic
And Cardiovascular Surgery, 51(5), 293-307. doi: 10.5090/kjtcs.2018.51.5.293
 Manzano, R. M., Carvalho, C. R., Saraiva-Romanholo, B. M., & Vieira, J. E. (2008).
Chest physiotherapy during immediate postoperative period among patients
undergoing upper abdominal surgery: randomized clinical trial. Sao Paulo medical
References journal = Revista paulista de medicina, 126(5), 269–273.
https://doi.org/10.1590/s1516-31802008000500005
 Mariana Barquet Carneiro, Débora Pinheiro Lédio Alves, and Marcelo Tomanik
Mercadante. Physical therapy in the postoperative of proximal femur fracture in
elderly. Literature review. ActaOrtopédicaBrasileira 2013 May-June; 21(3): 175–178.