2. Case
Mrs Sauls is a 25 year old female, she was
admitted to UWC’s physio department (hospital)
3 days ago. She was diagnosed with a tibial
plateau and patellar fractures of the right lower
limb. The patella was stabilised with k-wires. She
is in a fixed knee brace which is locked at 10
degrees of flexion.
3. Possible interview questions: Present
and past medical history
• Intro
• How did the injury occur?
• How long ago did it happen?
• Did you ever have any broken bones or serious
injuries before this injury?
• Were you ever hospitalised for any other
illness?
• Were you fit and active before this accident?
• Are you coughing at all at the moment?
4. Social context
• Are you working?
• What type of work do you do?
• Do you play any sports or have any hobbies?
• Do you smoke or occasionally drink alcohol?
• Are you married, or do you have any kids?
5. Home environment
• What is your home environment like?
• What type of surface do you have around your
house? Sand or grass or pavement?
• Do you have any stairs in or around your
house?
• Is your toilet inside the house?
• Who cleans the house, and cooks supper?
6. Functional capacity
• How are you managing here in hospital?
• Can you move around in bed easily?
• Can you roll?
• Have you been able to sit up out of bed, or
walk at all?
• How are you going to the toilet at the
moment?
• Have you ever walked with crutches before, or
has anyone showed you how to walk with
crutches here in hospital?
7. In-hospital management
• Did the physiotherapist come and see you at
all, and what did he / she do with you?
• Do you have any questions for me?
NOW FORMULATE WHAT YOU WANT TO ASSESS
OBJECTIVELY. NEVER TAKE THE PATIENT’S WORD
ON HIS OWN CAPABILITIES!
8. Objective assessment:
Check chest
• Vital signs: Respiratory rate and oxygen
saturation within normal limits?
• Chest X-ray (when available) any abnormalities?
• Ask patient to cough: Effective / ineffective ;
productive / unproductive
• Auscultate to check for possible basal
atelectasis if cough clear
• IF NO ABNORMALITIES detected: continue with
functional assessment
9. Functional
• Bed mobility
• Rolling (if safe)
• Moving up and down in bed
• Bridge (if using bed-pan)
• Sit up over side of bed
• Sit-to-stand (with assistance of physio)
• Mobilise with crutches if appropriate
10. Special tests:
• Quick test – lattisimus dorsi and triceps
strength
• Glutes strength(necessary for sit-stand)
• Quads strength (assess for quads lag) (contra-
indicated in this scenario)
• ROM if necessary – ankles – (standing)
11. Identify patient’s problems in order of
priority
• Chest clear – thus no chest problem
• If chest wasn’t clear - chest always takes
priority! If you cannot breath, you cannot walk
or do exercises!
• Problem: Struggling to sit over the edge of the
bed independently
• Impairment – fractured patella, unable to flex
knee
• Restriction: Unable to mobilise
12. Treatment plan
Problem (struggling
to sit up)
Functional
Impairment restriction
(# patella) (inability to
mobilise)
Treatment
goal
