091214 injury and healing

Question 1

most common mechanism for ankle sprain?

Answer 1

inversion

Question 2

most commonly sprained ligament in the ankle

Answer 2

anterior talofibular ligament

Question 3

why is inversion most common mechanism for ankle sprain?

Answer 3

because you have fibula obstructing the tibia from rolling outward (eversion)

also, you have deltoid complex–ligamentous stability on the medial aspect but on the lateral aspect, not so

Question 4

ankle sprain, 1st treatment?

Answer 4

RICE (rest, ice, compression, elevation)

Question 5

ankle sprain, 2nd treatment?

Answer 5

ibuprofen (for the inflam)

Question 6

5th metatarsal fracture-jones fracture

Answer 6

traumatic fracture at metaphyseal-diaphysis junction

Question 7

5th metatarsal fracture-pseudo jones fracture

Answer 7

stress fracture at proximal diaphysis

Question 8

5th mettarsal fracture-dancer’s fracture

Answer 8

spiral fracture mid to distal diaphysis

Question 9

5th metatarsal fracture-avulsion fracture

Answer 9

5th metatarsal base at peroneus brevis insertion

Question 10

how do you get avulsion fraction at the fifth metatarsal of foot?

Answer 10

the fibularis tertius tendon pulls at the base of the metatarsal and can get bone pulled off (b/c in a 9 yr old, would have weak growth plate)

Question 11

Maisooneuve fracture

Answer 11

proximal fibula fracture

Question 12

squeeze test

Answer 12

squeezing middle of leg–if positive squeeze test, means that you have pain the knee or ankle

if positive for the knee, you worry about a Maisonneuve fracture

if positive for the ankle, worry about a high ankle sprain

Question 13

if you externally rotate (external rotation test) the ankle and you have a standard lateral ankle sprain, what would the symptoms be?

Answer 13

symptoms would stay the same

Question 14

high ankle sprain

Answer 14

disruption of syndoesmosis btwn tibia and fibula or the transeverse tibiofibular ligament inferiorly

Question 15

which kind of tissue heals with least complete recovery?

Answer 15

cartilage

Question 16

rotator cuff tear

Answer 16

is a tendon tear

Question 17

which of following would make you suspcious most for a loose body?

locking, swelling, pain, weakness or buckling?

Answer 17

locking

Question 18

isolated medial collateral ligament tear-does it need surgery?

Answer 18

no, will heal pretty well on its own due to good blood supply

Question 19

anterior talar fibular ligament sprain is a sprain of what degree

Answer 19

mild

Question 20

ligament healing depends on

Answer 20

good blood supply
needs damage section to be approximated or guided to correct area

needs relative rest

a lot of ligament tears will therefore heal pretty well w/o surgery, but in the case of ACL (lack of good blood supply), will need to consider surgery

Question 21

when does the repair stage of bony healing kick in?

Answer 21

1 to 2 more more weeks after, goes until 3 or more months

Question 22

what to look for on radiograph with bony healing

Answer 22

is there sclerosis? appropriate healing?

Question 23

bony healing remodeling goes from when?

Answer 23

1-2 years after the fracture

Question 24

when do osteoclasts and osteoblasts invade the bloot clot after a bony fracture?

Answer 24

in the repair stage

Question 25

what happens in the repair stage for bony healing?

Answer 25

osteoclasts and osteoblasts invade the blood clot
soft callus formation
hard callus
callus matures
bony gaps bridged

Question 26

does time correlate with strength of healed bone?

Answer 26

generally yes, but not always (for ex, in the case of non union)

Question 27

with a transverse fracture that is displaced with angulation, what surgical approach would you use

Answer 27

would pull the bones so they align and place in an intramedullary rod

Question 28

Osgood Schlatter’s

Answer 28

due to weakness of immature skeleton compared to mature skeleton; repetitive tugging at growth plate

see irregularity and fragmentation of the tibial tubercle, where the patellar tendon inserts

see soft tissue swelling

Question 29

metaphysis

Answer 29

area btwn shaft and growth plate

Question 30

damage to the growth plate can cause

Answer 30

growth disturbances

Question 31

physis

Answer 31

growth plate

Question 32

apophysitis

Answer 32

pain and inflam of ossification centers from repetitive tension

Question 33

treatments for apophysitis

Answer 33

activity as tolerated, stretching, ice and NSAIDs

Question 34

complications of apophysitis

Answer 34

if severe, can get bony hypertrophy

fracture is rare

Question 35

common sites of apophysitis

Answer 35

osgood schlatter-tibial tubercle
sever’s-calcaneal
sinding larsen johansson-distal patellar pole
anterior superior iliac spine-sartorius
anterior inferior iliac spine-rectus femoris
little leaguer’s elbow0medial epicondyle