091214 injury and healing Flashcards
most common mechanism for ankle sprain?
inversion
most commonly sprained ligament in the ankle
anterior talofibular ligament
why is inversion most common mechanism for ankle sprain?
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
ankle sprain, 1st treatment?
RICE (rest, ice, compression, elevation)
ankle sprain, 2nd treatment?
ibuprofen (for the inflam)
5th metatarsal fracture-jones fracture
traumatic fracture at metaphyseal-diaphysis junction
5th metatarsal fracture-pseudo jones fracture
stress fracture at proximal diaphysis
5th mettarsal fracture-dancer’s fracture
spiral fracture mid to distal diaphysis
5th metatarsal fracture-avulsion fracture
5th metatarsal base at peroneus brevis insertion
how do you get avulsion fraction at the fifth metatarsal of foot?
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)
Maisooneuve fracture
proximal fibula fracture
squeeze test
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
if you externally rotate (external rotation test) the ankle and you have a standard lateral ankle sprain, what would the symptoms be?
symptoms would stay the same
high ankle sprain
disruption of syndoesmosis btwn tibia and fibula or the transeverse tibiofibular ligament inferiorly
which kind of tissue heals with least complete recovery?
cartilage
rotator cuff tear
is a tendon tear
which of following would make you suspcious most for a loose body?
locking, swelling, pain, weakness or buckling?
locking
isolated medial collateral ligament tear-does it need surgery?
no, will heal pretty well on its own due to good blood supply
anterior talar fibular ligament sprain is a sprain of what degree
mild
ligament healing depends on
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
when does the repair stage of bony healing kick in?
1 to 2 more more weeks after, goes until 3 or more months
what to look for on radiograph with bony healing
is there sclerosis? appropriate healing?
bony healing remodeling goes from when?
1-2 years after the fracture
when do osteoclasts and osteoblasts invade the bloot clot after a bony fracture?
in the repair stage
what happens in the repair stage for bony healing?
osteoclasts and osteoblasts invade the blood clot soft callus formation hard callus callus matures bony gaps bridged
does time correlate with strength of healed bone?
generally yes, but not always (for ex, in the case of non union)
with a transverse fracture that is displaced with angulation, what surgical approach would you use
would pull the bones so they align and place in an intramedullary rod
Osgood Schlatter’s
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
metaphysis
area btwn shaft and growth plate
damage to the growth plate can cause
growth disturbances
physis
growth plate
apophysitis
pain and inflam of ossification centers from repetitive tension
treatments for apophysitis
activity as tolerated, stretching, ice and NSAIDs
complications of apophysitis
if severe, can get bony hypertrophy
fracture is rare
common sites of apophysitis
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
