1 Fall from a Tree Flashcards
what is meant by the term ‘perfused’ and ‘perfused hand’
“perfused” refers to delivery of blood to a capillary bed in biological tissue. a “perfused hand,” means that the hand is receiving an adequate supply of blood,
Perfusion can be assessed in a variety of ways, including observing the colour and temperature of the skin, checking for a pulse, or using more advanced diagnostic methods like Doppler ultrasound to assess blood flow.
what is a a closed reduction percutaneous pinning
Closed reduction percutaneous pinning (CRPP) is an orthopedic procedure used to treat fractures, procedure is:
Closed Reduction: This refers to the process of aligning the fractured pieces of bone without making an open incision to expose the fracture site. The physician manipulates the bone from outside the skin to put the pieces back into their proper position.
Percutaneous Pinning: After the bones are properly aligned (reduced), thin metal pins are inserted through the skin (percutaneously) into the bone to hold the fractured pieces in place. This is done under imaging guidance to ensure proper placement of the pins.
The combination of these two techniques allows for stabilization of the fracture without the need for a large open surgical procedure,
a patient fractures their elbow and has no radial pulse, which blood vessels pass through the elbow/ are vulnerable
absence of a radial pulse following an elbow fracture is a concerning sign, indicating potential damage to the blood vessels that traverse the elbow region. The primary blood vessels passing through elbow that could be compromised are:
Brachial Artery: main artery supplying the arm, which runs medially down the upper arm and crosses the elbow region. At the level of the elbow, it typically lies close to the biceps tendon and median nerve and is susceptible to injury, especially in supracondylar fractures of the humerus.
Radial Artery: This artery typically branches from the brachial artery below the elbow, traveling down the lateral aspect of the forearm to the wrist. It is responsible for the radial pulse. It can become compromised due to trauma at the elbow, particularly with fractures that involve the lateral structures of the elbow or dislocations.
Ulnar Artery: Though the ulnar artery is less likely to be the direct cause of an absent radial pulse, it also branches from the brachial artery and travels along the medial aspect of the forearm. It could be affected by the same trauma that affects the brachial artery.
what does a neurological examination of the elbow consist of; which nerves are being tested for?
-docs usually test for nerves and muscles aroun them using an:
EMG (electromyography) : Measures electrical activity of muscles at rest and during contraction. It’s used to identify muscle dysfunction or nerve disorders that can affect the hand e.g. carpal tunnel syndrome or other neuropathies.
Nerve Conduction Studies: Measure how fast and how well the body’s electrical signals travel down the nerves. This test can help diagnose nerve compression or injury.
Nerves we check in elbow:
Ulnar Nerve: This nerve runs behind the elbow and is commonly tested by tapping over the nerve in the “funny bone” area to see if it produces a tingling sensation in the ulnar distribution (ring and little fingers).
Median Nerve: The median nerve is tested by examining the strength of the wrist flexors and the muscles of the anterior forearm, as well as by checking for sensation in the thumb, index, middle, and ring fingers.
Radial Nerve: The radial nerve is assessed by testing for wrist and finger extension strength, and by checking for sensation over the back of the hand and the first dorsal web space (between the thumb and index finger).
The examination may include:
Sensory testing: Checking for numbness, tingling, or pain in the area supplied by the nerves.
Motor testing: Evaluating the strength of muscles that are innervated by the nerves around the elbow.
Reflex testing: The biceps reflex (musculocutaneous nerve), triceps reflex (radial nerve), and brachioradialis reflex (radial nerve) can be tested to assess the integrity of the reflex arc.
Special tests: Tinel’s sign (tapping over a nerve to elicit a tingling sensation in its distribution) can be used to detect irritated nerves.
Observation: Looking for muscle wasting or changes in muscle tone that might indicate nerve damage.
The examination aims to determine the integrity and function of the nerves, whether there are signs of nerve compression or injury, and the possible causes of symptoms such as pain, weakness, or sensory loss.
how is age related to how bones break vs heal
As people get older, their bones may become weaker and more likely to break (decrease in calcium, bones lose density, slower reflexes, reduced muscle strength, balance issues). Also, when an older person breaks a bone, it often takes longer for it to heal compared to a younger person. This is because the body’s repair processes slow down with age (slower cell regeneration, reduced blood flow, nutritional deficiencies, reduced physical activity leads to muscle atrophy)
YOUNG PEOPLE + BONE BREAKING:
bones heal relatively quickly due to a richer blood supply and a higher presence of osteoprogenitor cells that can differentiate into bone-forming cells. Children’s bones are also more pliable and less likely to be completely broken, often resulting in what’s known as a greenstick fracture, which heals faster than a complete fracture. The growth plates in children are areas of developing cartilage tissue near the ends of long bones, which are responsible for the bone’s growth in length. During healing, proper alignment and stabilization are crucial to avoid growth plate damage that could result in growth disturbances.
When young people, particularly children, break a bone, the body’s healing process is very active and efficient. Sometimes, if the fracture is not aligned properly or if the child is not immobilized correctly, the bone can heal in a slightly different shape or length than it originally was. This can make the bone seem smaller or shorter.
Additionally, a child’s bone has something called a growth plate, which is where the bone grows from. If a fracture occurs near the growth plate and it gets damaged, it can affect how the bone grows, potentially leading to a shorter or irregularly shaped bone compared to its original structure. This is why proper medical treatment and alignment of the fracture are very important, especially in young, growing individuals..
a patient fractures their elbow, why do they have a sensory deficit in the palm? which nerves have been affected + how
These symptoms are indicative of nerve damage, likely involving the median nerve, which passes through the area affected by the supracondylar fracture. The entrapment of the nerve within the fracture callus caused nerve compression, resulting in sensory deficit and motor weakness.
what is osteoporosis
A condition in which there is a decrease in the amount and thickness of bone tissue. This causes the bones to become weak and break more easily.
Greek terms for “porous bones”.
what is ossification vs. what is bone resorption
Ossification: The process of creating bone, that is of transforming cartilage (or fibrous tissue) into bone.
Bone resorption: where mature bone tissue is removed from the skeleton
What Is a Greenstick Fracture?
A greenstick fracture is a type of broken bone. A bone cracks on one side only, not all the way through the bone.
