fracture healing / infection Flashcards
most common organisms is osteomyelitis
staph aureus
imaging modality of choice for avascular necrosis
MRI
Salter haris classification of paeds fractures
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what is a Salter Harris fracture (paeds)
one that involves the growth plate
what is the significance of the salter harris gradings
worse the fracture grading (5 is worse and indicated a crush injury), then the more likely it s that growth will be disturbed
what is a greenstick fracture
unilateral cortical breach only
most common organism in septic arthritis is
staph aureus
key symptoms of septic arthritis
red, hot, swollen joint, reduced ROM and systemic signs
IX for septic arthritis
FBC, U+E, CRP, blood cultures, joint aspiration and MC+S
Abx for septic arthritis
IV flucloxacillin
Complications of septic arthritis
sepsis, osteomyelitis, joint destruction
first stage of fracture healing
haeamtoma formation and inflammation where bleeding stops and dead tissue removed (weeks 0-2)
whats the second stage of fracture healing
soft callus formation (2-3 weeks)–>angiogenesis and granulation tissue makes a cartilaginous network
what is the third stage of fracture healing
hard callus formation (3-6 weeks) where the cartilaginous network undergoes ossification
how long does remodelling occur for in bone healing
8 weeks to 2 years
what is second healing in bone
when there is the formation of a callus (This occurs when there is some movement at the fracture site)
what is primary bone healing
where there is reestablishment of the cortex without formation of a callus (occurs when there is complete stability - screws/plates)
what causes non union in bone healing
when there is inadequate stability or inadequate blood flow
RF for non union in bone healing
smoking, age, DM
what are the options in helping union of a bone
dietary supplements, bone stimulators (US waves which stimulate growth factors) or bone grafts
what are BMPs
bone morphogenetic proteins which induce formation of bone and cartilage
what are kanavels 4 signs of a tendon sheath infection
1) finger held in slight flexion
2) fusiform swelling
3) tenderness along the sheath
4) pain on passive extension
what is a flexor tendon sheath infection
the flexor sheath where the finger tendons run get infected - can be proceeded by a penetrative injury. Emergency as causes a raised pressure with the sheath with compromises the finger
Mx of a flexor tendon sheath infection
if presenting early can do hand immobilisation and IV abx but normally requires surgery with a flexor tendon sheath washout
Complications of a tendon sheath infection
necrotising fasciitis
how might avascular necrosis appear on xray
sclerosis and flattening of the femoral head
things to comment on in a MSK xray
name, age, gender of patient
what the xray is imaging (this is an xray of the Left hip)
Comment on projection (AP)
Type of fracture eg oblique / transverse and whether it is displaced or not displaced
definition of a comminuted fracture
> 2 fragments
what is spondylodiscitis
infection of the disc and vertebrae normally with staph aureus
Ix for spondylodiscitis
blood cultures as can get a bacteraemia and MRI
Mx for spondylodiscitis
Abx for 6 weeks, spinal surgery input, immobilisation
what is cervical spondylosis
age related wear and tear of the discs which causes pain and stiffness, may also cause radicular symptoms if the nerve roots become compressed
RF of cervical spondylosis
neck trauma, age, congenital bony abnormalities
what is cervical spondylosis a good differential for
PMR
what is spondylolisthesis
where the proximal vertebrae displaces forward (due to fracture in the pars interarticularis)
symptoms of spondylolisthesis
lower back pain that is worse on movement, tight hamstrings, pain in the legs that may extend down the thighs
red flags of back pain
thoracic tenderness, pain that is not relieved by lying down, history of malignancy, systemic signs, <20 or >55,
pathophysiology of compartment syndrome
raised intracompartmental pressure (due to bleeding, oedema, inflammation), veins compressed first and then arterial blood supply compromised
presentation of lumbar stenosis
pain and claudication like pain but this is better going up hill
Mx of lumbar stenosis
conservative –> weight loss / physio
laminectomy
Signs of psoas abscess
fever, back pain, limb, pain on passive extension of the hip
RF for psoas abscess
crohns, UTI, diverticultiis, IVDU
imaging of choice for a psoas abscess
CT abdomen
what is firstline for back pain
NSAID (and stay physically active) + physio
-need routine secondary care referral if no improvement after 4-6 weeks
what is a segmental fracture?
more than one fracture alone a bone
what happens in brown sequard syndrome
hemisection of spinal cord injured.
-get ipsilateral paralysis and ipsilateral loss of dorsal column
-contralateral loss of spinothalamic
what is priority in open fractures
debridement first, need soft tissues to recover before definitive Mx
what are the nerve roots in the sciatic nerve
L4 to S1
causes of sciatica
1) lumbar disc herniation (most common)
2) spondylolisthesis
3) spinal stenosis
RF of sciatic
smoking, lifting heavy loads, obesity, whole body vibration
what screening tool can be used to assess for longer term disability with back pain
the start back tool
if NSAID is contraindicated for back pain, what can be used next?
codeine (paracetamol alone is ineffective)
advise for MX sciatica
-stay active
-apply local heat
-simply pain - NSAID
-codeine if NSAID doesn’t work
-consider CBT and physical exercise programme if this does not work
-more specialist mx –> epidural ICS
indications for lumbar spine Xray
back pain for > 6 weeks
<20 or > 50
ank spond
suspected osteoporotic fracture
