Fractures and soft tissue injuries Flashcards
week 2
In reaching a diagnosis of soft tissue injury/fractures, what should you consider?
- History
- Past medical history incl medications
- Physical examination
- Imaging
What is involved in the management of injuries?
- Immediate management (resus, prophylactic protection)
- MSK history and exam
- Diagnostic tests
- Definitive management (treatment)
- Rehabilitation
Soft tissue injury
Acute connective tissue injury. May involve: skin, subcutaneous tissue, muscle, ligament, tendon, nerve, blood vessel, capsule, cartilaginous structures.
What should you look out for when assessing soft tissue injuries in children?
Signs of child abuse
Signs of child abuse with soft tissue injuries
Bruising in unusual places (e.g. inner thigh, under arms) Burns Multiple injury sites Fractures in children under 1 Atypical fracture patterns given context
Age related changes to the skin and soft tissue can include:
Thinning Loss of strength Loss of elasticity of skin Loss of subcutaneous tissue Blood vessels more fragile
First degree soft tissue injury
Minor contusion with bleeding
Minimal pain/brusing
Minimal functional impairment
Second degree soft tissue injury
Moderate contusion, some tearing of fibres. Overalls structure in tact.
Bruising, muscle spasms, pain
Joint is stable although painful, some loss of muscle power/range
Third degree soft tissue injury
Structural disruption
Severe bruising, muscle spasm and pain
Instability and/or loss of muscle function
Immediate management of soft tissue injuries uses the acronym…
PRICE
PRICE =
Protection Rest Ice Compression Elevation
What are the key physical signs of a fracture?
Local bone tenderness Crepitus Deformity Swelling Loss of function
Ways to image fractures and soft tissue injuries
X-ray, CT, MRI, ultrasound
What imaging technique is best for soft tissue?
MRI
Skin intact, fracture uncontaminated
Closed/simple fracture
Colles’ fracture
Fracture of radius, posterior displacement
Smith fracture
Reverse Colles’ fracture, anterior displacement
Fracture in which soft tissues are contaminated. Has a risk of infection and nerve damage.
Open/compound fracture
Fracture in which one does not move and maintains proper alignment.
Undisplaced fracture
Fracture in which bone snaps in 2 or more parts and moves so that the 2 ends are not aligned straight
Displaced fracture
Bone breaks diagonally
Oblique fracture
Bone is broken into more than 2 fragments. Occur after high-impact trauma.
Comminuted fracture
A type of complete fracture which occurs due to rotational or twisting force.
Spiral fracture
A fracture occurring in an abnormal bone
Pathological fracture
Type of fracture that happens in osteoporosis. Bone becomes so osteoporotic it collapses under weight (e.g. spine)
Wedge fracture
Injury where a tendon or ligament attaches to a bone. Tendon/ligament pulls of a piece of bone.
Avulsion fracture
Fracture of bone causes by repeated mechanical stress
Stress fracture
2 ways a stress fracture can occur:
- Repeated abnormal stresses to a normal bone
2. Normal stresses to an abnormal bone
4 main aims of fracture management.
- Fracture heals in good position
- Joints have full range of movement
- Limb regains normal strength and functions
- Person able to take up role in society asap
Open wound management (pretty darn soon):
Protection - assess neuromuscular status of limb, temporary dressing, antibiotics, tetanus
Debridement
Stabilisation
