Fractures and soft tissue injuries

Question 1

In reaching a diagnosis of soft tissue injury/fractures, what should you consider?

Answer 1

1. History
2. Past medical history incl medications
3. Physical examination
4. Imaging

Question 2

What is involved in the management of injuries?

Answer 2

1. Immediate management (resus, prophylactic protection)
2. MSK history and exam
3. Diagnostic tests
4. Definitive management (treatment)
5. Rehabilitation

Question 3

Soft tissue injury

Answer 3

Acute connective tissue injury. May involve: skin, subcutaneous tissue, muscle, ligament, tendon, nerve, blood vessel, capsule, cartilaginous structures.

Question 4

What should you look out for when assessing soft tissue injuries in children?

Answer 4

Signs of child abuse

Question 5

Signs of child abuse with soft tissue injuries

Answer 5

Bruising in unusual places (e.g. inner thigh, under arms)
Burns
Multiple injury sites
Fractures in children under 1
Atypical fracture patterns given context

Question 6

Age related changes to the skin and soft tissue can include:

Answer 6

Thinning
Loss of strength
Loss of elasticity of skin
Loss of subcutaneous tissue
Blood vessels more fragile

Question 7

First degree soft tissue injury

Answer 7

Minor contusion with bleeding
Minimal pain/brusing
Minimal functional impairment

Question 8

Second degree soft tissue injury

Answer 8

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

Question 9

Third degree soft tissue injury

Answer 9

Structural disruption
Severe bruising, muscle spasm and pain
Instability and/or loss of muscle function

Question 10

Immediate management of soft tissue injuries uses the acronym…

Answer 10

PRICE

Question 11

PRICE =

Answer 11

Protection
Rest
Ice
Compression
Elevation

Question 12

What are the key physical signs of a fracture?

Answer 12

Local bone tenderness
Crepitus
Deformity
Swelling
Loss of function

Question 13

Ways to image fractures and soft tissue injuries

Answer 13

X-ray, CT, MRI, ultrasound

Question 14

What imaging technique is best for soft tissue?

Answer 14

MRI

Question 15

Skin intact, fracture uncontaminated

Answer 15

Closed/simple fracture

Question 16

Colles’ fracture

Answer 16

Fracture of radius, posterior displacement

Question 17

Smith fracture

Answer 17

Reverse Colles’ fracture, anterior displacement

Question 18

Fracture in which soft tissues are contaminated. Has a risk of infection and nerve damage.

Answer 18

Open/compound fracture

Question 19

Fracture in which one does not move and maintains proper alignment.

Answer 19

Undisplaced fracture

Question 20

Fracture in which bone snaps in 2 or more parts and moves so that the 2 ends are not aligned straight

Answer 20

Displaced fracture

Question 21

Bone breaks diagonally

Answer 21

Oblique fracture

Question 22

Bone is broken into more than 2 fragments. Occur after high-impact trauma.

Answer 22

Comminuted fracture

Question 23

A type of complete fracture which occurs due to rotational or twisting force.

Answer 23

Spiral fracture

Question 24

A fracture occurring in an abnormal bone

Answer 24

Pathological fracture

Question 25

Type of fracture that happens in osteoporosis. Bone becomes so osteoporotic it collapses under weight (e.g. spine)

Answer 25

Wedge fracture

Question 26

Injury where a tendon or ligament attaches to a bone. Tendon/ligament pulls of a piece of bone.

Answer 26

Avulsion fracture

Question 27

Fracture of bone causes by repeated mechanical stress

Answer 27

Stress fracture

Question 28

2 ways a stress fracture can occur:

Answer 28

1. Repeated abnormal stresses to a normal bone | 2. Normal stresses to an abnormal bone

Question 29

4 main aims of fracture management.

Answer 29

1. Fracture heals in good position 2. Joints have full range of movement 3. Limb regains normal strength and functions 4. Person able to take up role in society asap

Question 30

Open wound management (pretty darn soon):

Answer 30

Protection - assess neuromuscular status of limb, temporary dressing, antibiotics, tetanus Debridement Stabilisation