Injuries Of Joints (5) Flashcards
What are the most common injuries to synovial joints?
- Dislocation
- Fracture (intra-articular)
- Fracture-dislocation
- Sprain (ligament injury)
What are the three main functions of joints?
- Motion
- Shock absorber
- Growth
When presented with an injury what are the main points that need to be addressed about how the injury as caused?
- Low/high velocity injury
- Fatalities
- Self extricated (managed to get out themselves)
- Speed
- Airbag/seatbelt/helmet
What are the main things to examine for?
- LOOK: swelling/bruising/wounds/deformity
- FEEL: Joint fluid/painful sites/crepitus(crunching)
- MOVE: Range of movement (passive/active)
Outline the Gustillo & Anderson assessment.
- I: 1cm moderate contamination
- III: High velocity severe contamination
Then: - A: Adequate skin coverage
- B: Bone exposed
- C: Circulation compromised
What is the most important thing to document before any treatment occurs?
- Neurovascular status
What neurovascular structure is at risk with the following injuries:
- Distal radius (Colles)
- Dorsal ⅓ humerus
- Shoulder dislocation
- Hip dislocation
- Knee dislocation
- Distal radius: MEDIAN
- Distal ⅓ humerus: RADIAL
- Shoulder dislocation: AXILLARY
- Hip dislocation: SCIATIC
- Knee dislocation: POPLITEAL A/COMMON PERONEAL
What are the different types of investigations that can be used for injuries?
- X ray (anterior-posterior and lateral)
- Stress views
- MRI
- CT
- Aspiration
What is the rule for X-rays?
- 2 bones
- 2 joints
- 2 sides
- 2 views
What is the definition of a fracture?
- Soft tissue injury with underlying break in bony cortex.
What are the possible causes of a fracture?
- Trauma
- Pathological (fracture occurring through abnormal bone under physiological load)
- Stress
- Insufficiency (osteoporosis)
When describing a fracture what needs to be covered?
- Mechanism: fracture pattern, energy, soft tissue envelope, skeletal maturity
- Pathological: local/systemic
For fracture healing there are 3 stages what are these and how long do they take?
- Inflammation: 1-5 days
- Reparative: 4-40 days
- Remodelling: 25-200 days
What is the key thing for bone repair?
- Stability
- So can heal via callus
What are the systemic factors affecting healing?
- Age
- Malnutrition
- General health
- Generalised atherosclerosis
- Smoking
- Drugs
What are the local factors affecting healing?
- Degree of local trauma/bone loss
- Area of bone affected
- Abnormal bone = slower to heal
- Degree of immobilisation of fracture - motion delays healing
- ## Disruption of vascular supply
How do you describe a fracture? OLD ACID
- Open vs Closed
- Location
- Degree
- Articular extension
- Comminution (no. of pieces)
- Intrinsic bone quality
- Displaced/angulation/rotation
What is valgus and varus?
- Valgus: apex medial
- Varus: apex lateral
What are the 3 main goals for fracture treatment?
- Reduce
- Hold (plaster/sling)
- Rehabilitation
What are the local early fracture complications?
- Nerve injury
- Vascular injury
- Compartment syndrome (high pressure)
- Avascular necrosis
- Infection
- Surgical
What are the systemic early fracture complications?
- Shock / hypovolaemia
- Fat embolism
- Thromboembolism
- Acute respiratory distress syndrome
- Disseminated intravascular coagulation
What are the local late fracture complications?
- Delayed/mal/non - union
- Myositis ossificans
- Refracture
What are the regional late fracture complications?
- Osteoporosis
- Joint stiffness
- Chronic regional pain syndrome
- Abnormal biomechanic osteoathrosis
What is a sprain and the common sites for one?
- Damage to ligament
- Ankle
- Knee
- Thumb (joints of the hand)
