Intro to MSK Injuries Flashcards
What is the Gustilo-Anderson Classification? What are the 3 classifications?
Classifies open fractures
- I. Low energy wound, <1 cm.
- II. Wound >1 cm in length w/mod. amount of soft tissue damage.
- III. High energy wound, >10 cm/extensive soft tissue damage.
What types of injuries are associated w/type III open Fx classification when assoc. w/Fx?
- High velocity GSW.
- Shotgun wound.
- Segmental Fx.
- Co-existing vascular injury.
- Significant diaphyseal bone loss.
- Fx sustained in agricultural environment (high risk of infx).
- Crush from moving vehicle.
Describe a transverse, oblique and spiral fracture?
- Transverse - Fx at rt. angle to cortices of long axis of bone.
- Oblique - Fx line oblique to cortices of long axis of bone.
- Spiral - torsional force, spiral, “twist.”
What is the most worrisome aspect of fractures?
If the Fx involves the intra-articular space; 1/3 involvement requires an ortho consult.
Describe a comminuted and segmental Fx?
- Comminuted - more than one segment, “Shattered.”
- Segmental - bone separated into segments by a Fx.
- *Remember the diff b/t segmental and butterfly segmental.
How are a Torus/Buckle and a Greenstick Fx described?
Incomplete Fractures.
Describe a Torus/Buckle and a Greenstick Fx?
- Torus/Buckle - compression Fx or impaction of bone on itself.
- Greenstick - the bone bends and breaks but the Fx is incomplete.
Who are greenstick Fx’s most often seen in?
Children due to their bones being very flexible.
Are Torus/Buckle and Impacted Fx’s the same?
Essentially yes, but impaction is a more severe type of torus/buckle Fx.
What is the difference between Separation, Displaced and Non-Displaced Fx’s?
- Separation - a Fx w/distance between the bone ends; aligned longitudinally.
- Displaced - lateral distance between the two bones involved (distal fragment moved in relation to proximal fragment).
- Non-Displaced - Fx that is aligned correctly; longitudinally.
What is angulation? Give an example?
The angle of distal fragment in relation to proximal fragment.
**Colles Fx of the wrist.
What is an avulsion Fx?
A “chip” Fx; a ligament or tendon pulls a piece of bone off, rather than rupture itself.
What is an intra-articular Fx? What is required with an intra-articular Fx?
Where the Fx extends into or involves the joint articular space; requires ortho consult, will need OR.
What is a stress Fx?
Repeated small insults to a site; may not Fx completely.
What is a pathologic Fx?
A Fx related to a diseased bone; it is weakened by pathology and then a Fx.
What is an impacted Fx?
telescoping of bone, compaction of one bone into another.
Similar to a Torus/Buckle but at greater severity.
What is a depressed Fx?
Step-off, sunken in; typically involves the skull.
What is the difference between Dislocation and Subluxation?
Dislocation = no contact b/t articular surfaces; ex. humoral head dislocation from the glenohumoral joint.
Subluxation = an incomplete dislocation; there is partial contact of articular surfaces.
What is common among dislocation and subluxation?
They both will have swelling, pain and tenderness around the joint, along w/ligamentous disruption.
What is concerning regarding dislocations?
There is potential for neurovascular compromise.
What requires an Ortho Consult?
- Open Fx or Joint = often OR, IV Abx, Tetanus consideration.
- Articular surface involved in Fx.
- Epiphyseal (growth) plate Fx.
What is Delayed Union, Nonunion and Malunion?
- Delayed union = Fx that fails to unite in usually time required for union; 4-6 wks is normal union time.
- Nonunion = a failed union; fragments have stopped the process of bone repair, usually some separation and the bone cannot bridge the gap.
- Malunion = Fx union w/angulation; did not heal in the correct longitudinal position.
What is Osteopenia?
A condition that occurs when the body doesn’t make new bone as quickly as it reabsorbs old bone; bone loss.
What is the Salter-Harris Classification?
Used to classify epiphyseal/growth plate fractures in pediatrics; 5 classes.
Name the 5 classes of the Salter-Harris Classification.
- Class I: Fx thru the growth plate, closed reduction.
- Class II: Fx thru growth plate and metaphysis, closed reduction.
- Class III: Fx thru growth plate and epiphysis, open or closed reduction.
- Class IV: Fx thru metaphysis, growth plate and epiphysis; usually open reduction.
- Class V: growth plate crush, complications.
What is a soft tissue contusion?
extravasation of blood into the soft tissue after blunt trauma w/assoc. swollen and tenderness.
-ex: bruise = ecchymosis/ecchymoses.
What is a strain?
Strain involves a tendon or muscle fiber; injury occurs after excessive stretch or forced contraction under resistance.
Describe the 3 degrees of strain?
- 1st degree = minor stretching; spasm, mild swelling, local tenderness, slight decreased function.
- 2nd degree = partial tear or disruption of muscle fibers; moderate swelling, ecchymosis, decreased strength.
- 3rd degree = complete tear or disruption of muscle fibers; swelling, ecchymosis, decreased strength, palpable “bulge” caused by retracted muscle belly; may lead to significant disability.
What is a sprain?
Sprain involves an injury to a ligament (bone to bone) from abnormal motion at a joint.
Describe the 3 degrees of sprain?
- 1st degree = minor disruption of ligaments; mild hemorrhage and swelling, minor point tenderness, no abn. joint motion.
- 2nd degree = partial tear of ligaments; moderate hemorrhage and swelling, local tenderness, painful motion, loss of function, minor joint laxity.
- 3rd degree = complete disruption of joint ligament, abn. joint motion.
General treatment of Sprains, Strains and minor MSK injuries?
R.I.C.E
- R = rest, I = ice, C = compression, E = elevation.
- Analgesics and anti-inflammatories.
- Consider reduction (compare pre/post reduction films.
- Disposition - f/u, admitted.
Plain films/Conventional radiographs?
Most frequently obtained imaging for bone and soft tissues - get multiple views.
Fluoroscopy?
- Like and X-ray Movie; you see things in real time.
- useful for evaluating joint motion, placing pins/hardware and aspirating joint spaces.
What is an Arthrogram or MRA?
Contrast material is injected into the joint space via fluoroscopic technique, then MRI used for further evaluation.
**Indications like “rotator cuff tear” evaluation.
CT Scan?
Best for evaluating bone!
*Useful for evaluating Fx fragment position in multiple planes and evaluating bone tumors (can show perisoteal changes before MRI).
MRI?
Great for evaluating soft tissues structures in more detail (muscle, tendon, ligaments).
T1 and T2 fluid color?
T1 = black. T2 = white.
Nuclear Med - Bone Scan?
A radioactive substance is injected IV, then scans taken at various intervals.
- It can detect AVN, CA, inflammation (stress Fx), infection.
- Often the test used to screen for bony mets.
PET Scan?
Shows metabolic activity; it reveals how the body’s tissues and organs are functioning at the cellular level;
*May detect early onset of a disease.
What is a Fracture?
A ‘broken bone;’ or disruption of bony cortex that cause swelling, pain, deformity.
What is the major complication with an Open Fx?
Osteomyelitis
-Staph Aureus is the MC overall cause.
