Lec3 Flashcards
Complications related to the fracture itself
• Infection
• Delayed union
• Non-union
• Avascular necrosis
• Mal-union
• Shortening
Complications attributable to associated injury
• Injury to major blood vessels
• Injury to nerves
• Injury to viscera
• Injury to tendons
• Fat embolism
• Compartment syndrome
• Injuries and post-traumatic affections of joints
COMPARTMENT SYNDROME
clinical condition characterized by an elevation of intra-compartmental pressure, resulting in a decreased blood supply of the muscles and nerves within it; causing ischemic damage which may progress into necrosis of both muscles and nerves.
Classical features of ischemia or Volkmann’s ischemia contracture
5P:
1. Pain
2. Pallor
3. Paresthesia
4. Paralysis
5. Pulselessness.
Injury to nerves
Neurapraxia: the damage is slight and causes only a transient physiological block
Axonotmesis : the internal architecture of the nerve is preserved, but the axons are so badly damaged that peripheral degeneration occurs
Neurotmesis: the structure of the nerve is destroyed by actual division or severe scarring
POST-TRAUMATIC OSSIFICATION
Blood collects under the stripped soft tissues, forming a large hematoma about the joint. Instead of being absorbed, the hematoma is invaded by osteoblasts and becomes ossified
REFLEX SYMPATHETIC DYSTROPHY (Sudeck‘s atrophy; Sudeck’s post-traumatic osteodystrophy; post-traumatic painful osteoporosis; Complex regional pain syndrome)
Clinical condition prolonged disability after fractures or other injuries of the limbs
is characterized by pain, swelling and marked joint stiffness in the hand or foot of the injured limb. The cause and exact nature of the condition are unknown, but it probably results from ( disturbance of centrally mediated autonomic regulation with consequent increased stimulation of sympathetic and motor efferent fibers).
Isolated fractures(stable with no disruption of the pelvic ring )
1] Fracture of superior ischio-pubic ramus
[2] Fracture of inferior ischio-pubic ramus
[3] Fracture entering wall of acetabulum
[4] Fracture of wing of ilium
[5] Avulsion fractures of anterior inferior iliac spine, anterior superior iliac spine, or ischial tuberosity.
Fractures with disruption of the pelvic ring (unstable)
1] Combination of anterior and posterior fractures of the pelvic ring
2] Disruption of pubic symphysis and posterior sacro-iliac joint
Only three types of dislocation and fracture- dislocation of the hip need be considered:
1.Posterior dislocation or fracture-dislocation
2.Anterior dislocation
3.Central fracture-dislocation
Iliac apophysitis
pain and swelling (inflammation) of the growth plate along the side of the hip (iliac crest). The growth plate is an area of weakness, and injury to it occurs because of repeated stress or forceful exercise.
creating stress on the attachment site of the gluteus medius and tensor fascia latae on the iliac crest
Apophysitis
is due to long bones such as the femur (thigh bone)
growing more quickly than the muscles of the thigh or hip
Avulsion Fracture
always occurs in response to a large, rapid force where the muscle is in a position of stretch and contracting very hard, pulling on the growth center
Factors related to the development of apophysitis
Muscle tightness
Rapid growth spurts
Being male
High activity levels
Type of activity
apophysitis injuries which commonly occur in children are:
*Osgood Schlatter’s disease occurs at the top of the shin bone, at the front and just below the knee.
*Sinding-Larsen-Johansson (jumper’s knee) causes pain at the bottom of the patella (kneecap), like Patellar tendonitis. Affect the proximal end of patellar tendon
*Sever’s disease– causes pain at the back of the heel, where the Achilles tendon inserts.
Sacroiliitis
Is due to excessive mobility, large forces are transferred to the sacroiliac joint, producing an inflammation of the joint
• Sacroiliitis can cause pain in the buttocks or lower back and can extend down one or both legs.
• Prolonged standing or stair climbing, running can worsen the pain.
Iliotibial band syndrome
It is due to excess adduction and internal rotation movements, also due to excess tension in the tensor fascia latae in abducting the hip in single- stance weight bearing which seen in dancers and distance runners .
Causes of ITBS:
1-Excessive foot pronation
2-Hip abductor weakness
3-Internal tibial torsion
4-Medial compartment arthritis leading to genu varum
5-Preexisting iliotibial band tightness (congenital)
Snapping hip syndrome
a click as the hip capsule moves or the iliopsoas tendon snaps over a bony surface. which seen in dancers and distance runners .
Piriformis syndrome
Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks.
• Pain can be severe and extend down the length of the sciatic nerve (called sciatica).
• The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running.
Anterior knee pain ( chondromalacia)
1- Overuse (vigorous physical activities that put repeated stress on the knee, such as jogging, squatting, and climbing stairs.
2-Patellar Malalignment (abnormal tracking of the kneecap in the trochlear groove)
3- Iliotibial band tightness
4- Muscle imbalance
5- Hip problems
6- Tight quadriceps and hamstring muscles
7-Problems with alignment of the legs between the hips and the ankles
8- Pes Planus (Flat Feet)
DELAYED UNION happed because
the fracture is still freely mobile 3 or 4 months after the injury.
Surgical treatment for delayed union
1-Bone grafting operation offers the best prospect of promoting union.
2- Rigid internal fixation alone, without bone grafting, may be adequate.
Sites for AVASCULAR NECROSIS
1-Head of the femur
2- Proximal half of the scaphoid bone
3-Body of the talus
4-lunate bone.
