MSK 1 Flashcards
1
Q
What are the 2 types of bone and what is the purpose of each?
A
Cortical: provides structural support and attachment points for muscles
Cancellous: “soft” interior where vascular supply is situated; site of RBC production
2
Q
Which type of bone is where RBCs are produced?
A
Cancellous
3
Q
What are the 3 main parts of a long bone?
A
(1) diaphysis
(2) epiphysis
(3) metaphysis
4
Q
Which part of a long bone is also known as the shaft and provides skeletal support?
A
Diaphysis
5
Q
Which part of a long bone is a common site of muscle attachment?
A
Diaphysis
6
Q
Which part of a long bone is the ossification center?
A
Epiphysis
7
Q
Tendons attach ___ to ___.
A
Tendons attach muscle to bone.
8
Q
Ligaments attach ___ to ___.
A
Ligaments attach bone to bone
9
Q
What are 4 examples of acute musculoskeletal complaints?
A
(1) Fractures
(2) Dislocations
(3) Ligament strains/sprains
(4) Septic joints
10
Q
What are 3 examples of chronic musculoskeletal complaints?
A
(1) Overuse syndromes (tendonitis)
(2) Osteoarthritis
(3) Osteomyelitis
11
Q
Define direct, indirect, and twisting forces.
A
Direct: a direct blow
Indirect: force impacts one end of limb and damage is transmitted to a distant point
Twisting: one part of extremity stationary while the rest twists
12
Q
What 5 things would you look for on musculoskeletal physical exam?
A
(1) Swelling
(2) Deformity
(3) Neurovascular status
(4) Pain with palpation
(5) Painful/decreased ROM
13
Q
What are 3 special tests to assess joints on PE and what is the usefulness of each?
A
Provocative tests: recreate mechanism of injury to reproduce the pt’s pain
Stress tests: apply load to test ligament stability
Functional testing: useful to assess injury severity and ADLs
14
Q
What is the initial test of choice following skeletal trauma?
A
X-ray
15
Q
What 4 things does an x-ray evaluate?
A
(1) Cortical integrity
(2) Articular surface congruity
(3) Joint space
(4) Lesions
16
Q
What is a CT scan used in?
A
Trauma to identify and characterize injury pattern/severity
17
Q
A CT scan is better than x-ray in what 3 things?
A
(1) identifying subtle fractures (2) visualizing articular extension of fracture
(3) assessing for the presence of articular step-off/gap
18
Q
What are MRIs primarily used for? What additional 2 things are MRIs useful for?
A
Soft tissue eval; diagnosing occult fractures and when there is a concern for associated ligament or articular cartilage injury
19
Q
What is an ultrasound used for and what are 2 injury examples for ultrasound use?
A
Used in trauma setting to assess soft tissue injury; (1) Achilles’ tendon rupture (2) Quad tendon rupture
20
Q
What 2 fractures is a bone scan most commonly used for?
A
Occult and stress fractures
21
Q
What are the ABCs of reading an x-ray?
A
Alignment (long axes of bones), adequacy (of views and image quality) Bones (lucent lines, deformities) Cartilage (joint space, defects) Soft tissues (swelling, effusion)
22
Q
Define fracture. And list 2 additional things that may be affected by fractures.
A
Fracture: loss of continuity of the structure of a bone
(1) Sharp fragments may injure surrounding tissue
(2) Arteries and veins that run throughout the bones may tear or rupture and bleed
23
Q
Differentiate open fracture from closed fracture.
A
Open: break in skin w/underlying soft tissue injury
Closed: fracture is not exposed to environment, no break in skin
24
Q
In what amount of time after an open fracture should surgical tx be at least started?
A
6 hours
25
Salter-Harris fractures are fractures of the ____ plate.
Salter-harris fractures are fractures of the epiphyseal plate.
26
List the meanings of each letter in SALTER as it relates to the Salter-Harris fractures.
```
Straight across
Above (proximal)
Lower or below (distal)
Through (or two)
ERasure of growth plate (or crush)
```
27
What is the most common type of Salter-Harris fracture?
Type II (~75% of Salter-Harris fractures)
28
Describe a Salter-Harris type I fracture.
Fracture plane passes all the way through the growth plate, not involving the bone
29
Describe a Salter-Harris type II fracture.
Fracture passes across most of the growth plate and up through the metaphysis
30
Describe a Salter-Harris type III fracture.
Fracture plane passes some distance along the growth plate and down through the epiphysis (distally); proliferative and reserve zones are interrupted
31
Describe a Salter-Harris type IV fracture.
Contiguous through the metaphysis, physis, and epiphysis; proliferative and reserve zones are interrupted
32
Describe a Salter-Harris type V fracture.
Crush injury of the physis; does not displace the growth plate, but damages it by direct compression
33
What are the 5 principles of fracture immobilization?
```
Maintain position
Prevent movement of fracture
Protect from further injury
Limit neuro injuries
Pain control
```
34
What are 6 methods of fracture immobilization?
```
Splinting
Casting
Closed reduction percutaneous pinning (CRPP)
Open reduction internal fixation (ORIF)
External fixator (Ex-Fix)
Intramedullary (IM) rodding
```
35
What does a splinting allow for that casting does not and what does that help prevent?
Splinting allows for swelling; casting can cause compartment syndrome by not allowing for swelling
36
What is the first method of immobilization and what 3 principles of fracture immobilization does it cover?
Splinting; (1) immobilizes affected extremity/area (2) prevents further injury (3) pain control
37
What is the golden rule of immobilization?
Immobilize the joint above/below injury
38
What are 4 reasons to splint above/below the injury?
(1) Minimizes movement which decreases pain
(2) Prevents additional soft tissue injury to nerves, arteries, veins, +/- muscle
(3) Prevents closed fracture from becoming open
(4) Minimizes blood loss
39
When applying a splint that wraps an extremity, which direction do you wrap and why?
Wrap from distal to a more proximal point→ prevents trapping of blood distal to injury
40
What 3 things should you measure both before and after splinting?
(1) distal circulation (2) motor function (3) sensation
41
What type of fracture is a short arm cast (SAC) used for?
wrist fracture
42
What 2 types of fractures is a long arm cast (LAC) used for and what does it also help prevent?
(1) forearm fracture
(2) unstable wrist fracture
(3) prevents supination/pronation
43
What 2 types of fractures is a thumb spica cast used for?
(1) scaphoid fracture
| (2) radial styloid fracture
44
What 4 things are short leg casts (SLC) used for?
(1) foot (2) ankle (3) Achilles’ (4) Sever’s syndrome
45
What 2 things are long leg casts (LLC) used for?
(1) Tib/fib fracture
| (2) quad tendon repair
46
What are 2 benefits and 2 risks to closed reduction percutaneous pinning?
Benefits: hold unstable fx, reduces need for ORIF
Risks: skin infection around pins, nerve/vessel injury
47
Which type of fracture fixation is most definite and what does it allow for?
Plates/screws→ allow for anatomic reduction of fracture
48
What are 3 uses of an ex fix?
(1) Major non-life saving procedures must be avoided
(2) As a bridge to definitive internal fixation
(3) If pt in OR for life saving procedures, should be performed in concert w/them
49
How long does a fracture take to heal?
6 weeks
50
What are the 3 phases of fracture healing?
(1) Fracture hematoma (inflammatory phase)
(2) Fibrocartilaginous callus formation (reparative phase)
(3) Bone remodeling
51
What are the 4 steps to the fracture hematoma inflammatory phase and how long does it last?
Fracture hematoma: *lasts ~2 weeks
Hematoma and granulation tissue form
Blood vessels across fracture disrupted and leak blood
6-8 hours following fx, blood clot forms at fx site
Phagocytes (neutrophils and macrophages) and osteoclasts are recruited to remove the necrotic tissue at the fx site
52
What are the 3 steps to the fibrocartilaginous callus formation reparative phase and how long does it last?
Fibrocartilaginous callus formation: *callus lasts 3-4 months
Fibrovascular tissue invades the hematoma
Fibroblasts develop into chondroblasts and produce fibrocartilage
Results in fibrocartilaginous “callus”
53
What 2 things happen during the bone remodeling phase?
(1) compact bone replaces spongy bone around fracture periphery
(2) remaining dead fracture portions reabsorbed osteoclasts
54
What are 8 local factors that affect fracture healing?
```
Location of fracture in bone
Intra-articular extension
Severity of injury
Mechanical stability at fracture site
Blood supply
Infection
Underlying pathological lesion
Prior radiation to site
```
55
What is the number one systemic factor for delayed bone healing? What are 5 other systemic healing factors?
```
Smoking: number 1 reason for delayed bone healing
Age of pt
Nutrition status
Presence of underlying disease
Corticosteroids
NSAIDs
```
56
What is a sprain and what are the 2 possible mechanisms of injury?
Stretching or tearing of ligaments; MOI: inversion, eversion
57
What is the most common type of sprain?
An ankle sprain by inversion with plantar flexion
58
What is a strain and what is it most often caused by?
Injury to muscle or muscle and tendon→ muscle fibers tear; often caused by overextension or over stretching
59
What are 4 typical strain sx?
Swelling
Cramping
Pain
Muscle spasm/weakness
60
What are 2 contributing conditions of tendon rupture?
(1) injection of steroids into tendon
| (2) use of fluoroquinolones
61
What are the 4 most common types of tendon rupture?
(1) Achilles’
(2) Biceps (proximal>distal)
(3) rotator cuff
(4) quad
62
What are the 4 most common locations of tendonitis?
(1) shoulders
(2) elbows
(3) wrists
(4) knees
63
What are the 6 treatments of tendonitis?
```
Rest
Ice cube massage
NSAIDs (naproxen)
Cortisone
Physical therapy
Brace
```
64
How often should you tell pts to do ice cube massages to heal tendonitis?
3x/day
65
What do you want to evaluate before and after reduction of a dislocation?
Neurovascular status
66
What finding increases the severity of a dislocation injury?
Loss of distal pulses
67
What are the 6 treatments of tendon ruptures?
(1) Splint/immobilization
(2) Ice
(3) NSAIDs
(4) Repair/reconstruction
(5) Early ROM
(6) Physical therapy
68
What are the 4 ortho pharmacologic treatment options?
(1) Acetaminophen
(2) NSAIDs
(3) topicals
(4) narcotics
69
Which NSAID is preferred for tx and why?
Naproxen is preferred b/c it is BID and ibuprofen is QID
70
What is the rule of 2 when prescribing naproxen?
“Take 2 blue tablets, 2 times daily for 2 weeks, then as needed”
71
What is the modality of choice for both disc herniations and ACL tears?
MRIs
72
What “lights up” on T2 MRI images?
Occult fractures b/c they are well visualized as edema of the bone marrow “lighting up” (any fluid, blood, edema, effusions, etc. appear white on T2 images)
73
What appear as “hyperintense” signals on T2 weighted images?
Bone bruises
74
How does an MRI help in osteochondral injuries?
MRIs can help to characterize the fragment size and potential stability of an osteochondral injury
75
When ordering an x-ray, how many views should you get?
Always get at least 2 views! (usually AP/lateral→ perpendicular to each other)
76
If a pt is complaining of ankle pain, what view do you order and which view do you not order?
Order: 3-view ankle series→ don’t order a tib-fib view
77
If a pt presents symptomatic and high clinical suspicion, what 2 things do you do?
(1) tx as a fracture and splint (2) have pt follow up w/ortho in 7-10 days (repeat x-ray may show cortical changes)
78
What 7 things do you do when interpreting the x-ray?
(1) Open vs closed
(2) Anatomic location
(3) Morphology of fracture line
(4) Displacement (described in %)
(5) Distraction
(6) Angulation
(7) Rotation
79
Overpenetrated x-rays show up ____, while underpenetrated x-rays show up ____.
Overpenetrated x-rays show up darker, while underpenetrated x-rays show up lighter.
80
What is displacement?
The loss of normal anatomic position
81
How is displacement graded?
Graded in terms of shaft width in quartiles in terms of position of the distal fragment to the proximal fragment
82
Which direction of displacement does AP view describe?
Medial to lateral displacement
83
Which direction of displacement does lateral view describe?
Anterior to posterior displacement
84
T/F: displacement and angulation are the same thing.
False: you can have displacement w/o angulation and vise versa
85
What is angulation?
A method of describing the alignment of long bones that have been affected by injury or disease
86
What is a transverse fracture, what is it commonly caused by, and what is the most common location(s) of transverse fractures?
A fracture perpendicular to the long axis of the bone; commonly caused by direct force; most commonly located in forearm/leg
87
What type of force are oblique fractures commonly caused by, and are they more or less stable than transverse fractures?
Indirect force; less stable than transverse
88
What causes the shear force of oblique fractures?
Compression and angulation forces combine to cause shear force
89
What causes a spiral fracture?
Twisting motion through the long axis- a result from rotation/shear forces
90
Which type of fracture is the least stable of all?
Spiral fracture
91
T/F: comminuted fractures contain more than 2 fracture fragments.
True
92
What happens to produce a butterfly fragment?
An indirect force produces a bending of the bone w/resultant tension vector on the convex side and compression vector on the concave side
93
What side is a butterfly fragment produced along?
Along the concave, compression side
94
What is a greenstick fracture?
Incomplete fracture of a long bone→ produced on the convex cortex while concave cortex becomes bent w/o a visible crack
95
Is a buckle fracture stable or unstable?
A very stable fracture
96
Where does a buckle fracture typically occur and after what type of fall?
Typically occurs at metaphyseal diaphyseal junction after FOOSH
97
What is an avulsion fracture caused by?
Caused by abnormal tensile stress on ligaments or tendons
98
What are 3 locations of avulsion fractures?
Hands: dorsal distal phalanx w/extensor tendon avulsion
Feet: base of fifth metatarsal w/peroneus brevis avulsion
Pelvis: ischial tuberosity w/hamstring tendon avulsion
99
What are the 2 suggested x-ray views for the AC joint?
(1) AP with weights
| (2) AP without weights
100
What are the 2 suggested x-ray views for the chest?
(1) PA
| 2) lateral (full inspiration
101
What are the 2 suggested x-ray views for the clavicle?
(1) AP
| 2) oblique AP of the clavicle (15 degrees
102
What are the 2 suggested x-ray views for the humerus?
(1) AP
| (2) lateral
103
What are the 2 suggested x-ray views for the SC joint?
(1) AP
| 2) obliques (bilat
104
What are the 3 suggested x-ray views for the shoulder?
(1) AP
(2) Grashey
(3) Y-scapular view
105
What are the 3 suggested x-ray views for the elbow?
(1) AP
(2) external oblique
(3) lateral
106
What are the 3 suggested x-ray views for the fingers?
(1) AP
(2) oblique of hand
(3) lateral of affected finger
107
What are the 3 suggested x-ray views for the hand?
(1) AP
(2) oblique
(3) lateral
108
What are the 3 suggested x-ray views for the thumb?
(1) AP
(2) oblique
(3) lateral
109
What are the 3 suggested x-ray views for the wrist?
(1) AP
(2) oblique
(3) lateral
110
What are the 2 suggested x-ray views for the hip?
(1) AP pelvis
| (2) frog lateral
111
What are the 2 suggested x-ray views for the femur?
(1) AP
| (2) lateral
112
What are the 4 suggested x-ray views for the knee (under 40 y.o.)?
(1) AP
(2) lateral
(3) tunnel
(4) sunrise
113
What are the 4 suggested x-ray views for the knee (over 40 y.o.)?
(1) bilat PA weight bearing (30 degree PA flexed view)
(2) bilat tunnel
(3) bilat sunrise
(4) lateral of affected knee
114
What are the 2 suggested x-ray views for the tib-fib?
(1) AP
| (2) lateral
115
What are the 3 suggested x-ray views for the ankle?
(1) AP
(2) mortise
(3) lateral
116
What are the 3 suggested x-ray views for the foot?
(1) AP
(2) oblique
(3) lateral
117
What are the 2 suggested x-ray views for the heel?
(1) axial
| (2) lateral calcaneus
118
What are the 3 suggested x-ray views for the C-spine?
(1) AP
(2) lateral
(3) swimmer's view
119
What are the 2 suggested x-ray views for the T-spine?
(1) AP
| (2) lateral
120
What are the 4 suggested x-ray views for the L-spine?
(1) AP
(2) obliques
(3) lateral
(4) spot view
121
What are the 3 suggested x-ray views for the sacrum/coccyx?
(1) AP
(2) axials
(3) lateral
122
What are the 2 suggested x-ray views for the scoli survey?
(1) PA
| (2) lateral
