MSK Injury Flashcards
What is subluxation?
Partial separation of the articular surfaces of the joint
What is dislocation?
Complete separation of the articular surfaces of a joint
What is a fracture dislocation?
A dislocation where there is also a fracture involving one or more of
the articular surfaces of a joint
What is a sprain?
Stretching of the joint capsule and ligaments, insufficient to produce subluxation or dislocation
What factors determine the mechanism of joint injury?
Strength of bone
Force / energy applied
What are clinical signs & symptoms of a fracture?
Pain Swelling Tenderness Bruising Deformity Crepitus Abnormal Movement
What causes pain in a musculoskeletal injury?
Pain receptors in periosteum
Surrounding nerves activated by swelling
Bleeding into compartment
What is a compound fracture?
Open fracture, break in the skin around broken bone
Outside air can get to fracture site with no barrier
What is a complicated fracture?
Fracture causes damage to other structures eg lungs, major blood vessels, spleen
What is delayed union?
Fracture healing takes longer than expected
What is non union?
Fracture does not unite
What is mal union?
Fracture joins in the wrong alignment
What should be done to diagnose a fracture?
History & Examination X-ray Computerised Axial Tomography Magnetic Resonance Imaging Ultrasound Bone Scan
What are risks with pelvic fractures?
Blood Loss
Abdominal Injury
Nerve Injury
What are common causes of pelvic injury?
Road traffic collisions and falls
What is an open book injury?
Sacroiliac joint no longer attached so pelvis opens up, very unstable
What 3 joints form the pelvic ring?
2 sacroiliac joints
Pubic symphysis
Which fracture of the femur is most likely to lead to avascular necrosis?
Intracapsular neck of femur fracture
What divides intra and extra capsular regions of the femur?
Head and neck of femur - intracapsular
Beyond neck - extracapsular
What types of intracapsular fractures are there?
Subcapital - head of femur
Transcervical - neck of femur closest to head
What types of extracapsular fractures are there?
Basal - closest to neck of femur
Intertrochanteric - between greater and lesser trochanter
What is Shentons line?
Medial edge of femoral neck and inferior edge of superior pubic ramus
In a neck of femur fracture, what position does the affected limb end up in?
Shortened and externally rotated
How can an intracapsular fracture be fixed?
Screws
Prosthesis
How can an extracapsular femur fracture be fixed?
Dynamic hip screw
Which patients are at most risk of avascular necrosis?
Younger patients, greater risk to the blood supply and greater risk of AVN as force of injury probably greater
When is hip at highest risk of dislocation?
Frontal impact with hip flexed as ligaments lax in this position
Eg when sat in car
What can occur within 6 hours of damage to a synovial joint?
Chondrolysis
Avascular Necrosis
These can lead to degenerative arthritis
What is a diaphyseal fracture?
Break in shaft of a long bone
What can be used to fix a femur which has had a diaphyseal fracture?
Intermedullary nail
Metal plate
External fixator
What type of fracture is a patella fracture?
Intra-articular
What can be the results of a patella fracture?
Haemarthrosis
Loss of Knee Extension
Degenerative arthritis can develop
What is a patellectomy?
Surgical removal of the patella
What type of fracture is a tibial plateau fracture?
Intra articular
What is likely to cause a meniscal tear?
Rotation of the femur on a fixed tibia
Flat fixed foot, knee rotation
What can cause tibial shaft fractures?
Direct Trauma
Rotational Strain
What are treatment options for fractures?
Internal or external immobilisation
What is the main symptom of compartment syndrome?
Increasing pain scale
What is ankle diastasis?
Tibiofibular diastasis is separation of tibia and fibular often associated with extensive ligament tears
What can cause Achilles’ tendon rupture?
Overuse or overstress causes degeneration of the blood supply to the tendon and therefore increases risk of rupture
What is Simmonds test?
Examination to test for rupture of Achilles’ tendon
Patient lying face down, feet hanging off edge of bed. Squeeze corresponding calf, positive test - no movement of foot
What is conservative treatment for Achilles’ tendon rupture?
Serial plaster casts
Where does the sacral plexus sit?
Postero-lateral pelvic wall
Describe what the root values of the sacral plexus do?
Hip extension - L5-S1 Hip flexion - L1-L2 Hip adduction - L2-L3 Hip abduction - L4-L5 Knee extension - S1-S2 Knee flexion - L3-L4 Ankle dorsiflexion - L4 Ankle plantarflexion - S1-S2
What muscles are innervated by the tibial part of the sciatic nerve? L4-S3
Hamstrings (L5, S1, S2) Gastrocnemius & soleus (S1, S2) Deep leg flexor muscles (S1, S2) Tibialis posterior & popliteus(L4, L5) Intrinsic muscles of the feet (S2, S3) Plantar cutaneous nerves (L4 – S1)
What do intervertebral discs do?
Resit compression and form a mobile joint
What are intervertebral discs?
Secondary cartilagenous joints present from beneath C2 to above S1
Increase in thickness distally
Cartilage end plate on bone
Annulus fibrosus = Layers of fibrocartilage
Nucleus pulposus = Rubbery central core (GAG)
What are the 3 phases of disc prolapse?
Degeneration and leakage
Protrusion and prolapse
Herniation and extrusion
Where is IV disc prolapse most common? And what nerve does it affect?
Lumbar region
Spinal nerve of IVF one level below
What nerve and artery appears above piriformis and what signs will you see if it’s damaged?
Superior gluteal artery & nerve (L4-S1)
Nerve injury: Trendelenburg Sign, pelvis tilts toward side unsupported
by limb during gait (e.g. right sided paralysis, pelvic tilt to left when left limb lifted off the floor). Trendelenburg gait & lean trunk to affected side when walking to help prevent tilt to the unsupported side