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PCM 4 midterm > MSK procedures > Flashcards

MSK procedures Flashcards

1
Q

The most reliable sign of a fracture is?

A

PAIN

Also

  • Swelling
  • Deformity
  • Eccymosis
  • Loss of function
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2
Q

Comminuted fracture

A

Fracture that results in 2-3 pieces

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3
Q

Avulsion fracture

A

A fragment of bone tears away from the main mass of bone as a result of physical trauma.
This can occur at the ligament due to the application forces external to the body (such as a fall or pull) or at the tendon due to a muscular contraction that is stronger than the forces holding the bone together.

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4
Q

Impacted fracture

A

One whose ends are driven into each other

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5
Q

Torus fracture

A

Also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex.
They result from trabecular compression from an axial loading force along the long axis of the bone

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6
Q

Most common fracture in children?

A

Greenstick fracture

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7
Q

Open fracture

A

A fracture that has communicated with the outside environment

Due to high velocity trauma or missile injury
- Spikes of bone pierce the skin and can go back inside

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8
Q

What must you get for your patient with an open fracture?

A

A surgical consult

- It has to be cleaned as there is a high risk of osteomyelitis

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9
Q

Salter Harris Classification

A

I- slipped fracture, transverse fracture through growth plate or physis (6% of fractures)
II- above, fracture through metastasis and into growth plate (70%)
III- lower, fracture through epiphysis and into growth plate (8%)
IV- through metastsis, growth plate, and epiphysis (10%)
V- rammed and ruined, see compression of growth plate (1%)

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10
Q

The higher the salter number?

A

The poorer the prognosis for recovery

- More serious fracture can look benign

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11
Q

Most common growth plate fracture

A

Salter Type II

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12
Q

Where is the fracture if there is pain in the snuff box?

A

Scaffoid

not always apparent when first x-rayed

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13
Q

Colles fracture

A

Fracture of the distal radius with dorsal displacement, with or without ulnar involvement
(Associated with ulnar styloid process > 60%)

Dinner fork deformity

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14
Q

Most common bone fracture?

A

Clavicle

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15
Q

How do you get a colles fracture?

A

Falling on an outstretched hand

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16
Q

When won’t external mobilization work?

A

When the fracture is so unstable. Have to put nails in it.

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17
Q

Tri-malleolar fracture

A
  1. Lateral malleolus
  2. Medial malleolus
  3. Posterior tibia

Very unstable fracture

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18
Q

How do you get a tri-malleolar fracture and treatment?

A

Landing flat on the heal from significant height

Surgery- (ORIF): open reduction internal fixation

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19
Q

Local fracture complications

A
  • Vascular injury causing hemorrhage, internal or external
  • Visceral injury causing damage to structures such as the brain, lung, or bladder
  • Hemarthrosis- blood in the joint
  • Compartmet syndrome (Volkmann’s Ischemia)
  • Wound infection- common for open fractures
20
Q

Early Systemic fracture complications

A
  • Fat embolism- long bone/pelvic fractures from bone marrow
  • Shock- extensive bleeding
  • Thromboembolism (pulmonary or venous)
  • Exacerbation of underlying disease such as diabetes or coronary artery disease
  • Pneumonia
21
Q

Late fracture complications

A
  • Delayed union
  • Nonunion
  • Malunion
  • Joint stiffness
  • Contractures
  • Myositis ossifcans- calcifications and bony masses can form in muscle
  • Avascular necrosis- loss of blood supply (hip)
  • Algodystrophy (regional pain syndrome)
  • Osteomyelitis
  • Growth disturbance or deformity
22
Q

Late systemic fracture complications

A
  • Gangrene, tetanus, septicemia
  • Fear of mobilizing
  • Osteoarthritis
23
Q

Compartment syndrome

A

MEDICAL EMERGENCY
Pressure inside the fascial compartment exceeds the blood (arterial) pressure
- Causes compromise of the circulation to the soft tissues, ischemia, and necrosis
- Irreversible damage can occur in 8 hours

24
Q

Conditions associated with compartment syndrome

A
  • Soft tissue injuries
  • Soft tissue injury with fracture
  • Exercised induced
  • Crush injury
  • Prolonged tourniquet application
  • Electrical injury
  • Burns
  • Animal bites
25
Q

What do you use to measure compartment pressure

A

Stryker 295

26
Q

treatment of compartment syndrome

A

Fasciotomy

27
Q

What must you do when handling a fracture

A

A pre and post neurovascular exam

28
Q

Fracture blisters

A

Tense vesicles or bullae that arise on swollen skin directly over a fracture
Commonly over tibia, ankle and elbow

  • Arise in 24-48 hours post injury
  • Caused by separation of the dermis from the epidermis
29
Q

Types of fracture blisters and treatment

A

2 types: clear fluid filled and blood filled

Treatment
- Benign neglect, debridement, aspiration, surgical delay

30
Q

Malalignment of fractures

A

Forms a callus or healing

- Will straighten in kids if angle is less than 15 degrees

31
Q

Most common ankle sprain?

A

Inversion

32
Q

High ankle sprain

A

A sprain of the syndesmotic ligaments that connect the tibia and fibula in the lower leg

33
Q

Grade I ankle sprain

A

Mild pain, little swelling
Usually affects anterior talofibular ligament
- Joint stiffness without laxity
- Minimum or no loss of function
Can return to activity within a few days of the injury

34
Q

Grade II ankle sprain

A

Moderate to severe pain, swelling, and joint stiffness
Partial tear of the lateral ligament
- Moderate loss of function with difficulty on toe raises and walking
- Takes up to 2-3 months before regaining close to full strength and stability in joint

35
Q

Grade III ankle sprain

A

Severe pain initially followed by little or no pain due to total disruption of the nerve fibers
- Complete rupture of the ligaments of the lateral complex (severe laxity)
Usually requires some form of immobilization lasing several weeks
- Complete loss of function (functional disability) and necessity for crutches
- Usually managed conservatively with rehabilitation exercises, small percent may require surgery
- Recovery can be as long as 4 months

36
Q

Treatment of acute sprains

A 
Rice!
Rest
Ice
Compression
Elevate

May need immobilization with grade III strains

37
Q

When to immobilize

A
  • Fractures
  • Sprains
  • Severe soft tissue injuries
  • Reduced joint dislocations
  • Inflammatory conditions
  • Deep laceration repairs across joints
  • Tendon lacerations
38
Q

Benefits of a cast

A

Better immobilization in fixed position

  • Less movement at the fracture site
  • Lasts weeks-months
  • Can’t be removed by the patient
39
Q

Benefits of a splint

A
  • Faster and cheaper
  • Can be adapted from surrounding material
  • Not as likely to cause pressure problems
  • Can be removed by the patient
40
Q

Long vs short arm cast

A

Long arm cast will prevent supination, pronation, flexion, and extension
Fracture is usually in the shaft

41
Q

Hazards of casting

A
  • Compartment syndrome
  • Ischemia
  • Heat injury
  • Pressure sores and skin breakdown
  • Infection
  • Dermatitis
  • Joint stiffness
  • Neurologic injury
42
Q

Factors that speed cast setting times

A
  • Higher temperature of dipping water
  • Use of fiberglass
  • Reuse of dipping water
43
Q

How do you wrap a splint or cast?

A

Distal to proximal

44
Q

Indications for joint injections

A

Soft tissue conditions

  • Bursitis
  • Tendonitis
  • Trigger points
  • Ganglion cysts
  • Neuroma
  • Entrapment syndromes
  • Fasciitis

Joint conditions

  • Effusion
  • Crystalloid arthropathies (gout)
  • Synovitis
  • Inflammatory arthritis
  • Advanced osteoarthritis
45
Q

Absolute contraindications for joint injections

A
  • Local cellulitis
  • Acute fracture
  • Tendon sites are at high risk for rupture
  • Drug allergy
  • Septic arthritis
46
Q

Relative contraindications for joint injections

A
  • Minimal relief after 3 previous injections
  • Underlying coagulopathy/anticoagulation therapy
  • Uncontrolled diabetes
  • Surrounding joint osteoporosis
  • Anatomically inaccessible joint

PCM 4 midterm (6 decks)

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