MSK procedures Flashcards
The most reliable sign of a fracture is?
PAIN
Also
- Swelling
- Deformity
- Eccymosis
- Loss of function
Comminuted fracture
Fracture that results in 2-3 pieces
Avulsion fracture
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.
Impacted fracture
One whose ends are driven into each other
Torus fracture
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
Most common fracture in children?
Greenstick fracture
Open fracture
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
What must you get for your patient with an open fracture?
A surgical consult
- It has to be cleaned as there is a high risk of osteomyelitis
Salter Harris Classification
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%)
The higher the salter number?
The poorer the prognosis for recovery
- More serious fracture can look benign
Most common growth plate fracture
Salter Type II
Where is the fracture if there is pain in the snuff box?
Scaffoid
not always apparent when first x-rayed
Colles fracture
Fracture of the distal radius with dorsal displacement, with or without ulnar involvement
(Associated with ulnar styloid process > 60%)
Dinner fork deformity
Most common bone fracture?
Clavicle
How do you get a colles fracture?
Falling on an outstretched hand
When won’t external mobilization work?
When the fracture is so unstable. Have to put nails in it.
Tri-malleolar fracture
- Lateral malleolus
- Medial malleolus
- Posterior tibia
Very unstable fracture
How do you get a tri-malleolar fracture and treatment?
Landing flat on the heal from significant height
Surgery- (ORIF): open reduction internal fixation
Local fracture complications
- 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
Early Systemic fracture complications
- 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
Late fracture complications
- 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
Late systemic fracture complications
- Gangrene, tetanus, septicemia
- Fear of mobilizing
- Osteoarthritis
Compartment syndrome
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
Conditions associated with compartment syndrome
- Soft tissue injuries
- Soft tissue injury with fracture
- Exercised induced
- Crush injury
- Prolonged tourniquet application
- Electrical injury
- Burns
- Animal bites
What do you use to measure compartment pressure
Stryker 295
treatment of compartment syndrome
Fasciotomy
What must you do when handling a fracture
A pre and post neurovascular exam
Fracture blisters
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
Types of fracture blisters and treatment
2 types: clear fluid filled and blood filled
Treatment
- Benign neglect, debridement, aspiration, surgical delay
Malalignment of fractures
Forms a callus or healing
- Will straighten in kids if angle is less than 15 degrees
Most common ankle sprain?
Inversion
High ankle sprain
A sprain of the syndesmotic ligaments that connect the tibia and fibula in the lower leg
Grade I ankle sprain
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
Grade II ankle sprain
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
Grade III ankle sprain
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
Treatment of acute sprains
Rice! Rest Ice Compression Elevate
May need immobilization with grade III strains
When to immobilize
- Fractures
- Sprains
- Severe soft tissue injuries
- Reduced joint dislocations
- Inflammatory conditions
- Deep laceration repairs across joints
- Tendon lacerations
Benefits of a cast
Better immobilization in fixed position
- Less movement at the fracture site
- Lasts weeks-months
- Can’t be removed by the patient
Benefits of a splint
- Faster and cheaper
- Can be adapted from surrounding material
- Not as likely to cause pressure problems
- Can be removed by the patient
Long vs short arm cast
Long arm cast will prevent supination, pronation, flexion, and extension
Fracture is usually in the shaft
Hazards of casting
- Compartment syndrome
- Ischemia
- Heat injury
- Pressure sores and skin breakdown
- Infection
- Dermatitis
- Joint stiffness
- Neurologic injury
Factors that speed cast setting times
- Higher temperature of dipping water
- Use of fiberglass
- Reuse of dipping water
How do you wrap a splint or cast?
Distal to proximal
Indications for joint injections
Soft tissue conditions
- Bursitis
- Tendonitis
- Trigger points
- Ganglion cysts
- Neuroma
- Entrapment syndromes
- Fasciitis
Joint conditions
- Effusion
- Crystalloid arthropathies (gout)
- Synovitis
- Inflammatory arthritis
- Advanced osteoarthritis
Absolute contraindications for joint injections
- Local cellulitis
- Acute fracture
- Tendon sites are at high risk for rupture
- Drug allergy
- Septic arthritis
Relative contraindications for joint injections
- Minimal relief after 3 previous injections
- Underlying coagulopathy/anticoagulation therapy
- Uncontrolled diabetes
- Surrounding joint osteoporosis
- Anatomically inaccessible joint
