MSK - Trauma Flashcards
What is trauma?
Trauma - Any external force applied to the body which results in injury
High amount of morbidity when it occurs in working age and the elderly - Loss of income, pain, prolonged bed rest etc.
Leading cause of death and disability in first 4 decades of life
Constant level/incidence of trauma that occurs at all ages
Note - most injuries are from low energy incidents - falls from less than 2m
50% of Orthopaedics is dealing with consequences of trauma
What are the defintions of the following terms:
In general terms - what causes fractures?
- Injury mechanism that exceeds maximum force the bone can withstand leading to fracture
NORMAL bone, ABNORMAL force - Co-morbidity that increases risk of fracture after injury,
ABNORMAL bone, NORMAL force
For example..
a) Congenital - Osteogenesis imperfecta (brittle bones)
b) Acquired - Metabolic - Rickets/osteomalacia or Degenerative - Osteoporosis – most common
c) Tumour - Primary, secondary and haematogenous (blood born cancer)
- Co-morbidity that increases risk of injury…
a) Visual impairment
b) Alcohol/drug use
c) Neuropathy
d) Balance disorder
e) Epilepsy
NORMAL bone, ABNORMAL force, INCREASED RISK of trauma
When looking at different age ranges - what are the causes of fractures in younger and older age groups?
Young age group - males
Older age group - females
Note - RTC - road traffic collisions
What are the two main categories of fracture patterns?
What are the different complete fracture patterns?
How many views should you at least have when imaging a fracture?
At least 2 views - AP and lateral
What is primary healing?
- Direct healing without fracture callus
- Requires edges to be touching exactly with no movement
- Absolute stability
- Does not occur naturally (ie. It only happens with surgery)
- Important for certain fractures
- Lamellar bone formed - Haversian remodelling
On the cellular level, what do we observe during primary fracture healing?
Cutting cone formation - collection of cells going through the fracture
Osteoclasts – remove bone
Behind them we have osteoblasts – laying down new bone
What is secondary healing?
Outline the different steps of secondary healing?
- Inflammation - Haematoma and inflammatory cells recruited, Osteoblast and fibroblasts proliferate, and granulation tissue forms around bone edges (new connective tissue)
- Repair phase 1 (< 2 weeks) - Primary soft callus forms - cartilage formation - Wider than bone for strength
- Repair phase 2 - endochondral ossification - Soft cartilage replaced by bone - produces woven bone - Rapid production but disorganised & not stress-orientated
- Redemodelling - Conversion of woven bone into lamellar bone - using cutting cones - Wolff’s law - Remodels according to stress
What factor influences the differentiation pathway of osteogenic precursor cells during secondary healing?
What are the different types of remodelling in primary and secondary healing? What treatments are required to promote primary of secondary healing?
What are the broad goals of fracture management? What are the 4 R’s of fracture management?
The 4 ‘R’s of fracture management
1. Resuscitate - always first
2. Reduce
3. Restrict
4. Rehabilitate
What are the different types of non-operative management for fractures? What are the advantages and disadvantages of these types of treatment?
- Nothing - e.g. 5th meta-carpal fracture
- Simple splints for comfort
- Devices to help control position
What are the advantages and disadvantages of operative management of fractures?
What are features of high energy trauma?
When dealing with high energy trauma’s - what framework should you follow?
DR ABCDE
AIRWAY and C-spine control
BREATHING
CIRCULATION
DISABILITY - are they conscious
EXPOSURE - check the full body for injury
What are 6 life-threatening conditions that are reversible when dealing with high energy traumas?
ATOM FC
AIRWAY OBSTRUCTION
TENSION PNEUMOTHORAX - Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse - causes mediastinal shift
OPEN PNEUMOTHROAX - air builds up in the pleural cavity, the fluid-filled space that directly surrounds the lungs, due to a hole in the chest wall.
MASSIVE HAEMOTHORAX - accumulation of blood in the pleural cavity
FLAIL CHEST - sections of broken ribs are isolated from, and interfering with, normal chest movements.
CARDIAC TAMPONADE - happens when the fluid sac around your heart fills with blood or other fluid, putting pressure on your heart.
What is an important consideration when dealing with open fractures?
Compound fracture’ historical term - Direct communication between external environment (skin) and fracture
Prompt management is imperative –> Increased risk of infection (infected non-union)
Wash, reduce and antibiotics
What is the management used for open fractures?
What does surgery for open fractures look like?
Minimize infection is key for bone re-growth
What should we watch out for when we have a tibial shaft fracture?
Compartment syndrome!
Symptoms
1. Severe pain, increasing in severity
2. Refractory to strong opiates
3. Pain on passive stretching of toes
4. Paraesthesia
5. Pulses normal
6. Muscles in calf feel tight
What is compartment syndrome? How is it treated?
- Devastating condition
- Increased pressure inside a fixed fascial compartment - forms viscious cycle - swelling leads to increas pressure, resulting in decreased perfusion leading to increased damage leading to more swelling.
- Eventually, tissues in compartment become ischaemic, then necrotic leading to irreversible damage
- Classic signs
a) PAIN disproportionate to the injury
b) PAIN on passive stretch
c) Distal pulse does not mean no compartment syndrome - Can occur anywhere there is a fascial layer - most common in the leg, forearm and thigh
Treatment - fasciotomies - cut open to relieve pressure
