Musculoskeletal - Fractures - Complications Flashcards
1
Q
Fracture Blisters
A
- areas where the skin has seperated from the underlying dermis due to oedema / fluid
- seen in more severe #, heat application, PVD
- most common on ankle, elbow, knee or areas with less soft tissue between the bone & skin
2
Q
Compartment Syndrome
A
- increased pressure within a limited space (abdomen & limb compartments)
- compromises circulation & function of tissues within the space
- muscle necrosis can occur in 4-8hrs
- acute: occurs following # or crush injury, where excessive swelling results in increased pressure in a closed compartment
- chronic: may develop in long distance runners, symptoms are less severe & improve with rest
3
Q
Limb Compartment Syndrome
A
- muscles & nerves are enclosed in a tough inelastic fascial envelope called a muscle compartment
- high pressures (above 30mmHg) cause tissue circulation to be compromised
- normal pressure = 6mmHg
- pressure building depends on:
- duration of pressure elevation
- metabolic rate of the tissues
- vascular tone
- local blood pressure
- requires surgery to reduce intra-compartment pressure
4
Q
Compartment Syndrome - Causes
A
- a decrease in compartment size
- constrictive dressings / casts
- closure of facial defects
- burns (circumferential)
- increase in the volume of it’s contents
- trauma
- swelling
- vascular injury and bleeding
- oedema
- contusions and soft tissue injury
- ischemic events causing increased capillary permeability & oedema
- infiltration - of IV fluids / bleeding from arterial puncture site
5
Q
Compartment Syndrome - Symptoms
A
- 6 P’s
- pain (increasing)
- pressure
- pallor (colour, because artery is compromised)
- parathesia (sensation, numbness, tingling)
- paralysis (weakness)
- pulselessness (late sign)
6
Q
Compartment Syndrome - Management
A
- early detection
- continuous neurovascular observations
- loosen restrictive bandages
- bi-valve casts
- surgery - faciotomy - make incision into muscle
7
Q
Osteomyelitis
A
- acute or chronic infection of the bone
- MOST COMMON microorganism: staphylococcus aureus
- associated with persistent or recurrent fevers, increased pain at the operative or # site, poor incisional healing
- difficult to treat & eradicate, bacterial infections most common
- bone has no defense systems, not protected by immune system, bacteria can enter at time of trauma or be blood borne
- exogenous - infection that enters from outside the body: open fractures, penetrating wounds (gun shot, stab wound), surgical procedures (pin sites, joint replacements)
- endogenous - caused by pathogens in the blood: from sites of infection, spreads from bone to adjacent soft tissue
- haematogenous - carried in the blood from other sites within the body (abscesses, UTI)
8
Q
Osteomyelitis - Management
A
- goals:
- control infection
- reduce pain
- improve mobility
- ensure adhereance to prescribed treatment regime
- antibiotics - IV for 4-6 weeks then oral
- bed rest
- splinting / support of limb
- analgesia & fever control
- wound management
- hyperbaric oxygen (main aim to perfuse / oxygenate area, make aerobic, lungs are getting 100% oxygen)
9
Q
Fat Embolism Syndrome
A
- syndrome = collection of symptoms
- FES = collection of symptoms resulting from the presence of fat droplets in the small blood vessels of the lungs or other organs after a long bone # or major trauma - fat particles in the circulation
Fat embolism, occurs frequently, FES is infrequent
Due to:
- trauma: long bone / pelvic #, burns, orthopaedic procedures, liposuction, bone marrow harvesting / transplant
- non-trauma: pancreatitis, diabetes, osteomyelitis, alcoholic liver disease, steroid therapy, bone tumor lysis, lipid infusion (TPN)
10
Q
Osteopenia
A
- symptom NOT a disease
- reduction in bone mass, tells that bone appears thin
11
Q
Osteonecrosis
A
- death of bone and marrow in the absence of infection
- always due to ischemia (lack of blood supply)
- results in necrosis of cancellous bone & marrow, doesn’t usually involve cortex as it has external blood supply
