Musculoskeletal injuries 1 Flashcards
Stable fracture
The broken ends of the bone line up and are barely out of place.
Open, compound fracture.
The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.
Transverse fracture.
This type of fracture has a horizontal fracture line.
Oblique fracture.
This type of fracture has an angled pattern.
Comminuted fracture.
In this type of fracture, the bone shatters into three or more pieces.
Spiral fracture.
Complete fractures of long bones that result from a rotational force applied to the bone. Spiral fractures are usually the result of high energy trauma and are likely to be associated with displacement.
Segmental fracture.
A fracture composed of at least two fracture lines that together isolate a segment of bone, usually a portion of the diaphysis of a long bone. This fracture pattern is frequently associated with high energy mechanism and devascularisation of the segmental fracture fragment(s) meaning these injuries are associated with increased morbidity and long term complications such as: delayed union, non-union and/or infection.
Greenstick fracture
Incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. They are commonly mid-diaphyseal, affecting the forearm and lower leg.
Torus fractures (aka buckle fractures)
Incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They result from trabecular compression from an axial loading force along the long axis of the bone. They are usually seen in children, frequently involving the distal radial metaphysis.
impacted fracture
the affected bone shatters and the resulting fragments are driven into the bone pieces.
avulsion fracture
A bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma
Valgus deformity
A condition in which the bone segment distal to a joint is angled outward (angled laterally, that is, away from the body’s midline).[
Varus deformity
An inward angulation (medial angulation, that is, toward the body’s midline) of the distal segment of a bone or joint
Salter-Harris Type I
fracture through the physeal plate (often not detected radiographically)
Salter-Harris Type II
fracture through the metaphysis and physis (most common; up to 75% of all physeal fractures)
Salter-Harris Type III
fracture through the epiphysis and physis
Salter-Harris Type IV
fracture through the metaphysis, physis and epiphysis
Salter-Harris Type V
crush injury involving part or all of the physis
Compartment syndrome: definition
Muscle and nerve ischemia which being caused when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure. It typically occurs subsequent to a traumatic event, most commonly a fracture.
Compartment syndrome: S/Sx (6Ps)
Pain Parasthesia Pallor Paralysis Pulselessness Poikiothermia (cold)
Spine: anatomy
- 7 cervical (neck)
- 12 thoracic (upper back)
- 5 lumbar (lower back)
- 5 sacral* (sacrum–located within the pelvis) –> fused
- coccygeal* (coccyx–located within the pelvis)
Anterior longitudinal ligament (spine): definition
Runs anterior to the bony spine from C1 down nearly to the sacrum, and limits hypertextension
Posterior longitudinal ligament (spine): definition
Similar to the anterior ligament, this is thicker and runs posterior to the vertebral bodies and limits hyperflexion
Ligamentum flavum (spine): definition
Runs between each transverse process
Supraspinal ligament
Runs along the dorsal surface, bridging each of the spinous processes
Anulus Fibrosis
surrounds the soft intervertebral discs
Cervical strain
The most common, usually hyperflexion/extension injuries, also known as whiplash
Cervical spondylosis
Over-use, wear and tear, of the intervertebral discs
Cervical radiculopathy
Compression/irritation of the nerve roots, often involves pain radiating to the extremities (ie pinch nerves)
Cervical fracture
Less common, but must not be missed
Neck pain + HA/girdle pain
Giant cell arteritis (aka temporal arteritis), RA
Neck pain + fever
malignancy, meningitis
Neck pain + neuro signs
myelopathy, spinal cord injuries, carotid injury
Neck pain + parasthesias
radiculopathy, MS
L’Hermittes sign: definition
It is elicited with the neck flexed and causes an electrical sensation that runs down the back and into the limbs. The sensation can feel like it goes up or down the spine. It is generally considered uncomfortable.
L’Hermittes sign: indication
Possible MS, and compression of the spinal cord in the neck from any cause such as cervical spondylosis, disc herniation, tumor, and Arnold-Chiari malformation
Physical exam for neck pain/injury
- Vertebral tenderness (palpate or percuss the spinous processes)
- Paraspinal muscle tenderness
- Neurological exam
- Carotid exam
- NEXUS
- Spurlings’ maneuver
Spurling’s maneuver/test
Turn head and apply axial load. Reproduction of sx ipsilateral side is positive.
A technique to determine if neck pain is the result of radiculopathy
*Never attempt in the case of suspected fracture
NEXUS Criteria
National Emergency X-Ray Utilization Study
- There is noposterior or midlinecervicaltenderness
- There is no evidence of intoxication
- The patient is alert and oriented to person, place, time, and event
- There is nofocalneurological deficit
- There are no painful distracting injuries (e.g., long bone fracture)
Cervical spine imaging (plain films): swimmers
It shows C7
Cervical spine imaging (plain films): odontoid
shot through the Pt’s open mouth
Who needs radiographic studies of the cervical spine?
Indications for X-ray
- Mental status less than alert or intoxicated
- Reports neck pain
- Midline neck tenderness
- Neurologic signs and symptoms
- Distracting injury (i.e. painful injuries elsewhere, e.g. extremity fractures)
Criteria for excluding cervical spine fractures on a clinical basis
- No neck pain
- No neck tenderness on palpation
- Having full, painless, active ROM of c-spine
- No history of loss of consciousness, no mental status change, no neurologic deficit from neck injury
- No distracting symptoms.
If patient meets all these criteria, cervical spine injury is excluded on clinical basis and the cervical collar may be removed.
A patient arrived at the ED on backboard and a cervical collar. He has a blood alcohol level of 0.2. He does not complain of any neck pain. Shoud he get a complete cervical series?
Yes, because he is intoxicated (ie may not feel the pain)
An adequate spine series
An adequate spine series includes three views: a true lateral view (which must include all seven cervical vertebrae as well as the C7-T1 junction), an AP view, and an open-mouth odontoid view.
These three views do not require the patient to move his neck, and should be obtained without the removal of the cervical collar.
For a Pt who receive neck imaging frequently, which organ may be affected
thyroid
Why is a swimmer view is important?
All 7 cervical vertebrae and C7-T1 junction must be visualized because the cervicothoracic junction is a common place for traumatic injury.
Cervical spine imaging: the advantages of CT
- CT is excellent for characterizing fractures and identifying osseous compromise of the vertebral canal because of the absence of superimposition from the transverse view. The higher contrast resolution of CT also provides improved visualization of subtle fractures.
- CT provides patient comfort by being able to reconstruct images in the axial, sagittal, coronal, and oblique planes from one patient positioning.
Cervical spine imaging: the limitations of CT
- difficult to identify those fractures oriented in axial plane (e.g. dens fractures).
- unable to show ligamentous injuries.
- relatively high costs.
