ortho and radiology basics Flashcards
acute injuries
- less than 6 weeks
chronic injuries
- greater than 6 weeks
provocative tests
- recreate mechanism of injury to reproduce pts pain
stress tests
- apply load to test ligament stability
functional test
- assess injury severity and ADLs
open fracture
- break in skin and underling soft tissue
- surgical tx within six hours
why would you immobilize a joint after a fracture?
- maintain anatomic position
- prevent movement of fx and further injury
- limits NV injury
- pain control
methods of immobilization
- splint
- cast
- closed reduction percutaneous pinning (CRPP)
- open reduction internal fixation (ORIF)
- external fixator
- intramedullary rodding
how long does it take for fx to heal? phases of healing?
- 6 weeks
- inflammatory phase- hematoma
- reparative phase- callus that lasts 3-4 months
- bone remodeling
splinting a fracture
- splint for 2-3 days to allow swelling to decrease
- refer to ortho for possible cast
- splints allow soft tissue swelling
- minimize NV compromise
- immobilize joint above and below injury
- eval distal circulation, motor function and sensation before AND after splinting**
casting a fracture
- usually on for 4-6 weeks
- changed at about 3 week mark if no fx movement
- treatment of choice for most non-operative fx
what do you use short arm casts for?
- wrist fx
what do you use long arm casts for?
- forearm fx
- unstable wrist fx to prevent pronation and supination
what do you use thumb spica casts for?
- scaphoid or radial styloid fx
what is the best immobilization option for LE fxs?
- splint/ walking boot
what do you use short leg casts for?
- foot fx
- ankle fx
- achilles injury
- server’s syndrome
what do you use long leg casts for?
- tib/fib fx
- quad tendon repair
closed reduction
- reduce bone to near anatomic position
- “recreate the fx” to align
- MUST be a stable fx
closed reduction percutaneous pinning
- reduce/hold stable closed fx if cannot cast
- decreases need for ORIF
- risk if skin or nerve/vessel damage
ORIF
- holds unstable fx
- “internal splint”
- restores length
- needs 6 cortices above and below
- rod- prevents ant/post mvmt
- locking screws- prevent bone from rotation around rod
external fixator
- used when major non-lifesaving procedures must be avoided
- “bridge” to ORIF
sprain
- stretching/ tearing of ligaments
- inversion vs/ eversion injury
- ankle most common d/t inversion and plantar flexion
strain
- injury to muscle or muscle and tendon
- muscle fibers tear
- usually caused by overextension or over stretching
- pain worse with use
- cramping, muscle spasm/ weakness, swelling
treatment for sprains/strains
- RICE
- splinting
- NSAIDs
- early ROM
- PT
dislocations
- displacement of bone from normal position
- joint forced beyond normal ROM
- damage NV structures by compression or tearing
- must be treated soon
PE findings for dislocations
- pain and TTP
- inability to move extremity
- loss of distal pulse increases severity of injury
- eval NV status before AND after reduction
tendinitis
- inflammation/ irritation of tendon
- pain and tenderness
- common in shoulders, elbows, wrists, knees
- treat with rest, ice, brace, NSAIDs, PT, cortisone
tendon rupture
- force applied to tendon may be 5X body weight
- treat with splint, ice, NSAIDs, surgery, early ROM, pt
most common tendon ruptures
- achilles
- biceps (proximal)
- RTC
- quad
initial imaging study of choice for skeletal trauma
- XRAY
- need at least 2 views and be sure to examine pt first
basics for interpreting x-rays
- open vs. closed
- anatomic location
- morphology of fx line
- displacement
- distraction
- angulation
- rotation
CT scans
- best for determining subtle fx
- good for visualization of articular extension of fx
- good for assessment of presence of articular step off/ gap
MRI
- mainly for soft tissue eval
- dx of occult fx i.e. femoral neck fx
- modality of choice for disc herniation and internal derangement of joints
ultra sound
- assess soft tissue injury
- achilles tendon and quad tendon ruptures
bone scan
- best for assessment of metastases
how do most fracture lines appear on x-ray
- radiolucent lines
- need 2 views to assess
mach band
- appears at site of cortex overlap or skin fold over cortex
- may mimic lucent lines
- most common site- ankle where tibia overlaps fibula
sclerotic line
- usually d/t compression fx
- common in vertebral bodies or distal radius
impaction fx
- wedged into each other
- generally stable
avulsion fx
- d/t abnormal tensile stress on ligaments or tendons
- common in hands, feet, pelvis
transverse fx
- perpendicular to long axis of bone
- usually d/t direct force
- most common in forearm and leg
- generally stable
oblique fx
- compression and angulation forces cause shear force
- usually d/t indirect force
- unstable -> OR
spiral fx
- caused by twisting mvmt through long bone axis -> rotation/ shear forces
- unstable -> OR
- least common
comminuted fx
- more than 2 fx fragments
- unstable -> OR
butterfly fx
- fragment produced along concave compression side
- bending of bone -> tension vector on convex side and compression vector on concave side
greenstick fx
- incomplete fx of long bone on convex side
- concave side is bent
- usually in forearm of young kids
- d/t bending force applied perpendicular to shaft of bone
buckle fx
- aka torus fx
- incomplete fx
- occurs at metaphyseal diaphyseal junction after FOOSH
- stable
- heal faster than greenstick
