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Clin Med II MHM - FINAL > Ortho Overview Part 2 (Steiner) > Flashcards

Ortho Overview Part 2 (Steiner) Flashcards

1
Q

Tendons and ligaments are _____ structures

A

Viscoelastic

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2
Q

Function of tendons vs. ligaments

A
  • Tendons create movement

- Ligaments stabilize joints and define motion of 1 bone against another

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3
Q

Describe 1st degree sprains

A
  • Minimal fiber failure and pain
  • No detectable joint instability
  • Usually heals in a few days w/o sequelae
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4
Q

Describe 2nd degree sprains

A
  • Partial tear or stretching
  • Severe pain w/swelling
  • Minimal joint instability
  • 6 to 12 wks for recovery
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5
Q

Sprain is an injury to what?

A

Ligament

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6
Q

Describe 3rd degree spains

A
  • Completely (or nearly) ruptured
  • Severe pain at time of injury, but little or none afterwards
  • Unstable joint
  • 3-6 months recovery time
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7
Q

What is the best guide of grading a sprain early on?

A

Mechanism of injury (otherwise, they all present the same way)

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8
Q

Does the ACL self repair? Why?

A
  • ACL does NOT self repair
  • It lives within the joint (compared to the collateral ligaments)
  • Presence of synovial fluid in the joint disrupts healing
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9
Q

Describe extensive immobilization of the knee

A
  • Knee does NOT do well

- Reconstruction is recommended for those injuries

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10
Q

What are ligament/tendon healing events initiated by? How long does this last?

A
  • Inflammatory response w/PMN infiltrate, fluid exudation, capillary budding
  • Lasts about 3 days
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11
Q

By the 4th day of ligament/tendon healing, what occurs?

A

Fibroplasia - accumulation of fibroblasts from surrounding tissues

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12
Q

What occurs within 3 weeks of ligament/tendon healing?

A
  • Granulation tissue forms surrounding the injured tissue

- Collagen fibers become longitudinally oriented

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13
Q

Over 3 months of ligament/tendon healing, what occurs?

A

Collagen fibers form bundles identical to injured tissues (results in healing)

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14
Q

Function of intervertebral disks?

A
  • Sustain and distribute loads

- Prevents excess motion in spine

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15
Q

What are intervertebral disks composed of?

A
  1. Nucleus pulposus (inner, soft)

2. Annulus (outer, thick fibrous)

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16
Q

What allows the spine to handle compressive, shear and rotational forces?

A

Interaction of the nucleus pulposus and annulus components of the intervertebral disks

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17
Q

What does the interaction of the nucleus pulposus and annulus of intervertebral disks allow for?

A

Allows spine to handle compressive, shear and rotational forces

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18
Q

Which population is more susceptible to disk herniation?

A

Elderly

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19
Q

Why are elderly more susceptible to disk herniation?

A
  1. Nucleus pulposus dries out (reducing ability to handle stress)
  2. Annular bands weaken (NP can rupture out)
20
Q

How should a multi-trauma patient be assessed initially?

A

A - airway
B - breathing
C - circulation

21
Q

After ABC, how should a multi-trauma patient be assessed?

A

D - disability (neuro, consciousness)

E - expose patient (and log roll to find any other injuries)

22
Q

What is often a late finding in multi-trauma patients?

A

ARDS (adult respiratory distress syndrome)

23
Q

What should patients with long bone fractures (especially more than one) be watched for?

A

Fat embolism

  • Occurs 12-48 hrs after injury
  • Often happens in young adults
24
Q

How does a patient with a fat embolism present?

A
  • SOB, restlessness, confusion, fever/tach
  • Petechiae on chest and axillae
  • Hypoxemia on ABGs w/high PCO2
25
Q

Treatment of fat embolism

A
  • Resp support to correct hypoxemia
  • Some will use IV steroids
  • Anti-coagulants
26
Q

Describe compartment syndrome

A
  • Increased pressure in a closed space leading to neuro or vascular compromise
  • Bone and fascia
  • MC anterior tibial region or forearm
27
Q

What can unrecognized compartment syndrome lead to?

A

Significant and irreversible nerve damage

28
Q

What can untreated compartment syndrome lead to?

A

Muscle damage, necrosis, infection, even amputation

29
Q

Muscle tissue has a measurable pressure between:

A

0 and 10 mm Hg

30
Q

Capillary blood flow is compromised at what pressures?

A

20 or greater mm Hg

31
Q

What pressures can lead to ischemic necrosis of muscle?

A

30-40 mm Hg

32
Q

What body components are most sensitive to pressure?

A

Nerves then muscle

33
Q

Compartment syndrome MC caused by?

A

Trauma

-Nearly 50% arise from tibial fractures (closed MC)

34
Q

Other causes of compartment syndrome?

A
  • Ortho surgery
  • Vein harvesting for CABG
  • Improper splint/cast application
  • Reperfusion of an ischemic extremity
  • Anti-coagulant use or clotting problems
35
Q

Average age of onset for compartment syndrome?

A

30 yo

36
Q

Compartment syndrome affects males or females more?

A

Males

37
Q

Why may the elderly and women be protected against compartment syndrome?

A
  • Smaller “hypotrophic” muscles

- Relatively higher BP (elderly)

38
Q

How does exertional compartment syndrome develop?

A

Results from combo of muscle hypertrophy and associated edema that occurs w/exercise within a small compartment

39
Q

How does exertional compartment syndrome present?

A
  • Exertional pain or claudication

- Pain resolves w/cessation of activity

40
Q

Treatment of exertional compartment syndrome

A
  • Rest and gradual onset of training

- Surgery (fasciotomy) for intractable patients

41
Q

Which type of compartment syndrome is more ominous and requires more dramatic intervention?

A

CS from trauma or surgery

42
Q

Hallmark of compartment syndrome

A

Crescendo pain that is out of proportion to level of injury AND unrelieved by narcotics

43
Q

Treatment of compartment syndrome

A
  • Reduce pressure, restore BF
  • Remove external devices (casts, dressings)
  • Elevate limb to level of heart (maintains good venous return w/o compromising arterial flow)
  • Do NOT use ice (d/t vasoconstriction)
44
Q

Why do we elevate limbs to the level of the heart in compartment syndrome?

A

Maintains good venous return without compromising arterial flow

45
Q

Why is ice contraindicated in compartment syndrome?

A

Causes vasoconstriction

46
Q

Complications of fasciotomy

A
  • Need 2nd procedure to close fasciotomy (cosmetically not good)
  • Infection
  • Calf dysfunction
  • Foot drop
47
Q

Outcomes of compartment syndrome

A
  • Delays of 12+ hrs in treatment results in permanent damage and even amputation
  • Timely intervention provides immediate relief and prevents further tissue damage

Clin Med II MHM - FINAL (16 decks)

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