Ortho Overview Part 2 (Steiner) Flashcards
Tendons and ligaments are _____ structures
Viscoelastic
Function of tendons vs. ligaments
- Tendons create movement
- Ligaments stabilize joints and define motion of 1 bone against another
Describe 1st degree sprains
- Minimal fiber failure and pain
- No detectable joint instability
- Usually heals in a few days w/o sequelae
Describe 2nd degree sprains
- Partial tear or stretching
- Severe pain w/swelling
- Minimal joint instability
- 6 to 12 wks for recovery
Sprain is an injury to what?
Ligament
Describe 3rd degree spains
- Completely (or nearly) ruptured
- Severe pain at time of injury, but little or none afterwards
- Unstable joint
- 3-6 months recovery time
What is the best guide of grading a sprain early on?
Mechanism of injury (otherwise, they all present the same way)
Does the ACL self repair? Why?
- ACL does NOT self repair
- It lives within the joint (compared to the collateral ligaments)
- Presence of synovial fluid in the joint disrupts healing
Describe extensive immobilization of the knee
- Knee does NOT do well
- Reconstruction is recommended for those injuries
What are ligament/tendon healing events initiated by? How long does this last?
- Inflammatory response w/PMN infiltrate, fluid exudation, capillary budding
- Lasts about 3 days
By the 4th day of ligament/tendon healing, what occurs?
Fibroplasia - accumulation of fibroblasts from surrounding tissues
What occurs within 3 weeks of ligament/tendon healing?
- Granulation tissue forms surrounding the injured tissue
- Collagen fibers become longitudinally oriented
Over 3 months of ligament/tendon healing, what occurs?
Collagen fibers form bundles identical to injured tissues (results in healing)
Function of intervertebral disks?
- Sustain and distribute loads
- Prevents excess motion in spine
What are intervertebral disks composed of?
- Nucleus pulposus (inner, soft)
2. Annulus (outer, thick fibrous)
What allows the spine to handle compressive, shear and rotational forces?
Interaction of the nucleus pulposus and annulus components of the intervertebral disks
What does the interaction of the nucleus pulposus and annulus of intervertebral disks allow for?
Allows spine to handle compressive, shear and rotational forces
Which population is more susceptible to disk herniation?
Elderly
Why are elderly more susceptible to disk herniation?
- Nucleus pulposus dries out (reducing ability to handle stress)
- Annular bands weaken (NP can rupture out)
How should a multi-trauma patient be assessed initially?
A - airway
B - breathing
C - circulation
After ABC, how should a multi-trauma patient be assessed?
D - disability (neuro, consciousness)
E - expose patient (and log roll to find any other injuries)
What is often a late finding in multi-trauma patients?
ARDS (adult respiratory distress syndrome)
What should patients with long bone fractures (especially more than one) be watched for?
Fat embolism
- Occurs 12-48 hrs after injury
- Often happens in young adults
How does a patient with a fat embolism present?
- SOB, restlessness, confusion, fever/tach
- Petechiae on chest and axillae
- Hypoxemia on ABGs w/high PCO2
Treatment of fat embolism
- Resp support to correct hypoxemia
- Some will use IV steroids
- Anti-coagulants
Describe compartment syndrome
- Increased pressure in a closed space leading to neuro or vascular compromise
- Bone and fascia
- MC anterior tibial region or forearm
What can unrecognized compartment syndrome lead to?
Significant and irreversible nerve damage
What can untreated compartment syndrome lead to?
Muscle damage, necrosis, infection, even amputation
Muscle tissue has a measurable pressure between:
0 and 10 mm Hg
Capillary blood flow is compromised at what pressures?
20 or greater mm Hg
What pressures can lead to ischemic necrosis of muscle?
30-40 mm Hg
What body components are most sensitive to pressure?
Nerves then muscle
Compartment syndrome MC caused by?
Trauma
-Nearly 50% arise from tibial fractures (closed MC)
Other causes of compartment syndrome?
- Ortho surgery
- Vein harvesting for CABG
- Improper splint/cast application
- Reperfusion of an ischemic extremity
- Anti-coagulant use or clotting problems
Average age of onset for compartment syndrome?
30 yo
Compartment syndrome affects males or females more?
Males
Why may the elderly and women be protected against compartment syndrome?
- Smaller “hypotrophic” muscles
- Relatively higher BP (elderly)
How does exertional compartment syndrome develop?
Results from combo of muscle hypertrophy and associated edema that occurs w/exercise within a small compartment
How does exertional compartment syndrome present?
- Exertional pain or claudication
- Pain resolves w/cessation of activity
Treatment of exertional compartment syndrome
- Rest and gradual onset of training
- Surgery (fasciotomy) for intractable patients
Which type of compartment syndrome is more ominous and requires more dramatic intervention?
CS from trauma or surgery
Hallmark of compartment syndrome
Crescendo pain that is out of proportion to level of injury AND unrelieved by narcotics
Treatment of compartment syndrome
- 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)
Why do we elevate limbs to the level of the heart in compartment syndrome?
Maintains good venous return without compromising arterial flow
Why is ice contraindicated in compartment syndrome?
Causes vasoconstriction
Complications of fasciotomy
- Need 2nd procedure to close fasciotomy (cosmetically not good)
- Infection
- Calf dysfunction
- Foot drop
Outcomes of compartment syndrome
- Delays of 12+ hrs in treatment results in permanent damage and even amputation
- Timely intervention provides immediate relief and prevents further tissue damage
