Orthopaedic Injuries Flashcards
Three types of muscle
- Skeletal
- Smooth
- Striated
Skeletal muscle is also called ___
Striated muscle or voluntary muscle
Skeletal muscle is attached to the bone by ___
Tendons
Fibrous tissue
Fascia
Tendons are extensions of the ___
Fascia
Surrounds and supports the muscles and neurovascular structures
Fascia
Smooth muscle is also called ___
Involuntary muscle
Number of bones
206
The bones in the skeleton produce ___ in the ___ and serve as a reservoir for ___
- Blood cells
- Bone marrow
- Important minerals and electrolytes
Acts as a strut to hold the shoulder up
Clavicle
The pectoral girdle consists of ___
Two scapulae and two clavicles
Clavicle attachment points
- By ligaments to the sternum
- The acromion process
The upper extremity joins the shoulder girdle at the ___
Glenohumeral joint
Because the radius and ulna are ___, when one is broken, the other is often broken as well
Connected by stiff ligaments at both ends
Vulnerable to fracture when a person falls on an outstretched hand
Carpals
Phalanges are apt to be injured by a ___
Crush injury
Innominate bone
Hip
Top of the femur
Femoral head
Hip socket
Acetabulum
Long tubular portion of the femur
Shaft (diaphysis)
Common site for femur fractures
Femoral neck
Generally referred to as hip fractures
Femoral neck fractures
The lateral and medial bony protuberances below the femoral neck and above the shaft of the femur
Greater trochanter and lesser trochanter
Shinbone
Tibia
Supports the major weight bearing surfaces of the knee and ankle
Tibia
The tibia connects to the patella via the ___ and runs down the ___
- Patellar tendon just below the knee joint
- the front of the lower leg
Runs along the lateral side of the tibia and slightly posterior to it
Fibula
An important anchor for ligaments surrounding the knee joint
Fibula
Forms the lateral side of the ankle joint
Fibula
The calcaneus is subject to injury from ___
Axial loading
Joints are held together in a ___
Capsule, supported by ligaments
Joints are bathed and lubricated by ___
Synovial fluid
The area of potentially damaged soft tissue, adjacent nerves, and blood vessels surrounding an injury to a bone or a joint
Zone of injury
Forces that can be applied to fracture or dislocate a bone
- Direct blows
- Indirect forces
- Twisting forces
- High-energy injuries
When caring for a patient who has fallen, immediately ___
ID the point of contact and the MOI
Common location for twisting injuries
- Anterior cruciate ligament (ACL)
- Medial cruciate ligament (MCL)
(in the knee)
A slight force can easily fracture a bone that is weakened by a ___
Tumor, infection, or osteoporosis
Broken bone
Fracture
Fracture classifications
Open and closed
Complications of open fractures
Increased blood loss and infection
Fractures are also described by whether ___
The move is moved from its normal position
A simple crack of the bone that may be difficult to distinguish from a sprain or simple contusion
Nondisplaced fracture
Nondisplaced fracture is also called ___
Hairline fracture
Required to diagnose a nondisplaced fracture
Radiographic examination
Produces actual deformity , or distortion, of the limb by shortening, rotating, or angulating it
Displaced fracture
Often the deformity can be associated with ___
Crepitus
Specific types of fractures
- Comminuted
- Epiphyseal
- Greenstick
- Incomplete
- Oblique
- Pathologic
- Spiral
- Transverse
A fracture in which the bone is broken into more than two fragments
Comminuted
A fracture that occurs in a growth section of a child’s bone and may result in growth abnormalities
Epiphyseal
An incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children
Greenstick
A fracture that does not run completely through the bone; a nondisplaced partial crack
Incomplete
A fracture in which the bone is broken at an angle across the bone. Usually the result of a sharp, angled blow to the bone
Oblique
A fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer. Produced by minimal force
Pathologic
A fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone. Sometimes the result of abuse in young children
Spiral
A fracture that occurs straight across the bone. Usually the result of a direct and relatively high-energy blow
Transverse
The most reliable indicator of an underlying fracture
Point tenderness on palpation in the zone of injury
Tenderness that is sharply localized at the site of the injury, found by gently palpating along the bone with the tip of one finger
Point tenderness
Rapid swelling usually indicates ___ and is typically followed by ___
- Bleeding from a fracture
- Substantial pain
Fractures are almost always associated with ___
Ecchymosis of the surrounding soft tissues
Discoloration
Ecchymosis
Ecchymosis color progression
- Redness
- Blue, purple, and black
- Yellow and green
Grating or grinding sensations as bone ends grind together
Crepitus
Any motion at a point in the limb where there is no joint
False motion
False motion is also called ___
Free movement
False motion is an indication of ___
A fracture
The presence of a locked joint should alert you to the possibility of ___
An underlying fracture or cartilage injury
A disruption of a joint in which the bone ends are no longer in contact
Dislocation
A combination injury at the joint, in which the joint is dislocated and there is a fracture of one of the end of one or more of the bones
Fracture-dislocation
A joint returning to is normal position
Reduce
A dislocated joint may sometimes spontaneously ___
Reduce
Signs and symptoms of a dislocated joint
- Marked deformity
- Swelling
- Pain that is aggravated by any attempt at movement
- Tenderness on palpation
- Loss of normal joint motion
- Numbness or impaired circulation to the limb or digit
Occurs when a joint is twisted or stretched beyond its normal range
Sprain
A sprain can be thought of as a ___
Partial dislocation
Sprains can range from mild to severe depending on the ___
Amount of damage done to the supporting ligaments
In contrast with fractures and dislocations, sprains usually do not involve ___
Deformity
Signs and symptoms of a sprain
- Patient is unwilling to use the limb
- Swelling and ecchymosis are present at the injured joint as a result of torn blood vessels
- Pain prevents the patient from moving or using the limb normally
- Instability of the joint is indicated by increased motion
In determining if it is a sprain or a fracture, the approach should always be to ___
Determine the MOI
Stretching or tearing of the muscle and/or tendon, causing pain, swelling, and bruising of the soft tissues in the area
Strain
A strain is also called a ___
Pulled muscle
A strain, unlike with a sprain, ___
No ligament or joint damage typically occurs
No deformity is present and only minor swelling is noted. The patient noted a “snap”
Strain
An injury in which an extremity is completely severed from the body
Amputation
Pregnant women who sustain pelvic fractures tend to have higher ___
Mortality rates
Minor injuries
- Minor sprains
- Fractures or dislocation of digits
Moderate injuries
- Open fractures of digits
- Nondisplaced lone bone fractures
- Nondisplaced pelvic fractures
- Major sprains of a major joint
Serious injuries
- Displaced long bone fractures
- Multiple hand and foot fractures
- Open long bone fractures
- Displaced pelvic fractures
- Dislocations of major joint
- Multiple digit amputations
- Laceration of major nerves or blood vessels
Severe, life-threatening injuries (survival is probable)
- Multiple closed fractures
- Limb amputations
- Bilateral femur fractures
Critical injuries (survival is uncertain)
- Multiple open fractures of the limbs
- Suspected pelvic fractures with hemodynamic instability
Evaluation of an injured limb should include ___
The 6 Ps of musculoskeletal assessment
The 6 Ps of musculoskeletal assessment
- Pain
- Paralysis
- Paresthesia
- Pulselessness
- Pallor
- Pressure
Paresthesisa
Tingling or numbness
For fractures, splint ___
The joint above and below the injury
Patients with lower extremity injuries should lie ___
Supine with the affected limb elevated about 6 inches to minimize swelling
If swelling is present ___
Apply cold packs to the affected area
A patient with an isolated upper extremity injury will likely prefer the ___ position
Semi-fowler
Keep the extremity above the level of the ___
Heart
Any flexible or rigid device used to prevent motion in an injured bone or joint
Splint
Used to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain
Pelvic binder
A patient with a clavicle fracture will ___
Report pain in the shoulder and usually hold the arm across the front of the body
A young child with a clavicle fracture will ___
Report pain throughout the entire arm and is unwilling to use any part of that limb
The joint between the outer end of the clavicle and the acromion process of the scapula
Acromioclavicular (AC) joint
AC joint dislocation signs
The distal end of the clavicle will stick out, patient will report pain, including point tenderness over the AC joint
Fractures of the clavicle, scapula, and AC joint treatment
Splinted effectively with a sling and swathe
Any bandage or material that helps support the weight of an injured upper extremity
Sling
To be effective, a sling must ___
Apply gentle upward support to the olecranon process of the ulna
Bandage that passes completely around the chest
Swathe
To fully stabilize the shoulder region, a ___ must be used to bind the arm
Swathe
Where the head of the humerus meets the glenoid fossa of the scapula
Glenohumeral joint
The glenohumeral joint is also called ___
Shoulder joint
The part of the scapula that joins with the humeral head to from the glenohumeral joint
Glenoid fossa
In shoulder dislocations, the humeral head most commonly dislocates ___
Anteriorly, coming to lie infront of the scapula
A dislocated shoulder will compress ___, causing ___
- The axillary nerve
- A numb patch on the outer aspect of the shoulder
A patient will try to guard the dislocated shoulder and try to protect it by ___
Holding the dislocated arm in a fixed position away from the chest wall
Distal humerus fracture
Supracondylar or intercondylar fracture, depending on location
Fractures of the distal humerus is common in ___
Children
With an elbow injury that has a weak or absent distal pulse, you may be splinting it if the hospital is further than ___
10 to 15 minutes away
Any deformity close to a joint in children younger than 6 should be assumed to be a ___
Growth plate injury
Colles fracture
Fracture of the distal radius
Nightstick fracture
Isolated fracture of the ulna
Most reliable sign of fracture of the pelvis
Simple tenderness or instability on firm compression and palpation
Usual direction of hip dislocation
Posterior
Suspect hip dislocation in any patient in a vehicle accident who has ___
A contusion, laceration, or obvious fracture in the knee region
If the hip is dislocated anteriorly, the legs are ___
Suddenly and forcibly spread wide apart and locked in this position
Posterior hip dislocation is frequently complicated by injury to the ___
Sciatic nerve
Largest peripheral nerve in the body
Sciatic nerve
The sciatic nerve is located
Directly behind the hip joint
Controls the activity of the muscles in the posterior thigh and below the knee, and the sensation in most of the leg and foot
Sciatic nerve
Sciatic nerve compression will typically impact the foots ability to ___
Point up
Position of patient with posterior hip dislocation
Lie with hip joint flexed and the thigh rotated inward towed the midline of the body over the top of the other thigh
Three types of proximal femur fractures
- Neck of the femur
- Intertrochanteric (middle) region
- Subtrochanteric (proximal shaft of the femur)
The act of pulling on a body structure in the direction of its normal alighnment
Traction
The amount of traction does not often exceed ___
15 lbs
Dislocation of the knee may be associated with ___
Vascular occlusion
Compartment syndrome often develops within ___
6 to 12 hours
