Overview - MSK Flashcards
Ligaments
tough fibrous tissue connecting bone to bone, stabilize joints
Sprains
-Stretching or tearing of ligament
-Can occur in any joint (ankle and wrist most common)
-Pain, swelling, possible joint laxity
-X-rays often ordered to rule out associated fx
TX:
-Typically conservative: rest, ice, compression, elevation (RICE)
-Avoid prolonged immobilization–leads to stiffness
-Surgical repair: rarely needed, for complete tears
Typical Fractures
- Caused by significant trauma to healthy bone
- Direct blow
- Axial loading (force driven up the shaft of bone ie falling off ladder and falling directly on feet)
- Angular (bending) force
- Torque (twisting)
- Repetitive stress
Pathologic Fractures
- Caused by relatively minor trauma to diseased or abnormal bone
- Preexisting pathologic process weakens bone
- Metastatic lytic lesions in bone
- Benign bone cysts
- Advanced osteoporosis (commonly leads to vertebral compression fxs)
- find out what the underlying issue is that caused fracture
Stress Fractures
-“Fatigue” fx from repetitive forces
-X-rays are typically negative early on
-Presumptive dx made by H&P
-May be apparent on bone scan, CT, MRI
-Fx line may not become apparent on x-ray until days-weeks later
TX: immobilize, no movement rest etc
Open Fracture
aka, “Compound Fx”
- Fx associated with overlying open wound
- Creates communication between external skin and fx site
- Sharp bone may poke through skin
- Dreaded complication: osteomyelitis
Salter-Harris Fxs
- Fx involving the physis-the cartilaginous epiphyseal plate near the ends of long bones -growth plates
- Seen in growing children
- Class I through V
- Damage to physis may disrupt bone growth
- Type I and Type V may not be radiographically apparent
- Ephiphyseal plate is radiolucent cartilage, so fx line through the plate is not seen
- Need to make dx clinically–significant tenderness over plate
- If suspected, immobilize and follow up with ortho
Greenstick Fx
- Incomplete fx of cortex involving only one side of bone
- Seen in kids–bones are more compliant/bendable
- Stable, less painful than complete fxs
- Need for reduction depends on location, degree of angulation, age of child
Torus (Buckle) Fx
- Cortex of bone bulges/buckles, rather than breaks
- Seen in kids–bones are more compliant
- May be subtle on x-ray
- Usually not associated with significant angulation or displacement
- Managed with simple immobilization
Fracture Healing
- Inflammatory Phase
- Severed microscopic vessels, bone ends necrose, triggering inflammation, hematoma forms - Reparative Phase
- Bony callus forms, gradually becomes mineralized
- Necrotic bone reabsorbs - Remodeling Phase
- New bone laid down, replacing callus
usually takes 6 weeks for healing
Displacement
- The degree to which the fx fragments are offset from each another
- how far off is it from its normal alignment
- Direct measurement (e.g. 5mm-displacement)
- Percent of the width of the bone shaft (e.g. 50% displacement, complete displacement)
Shortening
- Amount by which bone’s length has been reduced
- Expressed in mm or cm
- Can occur by impaction or overlap
Angulation
-Amount, in degrees : e.g. 30 degrees angulation
Direction
-e.g., dorsal/volar, medial/lateral, anterior/posterior
-If fx near mid-shaft, describe direction of the apex of the angle formed by fx
-If fx near end of bone, describe direction that distal fragment is deviated
Rotational Deformity
- Extent to which distal fragment is twisted on its axis
- Best detected on physical exam
- Important in finger phalangeal fxs
Dislocation/Subluxation
- Dislocation: articular surfaces of bones that normally meet at joint are completely out of contact
- Subluxation: articular surfaces partially out of contact
- Urgent need to reduce dislocated joints if neurologic or circulatory compromise
- Neurovascular bundle is kinked around the deformity
