SM 235: MSK Trauma

Question 1

What should an MSK history focus on?

Answer 1

PDD:

Pain
Disability
Deformity

Question 2

What should the MSK Physical Exam focus on?

Answer 2

Examine the entire extremity:

Inspection
Palpation
Range-of-Motion of Joints
Neurovascular Exam

Question 3

What are the imaging options in MSK?

Answer 3

Xrays
Bone Scans
CT Scan
MRI

Question 4

When should an Xray be used?

Answer 4

An Xray is used to look at bones and give a big picture of what’s going on

Question 5

When should DXA bone scans be used?

Answer 5

Bone scans look at the entire extremity for anything abnormal, including: Fractures, arthritis, and tumors

Question 6

What can be seen on DXA scans?

Answer 6

FAT:

Fractures
Arthritis
Tumors

Question 7

When should a CT Scan be used?

Answer 7

Use a CT Scan for bone anatomy in higher detail than an Xray, such as fractures around joints

Question 8

If you suspect a fracture around a joint, should you order an Xray or a CT?

Answer 8

Order a CT because it gives you more detail

Question 9

When should an MRI be used?

Answer 9

Use an MRI for examining soft tissues and bone marrow signal, for things like: muscle tears, tumors, ligament ruptures

Question 10

If you suspect a ligament tear, what scan should you order?

Answer 10

Ligament = soft tissue = order MRI

Question 11

Compare and contrast a Strain to a Sprain?

Answer 11

Strain = tear of muscle or tendon 
Sprain = tear of a ligament

Question 12

What is a tear of a muscle or tendon?

Answer 12

Strain

Question 13

What is a tear of a ligament?

Answer 13

Sprain

Question 14

What is a closed fracture?

Answer 14

A broken bone with intact skin

Question 15

What is an open fracture?

Answer 15

A broken bone where the skin is violated and the boen is exposed to the outside environment

Question 16

What is a Reduction?

Answer 16

A Reduction refers to the act of aligning bone fragments back into their normal anatomic locatoin

Question 17

What is a Fixation?

Answer 17

A Fixation refers to methods of holding a bone in place

Question 18

What general approach refers to manipulating a broken leg or arm?

Answer 18

A Reduction manipulates a broken leg or arm by aligning the fragments of bone back into place

Question 19

What general approach refers to casts and screws and rods?

Answer 19

A Fixation, because these hold bones in place physically

Question 20

What is an ORIF?

Answer 20

Open Reduction Internal Fixation

Make an incision and use hardware to fix a fracture

Question 21

How should an open fracture be treated?

Answer 21

IDF

Irrigation
Debridement
Fixation

Question 22

Why is an Open Fracture an emergency?

Answer 22

It’s an emergency because the bone is exposed to the environment and there is a high risk of infection

Question 23

What does Irrigation refer to?

Answer 23

Getting rid of bacteria by cleaning a wound with solution

Question 24

What does Debridement refer to?

Answer 24

Removing dead tissue by cutting it out

Question 25

What does Fixation refer to?

Answer 25

Physically holding bones in place, potentially with screws and rods

Question 26

Why do we fix hip fractures?

Answer 26

Hip fractures are extremely painful and leave you immobile, so we fix them to improve mobility and quality of life

Question 27

Compare and contrast external and internal fixation?

Answer 27

External fixation: large soft tissue injuries, outside of body, temporary + for emergencies Internal fixation: into bone marrow, long-term

Question 28

Describe external fixation and when it's used?

Answer 28

External fixation: large soft tissue injuries, rod outside of body, temporary + for emergencies

Question 29

Describe internal fixation and when it's used?

Answer 29

Internal fixation: rod into bone marrow, long-term

Question 30

What does "none" fixation refer to?

Answer 30

Letting the body heal itself with just a sling/brace/cast

Question 31

Do most ortho injuries get better on their own, and with what supplements?

Answer 31

Yes - rest, ice/heat, compression, elevation, PT, NSAIDS, brace/cast

Question 32

What is the pathophysiology of Compartment Syndrome?

Answer 32

Increased pressure in a compartment leads to compression of blood vessels and ischemia, causing permanent tissue/nerve damage if left untreated

Question 33

What can cause Compartment Syndrome?

Answer 33

Lots of things: Injury - inflammation/edema Fracture Vascular/Crush injury

Question 34

How does Compartment Syndrome present?

Answer 34

5 P's of Compartment Syndrome: ``` Pain - out of proportion to injury and with stretching Pallor Paralysis Pulselessness Parasthesia ```

Question 35

How does the effected compartment appear in Compartment Syndrome?

Answer 35

Rock-hard, tense, swollen, extremely sensitive to pain and painful stretching of toes/fingers

Question 36

What is the treatment for Compartment Syndrome and how does it work?

Answer 36

Must release pressure via surgical fasciotomy - make a big cut in all compartments of the effected limb and let it decompress to restore blood flow

Question 37

What is a Pathologic Fracture and give an example?

Answer 37

Pathologic fracture is fracture through abnormal bone Ex. Metastatic bone disease

Question 38

What is Metastatic Bone Disease?

Answer 38

Cancer that spreads to bone and degrades the normal structure, leading to Pathologic Fracture BLTKP met's

Question 39

What types of cancer can lead to Metastatic Bone Disease and result in Pathologic Fracture?

Answer 39

BLTKP ``` Bone Cancer Lung Cancer Thyroid Cancer Kidney Cancer Prostate Cancer ```