SM 253a - MSK Trauma Flashcards
What are the risks associated with open fracture?
Tissue damage
Infection
What is the most common site of metastatic bone disease?
(Which bone does cancer usually spread to?)
Spine is most common
(Can be any bone, but spine is most common)
Baston’s vertebral plexus (blood vessels) - drainage is through the spine, which is probably why it is the most common site of metastatic disease
What is the ischemic threshold of normal muscle?
20 mmHg below diastolic BP
30 mmHg below MAP
Describe the presentation of compartment syndrome.
When should you take action?
- Pain
- Pallor
- Paralysis
- Pulselessness
- Parasthesias
Note: “if you see all 5, its too late”
Take action if:
- Pain out of proportion to the injury
- Pain in the compartment on passive stretching of toes or fingers
- Compartment is very hard - tense and swollen
What is the treatment for compartment syndrome?
Fasciotomy
- Make a big incision to release the compartments
- Need to release all compartments in the relevant limb
- Ex: Anterior, lateral, superficial posterior, deep posterior
- Make an incision on both sides of the leg
- Need to release all compartments in the relevant limb
What is the treatment for open fractures?
- Irrigation
- Dilute bacteria
- Debridement
- Cut dead tissue
- Explore the wound
- Fixation
- Prevent bone from moving around
What methods of fixation may be used after a fracture?
Give some examples of each
- None - immobilized, but not fixed; you let the body heal itself
- Sling
- Brace
- Cast
- Splint
- External - harware outside of the body
- Rigid metal bar outside of the skin with screws drilled into the bone
- Internal - metal inside of the body
- Intramedullary nail or rod
- Plate fixation
What is a strain?
Tearing or pulling of a muscle or tendon
Can be the same as tendinitis
What can cause compartment syndrome?
Anythign that causes inflammation and/or edema
- Fracture
- Vascular injury
- Crush
- Snake bite
- Burns
What is a sprain?
Tearing or pulling of a ligament
What is a pathologic fracture?
Fracture through an abnormal bone (a bone not usually injured)
Usually indicates metastatic disease
What are the 5 most common visceral carcinomas that metastasize to bone?
- Breast
- Lung
- Thyroid
- Kidney
- Prostate
(BLT with a Kosher Pickle)
What is compartment syndrome?
Increased pressure in a compartment that has no outlet
Can result in ischemia and permanent damage if the pressure is high enough to occlude blood flow
What is external fixation in orthopedic surgery?
When is it used?
A rigid metal bar outside of the skin with screws drilled into the bone that holds the bone in place
Used when there is a large soft tissue injury
- Tissue cannot fully cover internal hardwary = contamination -> infection risk
- Patient may not be stable enough for extensive surgery
What are the consequences of missed compartment syndrome?
- Muscle death
- Permanent nerve damage
- Loss of function or chronic pain
- Contractures
- Deformities
- Ulcerations
- Amputation
