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LOCO 2 > Trauma of the Musculoskeletal System > Flashcards

Trauma of the Musculoskeletal System Flashcards

1
Q

Musculoskeletal trauma affects both…?

A

Skeletal/joints and the soft tissues

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2
Q

Advanced Trauma Life Support (ATLS) - what makes up the primary survey? (5)

A 
Airway & C-spine Control
Breathing & Ventilation
Circulation & Haemorrhage Control
Disability & AVPU (level of consciousness)
Exposure & Environment Control
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3
Q

What makes up the secondary survey? (3)

A

Head to toe examination
Detailed history
Special tests (x-rays, blood labs)

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4
Q

What is the key message of advanced life support?

A

Treat life threatening injuries FIRST e.g. apply pressure to haemorrhage from an open wound / reduce a pelvic fracture if haemodynamically unstable, etc
THEN prevent long term complications once the patient is stable.

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5
Q

What imaging is done for musculoskeletal trauma?

A 
X-ray
Computerised tomography
Magnetic resonance imaging
Ultrasound 
Bone scan
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6
Q

What is polytrauma?

A

Trauma to several body areas or organ systems

One or more may be life threatening

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7
Q

Our upper limb or lower limb fractures/dislocations more disabling?
Which is associated with more severe injuries?

A

Upper limb more disabling

Lower limb associated with more severe injuries

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8
Q

What is the possible blood loss within the first 2 hours of a tibia/fibula haemorrhage?

A

500 ml

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9
Q

What is the possible blood loss within the first 2 hours of a femur haemorrhage?

A

500ml

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10
Q

What is the possible blood loss within the first 2 hours of a pelvis haemorrhage?

A

2000ml

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11
Q

Why are pelvic fractures a problem? (3)

A

Haemorrhage
10-20% mortality
Persistent pain in 25-35%

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12
Q

What are the biggest causes of trauma/haemorrhage?

A

Car accident (48.5%), work accident (27.3%), motorcycle accident (18.2%) and then crushing and tractors (make up 0.6% together)

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13
Q

Are pelvic bleeds usually venous or arterial?

A

85% are venous (they are thin walled vessels). The pre-sacral venous plexus overlies the sacroiliac joint, the fracture disrupts the joint and tears veins causing bleeding. There is also bleeding from cancellous bone surfaces.
Mainly from the internal iliac vein.

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14
Q

Stabilising a pelvic fracture - how is this done? What happens if it is not done?

A 
External fixation (frame) left for 8 weeks if possible
Mal-union
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15
Q

What are some potential skin soft tissue traumas? (3)

A

Open fractures
Degloving injuries
Ischemic necrosis

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16
Q

What are some potential muscles soft tissue traumas? (2)

A

Crush and compartment syndromes

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17
Q

What are some potential blood vessel soft tissue traumas? (2)

A

Vasospasm (can lead to clot formation) and arterial laceration

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18
Q

What are some potential nerve soft tissue traumas? (3)

A

Neurapraxias, axonotmesis, neurotmesis

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19
Q

What are some potential ligament soft tissue traumas? (2)

A

Joint instability and dislocation

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20
Q

What does neurapraxia mean?

A

Nerve is compressed, but no axonal damage after it has been decompressed.

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21
Q

What does axonotmesis mean?

A

There is axoplasmic damage, but the endoneural sheath intact (can reform, about 3mm a day).

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22
Q

What does neurotmesis mean?

A

Axon disrupted, loss of tubules, support cells destroyed.

As it regrows, it can form a tangle of nerve axons.

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23
Q

All severe soft tissue injuries require urgent treatment. Why?

A

Because of potential complications – for example, a severe soft tissue injury will delay fracture healing

24
Q

What is reduction?

What fractures require reduction?

A

Putting the bone back into alignment

If displaced

25
Q

Fractures that aren’t displaced - how are they treated?

A

Simple splintage (e.g. clavicle, ribs, MT’s carpals and stress or impacted fractures)

26
Q

What is closed reduction?

What is open reduction internal fixation (ORIF)?

A

Closed reduction is the manipulation of the bone fragments without surgical exposure of the fragments -
alignment without angulation. Done with anaesthesia.

Open reduction is where the fracture fragments are exposed surgically by dissecting the tissues - anatomic

27
Q

When is open reduction done?

A

When you need accurate reduction/when internal fixation is needed, i.e. close to a joint

28
Q

What are the downfalls of ORIF?

A

Risk of infection

Can slow healing if too rigid

29
Q

When is traction used?

A

Fractures or dislocation requiring slow reduction

30
Q

How are we going to hold the reduction?

A

Semi-rigid (Plaster) or Rigid (Internal fixation)

31
Q

How is internal fixation done?

A

Use K wires or intramedullary nails to hold everything in place

32
Q

What can internal fixation lead to?

A

Bone is too rigid and may develop osteoporosis – bone isn’t turning over quick enough and so gets removed

33
Q

Treating the fracture operatively – what are the benefits? (3)

A

Quick rehabilitation
Low risk of joint stiffness
Low risk of mal-union

34
Q

What are the benefits of treating a fracture non-operatively? (2)

A

Rapid healing

Low risk of infection

35
Q

What are the disadvantages of treating a fracture operatively? (3)
How have these been rectified?

A

Risk of non-union - improved implants
Slow healing
Risk of infection - antibiotic prophylaxis
(ALSO Development of minimally invasive methods)

36
Q

What are the disadvantages of treating a fracture non-

operatively? (4)

A

Risk of non-union
Risk of mal-union
Risk of joint stiffness
Slow rehabilitation

37
Q

What are the current absolute indications for operative treatment? (5)

A 
Displaced intra-articular fractures
Open fractures	
Fractures with vascular injury or compartment  syndrome
Pathological fractures
Non-unions
38
Q

What are the current relative indications?

A

Loss of position with closed method
Poor functional result with non-anatomical reduction
Displaced fractures with poor blood supply
Economic and medical indications

39
Q

What factors affect healing time? (2)

A

Local factors

Systemic factors

40
Q

What is meant by ‘Clinical Union’?

A

Bone moves as one

Can be tender when stressed

41
Q

What is meant by ‘Radiological Union’?

A

At least 3 out of 4 cortices healed on 2 views
Bridging callus formation
Fracture line often still present
Remodelling

42
Q

Is fracture union is equal to fracture consolidation?

A

No

43
Q

How long does it take for an upper limb fracture to heal in an adult?
What about lower limb?

A

6-8 weeks, 12-16 weeks

44
Q

How long does it take for an upper limb fracture to heal in a child?
What about lower limb?

A

3-4 weeks, 6-8 weeks

45
Q

What are the potential general early complications? (4)

A

Other injuries, pulmonary embolism, fat embolism, acute respiratory distress syndrome

46
Q

What are the potential early bone complications? (1)

A

Infection

47
Q

What are the potential early soft tissue complications? (4)

A

Plaster sores
Wound infection
Neurovascular injury
Compartment syndrome

48
Q

What are the potential general late complications? (3)

A

Chest infection
UTI
Bed sores

49
Q

What are the potential late bone complications? (3)

A

Non-union
Mal-union
Avascular necrosis

50
Q

What are the potential late soft tissue complications? (3)

A 
Tendon rupture
Nerve compression
Volkmann contracture (death of muscle)
51
Q

How does a patient with a fat embolism present? (3)

A

Mild hypoxaemia
Multiple hyperintense punctate lesions throughout cerebral white matter
Petechie (rash) over chest and upper arm

52
Q

If the pressure within an anatomical compartment exceeds the perfusion pressure of that compartment then…?

A

Causes collapse of the venous and capillaries close

53
Q

What are the six “P”s of musculoskeletal assessment?

A 
Paraesthesia
Pallor
Polar
Paralysis
Pain
Pulselessness
54
Q

Capillary blood flow within the compartment may be compromised at pressures of…?

A

> 20 mmHg

55
Q

How is compartment syndrome diagnosed?

A

Clinical presentation or pressure monitoring

56
Q

How is compartment syndrome treated?

A

Fasciotomy

LOCO 2 (28 decks)

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