Trauma of the Musculoskeletal System Flashcards
What is the imaging used for musculoskeletal trauma?
- x-ray
- CT
- MRI
- US (Doppler)
- Bone scan
What is polytrauma?
- trauma to several body areas/organ system
- 1 or more life may be life threatening
How much blood loss can there be from a haemorrhage of different bones in the first 2 hours?
- tibula/fibula = 500ml
- femur = 500ml
- pelvis = 2000ml
What are the 1st principles of trauma?
- airway and C spine control
- breathing and ventilation
- circulation and haemorrhage control
- disability and AVPU
- exposure and environmental control
What is AVPU?
- alert
- verbal stimuli
- painful stimuli
- unresponsive
In trauma what are the key messages?
- address life threatening injuries first = apply pressure to haemorrhage from open would
- prevent long term complications = systemic exam
What are the reasons for pelvic fractures being problematic?
Haemorrhages =
- posterior pelvic venous plexus (more difficult to control)
- bleeding from cancellous bone surfaces
- <10% arterial bleeding
How should a pelvic fracture be stabilised?
- does not have to be sophisticated, bed sheet around fracture and duct tape around feet to limit movement
- external fixation frame left for 8 weeks (
- mal-union if not dealt with appropriately
What areas can undergo soft tissue injury?
- skin
- muscles
- blood vessels
- nerves
- ligaments
What are examples of skin soft tissue injuries?
- open fractures
- de-gloving injuries
- ischemic necrosis
What are examples of muscle soft tissue injuries?
- crush and compartment syndromes
What are examples of blood vessel soft tissue injuries?
- vasospasm
- arterial laceration
What are some examples of nerve soft tissue injuries?
- neurapraxias
- axonotmesis
- neurotmesis
What are some examples of ligament soft tissue injuries?
- joint instability and dislocation
How is soft tissue trauma treated?
- urgent treatment
- potential complications
- fixation post treatment
- severe soft tissue injury can delay fracture healing
How is a fracture treated?
does it require reduction?
- is it displaced?
- if not -> simple splintage (clavicle, ribs, metacarpals, stress fractures, impacted fractures)
- how accurate a reduction is needed? (closed or open?)
- how will the reduction be held?
- what is the following treatment plan?
What are the methods of fracture reduction?
- closed -> anaesthesia
- traction -> fractures/dislocation requiring slow reduction
- open reduction internal fixation
When is open reduction internal fixation used? What are the effects?
- allows accurate anatomic reduction
- risk of infection
- when internal fixation needed
- can slow healing if too rigid
How can you hold a reduction?
- plaster (semi-rigid)
- internal fixation (rigid)
What are the properties of operative fracture treatment?
- rapid rehab
- low risk of joint stiffness
- low risk of malunion
- risk of non-union
- slow healing
- risk of infection
What are the properties of non-operative fracture treatment?
- slow rehab
- risk of joint stiffness
- risk of malunion
- risk of non-union
- rapid healing
- low risk of infection
What are the indications for operative treatment?
- improved implants
- antibiotic prophylaxis
- minimally invasive methods
- if open fracture
- if displaced intra-articular fractures
- if non-union
- if fracture with vascular injury/compartment syndrome
- if pathological features
What are some relative indications for operative treatment?
- loss of position with closed methods
- poor functional result with non-anatomical reduction
- displaced fractures with poor blood supply
- economic and medical indications
What factors affect healing time?
- local factors
- systemic factors
What is the healing time of the upper and lower limb for adults?
- upper = 6-8 weeks
- lower = 12-16 weeks
What is the healing time of the upper and lower limb for children?
- upper = 3-4 weeks
- lower = 6-8 weeks
What are the early and late complications?
Early
- other injuries
- PE
- fat embolus syndrome
- acute resp distress syndrome
Late
- chest infection
- UTI
- bed sores
What are the early and late bone complications?
Early - infection
Late - non-union, malunion, avascular necrosis
What are the early and late soft tissue complications?
Early
- plaster sores
- wound infection
- neurovascular injury
- compartment syndrome
Late
- tendon rupture
- nerve compression
- Volkmann contracture
What are the 6 P’s of musculoskeletal assessment?
- paralysis
- pain
- pulse
- paresthesia
- pallor
- polar (temperature)
if pressure within compartment exceeds perfusion pressure of that compartment = venous and capillaries close = compartment syndrome
How is compartment syndrome diagnosed?
- clinical presentation
- pressure monitoring
- medical emergency
How is compartment syndrome treated?
- fasciotomy (cut skin and open up fascia, 5 days minimum so inflammation goes down before closed up)
