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Locomotor 2 > Trauma of the Musculoskeletal System > Flashcards

Trauma of the Musculoskeletal System Flashcards

1
Q

what are the two types of musculoskeletal trauma

A

major

minor

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2
Q

What doe musculoskeletal trauma affect

A
  • affects both the skeets/joints and soft tissue
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3
Q

what does ATLS stand for

A

Advanced Trauma Life Support

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4
Q

what are the two components of ATLS

A

Primary survey

Secondary Survey

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5
Q

what does the primary survey of ATLS involve

A

Airway & C-spine Control

Breathing & Ventilation

Circulation & Haemorrhage Control

Disability & AVPU

Exposure & Environment Control

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6
Q

what does RICE stand for

A

rest
ice
compression
elevation

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7
Q

what does ABCDE stand fo r

A

Airway & C-spine Control

Breathing & Ventilation

Circulation & Haemorrhage Control

Disability & AVPU (assessment of alertness)

Exposure & Environment Control

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8
Q

what does AVPU stand for

A 
alert
verbal 
painful stimuli 
unresponsive 
- only the art state is normal
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9
Q

What is the key message of advanced trauma life support

A

Treat life threatening injuries 1st e.g. apply pressure to haemorrhage from an open wound / reduce a pelvic fracture if haemodynamically unstable, etc

  • Prevent long term complications: systematic examination of everything and planned treatment of non-life threatening injuries when patient stable
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10
Q

what imaging can you use in trauma

A

X-ray = want an AP and lateral view

Computerised tomography

Magnetic resonance imaging

Ultrasound/doppler ultrasound

Bone scan

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11
Q

what is polytrauma

A
  • Trauma to several body areas or organ systems

- One or more may be life threatening

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12
Q

what limb damage is more disabling and what limb damage is more serve

A

Upper limb rarely life threatening but more disabling

Lower limb associated with more severe injuries

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13
Q

why do you want to reattach the upper limb

A

= upper limb is more complicated and the prosthesis are not as developed yet compared to the lower limb

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14
Q

how much blood do you loose with

  • tibia/fibia
  • femur
  • pelvis

in the first 2 hours

A

Tib/Fib - 500 ml

Femur - 500 ml

Pelvis - 2000 ml

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15
Q

what morality rate does a pelvic fracture have

A

10% mortality rate
- especially in an unstable pelvic fracture that affects the sacroiliac joint and goes through both the superior and inferior pubic ramus

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16
Q

when you bleed in the pelvis where is it most likely coming from

A

Mostly (85%)

  • Posterior pelvic venous plexus(runs over the sacroiliac joint)
  • Bleeding from cancellous bone surfaces

<10% from arterial bleeding

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17
Q

how do you stabilise a pelvic fracture

A

Does not have to be sophisticated - e.g. a bed sheet wrapped around the pelvis

External fixation (frame) left for 8 weeks if possible

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18
Q

what happens if the pelvis fracture is not dealt with appropriately

A

If not dealt with appropriately associated with mal-union

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19
Q

what do patients with a pelvic fracture have after

A

persistent pain in about 25-35% of fractures due to lumbar plexus disruption

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20
Q

name injuries that can occur with skin

A

Open fractures, de-gloving injuries and ischemic necrosis

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21
Q

name injuries that can occur with muscles

A

Crush and compartment syndromes

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22
Q

name injuries that can occur with blood vessels

A

Vasospasm and arterial laceration

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23
Q

name injuries that can occur with nerves

A

Neurapraxias,
- no axonal discontinuity

axonotmesis,
- axoplasmic disruption, but endoneural sheath intact

neurotmesis
- axon disrupted, loss of tubules, support cell destroyed, whole nerve is cut

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24
Q

name injuries that can occur with ligaments

A

Joint instability and dislocation

25
Q

Why do all severe soft tissue injures require urgent treatment

A

because of potential complications - myoglobin is in the muscle which are toxic to the kidney
- can develop compartment syndrome which can lead on to other complications - have to make sure there is another room for swelling

26
Q

after treatment of the soft tissue injury the fracture…

A

the fracture requires fixation

- a severe soft tissue injury will delay fracture healing

27
Q

how do you decide if the fracture requires reduction

A
  • is it displaced

- if it is not displaced then simple splint age (e.g. clavicle, ribs, MTs carpals and stress or impacted fractures)

28
Q

What are the two types of reduction

A
  • alignment without angulation (closed)

- anatomic (open reduction)

29
Q

Describe closed reduction

A

Usually with anaesthesia

30
Q

describe traction

A

Fractures or dislocation requiring slow reduction

- Big bone with big muscles that are pulling it out of alignment

31
Q

when is open reduction usually done

A

which you need internal fixation

32
Q

describe open reduction

A
  • Allows very accurate (anatomic) reduction
  • Risk of infection
  • Usually when internal fixation is needed
  • Can slow healing if too rigid
33
Q

what are the negatives of open reduction

A
  • Can slow healing if too rigid

- Risk of infection

34
Q

what technique has most accurate reduction

A

open reduction

35
Q

how do we hold the reduction

A

Semi-rigid (Plaster)

Rigid (Internal fixation)

36
Q

What Treatment plan you want to follow

A

= how quickly do you want patient to be mobile

  • when can the patient load the injured limb
  • when can the patient allowed to move the joints
  • how long will we have to immobilise the fracture for
37
Q

what can you use instead of plates

A

Kay wires

- thinner and can go past the fracture line and allow the bones to move and respond

38
Q

Why do you want to remove an internal fixation

A
  • bone might become too rigid and thus you may develop osteoporosis
39
Q

when can you use external stabilisation

A
  • when the bone has not displaced
40
Q

describe the operative and non operative treating of the fracture

  • rehabilitation
  • risk of joint stiffness
  • risk of malunion
  • risk of non union
  • speed of healing
  • rose of infection
  • cost
A

Operative

  • rehabilitation = rapid
  • risk of joint stiffness = low
  • risk of malunion = low
  • risk of non union = present
  • speed of healing = slow
  • rose of infection = present
  • cost(both of the equipment and time it takes) = better than non operative

non operative

  • rehabilitation = slow
  • risk of joint stiffness = present
  • risk of malunion = present
  • risk of non union = present
  • speed of healing = rapid
  • rose of infection = low
  • cost
41
Q

what are the absolute indications for operative treatment

A

Displaced intra-articular fractures

Open fractures

Fractures with vascular injury or compartment syndrome,

Pathological fractures

Non-unions

42
Q

current relative indication or operative treatment

A

Loss of position with closed method

Poor functional result with non-anatomical reduction

Displaced fractures with poor blood supply

Economic and medical indications

43
Q

why are we moving towards operative treatment

A

Improved implants

Antibiotic prophylaxis

Minimally invasive methods

44
Q

what are the two factors that affecting healing time of the bone

A

Local factors = like infection

systemic factors = e.g. age

45
Q

what heals quicker the upper or lower limb

A

upper limb

  • Adult = 6-8 weeks
  • child = 3-4 weeks

lower limb

  • adult = 12-16 weeks
  • child = 6-8 weeks
46
Q

how do you determine fracture healing

A

clinical union

radiological union

47
Q

what is clinical union

A
  • Bone moves as one
  • Can be tender when stressed
  • can be used for upper limb as the upper limb is under less stress
48
Q

what is a radiological union

A

– at least 3 out of 4 cortices healed on 2 views

  • Bridging callus formation
  • Fracture line often still present
  • Remodelling
  • can be used for lower limb as the lower limb is under more stress
49
Q

fracture union is not equal to…

A

Fracture union is not equal to fracture consolidation

50
Q

what are early and late general complications

A

early

  • PE
  • Fat embolus syndrome which can lead to ARDS

Late

  • chest infections
  • UTI
  • Bed sores
51
Q

what are early and late bone complications

A

Early
- infection

Late

  • non-union
  • malunion
  • AVN
52
Q

what are the early and late soft tissue complications

A

early

  • plaster sores
  • wound infection
  • neurovascualr injury
  • compartment syndrome

Late

  • tendon
  • rupture
  • nerve compression
  • volkmann contracture
53
Q

what are the signs of a fat embolism

A

ABG = mild hypoxemia chest X-ray normal

MRI = multiple hyperintense punctate lesions throughout cerebral white matter (T2 = A, diffusion weighted = B)

7 hrs later widespread petechiae over chest, upper arm

54
Q

what are the 6 Ps of the musculoskeletal assessment

A
  • polar
  • pallor
  • pain
  • pulseless
  • paralysis
  • parenthesis
55
Q

what can happen with compartment syndrome

A

If the pressure within an anatomical compartment exceeds the perfusion pressure of that compartment then causes collapse of the venous and capillaries close

56
Q

what should normal compartment pressure be

A

0-10mmhg

57
Q

How do you diagnose compartment syndrome

A

clinical presentation or pressure monitoring

58
Q

How do you treat compartment syndrome

A

fasciotomy - leave open for 5 days

Locomotor 2 (30 decks)

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