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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
Why do all severe soft tissue injures require urgent treatment
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
after treatment of the soft tissue injury the fracture...
the fracture requires fixation | - a severe soft tissue injury will delay fracture healing
27
how do you decide if the fracture requires reduction
- is it displaced | - if it is not displaced then simple splint age (e.g. clavicle, ribs, MTs carpals and stress or impacted fractures)
28
What are the two types of reduction
- alignment without angulation (closed) | - anatomic (open reduction)
29
Describe closed reduction
Usually with anaesthesia
30
describe traction
Fractures or dislocation requiring slow reduction | - Big bone with big muscles that are pulling it out of alignment
31
when is open reduction usually done
which you need internal fixation
32
describe open reduction
- Allows very accurate (anatomic) reduction - Risk of infection - Usually when internal fixation is needed - Can slow healing if too rigid
33
what are the negatives of open reduction
- Can slow healing if too rigid | - Risk of infection
34
what technique has most accurate reduction
open reduction
35
how do we hold the reduction
Semi-rigid (Plaster) Rigid (Internal fixation)
36
What Treatment plan you want to follow
= 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
what can you use instead of plates
Kay wires | - thinner and can go past the fracture line and allow the bones to move and respond
38
Why do you want to remove an internal fixation
- bone might become too rigid and thus you may develop osteoporosis
39
when can you use external stabilisation
- when the bone has not displaced
40
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
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
what are the absolute indications for operative treatment
Displaced intra-articular fractures Open fractures Fractures with vascular injury or compartment syndrome, Pathological fractures Non-unions
42
current relative indication or operative treatment
Loss of position with closed method Poor functional result with non-anatomical reduction Displaced fractures with poor blood supply Economic and medical indications
43
why are we moving towards operative treatment
Improved implants Antibiotic prophylaxis Minimally invasive methods
44
what are the two factors that affecting healing time of the bone
Local factors = like infection systemic factors = e.g. age
45
what heals quicker the upper or lower limb
upper limb - Adult = 6-8 weeks - child = 3-4 weeks lower limb - adult = 12-16 weeks - child = 6-8 weeks
46
how do you determine fracture healing
clinical union radiological union
47
what is clinical union
- Bone moves as one - Can be tender when stressed - can be used for upper limb as the upper limb is under less stress
48
what is a radiological union
– 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
fracture union is not equal to...
Fracture union is not equal to fracture consolidation
50
what are early and late general complications
early - PE - Fat embolus syndrome which can lead to ARDS Late - chest infections - UTI - Bed sores
51
what are early and late bone complications
Early - infection Late - non-union - malunion - AVN
52
what are the early and late soft tissue complications
early - plaster sores - wound infection - neurovascualr injury - compartment syndrome Late - tendon - rupture - nerve compression - volkmann contracture
53
what are the signs of a fat embolism
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
what are the 6 Ps of the musculoskeletal assessment
- polar - pallor - pain - pulseless - paralysis - parenthesis
55
what can happen with compartment syndrome
If the pressure within an anatomical compartment exceeds the perfusion pressure of that compartment then causes collapse of the venous and capillaries close
56
what should normal compartment pressure be
0-10mmhg
57
How do you diagnose compartment syndrome
clinical presentation or pressure monitoring
58
How do you treat compartment syndrome
fasciotomy - leave open for 5 days

Locomotor 2 (30 decks)

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