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MSK > Diagnosis and Treatment of MSK Trauma > Flashcards

Diagnosis and Treatment of MSK Trauma Flashcards

1
Q

Reduction of fracture means doing what?

A

Reversal of injuring forces.

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2
Q

Reduction of fracture means doing what?

A

Reversal of injuring forces.

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3
Q

Stress radiographs: Why are they used and what are they?

A

Ligament injury.
Integrity of MCL: Tibia forced into valgus while femur is held steady. Abnormal widening of medial side of knee joint indicates ligamentous disruption.

Soft tissue lesions (muscle or tendon disruptions) may be seen on radiographs using underexposure techniques. Overpenetration (reverse of underexposure may be used for better visualization of hyperostotic areas).

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4
Q

Dye studies:

A

Contrast media injected into spinal canal, urinary tract, joints, blood vessels. Injection of dye into spinal canal (myelography).

Urinary tract evaluated using IV pyelography. Dye excreted by kidneys.

Cystography or urethrography: Retrograde injection of dye through urethra (valuable after injury to pelvis).

Arthrography: Injecting contrast into joints. Greatest value=diagnosing meniscal injury in knee and tears of rotator cuff in shoulder.

Angiography: Circulation of limb or organ can be studied by radiographs taken after dye injected into arterial or venous tree.

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5
Q

Scanograms: What are they?

A

Serial radiographs that are used to determine rate of growth in particular bone or limb. Accurate assessment of growth rates after injury than possible by clinical measurement.

Follow-up fractures in kids.

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6
Q

Technetium bone scans:

A

Effects of trauma. Reflect bone metabolism and circulation. May be used to elucidate an occult fracture (if present is seen in area of increased isotope uptake).

Avascular necrosis produces area of decreased uptake (cold scan).

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7
Q

CT and MRI:

A

Spinal and pelvic trauma.

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8
Q

CT and MRI:

A

Spinal and pelvic trauma. Useful to see structures.

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9
Q

Arthroscopy:

A

Direct visualization of interior of large joints. Used to remove fragments of bone, cartilage, or synovium or to repair torn ligaments.

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10
Q

Electrodiagnostic studies:

A

Electromyography (measurement of action potentials in muscles).

Nerve conduction: Measurement of nerve conduction time or velocity.

Denervation produces electrical changes in muscle known as fibrillation or denervation potentials.

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11
Q

Chemical determinations may be useful in diagnosis of injury or complications. What is it?

A

Presence of fat droplets in blood aspirated from joint. May indicate fracture entering the joint. Fat droplets in urine and sputum, elevated serum lipase, lowered PO2 following fracture suggest fat embolism.

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12
Q

Chemical determinations may be useful in diagnosis of injury or complications. What is it?

A

Presence of fat droplets in blood aspirated from joint. May indicate fracture entering the joint. Fat droplets in urine and sputum, elevated serum lipase, lowered PO2 following fracture suggest fat embolism.

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13
Q

Comminuted fracture

A

Fractures involving more than two fragments.

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14
Q

Open (compound) fracture

A

Fractures communicating with external environment.

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15
Q

Closed (simple) fracture

A

Fractures not communicating with external environment.

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16
Q

What is important to notice about a fracture?

A

Number of fragments, direction of fracture line (transverse, oblique, or spiral) and relationship of fracture fragments to one another (angulation, rotation, overriding, or distraction).

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17
Q

Partial tear of a ligament is a

A

sprain

18
Q

Partial tear of a muscle or tendon is a

A

strain

19
Q

Partial tear of a muscle or tendon is a

A

strain

20
Q

Five things to do in treatment of injury:

A
  1. Keep airway patent.
  2. Control hemorrhaging, usually with pressure, cover wounds with clean cloths.
  3. Prevent motion of injured spine.
  4. Splint injured extremities including joints above and below a fracture.
  5. Transport gently.
21
Q

Five things to do in treatment of injury:

A
  1. Keep airway patent.
  2. Control hemorrhaging, usually with pressure, cover wounds with clean cloths.
  3. Prevent motion of injured spine.
  4. Splint injured extremities including joints above and below a fracture.
  5. Transport gently.
22
Q

Reduction means:

A

Elimination of fracture deformity. Understanding of deforming forces and may be accomplished by closed manipulation, traction, operative treatment.

When comminution exists, impossible to acheive accurate reduction by manipulation or open reduction so TRACTION is method of chioce. Reduces effect of deforming muscle forces. May be significant factor in preventing reduction by other means.

Open reduction is required where precise restoration of anatomy is essential in intraarticular fractures or with fractures in which satisfactory reduction cannot be obtained or maintained by closed methods.

23
Q

Retention is

A

Maintenance of reduction by external immobilization (plaster casts, skeletal fixators, braces, splints) or traction (applied to skin or bone) or internal fixation devices (screws, plates, wires, pins, or intramedullary nails).

24
Q

What makes it impossible to turn a contaminated open wound into clean operative wound?

A

Task impossible if length of time between injury and treatment has permitted invasion of surrounding tissues by contaminating organisms (12 hours of injury).

25
Q

What makes it impossible to turn a contaminated open wound into clean operative wound?

A

Task impossible if length of time between injury and treatment has permitted invasion of surrounding tissues by contaminating organisms (12 hours of injury).

26
Q

What happens if wound cannot be debrided?

A

It is irrigated and left open so that free drainage can occur. Human tetanus antitoxin and antibiotics are usually employed in treatment of open fractures (not substitute for surgery).

27
Q

Describe Type I, II, IIIA, IIIB, IIIC fractures.

A

Type I: Open fractures have wound less than 1 cm.
Type II: Wound 1-10cm long.
Type III: Wounds longer than 10 cm.

28
Q

Describe Type I, II, IIIA, IIIB, IIIC fractures.

A

Type I: Open fractures have wound less than 1 cm.
Type II: Wound 1-10cm long.
Type III: Wounds longer than 10 cm.

29
Q

In child, which fractures have greater remodeling potential?

A

Fractures near epiphyseal plate or with deformity in plane of motion of joint.

30
Q

Rotation is deformity lease corrected by growth and must be corrected by…

A

reduction

31
Q

Delayed union

A

After reasonable period of immobilization, bone union has not taken place.

32
Q

Delayed union

A

After reasonable period of immobilization, bone union has not taken place.

Fracture line may increase in width but sclerosis of bone ends at fracture line is not present.

33
Q

Nonunion

A

Radiographic diagnosis characterized by failure of bone trabeculae to bridge the fracture site. Non-unions are characterized by diminished blood supply to fracture site.

Poor immobilization allows fragments to shear off newly formed capillaries growing into fracture callus. If hematoma is undisturbed, bone ends held in rigid apposition long enough, fracture will heal.

34
Q

Malunion

A

Inaccurate reduction (union with deformity)

35
Q

Osteonecrosis

A

One of fracture fragments occurs if fragment is deprived of its blood supply by fracture or treatment as in scaphoid fractures or following femoral neck fractures in which blood supply to femoral head is damaged.

Femoral head may die partially or totally.

36
Q

Osteonecrosis

A

One of fracture fragments occurs if fragment is deprived of its blood supply by fracture or treatment as in scaphoid fractures or following femoral neck fractures in which blood supply to femoral head is damaged.

Femoral head may die partially or totally.

37
Q

Acute infections vs. chronic infections treatment

A

Acute=Antibiotics
Chronic=Operative debridement of dead and avascular tissue in addition to chemo.

Clostridial organisms=most dangerous. In ischemic tissue to produce virulent myositis that results in loss of life.

38
Q

Division of tendon by displaced fracture fragment can cause loss of elasticity and gliding problems. What are other complications?

A

Rupture from tendons moving over boney irregularities.

39
Q

Myositis ossificans

A

Formation of bone in muscle result from seeding of muscle with endosteum or periosteum following injury to adjacent bone.

May resolve spontaneously with rest of part if not it can be operatively removed.

40
Q

Post traumatic arthritis

A

May follow fractures involving articular surface of joints. This risk is reduced (not eliminated) by anatomical reduction of fractures.

41
Q

Sudeck atrophy

A

Vasomotor disorder associated with intense pain, spotty osteoporosis.

Relieved by resumption of normal activities (interruption of sympathetic nerve supply to the part may be necessary).

MSK (8 decks)

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