Diagnosis and Treatment of MSK Trauma Flashcards
(41 cards)
Reduction of fracture means doing what?
Reversal of injuring forces.
Reduction of fracture means doing what?
Reversal of injuring forces.
Stress radiographs: Why are they used and what are they?
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).
Dye studies:
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.
Scanograms: What are they?
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.
Technetium bone scans:
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).
CT and MRI:
Spinal and pelvic trauma.
CT and MRI:
Spinal and pelvic trauma. Useful to see structures.
Arthroscopy:
Direct visualization of interior of large joints. Used to remove fragments of bone, cartilage, or synovium or to repair torn ligaments.
Electrodiagnostic studies:
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.
Chemical determinations may be useful in diagnosis of injury or complications. What is it?
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.
Chemical determinations may be useful in diagnosis of injury or complications. What is it?
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.
Comminuted fracture
Fractures involving more than two fragments.
Open (compound) fracture
Fractures communicating with external environment.
Closed (simple) fracture
Fractures not communicating with external environment.
What is important to notice about a fracture?
Number of fragments, direction of fracture line (transverse, oblique, or spiral) and relationship of fracture fragments to one another (angulation, rotation, overriding, or distraction).
Partial tear of a ligament is a
sprain
Partial tear of a muscle or tendon is a
strain
Partial tear of a muscle or tendon is a
strain
Five things to do in treatment of injury:
- Keep airway patent.
- Control hemorrhaging, usually with pressure, cover wounds with clean cloths.
- Prevent motion of injured spine.
- Splint injured extremities including joints above and below a fracture.
- Transport gently.
Five things to do in treatment of injury:
- Keep airway patent.
- Control hemorrhaging, usually with pressure, cover wounds with clean cloths.
- Prevent motion of injured spine.
- Splint injured extremities including joints above and below a fracture.
- Transport gently.
Reduction means:
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.
Retention is
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).
What makes it impossible to turn a contaminated open wound into clean operative wound?
Task impossible if length of time between injury and treatment has permitted invasion of surrounding tissues by contaminating organisms (12 hours of injury).
