INTRO TO TRAUMA Flashcards by Lourdes Rodriguez

MSK 1: intro to trauma

What is the Tx of Undisplaced unstable Fx?

Immobilization by extrernal splinting

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MSK 1: intro to trauma

Causes of Fx?

Single traumatic incident
Repetitive stress: fatigue or stress Fx (common in tibia, fibula, metatarsals)
Abnormal weakening: pathological Fx Ex. Woman with osteoporosis fractures her hip with weight bearing. Osteosarcoma, #1 bone tumor.

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MSK 1: intro to trauma

In what phase of bone healing cell proliferation occurs, hematoma is gradually absorbed, cartilage is replaced by woven bone, mineralization and vascularization occurs?

Stage B: cell proliferation

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MSK 1: intro to trauma

Epiphesial Fx Types I-III return to normal in how long?

2-3 weeks

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MSK 1: intro to trauma

What is Neuropraxia?

Nerve Injury
conduction block, nerve is in-continuity,
Wallerian degeneration does not take place.
3 months or less to heal
Ex. When the arms falls a sleep

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MSK 1: intro to trauma

A compression fracture of the growth plate resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray is what type of Fx?

Type V

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MSK 1: intro to trauma

What are the A, B, C, D, E of the primary survey at the ER?

Airway, Breathing, Circulation, Disability, Exposure.

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MSK 1: intro to trauma

What is and avulsion Fx?

Ttendon or ligament is avulsed with a small piece of bone.

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MSK 1: intro to trauma

reflex sympathetic dystrophy = complex regional pain syndrome is cause by what?

Trauma
Surgery
Immobilization

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MSK 1: intro to trauma

What is the treatment for reflex sympathetic dystrophy = complex regional pain syndrome?

PT, medication, nerve blocks, dorsal column stimulator, progressive loading.
Desensitization techniques, patience, ROM exercises, patience. Ice.

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MSK 1: intro to trauma

Classification of bone Fx by site:

Epiphyseal
Metaphyseal
Diaphyseal
Intra-articular
Fx-dislocation

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MSK 1: intro to trauma

Oblique and spiral Fx heal faster than transverse Fx. because …

periosteum is not completely damaged and bring nutrients to the healing process.

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MSK 1: intro to trauma

what is the bone heal time on a 8 and 12 year old individual?

8 and 12 weeks

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MSK 1: intro to trauma

What are the causes of delayed union?

Inadequate blood supply
Infection
Incorrect splintage

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MSK 1: intro to trauma

Fractures complications:

Myositis osificans (ossification of muscles)
Volkmann’s contracture (ischemic contracture of muscles) (same as compartment syndrome)
Skin injuries (burn, laceration, ulcers)
Vascular injuries (arterial division, compartment syndrome)
Venous thrombosis and pulmonary embolism
Neurological injuries (brain, SC, peripheral nerves)
Tetanus
Post-traumatic osteoporosis

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MSK 1: intro to trauma

In which phase of bone healing woven bone is replaced by lammelar bone?

remodeling phase, stage D

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MSK 1: intro to trauma

intra-articular Fx from joint surface to metaphysis.

A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis.
perfect reduction necessary, poor prognosis.

Type IV - perfect reduction

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MSK 1: intro to trauma

Where are stress Fx most common?

Tibia
fibula
metatarsals

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MSK 1: intro to trauma

RSD: reflex sympathetic dystrophy =

complex regional pain syndrome

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MSK 1: intro to trauma

All intra-articular fractures get treated how?

Open reduction and internal fixation

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MSK 1: intro to trauma

What is the treatment of a non-union Fx?

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Increase of mechanical forces
Electrical stimulation Bone grafts
“Freshening up” of bone ends (atrophic non-unions)
Gavriil Ilizarov

Ultrasound is contraindicated

MSK 1: intro to trauma

intra-articular Fx, from joint surface to epiphyseal plate (separation), sparing the metaphysis:

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Type III - ORIF

MSK 1: intro to trauma

What type of bone heals faster cancellous or cortical bone?

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cancellous, spongy

MSK 1: intro to trauma

Cortical bone (compact bone) withstands what type of forces?

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compression and shear forces

# MSK 1: intro to trauma A triangular shape fracture through the growth plate and the metaphysis, sparing the epiphysis:

**Type II - closed reduction**

# MSK 1: intro to trauma what is the bone heal time on a newborn individual?

3 weeks

# MSK 1: intro to trauma True or false: undisplaced bone Fx heal **slower** than displaced bone Fx

FALSE: Undisplaced bone Fx heals faster

# MSK 1: intro to trauma What is the difference between **Type III** and **Type IV** epiphesial Fxs?

* Type III: from joint surface to epiphesial plate * Type IV: from joint surface to metaphysis

# MSK 1: intro to trauma What are the **symptoms** of reflex sympathetic dystrophy (AKA complex regional pain syndrome)

* hyperalgesia, * skin color/temperature changes, * hyperhidrosis (sweating) * swelling

# MSK 1: intro to trauma What happens during the consolidation phase C of bone healing?

1. Proliferating cells become osteogenic 2. Osteoclast absorbs dead bone Osteoblastic activity fills the gap between the fragments

# MSK 1: intro to trauma Classification of bone Fx by extend:

1. **Complete** 2. **Incomplete:** 1. Hairline 2. Buckle 3. Greenstick * only in children with growth-plates. * **Fx in the tension side** 4. Spiral Fx

# MSK 1: intro to trauma How is the trauma examination done?

1. **History:** single injury, repetitive trauma, mechanism of injury, crack or crepitus (did you hear a pop?). 2. **General examination:** check for secondary injuries, localized pain with motion, decreased function, deformity whenFx is displaced. 3. Imaging 4. Clear the cervical spinal.

# MSK 1: intro to trauma What is **axonotmesis**?

* disruption of nerve cell axon, severe injury * with Wallerian degeneration occurring (neurotmesis) * Recovery 1 inch per month (1-2 mm per day)

# MSK 1: intro to trauma What is the Tx of displaced Fx?

* closed reduction and immobilization * Closed reduction by continuous traction

# MSK 1: intro to trauma What is the Tx of closed avulsion Fx?

**ORIF** ## Footnote An open reduction and internal fixation (ORIF) is a type of surgery used to fix broken bones. This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone. This can be done with screws, plates, rods, or pins that are used to hold the broken bone together.

# MSK 1: intro to trauma main causes of ER attendace

* Motor vehicle accidents * Gunshot * Pediatric trauma * Terrorism

# MSK 1: intro to trauma What is the treatment of open Fx?

* Cleaning the wound * Debridement * Tx of Fx (closed, ORIF, external fixation) * Closure of wound: leave open unless type I * Antibacterial drugs * Prevention of tetanus

# MSK 1: intro to trauma Cancellous bone is susceptible to what type of Fx?

compression Fxs

# MSK 1: intro to trauma What is compound Fx?

the bone has communicated with the environment, risk of infection.

# MSK 1: intro to trauma Epiphyseal Fractures Types:

* **Type I:** separation of epiphysis without Fx. Closed reduction * **Type II:** most common 90%, parallel to plate, triangular shape metaphyseal fragment, closed reduction. * **Type III:** intra-articular, from joint surface to epiphyseal plate (separation). ORIF * **Type IV:** intra-articular, from joint surface to metaphysis, perfect reduction necessary, poor prognosis. * **Type V:** crushing force to one side of epiphysis, premature closure, angulatory deformity, poor prognosis.

# MSK 1: intro to trauma Why can bone Fx in children be a diagnostic problem?

difficult to differentiate growth-plates from fractures in radiographs

# MSK 1: intro to trauma separation of epiphysis without Fx is what type of epiphesial Fx?

**Type I - closed reduction**

# MSK 1: intro to trauma What is the treatment of Non-reduction undisplaced Fx?

protection alone

# MSK 1: intro to trauma Classification of bone Fx by relationship pf fragments

1. **Undisplaced** 2. **Displaced:** * Translated * Angulated * Rotated * Distracted * Overriding * Impacted

# MSK 1: intro to trauma Non-union bone develops a pseudoarthrosis due to what?

* Distraction, separation * Interposition of soft tissue between fragments * Excessive movement * poor local blood supply.

# MSK 1: intro to trauma Causes of malunion Fx:

* failure to reduce Fx adequately, * failure to hold reduction in place * Diferent prognosis in children (grothw plates)

# MSK 1: intro to trauma what is the bone heal time on a 20 year old individual?

20 weeks

# MSK 1: intro to trauma In what stage of bone healing there is tissue destruction, torn vessels, hematoma formation, and the fracture becomes sticky, initial callus (cartilage) acts as an internal splint?

**Stage A**

# MSK 1: intro to trauma What is a pathological bone fracture?

* Pathologically weak bone * Fx caused by normal forces: ex. woman with osteoporosis steps out of the shower and breaks her hip without falling. * **Osteoporosis** * Neoplasm

# MSK 1: intro to trauma What is **neurotmesis**?

* rupture of the nerve, no longer a continuous fiber. * Recovery requires surgery

INTRO TO TRAUMA Flashcards

(50 cards)