MSK injuries trigger thing?

Question 1

at what phase of a strain/sprain do you see platelets aggregating and the release of cytokines, chemokines and hormones. Vasoconstriction also occurs during this time.

What PE finding might you see during this phase?

Answer 1

hemostasis phase (immediately after injury)
PE: temporary skin blanching

Question 2

at what phase of strain/sprain do you see capillaries dilating and becoming more permeable which causes swelling and the release of blood into the extravascular space.

What PE finding might you see during this phase?

Answer 2

inflammatory phase (0-72 hrs post injury)
PE - bruising

Question 3

at what phase of strain/sprain do you see graluation and collagen formation/deposition along with neovascularization and reduction of inflammatory mediators.

What is the treatment for this phase?

Answer 3

proliferative (72hrs - 3 weeks)

tx: begin full Assisted ROMS in addition to protection, pain control and compression.

Question 4

at what phase of strain/sprain do you see collagen and myofibers increase in number/strength and organization?

Answer 4

maturation phase (3 wks - 2 yrs)

Question 5

Raynauds, PVD, and impaired sensation are all contraindications for what treatment

Answer 5

Icing

also hypersensitivity rxn or coold induced urticaria

Question 6

A patient presents to you who recently moved here 6 weeks ago from a few states away. She reports she has had pain and swelling of her ankle which has been getting worse over the past 5 weeks. She reports she runs about 5 miles a day and has done so for the past 3 years and this has never been a problem. Which of the following would NOT increase your suspicion of overuse syndrome in this patient?
A. New running shoes
B. Bulge sign on PE
C. Starting a FQ
D. Inflammatory disorder such as lupus

What is the management for overuse syndrome

Answer 6

B - bulge sign is for knee effusion.

conservative: PT/OT, NSAIDS, ice/heat, pt ed, steroid injections

Question 7

which part of the bone contains the vessels, nerve endings and repair cells

Answer 7

periosteum

Question 8

what part of the bone lines the marrow cavity

Answer 8

endosteum

Question 9

how would you classify a fracture with an open wound of 8cm with slight contamination?

Answer 9

Grade 2

Question 10

how would you classify a fracture that has a 12cm open wound and vascular involvement

Answer 10

Grade 3C

Question 11

how would you classify a fracture that has an open wound of less than 1cm

Answer 11

Grade 1

Question 12

how would you classify a fracture that has an open wound of 12cm and exposed bone that is visible.

Answer 12

Grade 3B

Question 13

a fracture where the distal fragment longitudinally overlaps proximal by mm/cm is called what

Answer 13

bayoneted/shortened fx

Question 14

a fracture where the distal fragment is separated from proximal fragment by a gap in mm/cm is called what

Answer 14

distracted fracture

Question 15

what do you call a fracture that is incomplete along the distal metaphysis? where is this MC?

Answer 15

torus/buckle fracture

MC in distal radius

Question 16

what do you call a fx with incomplete extension through the periosteum? how does this fracture present?

Answer 16

greenstick fracture

presents MC in children d/t soft bone. causes fracture on tension side and buckling of the bone on the other side of the shaft of a long bone.

Question 17

what classification system is used to describe fractures involving the growth plates

Answer 17

salter-harris classificaition

growth plate = physis

Question 18

what is the classification for a fracture that goes through a portion of the physis and through the epiphysis into the joint

Answer 18

type 3 salter harris fracture

Question 19

what is the classification for a fracture that goes through a portion of the physis and extends through the metaphysis

Answer 19

type 2 metaphysis

Question 20

what is the classification for a fracture that goes across the metaphysis, physis and epiphysis?

Answer 20

type 4 salter harris

Question 21

what is the classification for a crush fracture of the physis

Answer 21

type 5 salter harris

Question 22

what is the classification for a fracture that separates through the physis

Answer 22

type 1 salter harris

Question 23

in what stage of fracture healing do bioactive cells migrate to the fracture site hematoma and lead to the formation of granulation tissue.

Answer 23

stage 1: inflammatory (peaks at several days)

Question 24

in what stage of fracture healing does neovascularization, phagocyte clearing, and fibroblast collagen production occur?

Answer 24

stage 2: reparative phase

soft callus is produced first in this phase and then converts slowly to woven/immature bone.

Question 25

when does soft callus begin to be produced in fracture healing

Answer 25

stage 2: reparative phase

also neovascularization, phagocyte clearing, and fibroblast collagen production occurs

Question 26

In what stage of fracture healing does the woven immature bone begin to be replaced by lamellar bone? when does this occur time-wise

Answer 26

stage 3: remodeling phase

occurs around 6-10 weeks

Question 27

this type of open fx is treated with cefazolin +/- metro for anaerobic infection

Answer 27

grades 1 and 2

Question 28

this type of open fracture is treated with cefazolin + gentamicin +/- metro for anaerobic

Answer 28

grade 3

Question 29

malnutrition, smoking, excessive NSAID use, inadequate immobilization, indolent infection and soft tissue injury can all factor into what healing problem with fractures?

Answer 29

nonunion

Question 30

what is an indicator that overuse syndrome may actually be a stress fracture instead?

Answer 30

no improvement with conservative therapy

Question 31

sentence for remembering high risk stress fracture areas

Answer 31

3 People Fracture Many Terribly Crucial Good Bones

• 3 p = paris interarticularis, patella, proximal 5th metatarsal
• F - femoral head and neck
• M medial malleolus
• T - talus, tarsal navicular
• C - anterior Cortex of tibia
• G - great toes sesamoids
• B - base of second metatarsal bones

Question 32

if your splint must remain in place for more than a few hours what type should you use

Answer 32

plaster or fiberglass