Ortho Overview Part 2 (Steiner) Flashcards Preview

Clin Med II MHM - FINAL > Ortho Overview Part 2 (Steiner) > Flashcards

Flashcards in Ortho Overview Part 2 (Steiner) Deck (47):
1

Tendons and ligaments are _____ structures

Viscoelastic

2

Function of tendons vs. ligaments

-Tendons create movement
-Ligaments stabilize joints and define motion of 1 bone against another

3

Describe 1st degree sprains

-Minimal fiber failure and pain
-No detectable joint instability
-Usually heals in a few days w/o sequelae

4

Describe 2nd degree sprains

-Partial tear or stretching
-Severe pain w/swelling
-Minimal joint instability
-6 to 12 wks for recovery

5

Sprain is an injury to what?

Ligament

6

Describe 3rd degree spains

-Completely (or nearly) ruptured
-Severe pain at time of injury, but little or none afterwards
-Unstable joint
-3-6 months recovery time

7

What is the best guide of grading a sprain early on?

Mechanism of injury (otherwise, they all present the same way)

8

Does the ACL self repair? Why?

-ACL does NOT self repair
-It lives within the joint (compared to the collateral ligaments)
-Presence of synovial fluid in the joint disrupts healing

9

Describe extensive immobilization of the knee

-Knee does NOT do well
-Reconstruction is recommended for those injuries

10

What are ligament/tendon healing events initiated by? How long does this last?

-Inflammatory response w/PMN infiltrate, fluid exudation, capillary budding
-Lasts about 3 days

11

By the 4th day of ligament/tendon healing, what occurs?

Fibroplasia - accumulation of fibroblasts from surrounding tissues

12

What occurs within 3 weeks of ligament/tendon healing?

-Granulation tissue forms surrounding the injured tissue
-Collagen fibers become longitudinally oriented

13

Over 3 months of ligament/tendon healing, what occurs?

Collagen fibers form bundles identical to injured tissues (results in healing)

14

Function of intervertebral disks?

-Sustain and distribute loads
-Prevents excess motion in spine

15

What are intervertebral disks composed of?

1. Nucleus pulposus (inner, soft)
2. Annulus (outer, thick fibrous)

16

What allows the spine to handle compressive, shear and rotational forces?

Interaction of the nucleus pulposus and annulus components of the intervertebral disks

17

What does the interaction of the nucleus pulposus and annulus of intervertebral disks allow for?

Allows spine to handle compressive, shear and rotational forces

18

Which population is more susceptible to disk herniation?

Elderly

19

Why are elderly more susceptible to disk herniation?

1. Nucleus pulposus dries out (reducing ability to handle stress)
2. Annular bands weaken (NP can rupture out)

20

How should a multi-trauma patient be assessed initially?

A - airway
B - breathing
C - circulation

21

After ABC, how should a multi-trauma patient be assessed?

D - disability (neuro, consciousness)
E - expose patient (and log roll to find any other injuries)

22

What is often a late finding in multi-trauma patients?

ARDS (adult respiratory distress syndrome)

23

What should patients with long bone fractures (especially more than one) be watched for?

Fat embolism
-Occurs 12-48 hrs after injury
-Often happens in young adults

24

How does a patient with a fat embolism present?

-SOB, restlessness, confusion, fever/tach
-Petechiae on chest and axillae
-Hypoxemia on ABGs w/high PCO2

25

Treatment of fat embolism

-Resp support to correct hypoxemia
-Some will use IV steroids
-Anti-coagulants

26

Describe compartment syndrome

-Increased pressure in a closed space leading to neuro or vascular compromise
-Bone and fascia
-MC anterior tibial region or forearm

27

What can unrecognized compartment syndrome lead to?

Significant and irreversible nerve damage

28

What can untreated compartment syndrome lead to?

Muscle damage, necrosis, infection, even amputation

29

Muscle tissue has a measurable pressure between:

0 and 10 mm Hg

30

Capillary blood flow is compromised at what pressures?

20 or greater mm Hg

31

What pressures can lead to ischemic necrosis of muscle?

30-40 mm Hg

32

What body components are most sensitive to pressure?

Nerves then muscle

33

Compartment syndrome MC caused by?

Trauma
-Nearly 50% arise from tibial fractures (closed MC)

34

Other causes of compartment syndrome?

-Ortho surgery
-Vein harvesting for CABG
-Improper splint/cast application
-Reperfusion of an ischemic extremity
-Anti-coagulant use or clotting problems

35

Average age of onset for compartment syndrome?

30 yo

36

Compartment syndrome affects males or females more?

Males

37

Why may the elderly and women be protected against compartment syndrome?

-Smaller "hypotrophic" muscles
-Relatively higher BP (elderly)

38

How does exertional compartment syndrome develop?

Results from combo of muscle hypertrophy and associated edema that occurs w/exercise within a small compartment

39

How does exertional compartment syndrome present?

-Exertional pain or claudication
-Pain resolves w/cessation of activity

40

Treatment of exertional compartment syndrome

-Rest and gradual onset of training
-Surgery (fasciotomy) for intractable patients

41

Which type of compartment syndrome is more ominous and requires more dramatic intervention?

CS from trauma or surgery

42

Hallmark of compartment syndrome

Crescendo pain that is out of proportion to level of injury AND unrelieved by narcotics

43

Treatment of compartment syndrome

-Reduce pressure, restore BF
-Remove external devices (casts, dressings)
-Elevate limb to level of heart (maintains good venous return w/o compromising arterial flow)
-Do NOT use ice (d/t vasoconstriction)

44

Why do we elevate limbs to the level of the heart in compartment syndrome?

Maintains good venous return without compromising arterial flow

45

Why is ice contraindicated in compartment syndrome?

Causes vasoconstriction

46

Complications of fasciotomy

-Need 2nd procedure to close fasciotomy (cosmetically not good)
-Infection
-Calf dysfunction
-Foot drop

47

Outcomes of compartment syndrome

-Delays of 12+ hrs in treatment results in permanent damage and even amputation
-Timely intervention provides immediate relief and prevents further tissue damage