Orthopaedic Injuries Flashcards
(29 cards)
How to Determine a Fracture in the Field?
Clinically, a history of loss of function, pain,
tenderness, swelling, abnormal motion, and deformity suggest a
fracture.
What does open fracture mean?
exposed to the outside environment in any way
Description of a Fracture
Exact Anatomical Position
Name of the bone
Left or Right of the body
Reference points along the bone (neck, tubercle, condyle)
Direction of the fracture line in relation to the long axis of the bone (see card below)
Position and alignment
Types of Fractures
A trans-verse fracture occurs at a right angle to the long axis of the bone
(Fig. 49-1A)
An oblique fracture runs oblique to the long
axis of the bone (Fig. 49-1B)
A spiral fracture results from a rotational force and encircles the shaft of a long bone in a spiral fashion (Fig. 49-1C).
A comminuted fracture is when there are more than two fragments
Avulsion fracture refers to a bone fragment that is pulled away from its normal position by
* the forceful contraction of a
muscle
* the resistance of a tendon or ligament to a
force in the opposite direction
An avulsion fracture is a fracture that occurs through abnormal bone - it’s suggested whenever a fracture occurs from seemingly trivial trauma
What does displacement mean?
any deviation from normal
Valgus - denotes a deformity in which the described part is angled away from the midline of the body
Varus - denotes a deformity in which the angulation of the part is toward the midline
Alignment - the relationship of the longitudinal axis of one fragment to another
Angulation - deviation from the normal alignment
* the direction of angulation is determined by the direction of the apex of an angle formed by the two fracture fragments (Fig. 49-4)
What’s Impaction?
forceful collapse of one fragment of bone into or onto another.
What medical weaknesses predispose people to bone injury?
- primary or metastatic malignancies
- cysts
- enchondromata
- giant-cell tumors
- osteomalacia
- osteogenesis imperfecta
- scurvy
- rickets
- Paget’s disease
Fracture Images
Fracture Images
Greenstick fractures are incomplete angulated fractures of long bones
A torus fracture is another form of incomplete fracture, characterized by a wrinkling or buckling of the cortex
Abnormal Unions
Delayed union is union that takes longer than usual for a particular fracture location
Malunion occurs when a residual deformity exists
Nonunion is the failure of a fracture to unite
* When nonunion results in a false joint, it is
termed a pseudarthrosis.
Salter-Harris Classification
Fact - Distal radius fractures account for two thirds of fractures in pediatric patients in the ED.
Classification and Emergency Management of Open Fractures
Blood loss associated with Fractures in Adults
In adults, blood loss can range from 100 mL from a forearm fracture to 3 L from a pelvic fracture
Nerve Injuries
Neurapraxia is the contusion of a nerve, with disruption of the ability to transmit impulses
Paralysis, if present, is transient, and sensory loss is slight
Axonotmesis is a more severe crush injury to a nerve
Neurotmesis is the severing of a nerve, usually requiring surgical repair.
O’Rian Wrinkle - when your fingertips (digital pupls) wrinkle after being in water for a long period of time (approx. 20min)
This indicates there is nerve function
What are the most likely adverse outcomes for life threatening emergencies?
**Compartment Syndrome **- a serious acute emergency in which the nerves and muscle tissue are the highest concern - this occurs when there is pain and parethesias in an extremity after a fracture within an enclosed osseofascial space (see below for causes)
The 3 main circumstances in which compartment syndrome occurs are:
1. Increased compartment contents
2. decreased compartment volume
3. external pressure
Management of Compartment Syndrome
NEVER elevate the limb as it’s counterproductive and excaerbates the syndrome
Compartment Syndrome Presentation
* Pain on passive stretching
* active flextion of involved muscles
* deep, burning, and unrelenting and is difficult to localize pain
OPTIONAL Complex Regional Pain Syndrome
Fat embolism - refers to the presence of fat globules in the lung parenchyma and peripheral circulation after a long bone fracture or major trauma
* fat embolism syndrome usually occurs after long bone fractures
* common manifestations include respiratory distress, hypoxemia, confusion, thrombocytopenia, petchial rash
* fat is seen in 50% of pts urine within 3days
Fracture Blisters - tense blisters or bullae that accompany high-energy injuries in areas of relatively little skin coverage over a fracture site - Most Common Sites include:
1. Ankle
2. Elbow
3. Foot
4. Knee
Caused by increased underlying tissue pressure
Subluxation - partial loos of continuity
Dislocation - a complete loss of continuity
* named for the major joint involved
Fracture-dislocation is when there is loss of articulation w/fracture
Sub’s and Dis’s are described according to the direction of the distal segment relative to the proximal segment or of the displaced bone relative to the normal structures
Sprains - Ligamentous injuries resulting from an abnormal motion of a joint
* injury to the fibers of a supporting ligament of a joint
- 1st degree - minor tearing of ligamentous fibers with resultant mild hemorrhage and
swelling - 2nd degree - a partial tear of a ligament, meaning more fibers are torn than in the first-degree injury
- 3rd degree - the complete tearing of a liga-
ment
Strain - an injury to a musculotendinous unit resulting from violent contraction or excessive forcible stretch (pulled muscle)
1. (mild) strain is a minor tearing of the musculo-
tendinous unit, characterized by minor swelling, local tenderness, and minimal restriction of movement.
- (moderate) strain, more fibers are torn, but without complete disruption; swelling, ecchymosis, and loss of strength are more marked
3.severe) strain, the muscle or tendon is completely dis-
rupted, with resultant separation of muscle from muscle, muscle from tendon, or tendon from bone
Tendinitis - classically described as an inflammatory condition characterized by pain at tendinous insertions into bone, occurring
in the setting of overuse
* certain systemic diseases, including diabetes mellitus, chronic renal failure, rheumatoid arthritis, and systemic lupus erythematosus; steroid use; and occasionally fluoroquinolone use are associated with the development of tendinopathy
Bursitis - a painful inflammation of the bursa that may be traumatic, infectious, or related to systemic illness
