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LOCO 2 > Trauma of the Musculoskeletal System > Flashcards

Trauma of the Musculoskeletal System Flashcards

(56 cards)

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1
Q

Musculoskeletal trauma affects both…?

A

Skeletal/joints and the soft tissues

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2
Q

Advanced Trauma Life Support (ATLS) - what makes up the primary survey? (5)

A 
Airway & C-spine Control
Breathing & Ventilation
Circulation & Haemorrhage Control
Disability & AVPU (level of consciousness)
Exposure & Environment Control
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3
Q

What makes up the secondary survey? (3)

A

Head to toe examination
Detailed history
Special tests (x-rays, blood labs)

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4
Q

What is the key message of advanced life support?

A

Treat life threatening injuries FIRST e.g. apply pressure to haemorrhage from an open wound / reduce a pelvic fracture if haemodynamically unstable, etc
THEN prevent long term complications once the patient is stable.

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5
Q

What imaging is done for musculoskeletal trauma?

A 
X-ray
Computerised tomography
Magnetic resonance imaging
Ultrasound 
Bone scan
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6
Q

What is polytrauma?

A

Trauma to several body areas or organ systems

One or more may be life threatening

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7
Q

Our upper limb or lower limb fractures/dislocations more disabling?
Which is associated with more severe injuries?

A

Upper limb more disabling

Lower limb associated with more severe injuries

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8
Q

What is the possible blood loss within the first 2 hours of a tibia/fibula haemorrhage?

A

500 ml

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9
Q

What is the possible blood loss within the first 2 hours of a femur haemorrhage?

A

500ml

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10
Q

What is the possible blood loss within the first 2 hours of a pelvis haemorrhage?

A

2000ml

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11
Q

Why are pelvic fractures a problem? (3)

A

Haemorrhage
10-20% mortality
Persistent pain in 25-35%

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12
Q

What are the biggest causes of trauma/haemorrhage?

A

Car accident (48.5%), work accident (27.3%), motorcycle accident (18.2%) and then crushing and tractors (make up 0.6% together)

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13
Q

Are pelvic bleeds usually venous or arterial?

A

85% are venous (they are thin walled vessels). The pre-sacral venous plexus overlies the sacroiliac joint, the fracture disrupts the joint and tears veins causing bleeding. There is also bleeding from cancellous bone surfaces.
Mainly from the internal iliac vein.

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14
Q

Stabilising a pelvic fracture - how is this done? What happens if it is not done?

A 
External fixation (frame) left for 8 weeks if possible
Mal-union
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15
Q

What are some potential skin soft tissue traumas? (3)

A

Open fractures
Degloving injuries
Ischemic necrosis

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16
Q

What are some potential muscles soft tissue traumas? (2)

A

Crush and compartment syndromes

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17
Q

What are some potential blood vessel soft tissue traumas? (2)

A

Vasospasm (can lead to clot formation) and arterial laceration

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18
Q

What are some potential nerve soft tissue traumas? (3)

A

Neurapraxias, axonotmesis, neurotmesis

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19
Q

What are some potential ligament soft tissue traumas? (2)

A

Joint instability and dislocation

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20
Q

What does neurapraxia mean?

A

Nerve is compressed, but no axonal damage after it has been decompressed.

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21
Q

What does axonotmesis mean?

A

There is axoplasmic damage, but the endoneural sheath intact (can reform, about 3mm a day).

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22
Q

What does neurotmesis mean?

A

Axon disrupted, loss of tubules, support cells destroyed.

As it regrows, it can form a tangle of nerve axons.

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23
Q

All severe soft tissue injuries require urgent treatment. Why?

Study These Flashcards
A

Because of potential complications – for example, a severe soft tissue injury will delay fracture healing

24
Q

What is reduction?

What fractures require reduction?

Study These Flashcards
A

Putting the bone back into alignment

If displaced

25
Fractures that aren't displaced - how are they treated?
Simple splintage (e.g. clavicle, ribs, MT’s carpals and stress or impacted fractures)
26
What is closed reduction? | What is open reduction internal fixation (ORIF)?
Closed reduction is the manipulation of the bone fragments without surgical exposure of the fragments - alignment without angulation. Done with anaesthesia. Open reduction is where the fracture fragments are exposed surgically by dissecting the tissues - anatomic
27
When is open reduction done?
When you need accurate reduction/when internal fixation is needed, i.e. close to a joint
28
What are the downfalls of ORIF?
Risk of infection | Can slow healing if too rigid
29
When is traction used?
Fractures or dislocation requiring slow reduction
30
How are we going to hold the reduction?
Semi-rigid (Plaster) or Rigid (Internal fixation)
31
How is internal fixation done?
Use K wires or intramedullary nails to hold everything in place
32
What can internal fixation lead to?
Bone is too rigid and may develop osteoporosis – bone isn’t turning over quick enough and so gets removed
33
Treating the fracture operatively – what are the benefits? (3)
Quick rehabilitation Low risk of joint stiffness Low risk of mal-union
34
What are the benefits of treating a fracture non-operatively? (2)
Rapid healing | Low risk of infection
35
What are the disadvantages of treating a fracture operatively? (3) How have these been rectified?
Risk of non-union - improved implants Slow healing Risk of infection - antibiotic prophylaxis (ALSO Development of minimally invasive methods)
36
What are the disadvantages of treating a fracture non- | operatively? (4)
Risk of non-union Risk of mal-union Risk of joint stiffness Slow rehabilitation
37
What are the current absolute indications for operative treatment? (5)
``` Displaced intra-articular fractures Open fractures Fractures with vascular injury or compartment syndrome Pathological fractures Non-unions ```
38
What are the current relative indications?
Loss of position with closed method Poor functional result with non-anatomical reduction Displaced fractures with poor blood supply Economic and medical indications
39
What factors affect healing time? (2)
Local factors | Systemic factors
40
What is meant by 'Clinical Union'?
Bone moves as one | Can be tender when stressed
41
What is meant by 'Radiological Union'?
At least 3 out of 4 cortices healed on 2 views Bridging callus formation Fracture line often still present Remodelling
42
Is fracture union is equal to fracture consolidation?
No
43
How long does it take for an upper limb fracture to heal in an adult? What about lower limb?
6-8 weeks, 12-16 weeks
44
How long does it take for an upper limb fracture to heal in a child? What about lower limb?
3-4 weeks, 6-8 weeks
45
What are the potential general early complications? (4)
Other injuries, pulmonary embolism, fat embolism, acute respiratory distress syndrome
46
What are the potential early bone complications? (1)
Infection
47
What are the potential early soft tissue complications? (4)
Plaster sores Wound infection Neurovascular injury Compartment syndrome
48
What are the potential general late complications? (3)
Chest infection UTI Bed sores
49
What are the potential late bone complications? (3)
Non-union Mal-union Avascular necrosis
50
What are the potential late soft tissue complications? (3)
``` Tendon rupture Nerve compression Volkmann contracture (death of muscle) ```
51
How does a patient with a fat embolism present? (3)
Mild hypoxaemia Multiple hyperintense punctate lesions throughout cerebral white matter Petechie (rash) over chest and upper arm
52
If the pressure within an anatomical compartment exceeds the perfusion pressure of that compartment then...?
Causes collapse of the venous and capillaries close
53
What are the six "P"s of musculoskeletal assessment?
``` Paraesthesia Pallor Polar Paralysis Pain Pulselessness ```
54
Capillary blood flow within the compartment may be compromised at pressures of...?
>20 mmHg
55
How is compartment syndrome diagnosed?
Clinical presentation or pressure monitoring
56
How is compartment syndrome treated?
Fasciotomy

LOCO 2 (28 decks)

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