Traumatic Ossification Overview

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Questions and Answers

Which symptom is NOT associated with the active stage of traumatic ossification?

Decreased range of movement

Swelling

Pain

Circumscribed shadow of calcification (correct)

What is a treatment strategy for the active stage of traumatic ossification?

Early reduction of fracture

Immediate excision of calcified tissue

Avoid passive movement after plaster removal

Encourage graduated active exercises (correct)

Which of the following is NOT part of the management for acute ischemia?

Wait for spontaneous recovery (correct)

Suture torn vessels

Explore vessels surgically if no improvement

Remove tight bandages

What is the earliest and most objective sign of compartment syndrome?

Tense compartment Signup and view all the answers

Which of the following is a component of the 5Ps of compartment syndrome?

Pain Signup and view all the answers

What might be done if a vessel is thrombosed during management of acute ischemia?

Perform endartrectomy Signup and view all the answers

During which stage of traumatic ossification do patients still experience local heat?

Active stage Signup and view all the answers

What is the recommended management for vasospasm in acute ischemia?

Papaverine sulphate solution Signup and view all the answers

What is the classic clinical finding of compartment syndrome?

Severe pain out of proportion to the injury Signup and view all the answers

Which of the following is NOT a recommended early treatment for compartment syndrome?

Apply ice to the area Signup and view all the answers

What is a primary characteristic of Volkmann's ischaemic contracture?

Flexion of the wrist and fingers Signup and view all the answers

What is a crucial preventive measure against Volkmann’s ischaemic contracture?

Early reduction of elbow fractures Signup and view all the answers

Which method is included in the non-operative treatment for Volkmann's ischaemic contracture?

Gradual stretching using a splint Signup and view all the answers

Which nerve injury type is characterized by complete loss of nerve function?

Neurotmesis Signup and view all the answers

What is the recommended treatment approach for carpal tunnel syndrome following a Colles' fracture?

Early surgical exploration Signup and view all the answers

Which treatment for Volkmann's ischaemic contracture may involve excision of necrotic muscle?

Carpectomy Signup and view all the answers

Which of the following is a general complication of fractures?

Deep venous thrombosis Signup and view all the answers

What type of local complication is caused by rib fractures penetrating the lung?

Pneumothorax Signup and view all the answers

Which of the following is NOT considered a late complication of fractures?

Infection Signup and view all the answers

What complication is associated with prolonged recumbency following a fracture?

Pulmonary embolism Signup and view all the answers

Which of the following describes myositis ossificans?

Formation of bone in muscle haematoma Signup and view all the answers

Which of the following represents a respiratory complication that can arise from fractures?

Fat embolism Signup and view all the answers

What is the primary mechanism that leads to traumatic myositis ossificans?

Osteoblast migration from periosteum Signup and view all the answers

Which complication would be classified as an urgent local complication?

Nerve injury Signup and view all the answers

What characterizes neuroapraxia?

Physiologic interruption of nerve function Signup and view all the answers

What is the most accurate outcome for axonotmesis within six months?

Complete recovery Signup and view all the answers

Which injury is most likely to result in a claw hand?

Fracture of the medial epicondyle of humerus Signup and view all the answers

Which of the following is NOT a common complication of joint injury?

Neuropraxia Signup and view all the answers

What is the potential outcome of reflex sympathetic dystrophy?

Severe pain and stiffness Signup and view all the answers

What is a primary cause of post-traumatic arthritis?

Joint incongruity after intraarticular fracture Signup and view all the answers

Which treatment is NOT typically associated with reflex sympathetic dystrophy?

Bone realignment surgery Signup and view all the answers

What is a key symptom of Sudeck's osteodystrophy?

Patchy rarefaction of bone on X-ray Signup and view all the answers

What is the primary cause of avascular necrosis (AVN)?

Interruption of blood supply Signup and view all the answers

Which complication involves healing that takes longer than the typical time frame for a bone injury?

Delayed union Signup and view all the answers

What term describes a fracture that has healed in a non-anatomical position, potentially causing deformities?

Mal-union Signup and view all the answers

What is a potential treatment option for non-union fractures?

Internal fixation with or without bone graft Signup and view all the answers

Which local cause is NOT associated with delayed union and non-union?

Excessive activity post-injury Signup and view all the answers

Study Notes

Traumatic Ossification (Myositis Ossificans)

Calcification and ossification outside the skeleton causing joint movement restriction
Can involve lacerated muscle, torn capsule, fascia, tendon, and periosteum
Frequent after elbow and hip injuries, but can occur at other sites
Predisposing factors: delayed reduction, massage, and passive exercises
Pathogenesis: osteoblasts from injured periosteum migrating to form bone in muscle hematoma, metaplasia of fibroblasts to osteoblasts

Traumatic Ossification Stages

Active stage: pain, swelling, local heat, decreased joint range of motion, cloudy shadow of calcification on X-ray
Quiescent stage: pain and heat subside, swelling rare, joint stiffness persists, circumscribed and denser calcification shadow on X-ray

Traumatic Ossification Treatment

Prophylactic: early fracture and dislocation reduction, immobilization, avoiding massage and passive movement after plaster removal
Curative: active exercises after rest in active stage, excision in quiescent stage (aware of recurrence tendency), vascular injuries

Acute Ischemia

Compartment syndrome: raised pressure within a closed space, potential for irreversible tissue damage
Diagnosis: tense compartment (earliest and most objective sign), 5 Ps (pain, parathesia, pallor, paralysis, and pulselessness)

Acute Ischemia Management

Surgical emergency, measures taken until blood flow restored: removal of tight bandages/plaster, fracture reduction if compressing artery, vessel exploration by urgent operation if no improvement within 30 minutes

Compartment Syndrome

Early detection and treatment are essential
Treatment: removal of constrictive dressings and casts, avoiding joint flexion, fracture reduction, elevation of limb
Operative treatment: fasciotomy (decompression by opening threatened compartments)

Volkmann's Ischemic Contracture

Massive forearm muscle infarction leading to fibrosis and permanent muscle shortening
Clinically: wrist flexion, interphalangeal joint flexion, metacarpophalangeal joint extension, muscle atrophy, ischemic neuritis with sensory loss along median nerve distribution, trophic changes in fingers
Contracture: flexors are short, fingers flex when wrist dorsiflexed and cannot passively extend, fingers can be passively extended when wrist flexed

Volkmann's Ischemic Contracture Prevention

Early fracture reduction around the elbow, avoiding acute elbow flexion after supracondylar fracture reduction, avoiding tight bandages and casts, treating ischemia and performing fasciotomy

Volkmann's Ischemic Contracture Treatment

Non-operative: gradual stretching with splint or wedged plaster cast in recent mild cases
Operative: muscle slide operation, carpectomy, excision of necrotic muscle and transfer of healthy muscle tendon in selected cases

Nerve Injuries

Types: neurapraxia, axontemesis, neurotemesis
Common sites: carpal tunnel syndrome in Colles' fracture
Neuroapraxia: physiologic interruption of nerve function, recovery in minutes to weeks
Axonotemesis: cut nerve axon with intact sheath, complete recovery within 6 months
Neurotemesis: cut nerve axon and sheath, bad prognosis

Nerve Injury Treatment

Simple fractures with neurapraxia or axontemesis: spontaneous recovery
Open fractures with neurotemesis: repair

Common Nerve Injuries and Their Effects

Axillary nerve: shoulder dislocation, deltoid paralysis
Radial nerve: humerus fracture, wrist drop
Median nerve: supracondylar humerus fracture in children, pointing finger
Ulnar nerve: medial epicondyle humerus fracture, claw hand
Sciatic nerve: post-hip dislocation, foot drop
Common peroneal nerve: knee dislocation, neck of fibula fracture, foot drop

Joint Complications

Sprain, dislocation, subluxation, joint stiffness, effusion (traumatic synovitis), hemoarthrosis, septic arthritis, Sudeck's osteodystrophy, post-traumatic arthritis

Post-Traumatic Joint Stiffness

Causes: adhesions (periarticular and intra-articular), traumatic ossification (myositis ossificans), Sudeck's osteodystrophy, osteoarthritis (late after many years), malunion, bone block

Reflex Sympathetic Dystrophy (Sudeck's Atrophy)

Pain, swelling, osteoporosis, and stiffness of hand and foot in wrist and ankle fractures
Etiology unknown, potentially due to disuse atrophy or over sympathetic activity
Often a neurotic female, more common in wrist and ankle fractures
Characterized by severe pain and stiffness, local vasomotor symptoms (discoloration, thinning, and excessive perspiration)
X-ray: patchy rarefaction of bone

Reflex Sympathetic Dystrophy Treatment

Physiotherapy: graduated exercises and paraffin baths
Analgesics, TENS, sympathetic block, and sympathectomy

Post-Traumatic Arthritis

Causes: joint incongruity after intraarticular fracture, avascular bone necrosis, malunited fractures

Bone Complications

Avascular necrosis, non-union, malunion, delayed union, growth arrest, bone shortening, epiphyseal injuries, osteomyelitis

Avascular Bone Necrosis (AVN)

Bone necrosis due to interruption of blood supply after fracture or dislocation injury
Site: head of femur (femoral neck fracture, hip dislocation), scaphoid, talus
Clinical presentation: late pain and malunion

Vulnerable Sites of AVN

Head of femur, scaphoid, talus, knee (condyles and tibial plateau), humeral head, radial head, and lunate bone

Bone Healing Complications

Delayed union: healing takes longer than average for a given bone injury
Non-union: arrest of healing process, sclerosis at fracture ends, fracture does not unite, fibrous union with pseudoarthrosis

Fracture Healing Time Frame

Clinical union: upper limb 3-4 weeks, lower limb 6-8 weeks in children, upper limb 6-8 weeks, lower limb 12-16 weeks in adults
Radiological union: bridging callus formation and remodeling

Types of Non-union

Atrophic: narrow fracture gap, sclerotic ends, minimal callus formation
Hypertrophic: wide fracture gap, large callus formation, no bridging callus

Delayed Union and Non-union Local Causes

Infection, inadequate blood supply, inadequate immobilization, distraction of fragments, interposition of soft tissue, severe soft tissue damage, avascular necrosis

###Delayed Union and Non-union Clinical Presentation

Pain, swelling, abnormal movement

Delayed Union Treatment

Prolonged immobilization, adequate fixation, bone graft for significant bone loss

Non-union Treatment

Internal fixation, bone graft

Malunion

Fracture healed in non-anatomical position
Can cause angular deformity, rotational deformity, limb shortening
Example: cubitus varus after supracondylar humerus fracture
Treatment: osteotomy

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Description

Explore the causes, stages, and treatments of Traumatic Ossification, also known as Myositis Ossificans. This quiz delves into how calcification occurs outside the skeleton, leading to joint movement restrictions, and provides insights on preventative and curative measures.