Skeletal Trauma PDF

Chapter 43 Disorders of the Skeletal System: Trauma, Infections, Neoplasms, & Childhood Disorders Skeletal Trauma  Fracture (#) Any discontinuity of bone Commonly affecting the hands, clavicles & humerus in the young proximal femur pelvis, vertebrae in the elderly Classi...

Chapter 43 Disorders of the Skeletal System: Trauma, Infections, Neoplasms, & Childhood Disorders Skeletal Trauma  Fracture (#) Any discontinuity of bone Commonly affecting the hands, clavicles & humerus in the young proximal femur pelvis, vertebrae in the elderly Classification of Fractures by anatomical location... Epiphyseal: at bone ends (both proximate Diaphyseal: at the shaft  Epiphyseal Fractures · proximal distal Diaphyseal Fractures  Intertrochanteric Good to have to walk , run - intertrochanteric - Very wean (fractures) Osteoporosis makes it more ~ to fractures prome · Particular to the proximal femur · Entire weight of body is carried by neck of femur Weal architecturally strong mobility wise , Malleolar Fractures · Often happens when you land jump and incorrectly medial malled us break lateral or ↳ Twist anule , made to cover · specialized shoes this anule to prevent Bottom of - tibuan e by degree of severity... simple – two segments ( bonebroken n a complex – more than two Reduction: Put bone back to original position Severity of Fractures Simple Fracture Complex Fracture A single linear disruption of the A fracture with several intermediate diaphyseal circumference that fragments. After reduction, there is delimits two fragments. no contact between the main fragments. by geometry... transverse perpendicular to the longitudinal axis oblique at an angle wi this that problem is that the muscle binds the bone at either end of this fracture these knive edges get damaged (spasm inpulls that will direction) opposite upwards more soft tissue dog than oblique · by geometry... (cont.) spiral in a spiral fashion · difficult day to stabilize + cause soft tissue longitudinal along the length Transverse Fracture tibia Oblique Fracture T Spiral Fracture ↑ Spiral fibular fracture Longitudinal Fracture ↓ / by degree of stability... stable not movable impacted fragment driven into the medulla by degree of stability... (cont.) linear (hairline) Hairlinethere line depressed bone fragments driven inward -depressed Impacted Fracture Depressed Skull Linear Skull Fracture Fracture AP view lateral view by degree of completion... torus (bone doesn't break , builds up into burdge) bulging fracture site incomplete (bonestillthere ,easyation) only partially fractured greenstick incompletely fractured; poorly ossified bone  by degree of completion... ⑪ comminuted ↑ multiple fragments avulsion torn away collision) (motor vehicle · Usually dit high speeds Clots of small segments bullets caused by · leads Complications Small supply : lose blood , segments · to massive inflammatory response overextend them internal plates Usually using · · If torn , might have to ampurate joing Torus Fracture - Incomplete Fracture Incomplete # 5th metatarsal Greenstick Fracture Comminuted Fracture radius humerus Avulsion Fracture Avulsion Fracture talar avulsion Avulsion Fracture talar avulsion by intactness of the skin... closed skin not disrupted compound (open) skin disrupted Closed Fracture Closed Fracture Compound Fracture - Compound Fracture Compound fracture of the humerus Compound (open) Fracture Compound Fracture Compound Fracture by position... angulated bone fragments at an angle to each other displaced bone fragments not anatomically placed rotated bone fragments twisted along the longitudinal axis of other (bone sittingwheretopthe on · shortened: Done has shortened of bone fracture end happened and is shorter than of anatomical position) Angulated Fracture humerus Displaced Fracture ↑ shortened Culhar + radius have gone up Displaced Fracture Forearm Rotated Fracture femur Angulated Compound Fracture-Dislocation · Angulated Compound Fracture-Dislocation by location... Colle’s fracture fracture of distal radius & ulnar falls be fall shifts to distal radius + ulnar body weight + Common wh · we , use hands Pott’s fracture bilateral malleolar fractures Colle’s Fracture Pott’s Fracture Pathophysiology of Fractures  Normally... Periosteum ~ & Cartilage missing start to osteoblasts area wh bones and cover impote Come #1 hemorrhage into the # site (living vascular bone very hematoma forms (contained by periosteum) bone tissue at # site subperiosteal dies and subendosteal osteoblasts form inflammatory cell a procallus infiltration (typedepends in a on infection neovascularization ( proliferation of bu in bone Tissue)  collagen and remodelling mineralization of · Osteoclasts remodel (remove extra or older Tissue) procallus forms callus S stages of bone healing Hematoma (dig to local carses hematoma vasculature + which Formation triggers repair process ↳ inflammation · Old Tissue reabsorbed , by old tissue removal osteoclast ( or it becomes the foundation/deposition of new bone I callus Organization of hematoma into fibrous network Callus formation of Deposition ir m + phope the Invasion of osteoblasts, lengthening of collagen strands, & deposition of calcium Remodeling (Done by Osteoclasts , tissue replaced normal bone tissue (  Complications soft tissue injury muscle, nerves, CNS hemorrhage (pressure on surrounding tissue which may effect blood supply) infection (complicates hearing) fracture fat embolism (pulmonary infarction) (lots spitlipid o a bone Coblique of bu in Fractures boner + day to en adipose deformity ConleymayNighty see be smaller than Ux : diabetes associated we circulatory problems · Medical ↳ wound wont heal properly union at fracture site if not reduced properly · Delayed Signs and Symptoms of a Fracture Pain and impaired sensation Decreased Muscle mobility spasm Deformity of the affected Swelling part Loss of function What is crepitus?  Closed Reduction Couin not cut open Manipulation Traction (Pull bone back to og anatomical position) (once bone put back into op this device , makes sure bone doesnt m o re  Open Reduction Copen shin) Internal Fixation External Fixation Trauma to Joints Types of joint injury sprain dislocation subluxation separation Sprain  Sprain Grade I - stretched ligament with minimal swelling and pain. Grade II - partial tear of the ligaments occurs with moderate pain and swelling. Grade III - complete tear of the ligament with instability, frequent and disabling pain and marked edema (swelling) and discoloration.  Dislocation Displacement of bone ends at a joint. Usually the joint capsule and ligaments tear when a joint becomes dislocated, and often the nerves are injured. hip knee Dislocation Fracture-Dislocation  Subluxation (partial dislocation) · PIP subluxation LCL tear, knee subluxation (Jant unstable but relatively normal) in anatomical location  Separation Dislocation at a cartilaginous joint  Tendonitis Inflammation of tendons Can cause permanent damage If overuse continues loss of flexibility due to scarring of the tissue. (Open by Andre Agassi)  Bursitis Inflammation of Bursae ~78 on each side of body Causes: systemic diseases: RA, psoriatic arthritis, gout ankylosing spondylitis chronic friction / trauma crystal deposition / infection  Bursitis / Tendonitis Most common causes: mechanical overload and repetitive micro-trauma Most injuries multifactorial  Diagnosis of Bursitis / Tendonitis  Medical history and physical examination  X-rays to exclude bone abnormalities or conditions like arthritis.  MRI’s and ultrasound to detect tendinitis  Screening tests: CBC, Rheumatoid factor  Prevention of Bursitis / Tendonitis Eliminate provoking factors Proper conditioning Gradual introduction of activity Warm-up and stretching prior to exercise Wearing appropriate shoes for the activity  Treatment Lidocaine or steroid injection can overcome refractory pain Analgesics + exercise: better results than exercise alone Additional pain control: NSAIDs, acupuncture, ultrasound, ice, heat, electrical nerve stimulation PT, OT, relative rest, immobilization