1 / 16

Clinical Quiz

Week 29 MSK. Clinical Quiz . Aetiologies. Trauma Excess force to healthy bone a direct blow, axial loading, angular (bending) forces, torque (twisting stress), or a combination Pathologic M inor trauma to diseased or abnormal bone.

mabyn
Télécharger la présentation

Clinical Quiz

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Week 29 MSK Clinical Quiz

  2. Aetiologies • Trauma • Excess force to healthy bone • a direct blow, axial loading, angular (bending) forces, torque (twisting stress), or a combination • Pathologic • Minor trauma to diseased or abnormal bone. • Due to localized/general lesions, congential, disuse, diseases, etc. • Stress • Repetitive force on normal bone> remodelling/repair

  3. Definitions A : a tearing injury to muscle fibers • Fracture C • Dislocation E • SubluxationB • Strain A • Sprain D • Fracture-subluxation or Fracture-dislocation F B: a partial dislocation of a joint with some degree of contact between articular surfaces of joint C: a disruption of bone tissue D: a tearing injury to one or more ligaments of a joint E: a complete dislocation of a joint where articular surfaces of joint are no longer in contact F: a disruption of joint with fracture of at least one of the bones involved in articulation

  4. Mnemonic: OLD ACID • O: Open vs. closed • L: Location • D: Degree (complete vs. incomplete) • A: Articular extension • C: Comminution / Pattern • I: Intrinsic bone quality • D: Displacement, angulation, rotation

  5. O: Open vs. Closed • Open fracture • AKA: “Compound fracture” • A fracture in which bone penetrates through skin; • Some define this as a fracture with any open wound or soft tissue laceration near the bony fracture • Closed fracture • Fracture with intact overlying skin

  6. L: Location Epiphysis Physis • Which bone? • Thirds (long bones) • Proximal, middle, distal third • Anatomic orientation • E.g. proximal, distal, medial, lateral, anterior, posterior • Anatomic landmarks • E.g. head, neck, body / shaft, base, condyle • Segment (long bones) • Epiphysis, physis, metaphysis, diaphysis Metaphysis Diaphysis (Shaft) Articular surface

  7. D: Degree of Fracture • Complete • Complete cortical circumference involved • Fragments are completely separated • Incomplete • Not fractured all the way through • “Only one cortex” involved • e.g “Greenstick fracture”

  8. A: Articular Extension / Involvement • Intra-articular fractures • “Involves the articular surface” • Dislocation • Loss of joint surface / articular congruity • Fracture-dislocation

  9. C: Comminution / Pattern • Transverse (Simple) • Oblique (Simple) • Spiral (Simple) • Linear / longitudinal • Segmental • Comminuted • Compression / impacted • Distraction / avulsion

  10. I: Intrinsic Bone Quality Osteopenia: ↓density Normal

  11. D: Displacement, Angulation, Rotation - Angulation • Extent to which Fx fragments are not anatomically aligned -In a angularfashion - Rotation • Extent to which Fx fragments are rotated relative to each other - Displacement • Extent to which Fx fragments are not axially aligned • Fragments shifted in various directions relative to each other

  12. Angulation - Valgus - Apex medial - Parallel - No angulation - Varus - Apex lateral

  13. Salter-Harris Fractures

  14. Management • Control pain and swelling • RICE, oral analgesics, removal of jewelery • Withhold oral intake • patient may require surgery • Reduced fracture deformity •  alleviate pain, ↓ pressure on nerves/vasculature, prevent a open fracture • Executed under appropriate sedation • Immobilize limb • Indications for Orthopedic consult: • Compartment syndrome, irreducible dislocation, circulatory compromise, open fractures, surgical intervention.

  15. Complications • Neurological deficit • Traction or pressure on nerves  numbness, parathesisa, muscle wasting, etc. • Vascular injury • Peripheral vessels near joint may be compressed or disrupted  loss of pulses and poor capillary refill • Compartment syndrome • Surgical emergency • Impaired venous flow of extremity  ↑ Pressure of limb • Leading to compromised circulatory, neurologic deficits and muscle necrosis • 5 P’s + S : pain, parathesia, pallor, pulseless, paralysis, swelling

  16. Delayed and Late Complications • Most common: • Malunion: healing with deformity • Nonunion: no healing has occured • Joint stiffness • Traumatic arthritis: joint pain associated with trauma • Avascular necrosis: bone death due to poor blood supply • Pulmonary fat embolus from marrow of large bone (e.g. Femur)  respiratory distress

More Related