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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.

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Clinical Quiz

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  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

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