MSK fx, sprains, strains

green stick fx

green stick fx

incomplete fx with angular deformity

mostly seen in children

transverse fx

fx that is perpendicular to the shaft of the bone

comminuted fx

fx in which there are more than 2 fx fragments

compression fx

type of impaction fx that occurs in the vertebrae

results in depression of end plates

pathologic fx

fx through bone weakened by tumor, metabolic bone disease, or osteoporosis

intra-articular fx

fx line crosses the articular cartilage and enters the joint

segmental fx

type of comminuted fx in which a completely separate segment of bone is bordered by fx lines

avulsion fx

fx in which bone fragment is pulled away from its main body by tendon or ligament that is attached to it

oblique fx

angulated fx line

spiral fx

multiplanor and complex fx line

stress (fatigue) fx

fx in normal bone that has been subjected to repeated or cyclical loads that in and of themselves are not sufficient to cause a fx

stress (insufficiency) fx

fx in weakened bone that has been subjected to a load insufficient to fx normal bones

nondisplaced fx

fx in which fragments are in anatomic alignment

displaced fx

fx in which fragments are no longer in their usual alignments

angulated fx

fx in which fragments are malaligned

distracted fx

fx in which distal fragment is separated from the prox fragment by a gap

bayonetted fx

fx in which distal fragment longitudinally overlap the prox fragment

sprain etiology

injury to ligament (fibrous tissue connecting 2 bones providing joint stability)

ex. foot, ankle, knee, elbow, wrist, fingers

strain etiology

trauma to muscle or musculotendinous unit

eccentric contractions at musculotendinous junction of muscles with a lot of fast-twitch fibers spanning 2 joints

ex. gastrocnemius, hamstring, quadriceps

sprain mechanism

stretching ligaments beyond normal limits

usually result of traumatic event

strain mechanism

common in sports that requiring running, jumping, or kicking

aging = dec collagen elasticity = muscle-tendon unit susceptible for injury

sprain and strain s/s

popping, snapping, or tearing sensation followed by pain, swelling, stiffness, and difficulty bearing weight

bleeding and ecchymosis 24-48 hours after injury

strain s/s

immediate pain following traumatic injury and delays functional return for several days

sprain s/s

delayed onset of muscle soreness occurring several hours after vigorous exercise and improves with sx care in several days

sprain exam

examine for joint stability

may require specific clinical maneuvers to determine instability

strain exam

gently attempt to stretch injured muscle while palpating for defect

palpate to distinguish between partial and complete rupture

complete rupture = inability to actively contract muscle to move a joint

limited function due to pain

classification of sprains

based on deg of injury to ligament and fibers

grade I-III

grade I sprain

partial tear but no instability or opening of joint on stress maneuvers

tx = sx tx only

grade II sprain

partial tear with some laxity indicated by partial opening of joint on stress maneuver

tx = protected motion of injured part; full healing expected

grade III sprain

complete tear with laxity of joint on stress maneuver

tx = protected motion or possibly repair

Ottawa ankle rules - ankle sprain

pain at medial malleolus or along distal 6cm of posterior/medial tibia

pain at lateral malleolus or along distal 6cm of posterior fibula

inability to bear weight immediately for 4 consecutive steps

Ottawa ankle rules - foot sprain

pain in midfoot at base of 5th metatarsal

pain in midfoot at navicular bone

inability to bear weight immediately for 4 consecutive steps

sprain and strain diagnostic imaging

x-ray and MRI

classification of strain

based on amount of musculotendinous fibers torn

grade I-IV

grade I strain

tear of a few fibers (<10%) with fascia intact

grade II strain

tear of moderate amount of muscle fibers (10-50%) with fascia intact

grade III strain

tear of most or all muscle fibers (50-100%) with fascia intact

grade IV strain

tear of all muscle fibers (100%) and disrupted fascia

rupture

adverse outcomes of strains and sprains

joint instability

accelerated degenerative changes in involved joint

muscle atrophy, weakness, loss of ROM, and disability

complex regional pain syndrome (CRPS)

compartment syndrome

myositis ossificans - ossification in muscle

referral criteria of sprains and strains

referral to sports med ortho surgeon for further eval of grade IV strains, grade III sprains, or severe grade II sprains or strains

chronic joint laxity may need surgical repair

referral to pain specialist if sx disportionate to injury —> can be at risk for CRPS