Musculoskeletal(potentially not needed?)

What happens to skeletal muscle after an injury?

Regeneration increases in response to the injury.

What determines how well injured muscle returns to function?

The condition and healing of surrounding nerves and blood vessels

Why are nerves important in muscle healing?

Nerves help restore muscle function after injury.

Why are blood vessels important in muscle healing?

Blood vessels supply oxygen and nutrients needed for tissue repair.

Is repaired muscle as strong as uninjured muscle?

No. Repaired muscle is generally weaker.

muscle contusion

A bruise caused by blunt trauma that damages muscle tissue.

soft tissue injury

Damage to tissues surrounding and supporting structures such as muscles.

What are three factors involved in recovery of injured muscle?

Muscle regeneration, nerve healing, and blood vessel healing.

Passive Range of Motion (ROM) assessment

Muscle relaxed while examiner moves the joint

Active Range of Motion (ROM) assessment

Patient uses his or her muscles for movement

Active and Passive ROM comparison

Active and passive ROM should be equal

Crepitus

Clicking of joint

Neurological and Vascular Injury Assesment

Check pulses and sensation distal to injury

Neurological and Vascular Injury Clinical presentation

Pain

weakness

lack of sensation

decreased motor strength

absent or weak pulses

Tendons

Attach muscle to bone

overuse can cause injury

Strain

Overstretch of muscle or tendon

Ligaments

Attach bone to bone

Ligaments components

Capsular

Extracapsular

Capsular

Part of joint capsule

Extracapsular

Provide stability

Joint Rupture

Can rupture

‒ Less stability after injury and healing

Sprain

Overstretch ligament with possible tear

3 grades

Bone fracture types

Traumatic or pathological

Pathological fracture

Weakened bone

Fracture occurs without significant trauma

Fragility fracture

Closed (complete)

A fracture in which bone fragments separate completely

Open (compound)

Fracture of bone that protrudes to the outside of the body

Incomplete

A fracture in which the bone fragments are still partially joined

Compression

A fracture that consists of the crushing of cancellous bone

Transverse

A fracture where parts of the bone are separated but close to each other

Comminuted

A fracture with more than one fracture line and more than two bone fragments, which may be shattered or crushed

Stress fracture

A failure of one cortical surface of the bone, often caused by repetitive activity

Avulsion

Separation of a small fragment of bone at the site of attachment of a ligament or tendon

Greenstick

An incomplete break in the bone with the intact side of the cortex flexed (one side is broken and the other is bent). It is usually seen in children

Impacted

One part of the fracture is compressed into an adjacent part of the fracture

Compartment Syndrome

Pressure builds inside a closed muscle compartment, exceeding blood-flow (perfusion) pressure → ischemia → tissue death → loss of function.

Classic signs of compartment syndrome

Severe pain out of proportion + weak/absent distal pulses.

What is the emergency action for suspected compartment syndrome?

Immediate surgical evaluation.

What can a hip fracture cause in patients with osteoporosis?

Joint instability and inability to bear weight.

What type of hip fracture is most common in patients with osteoporosis?

Femoral neck fracture.

Femoral head fractures are most common in whom?

Younger individuals following high-energy trauma.

Hip Fracture Complications

Death after fall

What is the role of osteoblasts in bone repair?

Build new bone by producing osteoid, which mineralizes to form hard bone.

What is osteoid?

A collagen-rich material produced by osteoblasts that later mineralizes with calcium and phosphate

What is a soft callus?

Temporary tissue that forms around a fracture during early healing.

What is a hard bony callus?

Mineralized bone that bridges the broken ends of a fracture.

What is the role of osteoclasts in bone repair?

Break down damaged and excess bone and reshape the callus.

What happens during bone remodeling?

Osteoclasts remove temporary bone while osteoblasts replace it with stronger, organized lamellar bone.

What is the goal of bone remodeling?

Restore the bone's normal shape, internal structure, and strength.

Stages of bone healing

1-5

Bone healing Stage 1

Fracture and inflammatory phase

Bleeding between edges of fractured bone

Bone healing Stage 2

Granulation tissue formation

Fibroblasts, growth of vascular tissue

Bone healing Stage 3

Callus formation

Bone healing Stage 4

Lamellar bone deposition

Strengthening phase, ossification occurring

Bone healing stage 5

Remodeling

Adequate strength commonly occurs in 3–6 months

Diagnosis of fractures

X-ray

Ultrasound

DEXA (bone mineral density)

CT, MRI, radionuclide bone scan

EMG

Fracture treatment

Most injuries are self-limiting

Increased risk for DVT and PE with orthopedic surgery

RICE therapy

Rest, ice, compression, elevation

Closed reduction treatment

Realign bones, device worn on outside

Open reduction

Surgical insertion of hardware

ORIF

Open reduction and internal fixation

Rhabdomyolysis

Breakdown of skeletal muscle that releases muscle contents into the bloodstream.

What can cause rhabdomyolysis in a fracture patient?

Compartment syndrome with muscle damage

What is myoglobin, and why is it dangerous?

A muscle protein released during breakdown that can damage the kidneys in large amounts.

What major complication can rhabdomyolysis cause?

Acute kidney injury (AKI) due to myoglobin accumulation.

What is the classic triad of rhabdomyolysis?

Myalgia (muscle pain), muscle weakness, and myoglobinuria (myoglobin in urine).

What laboratory finding is elevated in rhabdomyolysis?

Creatine kinase (CK), an enzyme released from damaged muscle.

2 infection types

local or systemic

local

Cellulitis or osteomyelitis

Systemic

Sepsis

Infection Signs and symptoms

• Fever, chills, nausea, vomiting

• Warmth, edema, and erythematous around injury

• Elevated WBC, ESR, and C-RP

Avascular Necrosis Fractures

Femoral head and neck, proximal humerus

Avascular Necrosis Cause

Insufficient blood supply to bone causing bone deterioration

Avascular Necrosis diagnosis

MRI or bone scintigraphy

Avascular Necrosis Treatment

Surgical removal of necrotic bone

Orthopedic surgery consideration

Increased risk DVT and PE

Decreased blood flow and neural function effects

Five Ps

Pain

Pulselessness

Pallor

Paresthesias

Paralysis

Rib and clavicle fractures consideration

Increased risk for pneumothorax