CM2 1 MSK basics

joint

point of artiuclation of two or more bones

bursa

small fluid-filled sac lined with synovial membrane, secretes viscous fluid → reduce friction and allow free movement

contusion

crushing injury of deep tissues → bruise (eccymosis)

tendon

connects muscle to bone

sTrained

ligament

connects bone to bone

gets sPrained

Enthesis

point where tendon/ligament/muscle inserts into bone, where collagen fibers become mineralized and integrated into periosteum of bone tissue

Periosteum

dense fibrous membrane covering surface of bone

outer layer of periosteum

collagen, has sensory nerve fibers, and blood vessels to osteocytes

Apophysis (process, tubercle, tuberosity)

bony process caused by secondary center of ossification -> fuses with nearby bone

Valgus

away from midine

Varus

toward midline

Cephalad

toward head

Caudad

toward feet

Ventral = ?

volar

sagittal plane

sections from side to side

coronal plane

sections from front to back

transverse plane

sections from top to bottom (ie cross sections)

Strain

tearing injury to muscle fibers or tendons -> excessive tension or overuse

Sprain

tearing injury to one or more ligaments of joint

occurrence of sprain

joint is forced beyond limits of its normal range of motion

mild sprain/strain

mild stretching/microscopic tears to ligament/tendon, NO joint instability, mild swelling and pain

moderate sprain/strain

incomplete tear to ligament/tendon, mild-mod joint instability, LROM, mild-mod pain and swelling

severe sprain/strain

complete ligament/tendon tear, significant joint instability, severe LROM, severe pain/swelling/tenderness/ecchymosis

management of sprain/strains

• Limit inflammation and swelling, maintain ROM

• Early tx = RICE (rest, ice, compression, elevation) for 2-3 days

• NSAIDS/acetaminophen

fractures

Cortical disruption (“breaking”) of bone d/t excessive force

Disease OF bone

primarily bone disease (started in bone, stayed)

Disease IN bone

started OUTSIDE the bone

stress fracture cause

inability of normal bone to withstand repeated forces, cumulative problem

Normal but excessively frequent force applied to normal bone

stress fracture

fatigue fracture (traumatic fracture) cause

overwhelming force breaks healthy bone

Abnormal force applied to normal bone

Fatigue fracture (Traumatic fracture)

Pathologic Fracture cause

normal force/relatively minor trauma to focally/LOCAL disease bone

Pathologic Fracture cause examples

Tumors in or of bone, bone cysts, osteomyelitis

Normal, frequent, or modestly excessive force applied to abnormal FOCUS of bone

Pathologic Fracture

Insufficiency Fracture cause

bone strength reduced so ordinary stress fractures it d/t generalized disease state

Insufficiency Fracture cause examples

Osteoporosis, osteomalacia, RA, paget’s disease, DM

Normal force applied to GENERALLY abnormal bone

Insufficiency Fracture

DM classically causes

calcaneal insufficiency avulsion

#1 common fracture site

vertebral (crush or wedge)

common fracture sites (other than vertebral)

Sacrum

neck of femur

proximal third of femur

pubic rami

sternum

specific sx of fracture

• Deformity

• Bone protruding from skin

• Joint locked in position

• Grating (crepitus)

Diaphysis

long straight portion of femur

metaphysis

widening of the diaphysis

epiphysis

very end of the bone

physis

growth plate (epiphyseal plate)

where bone grows from

open fracture (compound)

skin over/near fracture is lacerated or abraded by injury (susceptible to infection)

bayonetted

fracture where distal fragment longitudinally overlaps the proximal fragment

displaced

fracture where fragments are not in usual alignment

distracted

fracture where distal fragment is separated from proximal fragment by a gap

angulated

fracture where fragments are misaligned

transverse

fracture perpendicular to shaft of bone (complete)

comminuted

fracture where there is more than 2 fracture fragments

oblique

angulated fracture line

segmental

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

spiral

multiplanar and complex fracture line (all the way around)

intra-articular

fracture line crosses articular cartilage and enters the joint

torus

incomplete buckle fracture of one cortex (does NOT go all the way around)

children

greenstick

incomplete fracture with angulated deformity

children

impaction

fracture occurring when one bone hits/impacts adjacent bone

compression

type of impaction fracture occurring in vertebrae

→ depression of end plates

buckle

fracture where bony cortex compressed and bulges without the fracture going all the way to cortex

when describing fractures, think about

1. name of injured bone

2. location on bone (dorsal or volar, metaphysis, etc)

3. direction (transverse, oblique, spiral)

4. condition of overlying tissues (open/closed)

5. shape (angulation - valgus, varus, dorsal, volar)

6. pieces of bone

7. position of broken ends with respect to each other (displacement)

fracture vertebral description

“There is a” (fragmentation) (orientation) “fracture of the” (side) “of the” (location) “of the” (name of bone)

The fracture shows (XX%) displacement

Fragments are (relative orientation)

Fragmentation

simple, comminuted, segmental, intra-articular

Orientation

transverse, oblique, spiral

Side

medial, lateral, palmar, dorsal

Location

epiphysis, diaphysis, metaphysis, proximal, middle, distal, radial, ulnar

Relative orientation

bayoneted, distracted, impacted, angulated (with X degrees)

inflammatory phase of fracture healing

microvessels at fracture site are damaged -> fracture hematoma and inflammatory

reparative phase of fracture healing

collagen, cartilage and bone start to form callus to stabilize

remodeling phase of fracture healing

excess callus is restored and new bone is put in place

knowing if MVA belted vs nonbelted is important b/c?

suspect sternal, head, or other injuries

referred pain

Hip <-> hip <-> ankle

distracting injury

pain from that injury masks other injuries

PE inspection

gross deformity = fracture

swelling

complete loss of range of motion increases suspicion of?

fracture

what should you document before doing any manipulation?

neurovascular assessment

important things to think about when eval pt

• associated head, neck injury

• LOC

benefits of splinting

1. reduces pain

2. reduces damage to soft tissue

3. reduce chance of → open fracture

4. easier to transport patient

rules when splinting

• elbow: immobilized from distal wrist to humeral neck

• ankle splint: beneath metatarsal head to upper calf

• midshaft fracture: include joint above and joint below fracture

sugar tong prevents

motion at wrist and elbow (pronation and supination)

short arm gutter

metacarpal or 4/5th proximal phalanx fractures

long arm gutter is for

fractured elbow

shoulder immobilization is good for

clavicle fracture

ac separation

shoulder dislocation

humeral neck fracture

thumb spica is good for

scaphoid fracture

thumb metacarpal/proximal thumb phalanx fracture

knee immobilizer is good for

patellar fracture

knee dislocation

tibial plateau fracture

knee ligament injury

why follow up within 7 days if pt on knee immobilizer?

prevent stiffness of joint

posterior ankle cast is good for

ankle dislocation

fracture dislocation

widened medial mortise

risk with posterior ankle cast

foot drop

why do you get foot drop from long usage of posterior ankle cash?

palsy secondary to pressure on common peroneal nerve

ankle stirrup is good for

simple ankle sprains

stable lateral malleolus fracture

Compartment Syndrome

Tissue pressure within closed muscle compartment exceeds perfusion pressure -> muscle and nerve ischemia

Compartment Syndrome occurrence

subsequent to traumatic event (most common: fracture/crush injury) or rhabdo

place in hand that gets injured that has highest risk of injury

no mans land (mid palm)

dislocation

Articular surfaces completely out of contact

Subluxation

Articular surfaces partially out of contact

ortho: urgent consults (not emergency)

1. irreducible dislocation

2. circulatory compromise

3. open fractures

osteomyelitis

infection of bone

what should you watch out for in open fracture?

tetanus

open fracture tx

Abx (all types)

tdap