Exam #6 Muskoskeletal & Trauma Unit

What is osteogenesis imperfecta and it’s key features?

genetic in origin 

• Key Features: Brittle bones, due to not enough collagen or abnormal collagen

  • Marked scoliosis of the spine 

What resembles a cage?

external fixator

The difference between an advancement flap and free graft is:

Advancement flap is still attached and free graft is harvested

What is Duchenne Muscular Dystrophy?

• congenital muscle disorder

• It’s a delayed motor development and muscle weakness

  • Deficiency of a muscle protein called dystrophin

  • Present in both skeletal & cardiac muscles

What is Paget’s disease and it’s key features?

osteitis deformans

• acquired bone disorder

  • Rapid regeneration of bone in which the bone remains immature while entering the normal degeneration process 

  • Immature bone is crudely structured and weak 

    • Osteoarthritis (OA), heart problems, bone cancer 

  • Treatment: Bisphosphonates

What is osteoporosis?

• “lacy bones”; genetic 

• Progressive loss of bone mass 

• The greatest impact is on the spine 

  • No cure; focuses on prevention

    • X-Ray, bone density scans (low dose), hips/spine

Osteoporosis causing reduced spinal bone density can result in

• a compression fracture

• a loss of height

• a stooped posture

What is the treatment for osteoporosis?

Oral drugs to increase bone density to slow bone loss (bisphosphonates)

• Fosamax

• Boniva

• Prolia

What is gout?

Acute inflammation of joints caused by kidney dysfunction or too much uric acid is produced by the body 

• Hot, red, and tender 

• Affects the big toe, can also affect ankles, wrist & hands 

  • Diagnosis: blood for increased uric acid and creatinine 

What’s the medication to treat gout?

allopurinol; change of diet from the eating of meats, fructose, beer, etc

What could be some dietary reasons someone get’s gout?

too much red meat, fructose, and beer

what is rhabdomyolysis?

(rhabdo) - acute muscle damage (can be life-threatening) 

A release of protein byproduct of muscle damage is called

myoglobin

What are the causes and symptoms of rhabdomyolysis?

Causes

• High-intensity exercise and trauma

• Medications and illegal drugs/alcohol

• Snakebites 

• Dehydration

Symptoms 

• Muscle weakness and soreness 

• Dark red urine 

• Nausea & vomiting 

How is rhabdomyolysis diagnosed & treated?

• Diagnosed 

  • Lab test (urine) for myoglobin 

  • Lab test (blood) for creatinine 

    • Can look like coco-Cola 

• Treatment 

  • IV fluid resuscitation 

  • Dialysis 

What can rhabdomyolysis result in?

acute renal failure, possibly leading to death 

What is osteomyelitis?

• Infection in the bone that travels through the bloodstream or spreads from nearby tissue

  • It can also begin in the bone itself if an injury exposes the bone to germs

What is osteomyelitis associated with?

• Diabetes mellitus (DM)

• Surgical infection

• Fistula (postoperative)

What is the post-operative complication that could be described as an abnormal connection between 2 body parts?

fistula

Why might a burn victim suffer form hypothermia?

skin is no longer able to hold in heat or fluid which can cause evaporation

What’s the surgical treatment for osteomyelitis?

• Antibiotics (IV and oral) 

• Surgical debridement to clear necrotic tissue down to the viable bone

  • Use of rongeur and a curette

A large amount of hemorrhaging could be expected during what?

• Joint replacements or amputations

• Open heart surgery

• thyroid procedures

What is osteoarthritis and it’s causes?

• degenerative condition of the joint from wear & tear 

• Cartilage between the joints breaks down causing loss of lubrication and rubbing of bones together

  • Causes 

    • Weight gain 

    • Injury 

    • Genetics 

    • Not “cracking” or “popping” joints

A hematoma or seroma of an operative site wound

evacuation & drainage

What are some symptomatic treatments for osteoarthritis?

• Weight loss/exercise

• Oral medications

  • NSAIDS

  • Opioid pain meds: Vicodin

• Steroid injections into the joint

• Physical Therapy

What material is used in a hip prosthesis?

• Polyethylene (plastic polymer)

• Ceramics

• Metals

What are neurostimulator devices?

failed back surgery syndrome 

• directs mild electrical impulses with pain messages to the brain

  • Spinal array and generator device  

cervical nerve compression

• More common in herniation and spondylosis

• C4-C5 (shoulder and neck pain; loss of mobility, hurts bending head forward or to side)

• C5-C6 (bicep, wrist, and thumb weakness and tingling)

• C6-C7 (triceps, forearm, and fingers weakness and tingling)

• C7-T1 (hand grip weakness, little finger tingling)

A collection fluid other than blood or pus in a wound

seroma

A collection of blood and clot in a wound

hematoma

The primary concern with a blow out fracture of the orbital floor

herniation of the eyeball or other tissues

thoracic nerve compression

• Upper back pain, abdominal pain, chest pain, lower body dysfunction

• Can affect your breathing

• Common in scoliosis and kyphosis

lumbar nerve compression

• sciatica/foot drop

• L1-L2 (most often anterior thigh and increase cases of cauda equina)

• L2-L3 (pain in the anterior thigh)

• L3-L4 (posterior thigh pain, lack of patellar reflex)

• L4-L5 (sciatica; numbess on top of foot drop

• L5-S1 (inability to stand on toes; ankle can’t support weight)

What are some chiropractic treatments to treat spinal disorders?

• Adjustments

• Decompression

• Heat therapy

• Exercises

laminectomy

• Creates space by removing the lamina or back part of the vertebra

• Spinal decompression surgery, usually for stenosis and spondylosis

diskectomy

• Removes a portion of a herniated disk material which is pressuring the nerve root

spinal fusion

• Fusing vertebral levels, so they form one bone

• Loss of flexibility of the spine

Interbody cages, pedicle screws, and plating systems are instruments that can be used for this procedure

spinal fusion

open (compound)

a fracture when the bone protrudes from the skin (penetration or laceration)

closed (simple)

the bone is broken; the skin is intact

transverse

a fracture straight across the bone shaft

oblique

a fracture at an angle to the bone shaft

spiral

a fracture that twists around the bone shaft

displaced

a fracture when the bone is out of alignment

comminuted

a fracture when the bone is broken into 3 or more parts

greenstick

an incomplete fracture in which the bone is bent and only the outer curve of the bend is broken

compression

a fracture in which the bone is crushed or collapses into small pieces

intra-articular

a fracture that crosses a joint surface

A nasal fracture is accompanied by:

• a deviated septum

• nasal airway obstruction

  • Open or closed reduction/repositioning

closed reduction

Reposition & manipulate the bone to put it in a cast or splint

Kirschner/K-wire is used for:

flexibility for holding broken bones in place

ORIF (Open Reduction Internal Fixation)

treatment for fractures

• A doctor creates an incision to gain access to the fracture site, to reposition the bone

• Applying hardware to secure the bone

  • Such as: Rods, plates, screws, nails

What is blunt force trauma and it’s treatment?

• The force of impact containing damage where the hemorrhage damages critical organs, determining mortality

• Treatment: symptomatic or surgical, blood transfusions

How is blunt force trauma diagnosed?

x-ray, ultrasound, CT scan, CBC, examining body fluids for blood

• Blood loss and organ dysfunction may be immediate or delayed

• Signs may be not visible

Morality due to penetrating injuries is determined by:

blood loss and vital organ damage

laparotomy

surgical treatment for internal injuries

• surgically opening the abdomen 

thoracotomy

surgical treatment opening the chest cavity for internal injuries

craniotomy 

surgically opening the skull for internal injury treatment

amputation

• Partial or complete separation of a limb

• Damage to the bone, nerves, blood vessels, tissue, and skin of the stump

• Reattachment (replantation) viability depends on time and the extent of damage

avulsion 

a forcible separation or detachment, such as a tearing away of a body part

What are the treatments of amputations?

Treatment

• Freshening of the amputation stump

• Sealing off blood vessels and preparing the stump for grafting

What are the complications of amputation?

• Infections of the amputation stump

• Non-healing graft due to comorbid conditions

• Phantom limb syndrome

When an amputee feels like a limb is still attached

phantom limb syndrome

What is the cause of post-laminectomy syndrome?

scar tissue

The main concerns after an amputation due to an animal bite

blood loss and infection

What happens to tissues to cause compartment syndrome?

• pressure & swelling damage tissues

• Fascia does NOT allow for tissues to expand

• may be a result of trauma, especially in crush injuries or higher energy BFT (blunt force trauma)

What are lacerations?

• Open wounds

  • Full thickness disruption through the skin & deeper tissues underneath 

    • Evidence of nerve and tendon damage

    • Mortality depends on degree of blood loss from lacerated blood vessels

• Risk of infection and development of cellulitis and gangrene

What is degrees of burns?

classified by the extent and severity of damage caused of the layers of skin affected

1st degree (superficial) burns 

Affects only the outer layer of skin - epidermis.

• The burn site is red, painful, dry, and with no blisters.

  • Mild sunburn is an example.

Second-degree (partial thickness) burns

• Involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful

third-degree (full thickness) burns 

Full thickness - destroys the epidermis and dermis.

• They may go into the innermost layer of skin, the subcutaneous tissue.

• The burn site may look white or blackened and charred

fourth-degree (underlying tissue) burns 

Go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle, tendons, ligaments, and bone.

• There is no feeling in the area since the nerve endings are destroyed

What are the body parts for rule of 9’s?

EMTs use this method of quickly estimate the body surface area of a burn

• Head and Neck:

• Upper Extremities: arm, forearm, hand

• Torso: anterior and posterior

• Lower Extremities: leg, thigh, lower leg, foot

• Genital or Perineal Region: private areas

The complications and treatments for a 3^rd degree burn?

Treatment

• Surgical debridement of necrotic tissue down to granulation tissue

• Pealing or sloughing at a burn center 

• Skin grafting 

  • Xenografts - fish skin 

Complications 

• Dehydration

• Hypothermia 

• Thrombosis

contusions 

• Bruising caused by broken capillaries

• Blood may gravitate to other areas, turn purple and yellow as blood is absorbed

  • Treatment: Tylenol, nothing with bleeding properties, rest, ice, compression, and elevation (RICE)

  • “I’ve fallen and I can’t get up”

Cause of friction burns/abrasions include:

• Rubs off the skin due to direct contact with rough surface

  • Skinned knee (“raspberries”)

  • Grazing an object

  • Continued rubbing or scratching

  • Friction burns

    • Floor/rug/carpet burn

    • Rope burn

    • Road rash

    • Treadmills

• Minimal bleeding, but area scabs over and may form a scar

• Treatment is topical

  • Covered with breathable gauze or non-stick bandage

  • Ointments to minimize risk of infection

major sprain & its complications

• acute inflammatory response, swelling pain

• Rest, Ice, compression, elevation (RICE), and immobility/NSAIDS

• Complications

  • Tearing, permanent weakening, arthritis

  • May require surgical intervention later

deep scar 

scar formation 

• fibrotic area under the skin (bumpy) or depressed area

  • massage area to break up fibrotic tissue, so it can be absorbed

  • Can take months

  • May need dermatologist intervention

superficial

scar formation

• keep soft with creams 

• massage area to prevent scar contracture 

• can take months to go away or may leave a permanent scar due to the destruction of pigment producing cells 

• dermatologist intervention 

  • chemical peel 

  • radiofrequency and ultrasonic directed therapies 

A closed wound that comes apart

dehiscence

• separation of wound edges (internal or external)

Resection (removal of whole) and excision (removal of part) end in this suffix

ectomy

What practice is an operating room can help prevent a retained foreign body?

pre and post count

Mechanical complications that could occur due to an implanted device in the body

• Displacement and obstruction

• Erosion and leakage

• Breakage and protrusion

What are two anatomical components of a prosthesis in a total hip arthroplasty?

acetabulum and femoral head

Long periods of immobility, especially for the elderly, could lead to:

deconditioning

Bone harvested (grafting) in an autograft for spinal fusion is likely to come from these places

iliac crest & vertebra