Essential-Orthopaedics-by-Maheshwari-7th-Edition-NotesMed

Page 11: Overview of Musculoskeletal Injuries

Topics Covered

• Classification of fractures

• Fractures with eponyms

• Pathological fractures

• Injuries to joints

• Injuries to ligaments

• Injuries to muscles and tendons

Introduction

• Musculoskeletal injuries can affect bones, joints, muscles, and tendons.

• Neurovascular bundles may also suffer damage.

• This section outlines principles for diagnosing and managing these injuries.

Classification of Fractures

• A fracture is defined as a break in the continuity of a bone.

• Fractures can be classified based on several criteria:

  • Aetiology

  • Displacement

  • Pattern

On the Basis of Aetiology

• Traumatic Fracture:

  • Caused by trauma; occurs when excessive force is applied to normal bone.

  • Common incidents include falls, accidents, and fights.

• Pathological Fracture:

  • Occurs in bones weakened by disease.

  • Fracture may happen with little or no force, e.g., fractures due to metastasis.

  • Often leads to non-union as compared to traumatic fractures.

• Stress Fracture:

  • Caused by chronic repetitive injury, presenting primarily as pain; may not be visible on X-rays.

On the Basis of Displacements

• Undisplaced Fracture:

  • No significant displacement noticed.

• Displaced Fracture:

  • Displacement caused by the fracturing force, muscle pull, or gravity.

  • Described in terms of distal fragment displacement concerning the proximal fragment.

  • Types of displacement include shifts, angulations, or rotations.

Page 12: Injury Types and Classifications

Classification of Fractures by Force

• Low-Velocity Injury:

  • Result of mild trauma, often heal predictably.

• High-Velocity Injury:

  • Results from severe trauma (e.g., traffic accidents), often leading to complex fractures that are harder to treat.

On the Basis of Pattern

• Transverse Fracture:

  • Fracture line is perpendicular to the bone's long axis; caused by tapping or bending force.

• Oblique Fracture:

  • Fracture line is angled and caused by a bending force with a component along the long axis.

• Spiral Fracture:

  • Fracture line runs spirally, resulting from twisting forces.

• Comminuted Fracture:

  • Multiple fragments caused by crushing forces.

On the Basis of Relationship With External Environment

• Closed Fracture:

  • Skin over fracture is intact.

• Open Fracture:

  • Skin over fracture is broken, increasing infection risk.

  • Can be internally open (pierced from inside) or externally open (pierced from outside).

On the Basis of Complexity of Treatment

• Simple Fracture:

  • In two pieces, typically easy to treat.

• Complex Fracture:

  • In multiple pieces, more challenging to treat.

On the Basis of Quantum of Force Causing Fracture

• Segmental Fracture:

  • Two fractures in one bone at different levels.

  • Combination of fracture patterns may exist.

Page 13: Fractures with Eponyms

Common Eponymous Fractures

• Jone's Fracture:

  • Avulsion fracture of the base of the 5th metatarsal.

• Rolando Fracture:

  • Base of the first metacarpal fracture.

• Jefferson’s Fracture:

  • Fracture of the first cervical vertebra.

• Whiplash Injury:

  • Cervical spine injury due to flexion and hyperextension.

• Chance Fracture:

  • Horizontal fracture through the vertebra body.

Other Notable Fractures

• March Fracture:

  • Fatigue fracture of the 2nd or 3rd metatarsal.

• Burst Fracture:

  • Comminuted fracture of a vertebral body.

• Mallet Finger:

  • Flexed finger due to extensor tendon rupture.

Page 14: Pathological Fractures and Treatment

Definition and Causes

• Pathological Fracture:

  • Break in a bone weakened by disease, often resulting from trivial trauma.

• Common Causes:

  • Osteoporosis is the leading cause, especially in the elderly.

  • Other causes include osteogenesis imperfecta and bone tumors.

Diagnosis

• Pathological fractures may present with discomfort before the fracture occurs, indicating underlying diseases.

Treatment of Pathological Fractures

• Focus on:

  1. Detecting the underlying cause.

  2. Assessing fracture union based on the condition.

• Treatments may range from non-invasive (for conditions like osteoporosis) to more complex surgical interventions depending on the underlying cause.

Examples of Bone Weakening Disorders

• Localized Diseases:

  • Pyogenic osteomyelitis, benign tumors.

• Generalized Diseases:

  • Osteogenesis imperfecta, osteoporosis, and Paget's disease in older adults.

Age-Related Causes

• Different age groups may present varying causes of fractures from conditions such as osteomyelitis in children to metastatic tumors in seniors.

Page 15: Joint, Ligament, and Muscle Injuries

Joint Injuries

• Joint injuries can be classified as:

  • Subluxation: Partial displacement of articular surfaces.

  • Dislocation: Complete loss of contact between articular surfaces, requiring immediate treatment.

Ligament Injuries

• Injuries to ligaments are categorized as sprains:

  • First-degree Sprain: Minimal swelling, few torn fibers.

  • Second-degree Sprain: Moderate pain and swelling, significant disruption.

  • Third-degree Sprain: Complete tear, identifiable through stress tests.

Treatment Approaches for Sprains

• Initial treatment involves RICE (Rest, Ice, Compression, Elevation).

• Immobility for serious sprains may require a brace or a cast, though early mobilization is encouraged for healing.

Muscle and Tendon Injuries

• Tendon injuries are more common in older adults, often due to underlying degeneration.

• Signs of ligament injuries include localized pain and swelling, with joint instability in severe cases.

Investigation Methods

• Standard X-rays typically display normal findings, but stress X-rays or additional imaging may be utilized to diagnose specific injuries.

Conclusion

• Identifying whether a fracture is traumatic or pathological is essential for treatment.

• Understanding the nature of the fracture and associated soft tissue injuries informs management decisions.