Hehi 2 Final Exam - Acute Musculoskeletal Conditions

Front 1

Osteoblasts

Back 1

Building up bone tissue in a process called deposition

Secrete collagen that forms the matrix of bone which then calcifies

Front 2

Osteoclasts

Back 2

Breakdown bone, through process called bone reabsoption

Front 3

Epidemiology of MS trauma

Back 3

1. An average of 1 in 10 people experience musculoskeletal trauma annually
2.Most common among males 15-24 years of age and in elderly
3. Women above the age of 65 are particularly vulnerable

Front 4

History and Assessment

Back 4

1. Factors promulgating fractures
2. Factures in GENERAL, not just the result of trauma

Front 5

Risks for Fracture

Back 5

1. Genetics - Caucasians & Asians, small frame, female, family history; predisposed to low bone mass
2. Age - Post-menopausal, advanced age, low testosterone in men, decreased calcitonin; Hormones that inhibit bone loss
3.Nutrition - Low calcium intake, low vitamin D, High phosphorus, inadequate calories; Reduces nutrients needed for bone modeling

Front 6

More Risk factors for fractures

Back 6

1. Physical exercise - sedentary, lack of weight bearing, low weight and body mass; bones need stress for bone maintenance
2. Lifestyle Choices - caffeine, alcohol,smoking, lack of exposure to sunlight; reduces osteofenesis and remodeling
3. Medications - corticosteroids, anti-seizure meds, heparin, thyroid hormone, (comobidities- anorexia nervosa, hyperthyroidism, and renal failure)

Front 7

Hormones that increase bone resorption

Back 7

1.Parathyroid hormone
2. Glucocorticoids
3. Thyroid Hormones
4. Vitamin D Metabolites in high doses

Front 8

Hormones that increase bone formation

Back 8

1. Growth hormone
2. Vitamin D metabolites
3. Gonadal steroids (testosterone and estrogen)

Front 9

Hormones that decrese bone resorption

Back 9

1. Calcitonin
2. Gonadal hormones

Front 10

Hormones that decrease bone formation

Back 10

1. Glucocorticoids

Front 11

Effects of estrogen on bone modeling

Back 11

deficiency result in an increase in osteoclastic bone reabsorption and osteoporosis

Front 12

Effects of testosterone on bone modeling

Back 12

Deficiency results in low bone mass

Front 13

Effects of glucocorticoids on bone modeling

Back 13

1. decreased calcium from intestin
2. Increase renal calcium excretion
3. Increased osteoclastic bone resorption and decreased bone formation
4. Increased parathyroid hormone and decreased gonadal steroids

Front 14

Effects of Vitamin D on bone modeling

Back 14

Promotes absorption of calcium and phosphorus - necessary for bone mineralization

Stimulates bone reabsoption when given in high doses

Front 15

Assessment

Back 15

1. Observation - 24 hour diet recall
2. Labs - Ca and Phosphorus
3. Radiographic and Imaging studies - bone scan, scintillation, CT, DXA (dual energy x-ray absorptiometry), MRI

Front 16

Fracture

Back 16

a break or a disruption in the continuity of a bone.

Front 17

Subluxation

Back 17

partial dislocation of a joint; a sprain

Front 18

Dislocation

Back 18

temporary displacement of a bone fro its normal position

Front 19

Sprain

Back 19

A stretch and/or tear of a ligament (band of fibrous tissue that connects two or more bones at a joint)

Front 20

Strain

Back 20

An injury to either a muscle or tendon (fibrous cords of tissue that connect muscle to bone)

Front 21

Complete Fracture

Back 21

Fracture involving the entire width of the bone

Front 22

Incomplete Fracture

Back 22

A fracture that does not extend through the full transverse of a bone

Front 23

Simple Fracture (closed)

Back 23

An uncomplicated fracture in which the broken bones do not pierce the skin

Front 24

Compound Fracture (open)

Back 24

A fracture in which the bone is sticking through the skin.

Front 25

Pathological Fracture

Back 25

A fracture occurring in a bone weakened by a pathological lesion following a trivial injury

Front 26

Pathological Fracture Etiologies - Children

Back 26

1.Osteogenesis Imperfecta
2.Rickets

Front 27

Pathological Fracture Etiologies - Adults

Back 27

1. Osteomalacia - Adult rickets
2. Osteosclerosis - No flexibility
3. Hyperparathyroidism

Front 28

Pathological Fracture Etiologies - Older Adults

Back 28

1. Generalized Osteoporosis
2. Paget's disease of bone
3. Carcinomatosis
4. Multiple myelomatosis

Front 29

Benign Local Lesions of the bone

Back 29

1. solid bone cyst
2. parathyroid lesion
3. fibrous dysplasia
4. Osteomyelitis

Front 30

Ewing's Sarcoma

Back 30

Esing's tumor is a primitive small blue cell tumor that most commonly affects young patients

Front 31

Fatigue or Stress Fracture

Back 31

Fractures that usually occur in weight bearing bones, caused by repeated minimal stressors. It is seen following unaccustomed strenuous exercise in military recruits under training (march fracture) upper tibia and fibula and neck of femur

Front 32

Avulsion

Back 32

A fracture occuring when a ligament or tendon attached to a bone pulls away part of the bone

Front 33

Greenstick Fracture

Back 33

An incomplete and the break occurs on the convex surface of the bend in the bond

Front 34

Transverse Fracture

Back 34

fracture line is perpendicular to the long axis of the bone

Front 35

Comminuted (shattered)

Back 35

there are at least three fragments and the fracture lines interconnect. Generally are result of high energy trauma. The degree of comminution is usually indicated

Front 36

Spiral Fracture

Back 36

Result of twisting motion of the bone

Front 37

Oblique Fracture

Back 37

The fracture line runs oblique to the long axis of the bone

Front 38

Colle's Fracture

Back 38

Fracture of the distal radius, often happens as a result of a person trying to catch themself when they fall

Front 39

Clinical Manifestations of fractures

Back 39

1. Pain
2. Loss of function
3. Potential deformity
4. Crepitus - rice crispies
5. Edema
6. Erythema and Eccymosis
7.Sensory
8. Potential shock symptoms
0. Potential growth impairment

Front 40

Clinical Management

Back 40

1. X-ray confirmation - or MRI
2. Medicate for pain and potential for infection (tetanus toxoid if open)
3. Stabilization
4. Reduce - allign the bones; can be surgical (open reduction) or just reset (closed reduction)
5. Serial assessments to detect changes in patient status

Front 41

Stabilization and reduction of fractures

Back 41

1. Cast or splint
2. Traction
3. Internal fixation
4. External fixation
5. Combination of the above

Front 42

Healing process of a fracture

Back 42

1. Hematoma formation - blood vessels o bone and periosteum disrupted;bleeding; clot formation
2. Franulation tissue formation - soft firbrous tissue - fibroblasts first repair cells to arrive in area; local osteogenic cells start dividing; osteoclasts, osteoblasts invade from periosteum and endosteum
3. Soft, callus formation - fibroblasts deposit collagenl osteogenic cells differentiate into chondroblasts - produce fibrocartilage
4. Hard callus formation - other osteogenic cells, differentiate into osteoblasts - form boney collar
5. Remodeling - over about 3-4 mos.

Front 43

Where do you immobilize a fractured bone?

Back 43

You must immobilize the joints above and below the fracture

Front 44

Cast Care

Back 44

1. Plaster, fiberglass, or plastic
2. Thorough baseline exam
3. Neurovascular checks q1-2h after application for 48 hours, then q8h
4. Observe for skin irritation around fingers
5. Evidence of infection
6. Edema
7. Pain
8. Patient/ Family education

Front 45

Functions of Traction

Back 45

1. Reduction or immobilization of fracture
2. Decreases muscle spasms
3. Stretches adhesions
4. Prevents deformity

Front 46

Traction Care

Back 46

1. Vigilant neurovascular assessment
2. Skin assessment (including pin care)
3. Traction system integrity (includes patient): alignment, weight, attachement
4. Psychosocial concerns
5. Pain management
6. Nutritional concerns
7. Patient Safety

Front 47

Complications of Traction

Back 47

1. Thromboembolism (blood or lipid)
2. Compartment syndrome
3. Loss of skin integrity
4. Contractures - shortening or contracting of muscle or other connective tissues due to muscle spasms, scar, or paralysis of the antagonist of the spasm
5. Delayed healing or non-union

Front 48

Fat Embolism Syndrome

Back 48

Rare but potentially fatal complication of long bone or pelvic fracture. The classic syndrome involves pulmonary, cerebral, and cutaneous manifestations, and presents within 72 hours post-injury

Front 49

S/S of FES

Back 49

1. Petechiae
2. Chest x-ray changes
3. hypoxemia
4. Fever
5. Tachycardia (>120 bpm)
6. Tachypnea (>30 bpm)
7. Confusion

Front 50

Management of FES - Non-Pharm,

Back 50

1. High flow oxygen
2. Fluid restriction (decrease edema)
3. Albumin (increase choloids)
4. Ventilator (PEEP - positive end expiratory pressure)

Front 51

Management of FES - Pharmacological

Back 51

1. Corticosteroids
2. Diuretics

Surgical - prompt surgical stabilization of long bones prevents onset

Front 52

Compartment Syndrome

Back 52

Occurs when pressure within soft tissues in a fixed body compartment increases to level that exceeds venous pressure, compromiseing venous blood flow, and limiting capillary perfusion

Leads to muscle ischemia and necrosis
TRUE ORTHOPEDIC EMERGENCY

Front 53

Factors that contribute to compartment syndrome

Back 53

External - conditions that reduce size of muscle compartment (casts/splints); occlusive dressing; eschar of burns

Internal - conditions that increase compartment volume: bleeding, swelling, cluid extravasation into tissue

Front 54

Recognizing Compartment Syndrome

Back 54

Suspect with long bone fixation, crush injuries

Presents as pain out of proportion ot physical findings.+/- hypoesthesia, pulselessness (late)

Front 55

Hip Fractures

Back 55

1. Affects primarily elderly and chronically ill
2. Frequency high in females, but incidence increses for both genders with age
3. Accounts for 7 billion dollars in U.S. health care expenses annually
4. A leading cause of mortality in the elderly

Front 56

Intracapsular Hip Fracture

Back 56

Femoral neck fracture occurs just below the ball of the ball-and-socket hip joint; this regionis called the femoral neck. when a femoral neck fracture occurs the ball is disconnected from the rest of the thigh bone (the femur)

Healing is a big issue because of the lack of sufficient blood supply intracapsular to provide the nutrients that are needed to heal - if it won't heal intracapsular hip fractures are often treated with partial hip replacement surgery

Front 57

Extracapsular hip Fracture

Back 57

An intertrochanteric hip fracture occurs lower than a femoral neck fracture

More prone to hypovolemic shock due to the incresed blood flow and the damage that the broken bone can cause on the surrounding tissues

Front 58

Clinical Manifestations of hip fracture

Back 58

1. limb shortening
2. pain that radiates
3. external rotation
4. potential shock symptoms