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56 Cards in this Set
- Front
- Back
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the shaft of the long bone
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diaphysis
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The end of a long bone; initially separated from the main bone by a layer of cartilage that eventually ossifies so the parts become fused
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epiphysis
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The synovial sheath within which tendons move
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tenosynovium
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the stretching or tearing of ligaments
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sprain
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injury to muscle or tendon
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strain
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great toe
foot knee |
hallux
pes genu |
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pollex
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thumb
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talus (ankle) and pes (foot)
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talipes
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anterior palmar surface of the hand
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volar
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degenerative disease of the spine
inflammation of the spine |
spondylosis
spondylitis |
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dissolution or loosening of the vertebrae
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spondylolysis
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forward displacement of one vertebrae over the one beneath it which may produce pressure on spinal nerves
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spondylolisthesis
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involving the spinal nerves
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radicular
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Injury to a nerve in which there is localized dysfunction of the myelin sheath with transient nerve conduction abnormality
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neuropraxia
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Characterized by an abnormal inward turning of a bone, especially of the hip, knee, or foot
“Bow legged” |
varus
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Characterized by an abnormal outward turning of a bone, especially of the hip, knee, or foot.
“Knock-kneed |
valgus
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recurvatum
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hyperflexion or backward bending
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plantar flexion of the foot
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equinus
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a fracture near a joint that is usually attached to ligament or tendon
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avulsion "chip" fracture
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a fracture involving the jt surface
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intra-articular fracture
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a fracture w/multiple fragments
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comminuted fracture
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multiple fractures within the same bone
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segmental
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A deformity in children caused by the longitudinal compression of the soft bone in either the radius or ulna, or both, and characterized by localized bulging
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torus (buckle) fracture
-treated for shorter duration -may not have to cast -similar to a compressed paper towel roll -area of weakness |
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A fracture that occurs because the bone is weakened by some abnormal condition (often a tumor)
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pathologic fracture
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retropulsion
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burst fracture pushed into spinal canal
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what is considered normal angulation: position of a fracture expressed in degrees
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<10%
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A fracture in which there is poor apposition of the proximal and distal segments
Expressed as a percentage |
displaced
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what bone is particularly susceptible to avascular necrosis
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scaphoid
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what are the 6 main pts to remember in describing a fracture?
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open vs closed
orientation displacement (%) angulation shortening location |
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what is used to classify closed fractures:
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Tscherne classification
grades 0 - 3 Grade 0 Minimal soft tissue injury Indirect injury Grade 1 Injury from within Superficial contusions or abrasions Grade 2 Direct injury More extensive soft tissue injury with muscle contusion, skin abrasions More severe bone injury (usually) high risk for infection Grade 3 Severe injury to soft tisues degloving with destruction of subcutaneous tissue and muscle degloving: disruption of fascial plane Can include a compartment syndrome, vascular injury |
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what is used to decribe open fractures?
tibia is the model |
Gustillo system
types I, II, IIIA, IIIB Emphasis on extent of skin and soft tissue injury Fracture healing, infection and amputation rate correlate with the degree of soft tissue injury Fractures should be classified at the time of initial debridement Evaluate periosteal stripping Type I Inside-out injury Clean wound Minimal soft tissue damage No significant periosteal stripping Type II Moderate soft tissue damage Outside-in mechanism Higher energy injury Some necrotic muscle, some periosteal stripping Type IIIA High energy Outside-in injury Extensive muscle devitalization Bone coverage with existing soft tissue not problematic Type IIIB High energy Outside in injury Extensive muscle devitalization Requires a local flap or free flap for bone coverage and soft tissue closure Periosteal stripping |
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this forms along the periphery of the fracture site (more difficult w/periosteal stripping)
Intramedullary callus forms in the center of the fracture site Chemical and mechanical factors stimulate callus formation and mineralization |
periosteal callus
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Remodeling
Woven bone is gradually converted to lamellar bone Medullary cavity is reconstituted Bone is restructured in response to stress and strain What law descibes remodeling? |
Wolff's Law
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Mechanism of bone healing seen when there is no motion at the fracture site (i.e. rigid internal fixation)
Does not involve formation of fracture callus |
Direct (primary) bone healing
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Mechanism for healing in fractures that are not rigidly fixed.
Bridging periosteal (soft) callus and medullary (hard) callus re-establish structural continuity Callus subsequently undergoes endochondral ossification Process fairly rapid - weeks |
indirect bone healing
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a complication of reduction:
also known as complex regional pain syndrome (CRPS), is a chronic progressive neurological condition that affects skin, muscles, joints, and bones. |
reflex sympathetic dystrophy
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In compartment syndrome:
What is the tissue pressure? How long until irreversible changes to nerve and muscle occur? |
Normal tissue pressure:
0-4 mm Hg 8-10 with exertion Compartment Syndrome: 30 mm Hg - 45 mm Hg Muscle 3-4 hours - reversible changes 6 hours - variable damage 8 hours - irreversible changes **** Nerve 2 hours - looses nerve conduction 4 hours - neuropraxia 8 hours - irreversible changes *** |
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Most sensitive (the 6 P's)
Pain out of proportion Palpably tense compartment Pain with passive stretch Least sensitive May be late signs or not present at all Paresthesia/hypoesthesia Paralysis Pulselessness/pallor |
compartment syndrome
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what are 3 ddx to compartment syndrome?
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arterial occlusion
peripheral nerve injury muscle rupture |
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compartment syndrome
A standard needle will give higher results than a side port (______) or wick catheter. The _______ device is one of the more commonly used portable hand-held devices used for the tissue pressure measurements and since the redesign of the side port needle is very accurate. |
Stryker
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An infectious inflammatory disease of bone that is often of bacterial origin and is marked by local death and separation of tissue.
Pathogenesis: 1)Hematogenous 2)Contiguous focus of infection 3)Direct inoculation |
osteomyelitis
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Must have high index of suspicion
Must obtain diagnosis quickly If appropriate treatment started < 72°: Decrease incidence of chronic ________ Decrease destruction of bone |
osteomyelitis
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Acute
elevated WBC (25% of time) Abnormal differential, Left Shift (65%) Blood Culture 50% positive Chronic Mild anemia, Elevated WESR, C-reactive protein Possible leukocytosis with L shift Blood Culture – usually negative |
osteomyelitis
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Radiography:
Soft Tissue Swelling Obscured soft tissue planes Haziness Osseous Hyperemia, demineralization Lysis (when > 40% resorbed) Periosteal reaction Sclerosis (late) |
osteomyelitis
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in osteomyelitis, how long until x-ray findings appear
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10 - 21 days
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osteomyelitis bone scan is the mainstay but there may be false positive caused by:
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DM foot disorders
Septic arthritis Inflammatory bone disease Adjacent to pressure sores |
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in osteomyelitis
Acute: Good, only 10-15% false negative Chronic: Sinus tract culture: 76% sens, 80% spec 70% with S aureus & _______ 30% _____________ Does not determine correct Abx |
in osteomyelitis:
70% with S aureus and Enterococcus 30% with Pseudomonas |
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X-Ray - Know your views!
Hip (AP pelvis, lateral hip, oblique) Knee (AP, Lat, _______) degenerative changes Ankle/Foot (AP, Lateral, _____ view) Shoulder (AP, Axillary, _____ Y) Elbow/Forearm (AP, Lateral) Wrist/Hand (PA, Lateral, oblique helpful) C/T/L spine (AP, Lateral) (odontoid (dens) view for C1) (flexion and extension views also for C and T) _______ L spine for spondylolisthesis |
knee: sunrise
ankle/foot: mortise shoulder: scapular Y spondylolisthesis: oblique |
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Patient with a radial head fracture may only complain of pain in the _____
A knee or hip fracture may cause _____ pain as chief complaint |
wrist
thigh |
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Helpful to define bony anatomy
Readily available and can make a 3D image through computer imaging Very useful in certain fractures that are otherwise not well visualized: Calcaneous Facial bones/Orbits/Skull High cervical spine (x-rays not very good at C1 or C2) Tibial plateau Also helpful in visualizing bony extension of tumors May identify changes seen in osteomyelitis (but not the best test for osteomyelitis) |
CT scan
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Helpful for evaluation of soft tissues:
Meniscus Ligaments Tendons Intervertebral discs Marrow Extension of a tumor into the marrow cavity Will show periosteal edema associated with stress fractures much earlier than first visual signs of callus formation on an x-ray. Should be used selectively: Confirm an otherwise questionable diagnosis Should not be relied upon as a routine diagnostic tool |
MRI
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a type of radiology study:
The instillation of radiopaque dye followed by plain radiography, CT or MRI Used to outline intra-articular structures Less commonly used now |
arthrography
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A type of radiology study Identifies areas of increased bony production
Technetium TUMORS Labels osteoblastic activity and increased blood flow Helps recognize stress fractures or bony tumors Primary Metastatic Gallium LYMPHOCYTES and INFLAMMATION Labels lymphocytes Helps recognize chronic inflammation or infection Indium INFECTION Labels leukocytes Helps recognize acute infection |
nuclear medicine studies
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a type of radiology study:
Real-time static or dynamic visualization Often used in intraoperative fracture management Evaluation of ligament injuries |
flouroscopy
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a type of radiology study:
May help in the identification of: Cysts (i.e. Baker’s Cyst) Rotator cuff tears Other pathology |
ultrasound
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Electromyography (EMG)
Uses IM needle electrodes to evaluate muscle units Denervation of muscles is demonstrated by Fibrillations Sharp waves Abnormal patterns Nerve Conduction Studies (NCS) Nerve abnormalities suggested by: Latencies of more than ____ milliseconds Conduction velocities of less than 50 meters per second |
3.5
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