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hester-kennedy
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• SPRAINS
• Occurs due to microfailure of collagen fibers secondary to stress exceeding their physiologic capacity
• SEVERITY OF LIGAMENT INJURY
• FIRST-degree sprain: Minimal pain , no detectable joint instabiliy
• Treat symptomatically and return to full activity within a few days
• Second –degree sprain :severe pain, minimal joint instability ,partial ligament rupture, 50% decrease in ligament strength and stiffness.
• Third-degree sprain
• Severe pain during course of injury
• Joint completely unstable
• Ligament can’t support any load
• Treatment :surgery
• Open fractures• Fracture communicate with the
external environment due to a breach of the soft tissue
• True orthopedic emergency• Prognosis dependent on extent
of soft tissue injury and by type /level of bacterial contamination
• Treatment plan
• Prevent infection
• Restore soft tissues
• Achieve bone union
• Early joint motion and muscle rehabilitation
• Pathologic fracture
• Occurs due to minimal trauma on a bone weakened by preexisting disease
• Predisposing conditions :primary or metastatic carcinoma, cyst, enchodroma, giant cell tumors ,osteomalacia, osteogenesis imperfecta, scurvy , rickets, and Paget’s disease
• Treatment : treat the broken bone , diagnose and treat the underlying condition
• STRESS OR FATIGUE FRACTURE
• Complete fx resulting from repetitive application of minor trauma
• Most stress fx occur in Lower ext
• Affect people involved in sports, military recruits
• Xray can be normal
• Pain occurs only with activity
• Treatment : decrease physical activity
• Comminuted fracture :
• Bone is divided into more than 2 fragments
• Greenstick fracture :
• Incomplete and angulated of the long bone
• Very common in children
• Treatment: complete the fx and immobization
• Fat embolism fracture:
• Acute respiratory distress sd caused by realease of fat droplets from the marrow as may occur secondary a long bone fx
• Signs&symtoms
• Sx occur immediately or 2 to 3 days after trauma
• SOB
• Confusion, restlessness, disorientation, stupor or coma
• Fleeting petechial rash on chest and conjunctiva
• Fever,tachycardia• DIAGNOSIS :• ABG : PO2 < 60 mm Hg• CX-ray :progressive snowstorm-
like infiltration• Presence of fat globules in urine is
pathognomonic
• Typical scenario: A 25 y/o male complaints of difficulty breathing .His family notes he is acting a little confused , and that he has a spotty purplish rash. Two days ago , he sustained a femur fx after a high-speed motor vehicle collision.
• SHOULDER DISLOCATION:• Anterior dislocaton• High risk of recurrence 70 %• Occurs in younger than 30 y/o• Types : subcoracoid most common,
subclavicular , subglenoid• Mechanism :abduction and external rotation of
the arm causing strain on anterior capsule and glenohumeral ligaments
• Signs&Symptoms:
• Arms held to the side
• Patients resists medial rotation and adduction
• Prominent acromion
• Loss of normal rounded shoulder contour
• Posterior dislocation
• Diagnosis missed in 60 %
• Precipitated by convulsion,seizure, electrical shock
• Types :subacromial, most common
• Mechanism :internal rotation and adduction
• Signs &Symptoms
• Patient hold arm medially rotated and to the side
• Abduction limited
• External rotation limited
• Flattening of anterior aspect of shoulder
• Complications common to all dislocations
• Palpate radial pulse to check axillary artery
• Check sensory component of axillary nerve by assessing sensation over the lateral part of upper arm
• Anterior dislocation complications:
• Rotator cuff tear
• Coracoid fractures
• Greater tuberosity
• Posterior dislocation:
• Fractures of the lesser tuberosity
• COMPARTMENT SYNDROMES
• Increased pressure within a limited space comprises the circulation and function of tissues within that closed space
• Theories of tissue ischemia
• Increased pressure leads to decreased transmural pressure,causing arterioles to close
• Causes :• Fractures• Soft tissue crush injuries• Vascular injuries• Drug overdose with prolonged limb
compression• Burn injuries• Trauma
• Signs &Symptoms: 6P• Pain :deep, unremitting,and poorly
localized.Pain increases with passive stretching of involved muscle
• Pallor :not necessary for diagnosis• Paresthesias :of cutaneous distribution supplied
by the compressed nerve is an early sign• Paralysis :occurs after ischemia is well
established• Pulselessness :shown to occur late at times
• Diagnosis
• Measure pressure within compartment
• Pressure < 30 mm Hg will not produce a compartment syndrome
• Pressure >30mm Hg is an indication for fasciotomy
• Treatment :
• Complete fasciotomy
• 0steomyelitis• Epidemiology :mainly affects children• Pathophysiology• 1- bacteria lodge in end artery of metaphysis
and multiply• 2-local increase in serum and white blood cells• 3-decrease in blood flow and pressure necrosis• 4- pus moves to haversian and medullary canals• 5-goes beneath the periosteum
• Signs&symptoms
• Hx infection or trauma
• Significant pain in the affected area,anorexia, fever,nausea
• Limited joint motion, tenderness and swelling of soft tissue
• Low back pain
• Epidemiology
• 4 out 5 people suffer from low back pain
• Incidence 15 -20 %, male >females
• Often back pain is a sx of systemic illness such as primary or metastatic neoplasm , infection disease or inflammatory disorder
• History
• Localization of the pain
• Character of pain
• Hx of pain development and how it affects everyday of pain
• Hx of weight loss, malaise, fever,Gu
• Physical examination
• 1- straight leg-raising test:positive in nerve root irritation
• 2-check for reflexes and motor and sensory deficits
• 3-check spine for range of motion
• 4- bowel and bladder sx are suggestive of cauda equina syndrome
• Diagnosis
• 1- xray of lumbar spine
• 2-MRI if xray negative
• 3-technetium bone scan and gallium scan can be done if an infection of the spine is suspected
• Treatment
• 1- Rule out a serious pathologic condition
• 2- goal is early return to normal activities
• 3-NSAIDs
• 4- physical and occupational therapy programs