fracture
break in the continuity of a bone
Comminuted Fracture
More than one fracture line
More than 2 bone fragments may be shattered or crushed
Hard to treat because of soft tissue damage and bone fragments
oblique
45 degree angle break
Typically results from: direct or indirect energy, with angulation and some compression
linear fracture
Fracture parallel to long axis of bone
spiral
Rotational forces cause bone to separate in the form of an axis
cause: direct or indirect twisting energy with distal part held or unable to move
occult
fracture that is heidden or not readily discernible
cause: minor force or energy
open
skin broken over fracture, possible soft tissue trauma
cause: moderate to severe energy that is continuous and exceeds tissue tolerance
transverse
Straight line
90 degrees across the bone
cause: minor energy or force which may be direct or indirect
greenstick
incomplete fx
break in one cortex of bone with splintering of inner bone surface. commonly occurs in children and elderly
cause: minor or indirect energy
torus
buckling of cortex but not breaking
incomplete fx
bowing
bending of bone
cause: longitudinal force
incomplete fx
pathologic
break at the site of a preexisting abnormality
incomplete fx
stress
microfracture
incomplete fx
callus formation
A. bleeding at broken ends with subsequent hematoma formation
B. apoptosis
Macrophages are eating old dead tissue
C. Osteoblasts infiltrate the site and surround the ends of the bone to mend the ends together. Spaces that are left between the bone fill in.
D. Remodeling - unnecessary callous removed, bone cells are replaced.
E. normal functioning is resumed and individual is pain free.
cm of bone fracture
unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired senstation and possible muscle spasms
Reduction
putting a bone fracture back in place.
Closed reduction
popping a bone back into place.
traction
series of weights to pull on bone with counter traction with controlled movement and weight distribution
Fatigues muscles to stop spasms.
skin traction
used for short term treatment
external traction
using a pin or wire through the skin
open reduction
plates, pins & screws to put bone back in place.
internal fixation
screw, plate, nail, or wire is used to maintain reduction
external fixation
pins or rods are surgically placed into uninjured bone near the fracture site and then stabilized with an external frame of bars
nonunion
bone fails to grow together; fracture fills w/ fibrous collagen and is weak; continues to break
delayed union
takes long time to heal
malunion
mends in incorrect position
dislocation
Temporary displacement of two bones
Loss of contact between articular cartilage
are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
subluxation
Contact between articular surfaces is only partially lost
are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
compartment syndrome
a dangerous complication associated with severe muscle trauma or fractures
patho of compartment syndrome
increased pressure reduces capillary blood flow, blood can't flow through it. Muscles and nerves in that area become ischemic and painful. Skin looks pale, cannot find pulse in area. Patient's sensation is diminished. Is a medical emergency. Nerve cells can only last 2-4 hrs w/o bloodflow, muscles only 6-8 hrs
6 p's of compartment syndrome
Pain,
paralysis,
pallor,
pulselessness,
polar (cold to touch)
parasthesia
strain
muscle to bone
Tear or injury to a tendon
sprain
bone to bone
Tear or injury to a ligament
avulsion
Complete separation of a tendon or ligament from its bony attachment site
tendonopathy
Repetitive motion causes injury; there is more stress than the tendon can tolerate
epicondylitis
tendonopathy in elbow
Commonly golf sports injury
patho of tendonopathy
Fluid accumulation secondary to inflammatory process causes pressure within the tendon sheath
Swelling and pain result in limited movement
May involve microtears and bleeding
CM of tendonopathy
pain worsens with activity. Active motion (innervating an area) hurts more than passive motion. Joint feels weak, but limb is not limited.
bursitis
Painful inflammation of bursa
Common in shoulder, hip, knee, elbow
etiology of bursitis
Inflammation from excessive movement, repeated trauma
bacterial infection
patho of bursitis
Inflammation causes fluid accumulation and engorgement
Can spread to adjacent tissues
osteoporosis
metabolic bone disease resulting in a reduction of density or mass of bone.
Primarily loss of spongy/cancellous bone
Bones become fragile and there is an increased risk of fracture
The remodeling process is disrupted. It normally takes 4 months but can take as long as 2 years with ______
etiology of osteoporosis
Decreased levels of estrogen and testosterone
Decreased activity level
Inadequate levels of vitamins Ca, and vitamins D and C , and Mg
osteotitis deformans
Paget disease
Excessive resorption of spongy bone and accelerated formation of softened bone
Disorganized, thickened, but soft bones
Most often affects the: long bones, skull, pelvis, and vertebra
patho of osteotitis deformans
Thickened bones can cause: abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve
osteoarthritis
Degenerative Joint Disease
osteoarthritis
Form of arthritis involving progressive destruction of cartilage
Most common form of arthritis
Commonly affects weight bearing areas (knees, hips, spine, hands)
etiology of osteoarthritis
unknown
Associated with: joint stress, congenital abnormalities and joint disability due to trauma
Increased risk with: age and obesity
patho of osteoarthritis
Erosion of articular cartilage
Fissures develop and underlying bone is unprotected
Bone becomes: irritated/thickened/hardened
Bone spurs form
Deformities occur
cm of osteoarthritis
Pain, stiffness, enlargement, swelling, tenderness, limited ROM , muscle wasting, partial dislocation, deformity
Joint more symptomatic at end of day
May limp
Usually affects one joint, but can affect several
rheumatoid arthritis
A systemic, inflammatory autoimmune disease that causes chronic inflammation of connective tissue, primarily the synovial joints.
Synovial membrane primarily affected. Inflammation spreads to articular cartilage, fibrous joint capsule, tendons, and ligaments.
etiology of RA
Believed to be: autoimmune disease
Genetic Rheumatoid Factor has been identified
Females have 2-3x greater incidence
patho of RA
Immune complexes being deposited in the synovial membrane or articular cartilage in the joints
Inflammatory response; neutrophils release enzymes that damage articular cartilage and thicken synovial lining
Joint changes from chronic inflammation invades surrounding cartilage, ligaments, tendons, and joint capsule
"Pannus" forms within the joint, resulting in contracture and joint laxity
Fibrous adhesions may form, causing joint immobility and deformities
testing for RA
Presence of rheumatoid factors (RA or RF test)
Antibodies (RF) against own antibody (IgG)
Joint fluid presents with inflammatory exudate
evaluation of RA
Four or more of the following:
Morning joint stiffness lasting at least 1 hour
Arthritis of three or more joint areas
Arthritis of the hand joints
Symmetric arthritis
Rheumatoid nodules
Abnormal amounts of serum rheumatoid factor
Radiographic changes
gout
is caused by an inflammatory response to uric acid production in individuals who lack uricase.
patho of gout
Uric acid : hyperexcretion or underexcretion
Cannot be excreted. Deposits accumulate and crystallize inside joints and connective tissues
Inflammation, redness, pain and swelling at the site
CM of gout
Pain
Erythema
Edema
Warmth
What joints are most commonly affected? ankles
Asymptomatic hyperuricemia
elevated uric acid levels that dont cause symptoms
Acute gouty arthritis
Attacks of joint pain
Triggered by: trauma, drugs, alcohol
Tophaceous gout
Occurs 3-40 years after initial attack
Urate crystals appear in cartilage, synovial membranes, tendons, soft tissues.
Chronic inflammation and deformites may be seen. Can involve kidneys, heart valves, ear cartilage, etc.
contracture
occur when there is fibrosis of supporting soft tissue. The result is resistance of movement in muscles or joints.
etiology of contracture
Occurs in the absence of muscle contraction, such as an immobilized extremity
Caused by: muscle spasms or weakness
Commonly seen: muscular dystrophy and CNS injury
Can also be caused by: burned tissue
disuse atrophy
Reduction in the normal size of muscle cells as a result of prolonged inactivity
Bed rest, trauma, casting, or nerve damage
treatment for disuse atrophy
isometric movements and passive lengthening exercises
fibromyalgia
Chronic syndrome characterized by diffuse pain, fatigue, and tender points
CM of fibromyalgia
Chronic widespread joint and muscle pain
Vague symptoms
Increased sensitivity to touch, absence of inflammation, fatigue, and sleep disturbance