Musculoskeletal injuries are fractures Gelenkdislokationen Bänderverstauchungen pulled muscle tendon injuries These injuries are very different and often in mechanism, severity and treatment. The Extremitätn, spine and pelvis can all be involved. Some injuries are discussed elsewhere in the Merck Manual: vertebral fractures, spinal trauma of the temporal bone, the jaw or related structures and nose, facial trauma; metatarsal stress fractures stress fractures; Orbital fractures, facial trauma, broken ribs (rib fractures); Fractures that occur during birth (birth injury), spinal subluxation (non-traumatic Spinalsubluxation) and mandibular dislocation (dislocation of the mandible). For dental fractures, fractured and avulsed teeth. Musculoskeletal injuries may occur alone or as part of a multi-trauma (handling trauma patients). Most musculoskeletal injuries caused by blunt trauma, penetrating trauma but may also violate musculoskeletal structures. The fractures and dislocations can be open (in conjunction with the environment through a skin wound) or closed. Pathophysiology fractures A fracture is a break in a bone. Most involve a single, sufficiently large force action on an otherwise normal bone. In a closed fracture the overlying skin is intact. In an open fracture the overlying skin is injured and broken bones are related to the environment. Pathologic fractures arise if weak or small forces break a bone surface, have been previously damaged by disturbances (for. Example, osteoporosis, malignancy, infection, bone cyst). If this is the condition is osteoporosis, they are often called insufficiency or fragile fractures. Stress fractures (stress fractures) result from repetitive applications of excessive force as they carry a heavy burden in long distance runners or soldiers marching as they occur. Normally heal bones that have been hurt by microtrauma of excessive force during rest periods by itself, but repeated application of force to the same location predispose further damage and cause the microtrauma verbreiten.Dislokationen A dislocation is a complete separation of the two bones that zubilden a connection. Subluxation is a partial separation. Often a dislocated joint remains augerenkt until it put right again by a doctor (realigned) is, but sometimes it dislocates spontaneously einVerstauchungen again and strains Ligaments connect bones together. can rupture with tapes (sprain) or muscle (strain) occur. Cracks can be divided into 1st Grade: Minimum (stretched fibers but intact, or only a few fibers torn) 2. Grade: partially (some up almost all of the fibers are torn) 3rd Grade: Full (all fibers are torn) connecting tendon injuries tendons the muscles to bones. Tendon tears can also be partially or completely. For complete cracks the movement produced by the free-standing muscle is usually lost. Partial cracks can be caused by a single traumatic event (eg. B. penetrating injuries), or repetitive stress (chronic caused tendinopathy). Movement is often intact, but some cracks can become complete tears, especially when significant or repeated force exerted wird.Heilung bones heal at different speeds, depending on the age of the patient and the coexisting disorders. For example, they heal much faster than in adults in children; Disorders that affect the peripheral circulation (eg., Diabetes, peripheral vascular disease), slow to heal. Fractures heal in three overlapping phases: Flammable reparative remodeling The inflammatory phase occurs first. A hematoma forms at the breaking point, and a small amount of bone in the distal fracture fragments is absorbed. When a fault line is not initially obvious (for example, on some non-disliozierten fractures), is typically about a week after the injury evident after the injury in this small amount was absorbed to bone. During the reparative phase, a callus is formed. New blood vessels develop, so that cartilage can form on the fault lines. Immobilization (z. B. gypsum) is required during the first 2 stages, so that new blood vessels grow. The reparative phase ends with clinical union of fracture (d. E. If there is no pain at the fracture site, the injured limb can be used without pain, and the clinical examination no bones detects motion). In derUmbauphase, the callus, which was originally cartilage, ossified, and the bone is broken and rebuilt (rebuilt). During this period, patients should be advised of and normal to move back to the injured parts, including burdening them. Most joint injury can be reduced without surgery (to be returned to the normal anatomical position). Occasionally dislocations can not be reduced by closed manipulation techniques and open surgery is required. Once a joint is reduced, further surgery is often unnecessary, but the surgery is sometimes necessary to treat associated fractures, dirt in the joint or residual instability. Many Teirisse of ligaments, tendons or muscles heal spontaneously. Complete tears often require surgery to restore anatomy and function. Prognosis and treatment vary greatly depending on the location and severity of the Tumors.Komplikationen Serious complications are uncommon, but can also threaten life or the viability of a limb or cause permanent dysfunction of a limb. The complication rate is high for open injuries (that predispose to infections) and injuries that destroy the blood vessels, tissue perfusion and / or nerves. Dislocations, especially if they are not reduced quickly, tend to have a higher risk of vascular and nerve injuries as fractures. Closed injuries that do not involve blood vessels or nerves, especially those who are quickly repositioned cause the least likely to cause serious complications. Among the acute complications (associated injuries) include: bleeding: bleeding accompanies all fractures and soft tissue injuries. Rarely internal or external bleeding are strong enough to cause a hemorrhagic shock (for example, pelvis, femur, and some open fractures). Vascular lesions: Some open fractures destroy blood vessels. Some closed injuries, v. a. Knee or Hüftdislokationen and rearwardly shifted supracondylar fractures of the humerus, destroy the vascular supply enough to cause a distal limb ischemia; this vessel destruction may be clinically occult for hours after the injury. Nerve injuries: nerves can be injured if they are stretched from suspended pieces of a broken bone or dislocated by a hinge when they are injured by a blunt impact crushed in severe crush injuries or torn by sharp bone fragments. If nerves are squeezed (called neurapraxia), the nerve conduction is blocked, but the nerve not torn. Neurapraxia caused temporary motor and / or sensory deficits; neurological function returns complete after about 6 to 8 weeks. If nerves are crushed (called axonotmesis) the axon is injured, but not the myelin sheath. This injury is more serious than neurapraxia. Depending on the extent of the damage to the nerve for weeks to regenerate to years. In general, the nerves are in open injuries torn (called Neurotmesis). Torn nerves do not heal spontaneously and need to be surgically repaired eventually. Fat embolism: fractures of the long bones can release enough fat and other bone marrow substances that can pass through a venous embolism in the lungs respiratory complications after themselves (non-thrombotic-related pulmonary embolism). Compartment Syndrome: The tissue pressure within a closed fascial area, which prevents the inflow tissue and reduces the tissue supply. Injuries from bruising or a very small-scale chipping fractures are a common cause, increasing tissue pressure, such as edema develop. The risk is high for forearm fractures, affecting both the radius and ulna, in tibial plateau fractures (proximal tibia fractures, propagating into the joint space) or tibial shaft. An untreated compartment syndrome can lead to rhabdomyolysis, hyperkalemia and infection. It can also cause contractures, sensory disturbances and paralysis. Compartment syndrome threatens the viability of the limb (möglicherweiseist amputation) and survival. Infection: Any injury can become infected, but the risk is highest among those who are open or be treated surgically. Acute infections can lead to osteomyelitis (osteomyelitis), which can be difficult to heal. Among the long-term complications include the following: Instability: Various fractures, dislocations and ligament injuries, particularly sprains 3rd degree can lead to joint instability. Instability can obstruct and increases the risk of osteoarthritis. Rigidity and impaired movement: observe fractures with joint involvement of the cartilage is usually involved with. Poorly healed cartilage tends to scarring with the possible consequence of osteoarthritis or disabled joint motion. Stiffness is more likely if a joint has to be made longer quiet. The knee, elbow and shoulder are particularly susceptible to post-traumatic stiffness, especially in the elderly. Nonunion or delayed healing: Occasionally heal fractures not (so called pseudoarthrosis.) Or the convergence is delayed. Important factors are incomplete immobilization, partial interruption of blood supply and patient factors affecting the cure (z. B. use of corticosteroids or thyroid hormone). Deformity: deformity heals with residual deformity. This is more likely when a break is not sufficiently reduced and stabilized. Osteonecrosis: Part of a fracture fragment can be necrotic, v. When the blood supply is damaged a.. To the closed injuries that are prone to osteonecrosis include scaphoid fractures, shifted femoral neck fractures, dislocations of a native (non prosthetic) and hip displaced talar neck fractures. Osteoarthritis: injuries, destroy the weight-bearing surfaces of a joint, or which lead to deformity and instability of the joints, predispose to articular cartilage degeneration and osteoarthritis. Review investigation of serious injury history and physical examination X-rays to identify fractures occasionally MRI or CT in the emergency room when the accident happened suggests a potentially dangerous or multiple violations (such. As in motor vehicle crashes at high speed or a fall from a great height ), are first examined the patient from head to toe in order to prevent serious injury to the organ systems and, if necessary resuscitated (handling trauma patients). Patients, especially those with a pelvic or femur fracture, pay special attention to a possible hemorrhagic shock is to be placed by occult blood loss. If a limb is injured, it will immediately open wounds and symptoms or signs of neurovascular damage (deafness, paralysis, poor circulation) and compartment syndrome studied (z. B. pain out of proportion to the injury, pallor, paresthesias, coolness , no pulse). Patients should be checked for ligament, tendon and muscle injuries and fractures; Portions of this evaluation sometimes are deferred until a fraction excluded. The joints above and below the injured joint should also be investigated. History The accident happened (z. B. the direction and strength of the force) can often suggest the type of injury. However, many patients can not remember the course of events may or may not accurately describe it. If a patient reports a deformity that has evaporated before the patient was medically examined, it should be assumed that there has been a real deformation which has fallen spontaneously. A wahrgenommes snapping or popping sound when the injury can be a Bänderruptur or vascular injury signaling. Fractures and severe ligament injuries cause immediate pain usually. A pain that does not begin until hours or days later, is probably more of a minor injury. Pain out of proportion to the apparent extent of the injury, or the increase constant in the first hours and days after the trauma may indicate a compartment syndrome or ischemia be (compartment syndrome) .Körperliche investigation The investigation includes vascular and neurological assessment study on deformation, swelling, dimensional skin perfusion, open wounds, and decreasing or anomalous mobility. above palpation sensitivity, crackle and gross defects in bones or tendons examination of the joints and below the injury site after fracture and dislocation are excluded (clinically or by imaging), stress tests of the affected joints to pain and instability If muscle spasms and pain a physical examination limit (in particular stress tests), an investigation is sometimes easier after the patient has received a systemic analgesic or local anesthetic. Or injury can be immobilized until the muscle spasm stops, usually for a few days, and then the patient can be re-examined. A deformity is an indication of dislocation, subluxation (partial Knochenluxation a joint) or fracture. If a wound is near a dislocation or fracture must be considered from an open fracture. Open fractures can be classified with the Gustilo-Anderson system: Grade I: wounds <1 cm, II with minimal contamination, comminution and soft tissue damage degree: Sore> 1 cm with certain soft tissue damage and minimal periosteal stripping level IIIA: Severe soft tissue damage and serious pollution with sufficient soft tissue coverage IIIB: Severe soft tissue damage and significant contamination with insufficient soft tissue coverage IIIC: Open fracture with arterial injury, the repair requires higher levels show a higher risk of osteomyelitis; However, the interobserver reliability is using this system is not high (usually about 60%), and certain aspects can best be assessed intraoperatively. Swelling usually shows signs of a serious damage to the musculoskeletal system, but can also only develop over several hours. If no swelling occurs within that time, a break or serious ligament damage is unlikely. Some fractures (z. B. Buckle fractures, small fractures without dislocation) can be subtle swelling, but rarely missing. Sensitivity accompanied almost all injuries and for many patients palpation causes all over the injured area inconvenience. However, a striking increase in sensitivity indicates a fracture or a sprain in a certain area (point sensitivity). A localized painful ligaments sensitivity and pain when the joint is loaded, are typical of the sprain. Some fractures and complete muscle or tendon tears, a defect in the affected structure can be felt. A crepitus (a characteristic tactile and / or audible cracking or popping, which occurs when the joint is moved) may be an indication of a fracture. A rough joint instability indicates a dislocation or severe sprain. Stress tests are performed in order to investigate the stability of an injured joint (Knieverstauchungen and meniscus injury: stress tests); however, there is a suspected fracture, the test is postponed until an X-ray has ruled out a fracture. Night stress tests includes passive opening of the joint in a direction generally perpendicular to the normal range of motion (stresses). Since a muscle spasm can cover a joint instability during acutely painful injury, the muscles around should be relaxed as far as. The investigation is smoothly started, and then repeated, always a little increasing intensity. The findings are compared with the contralateral side, but may be limited by their own subjective nature. Findings may help distinguish between 2nd and 3rd degree sprain: Grade 2 sprain: The stress test is painful and limits the expandability of the joint. Sprains Grade 3: The stress test is less painful because the ligaments severed completely and not overstretched and thus the expandability is less significant. Are pronounced muscle spasms, except for the use of analgesics or sedation, the test should be repeated after a few days when the spasms have subsided. Tips and risks stress testing may be less painful for sprains Grade 3 sprains than 2nd degree. Some partial tendon tears are not detected at baseline, because the function appears intact. Any of the following symptoms suggesting partial tendon tears: Sensitivity of tendon pain when the joint is moved through its range of motion dysfunction weakness Palpable defects part of tendon rupture may become complete tears when patients continue to use the injured part. When the accident happened the injury or the investigation suggests a partial tendon injury, or if the investigation is not unique, a rail should be applied in order to limit the movement and thus further damage. A follow-up examination, occasionally using MRI can assess the extent of the injury probably better. Special attention to some specific areas during the clinical examination may lead to the diagnosis of some easily overlooked injuries (see table: Investigation on some often overlooked injuries). Investigation to some frequently overlooked injury symptoms characteristic anamnesis findings trauma shoulder pain attacks electrocution Limited passive external rotation with the elbow flexed dislocation of the posterior shoulder (the shoulder joint), possibly on both sides history of shoulder dislocation in patients> 40 inability arm at an angle of 90 ° sideways met if a slight pressure downwards a is usgeübt (the arm falling down) Various mechanisms (e.g. Acute complete rupture of the rotator cuff. B. injury from pileup in football, direct blow to the joint) pressure sensitivity over the sternoclavicular joint injury to the sternoclavicular joint In most cases directly on the shoulder pressure sensitivity over the acromioclavicular area acromioclavicular load or disorder (shoulder separation) wrist pain or turgors case on an outstretched hand pressure pain sensitivity over the anatomical snuff box, between the tendons of the extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus. Scaphoid fracture Various mechanisms pressure sensitivity over the lunate (in the wrist to the base of the third metacarpal bone) and pain in the axial compression of the 3rd metacarpal fracture of the lunate Lunäre or perilunate dislocation hip traps pain on passive hip rotation when the knee is flexed inability to rotates to bend the hip bone to the outside and reduces inability to bear weight, even if plain X-rays are normal (particularly in patients with osteoporosis) hip fracture Knee pain in a child or an adolescent Various mechanisms pain on passive hip rotation when the knee is flexed hip injuries (eg. B. slipped capital femoral epiphysis [Epiphysiolysis femoris (Slipped capital femoral epiphysis, SCFE)], Legg-Calve-Perthes disease [Legg-Calve-Perthes syndrome]) knee pain or turgors Various mechanisms weak or missing active knee extension and normal radiographic findings of knee rupture of the quadriceps tendon rupture of the patellar tendon, if the physical examination of a joint that referred the patient to be painful, is inconspicuous, the reason may be a radiating pain. For example, patients with a slipped capital femoral epiphysis (or less frequently hip fracture) pain in the knees fühlen.Bildgebende procedures Not all injuries to the extremities require imaging. Some fractures are minor and are similar to soft tissue injuries treated. For example, most violations of the 2nd to 5th toes and many fingertip injuries are treated symptomatically whether a fraction is present or not, so X-ray examinations are not necessary. Many ankle sprains do not require X-rays at the first examination, since the probability of finding a fracture that would require a different type of treatment that is accepting low. With ankle sprains commonly accepted criteria for the preservation of radiographs can explicitly (Ottawa Ankle Rules- imaging techniques) help to limit X-ray examinations for patients with fractures that are likely to require special treatment. Plain radiographs be performed first; they show v. a. Bone structures (including joint effusion as a result of bleeding or occult fractures) and are thus more useful for the diagnosis of dislocations and fractures than for sprains. You should always in two planes, z. B. be an anterior-posterior and lateral, customized. Torusfraktur the finger PHOTOSTOCK-ISRAEL / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/-/media/manual/professional/images/c0197305_torus_fracture_of_the_finger_science_photo_library_with_arrow_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual /professional/images/c0197305_torus_fracture_of_the_finger_science_photo_library_with_arrow_high_de.jpg?la=de&thn=0 ‘, title:’ Torusfraktur the finger ‘, description:’ u003Ca id = “v37898255 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eTorus fractures can only be as subtle irregularities in the cortical bone visible u003c / p u003e u003c / div u003e. ‘credits’ PHOTOSTOCK-ISRAEL / SCIENCE PHOTO LIBRARY ‘


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