Orthopedic emergencies and its types

Orthopedic emergencies are sudden medical conditions involving the spine, the limbs, or related structures, or involving their aberrant shape or function. Orthopedic emergencies are frequent in the emergency room (ED) and can pose a risk to limb function if not handled immediately.

TYPES OF ORTHOPEDIC EMERGENCIES

1. Muscle contusion (bruise): A muscle contusion is caused by blood extravasating into the muscle tissue as a result of direct stress. At first, the bruised muscle will be tender and swollen, and the skin above it will seem red or blue (ecchymosis). The hue of the skin shifts from purple to a greenish-yellow as the blood is reabsorbed.

2. Strain: The degree of muscle fiber damage that develops after a muscle is either too stretched or violently flexed against resistance is used to categorize muscular strain injuries.

a) First-degree muscle strain is a minor stretching injury of the muscle fibers that is characterized by muscle spasm, mild swelling, local tenderness, and a slight decrease in function.

b) Second-degree muscle strain is a partial tearing of the muscle fibers that is characterized by moderate swelling, ecchymosis, and decreased functional strength.

c) Third-degree muscle strain is a complete disruption of the muscle that is characterized by swelling, ecchymosis, decreased strength, and a palpable “bulge” caused by the retracted unattached muscle belly. Third-degree muscle strains can lead to significant long-term disability but fortunately are not as common as first- and second-degree strains.

3. Sprain: Sprains are damage to the ligaments in the joints that happen when a joint is forced to move abnormally.

a) First-degree sprains are characterized by mild hemorrhage and swelling, minimal point tenderness, and no abnormal joint motion (i.e., the joint is stable).

b) Second-degree sprains, which occur when the ligaments are partially torn, result in moderate hemorrhage and swelling, tenderness, painful motion, loss of function, and minor joint laxity.

c) Third-degree sprains occur when the joint ligaments are completely disrupted. Third-degree sprains may initially appear similar to second-degree sprains, but the patient will have severe joint instability after the swelling subsides.

4. Dislocation: When the opposing articular surfaces of the bones are no longer in touch, a joint is said to be dislocated. A partial dislocation is a subluxation (i.e., the articular surfaces are in partial contact).

5. Fracture: The disruption of the bony cortex results in a fracture. Pain, edema, and deformity are brought on by the bleeding into the surrounding tissue from the broken bone.

a) Descriptive terms: Important details include the following: the affected bone, fracture location, whether the fracture is open or closed, whether the intra-articular extension has occurred, the type of fracture line, description of bone fragments (if present), whether the fracture is complete or incomplete, neurovascular status, and the position or alignment of the bone segments.

An open fracture occurs when the skin overlying the fracture is not intact either due to direct trauma or a fragment of bone that penetrates the skin. A subtle open fracture can occur when a bone fragment pierces the skin and then withdraws, leaving only a small puncture wound. Therefore, any fracture with an overlying skin wound should be suspected of being open. A closed fracture occurs when the skin and soft tissue overlying the fracture are intact.

An intra-articular fracture is a fracture that extends into the joint surfaces.

The fracture line may be spiral, oblique, or transverse. Fractures in children are often described as the buckle (torus), greenstick, or complete fractures. A fracture can also be described as compression, avulsion (chip), or comminuted (shattered) fracture.

The bone segments may be in contact with each other or separated by a measurable distance (usually stated in millimeters). The bone segments may be completely displaced (i.e., lying next to each other instead of end to end), partially displaced (i.e., offset from each other by a measured amount), or non-displaced.

The angulation of the two bone segments is described by both the direction of the angle (e.g., radial, dorsal, anterior, lateral) and by the degree of the angle formed by the two bone segments.

b) Special fractures

Pathologic fractures occur when a relatively minor force is applied to the diseased or otherwise weakened bone.

Stress fractures are caused by the repetitive application of a minor force to a bone, usually a long bone in the lower extremities. Stress fractures are commonly seen in military personnel (march fracture) and athletes (e.g., joggers, dancers).

Salter-Harris fractures involve the epiphyseal plate (i.e., the growth plate) and are common in children.