Fractures & Wounds

Abrasion Result from scraping off one or several layers of epidermis usually superficial Minimal bleeding

Laceration A jagged, irregular, wound caused by a tearing of the epidermis.

Puncture When a pointed object is driven deep into the tissue minimal bleeding high infection risk

Incision An open wound made by a sharp cutting object (i.e. medical scalpel in surgery) characterized by a straight line cut.

Avulsion A partial tearing away of a body part warning

Calluses A thickened usually painless area of skin caused by friction or pressure

Blisters A bubble-like collection of fluid beneath or within the epidermis of the skin

Blood filled swollen area under the skin – “goose egg” Hematoma Blood filled swollen area under the skin – “goose egg”

A closed wound that bleeds under the surface of the skin Contusion A closed wound that bleeds under the surface of the skin

Myositis Ossificans Bone formation within a muscle as a result of a deep contusion. (6 weeks post injury)

Contrecoup Occurs on the opposite side of the initial injury – usually occurs in the brain when the head hits against an immovable object or surface

Soft Tissue Injuries

Sprains & Strains

Strains A stretching or tearing of a muscle or tendon as a result of excessive force.

Strains by degree Strains involve muscle or tendon tissue. A grade I strain means a tendon has been overstretched. A grade II strain means a tendon has been partially torn. A grade III strain means a tendon has been completely ruptured.

Sprains A stretching or tearing of ligaments as a result of excessive force at a joint.

Sprains by degree Sprains involve ligament tissue. A grade I sprain means a ligament has been overstretched. A grade II sprain means a ligament has been partially torn. A grade III sprain means a ligament has been completely ruptured.

Tendonitis Inflammation of tendon due to repetitive motions or improper mechanics

Synovitis This is a chronic injury to the synovial lining of the joint. Caused by an injury that was not treated properly or rested. Most often is the result of a repeated joint injury.

Bursitis This is chronic inflammation of a bursa sac. Bursa sacs are located near joints where soft tissue may rub near a bone. When the bursa becomes irritated it swells and creates a pocket of swelling at the joint.

Fasciitis Fascia is thick tough connective tissue that surrounds muscles and binds the skin to fat and muscle When the fascia becomes strained (overuse), it becomes thick, swollen, and painful

Dislocations (luxation) Occurs when a significant force displaces a bone from its joint (luxation) Includes connective & soft tissue damage

Subluxation When a bone is temporarily displaced from its position (partial dislocation) Includes connective & soft tissue damage

Avulsion A ligament or tendon pulls a portion of bone away from its attachment due to excessive tension on the attachment

Soft Tissue Injury Healing Stage I: Acute Inflammatory (2 days) Increased flow of blood to the injured area Phagocytes Cells that engulf and eat up dead cells Leucocytes Infection fighting white blood cells Platelets Blood clotting

Soft Tissue Injury Healing Stage II: Repair Fibroblasts: fiber building cells begin building fibers across injury They form the scar – which takes 6 weeks to 3 months

Soft Tissue Injury Healing Stage III: Remolding Takes up to 1 year Depends on 3 Things: Degree of injury Location of and blood supply to injury Age of athlete If blood supply to the area is poor, healing process takes longer. Ex: eye

Scar Tissue This can be a complication of the healing process if more tissue is laid down than what is necessary to repair the wound Excessive Scar Tissue: Can delay healing Can interfere with functions Sometimes has to be removed

Scar Tissue Large Wounds (edges are far apart) Will take longer to heal Try to keep wound closed with stitches/skin closures Skin Closures: Butterfly Stitch Tough piece of material that brings together the edges of a wound and can close a deep wound effectively

Bone injuries: fracture types

Stress fatigue-related fracture that occurs as a result of repetitive stress not always noticeable on x-ray later x-ray shows healing bone callus

Greenstick indicated by the bone splintering as it is bent commonly as the result of a fall on an outstretched arm

Impacted compression of bone where pieces are embedded into other bone (red arrows indicate direction of force)

Longitudinal runs the length of a long bone as the result of repeated stress or axial force

Oblique indicated by a diagonal fracture line across a bone caused by bending or axial loading

Spiral indicated by a candy-cane striped appearance up the length of a long bone

Transverse travels across a bone as the result of bending or direct impact

Comminuted indicated by a bone being broken into 3 or more pieces commonly from a fall or large force (car accident)

Blowout Occurs around the eye. It is a comminuted fracture to the orbit as the result of a direct impact

Salter-Harris (Epiphyseal) any fracture that occurs at the growth plate in young athletes

Compression Occurs in the spine Happens when opposing forces are applied to a bone from both ends at the same time

Depressed Occurs from a direct impact to the skull Makes an indent

Pathological Disease process like a tumor weakens bones so that stress causes fracture Improper nutrition and eat disorders

Named after a French surgeon Lisfranc Injury Named after a French surgeon An injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus

Skeletal Anatomy Terms

Prefix “osteo” refers to bone Terms Deformity Misalignment of a body part Osteoporosis Caused in young people by lack of calcium & body’s inability to absorb minerals Bones are porous & fragile Prefix “osteo” refers to bone

Terms Osteogenesis Osteocytes Osteoblasts Osteoclasts Process of laying down new bone Osteocytes Bone cells Osteoblasts Bone forming cells Osteoclasts Cells involved in bone resorption (“eat” the interior layer of bone & allow new bone growth)

Healing Fractures Fracture Failure Point Time Broken bone Amount of energy required to cause a fracture Vary by athlete, age & structure Time Typically 6-8 weeks to heal a fracture

Fracture Healing Process: Stage 1: Acute Injury occurs Bone breaks & bleeding occurs Osteoclasts “eat” the debris and reabsorb it into body Osteoblasts Add new layers to outside of bone Length Approximately 4 days

Fracture Healing Process: Stage 2: Repair Osteoclasts & Osteoblasts Continue with regeneration Callus (different from callus wound) Bony splint Callus Transforms The fibrous callus transforms into hard callus bone Length This begins at the 3rd week and continues for 3 months 6 weeks in a cast is enough to allow participation & protection

Fracture Healing Process: Stage 3: Remodeling This takes several years Callus is reabsorbed and replaced with a fibrous cord that is formed around the fracture site If bone is not healing – growth can be stimulated with electrodes

Non-union Fracture When a bone never heals If it occurs in a weight bearing bone (leg) the athlete will never walk Common non-union fracture of the wrist occurs in Scaphoid Bone Results in arthritis and inability to move the wrist

Internal Fixation Surgical implementation of implements to repair a bone Implements can be plates, pins, screws, etc. Implements will remain in the body unless they become a problem This surgery could result in additional tissue damage & recovery time Screws may need to be adjusted as healing occurs or attached to an external structure for additional stabilization outside of the body (external fixation)

Internal/External Fixations