CHAPTER 22 SOFT TISSUE TRAUMA LIGAMENT INJURIES

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CHAPTER 22SOFT TISSUE TRAUMALIGAMENT INJURIES

• Ligaments Elastic structures that stabilize
  joints.
• SPRAIN When a tensile force (stretching)
  elongates a ligament beyond its elastic limit.
• AVULSION FRACTURE Can occur when a ligament is
  stretched beyond its limits of deformation.
  Avulsion fracture occurs if ligament fails at
  insertion instead of midsubstance.

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• 1st DEGREE SPRAIN Only slight stretching.
• 2nd DEGREE SPRAIN Partial tear of ligament,
  leads to some abnormal laxity.
• 3rd DEGREE SPRAIN Complete tear, leads to gross
  instability.

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DISLOCATION

• When articular surfaces lose contact with each
  other. (Abnormal motion is named according to
  the direction of distal portion relative to the
  proximal part.)
• Anterior knee dislocation tibia/fibula are
  anterior to femur.
• Dislocations can lead to permanent instability
  (ACL tears, shoulder dislocations).
• Dislocations can lead to vascular injury with
  complete knee dislocations. Hip dislocations can
  lead to osteonecrosis.

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SUBLUXATION

• Partial shoulder dislocation.

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HILL-SACHS LESION

• Impaction of fracture on posterior surface of
  humeral head when it dislocates anteriorly onto
  the glenoid.

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ANKLE SPRAINS

• Deltoid ligament Medial, resists eversion.
• Syndesmosis Between tibia and fibula, high
  ankle sprain.
• Lateral Anterior talofibular and
  calcaneofibular, resist inversion injuries. Most
  common ligament sprain.

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SHOULDER DISLOCATIONS

• Inferior glenohumeral ligament is main stabilizer
  against anterior translation with arm abducted.
• 98 anterior.
• Bankart lesion Anterior labrum and capsule torn
  away from glenoid.
• Hill-Sachs lesion.
• Younger patients high recurrence rate of
  dislocations.

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• Older patients lt40 years of age low recurrence
  of dislocations, however there is a high
  incidence of rotator cuff tears.
• Axillary nerve.
• X-rays AP/scapular Y/axillary lateral.

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ACL INJURIES

• Stabilizes knee against anterior translation.
• Pivoting sports (skiing, soccer, basketball).
• Trick Knee.
• If knee left unstable this can lead to increased
  cartilage damage which leads to arthritis. Not
  all tears are surgically reconstructed.
• If reconstructed, biologic tissue can be used
  Autograft (tissue from the patient) Allograft
  (tissue from cadaver).

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HIP DISLOCATIONS

• Traumatic different from developmental hip
  dislocation.
• Hips very stable. Secondary deep socket with
  thick surrounding connective tissue.
• High energy trauma.
• Posterior usually (dashboard injuries).
• Emergent reduction needed due to high risk of
  vascular injury which leads to osteonecrosis.

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TENDON INJURIES

• Eccentric (elongating) contraction of muscle as
  it is pulled in opposite direction.
• Quadriceps tendon, patellar tendon, Achilles
  tendon, flexor tendons.
• Acute traumatic.
• Chronic rheumatoid arthritis.

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SKIN INJURIES

• BURN INJURIES
• FIRST DEGREE BURN Superficial, epidermis only.
• SECOND DEGREE BURN Partial thickness down to
  dermis, painful blistering.
• THIRD DEGREE BURN Deep to muscle and bone, waxy
  and dry. May not be painful (nerve damage).

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MUSCLE INJURIES

• Myositis ossificans (deep quadriceps contusion
  abnormal production of bone muscle.
• Heterotopic ossification formation of bone in
  any non-osseous tissue (after elbow dislocations).

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TREATMENT

• Bisphosphates, Anti-inflammatories, radiation.