CHAPTER 22 SOFT TISSUE TRAUMA LIGAMENT INJURIES TULSA BONE & JOINT CHAPTER 22 SOFT TISSUE TRAUMA LIGAMENT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

1st DEGREE SPRAIN – Only slight stretching. TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

SUBLUXATION Partial shoulder dislocation. TULSA BONE & JOINT TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TULSA BONE & JOINT HILL-SACHS LESION Impaction of fracture on posterior surface of humeral head when it dislocates anteriorly onto the glenoid. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

ANKLE SPRAINS Deltoid ligament – Medial, resists eversion. TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

SHOULDER DISLOCATIONS TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

X-rays – AP/scapular Y/axillary lateral. TULSA BONE & JOINT Older patients <40 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

ACL INJURIES Stabilizes knee against anterior translation. TULSA BONE & JOINT 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). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TULSA BONE & JOINT 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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

SKIN INJURIES BURN INJURIES TULSA BONE & JOINT 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). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TULSA BONE & JOINT 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). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

TREATMENT Bisphosphates, Anti-inflammatories, radiation. TULSA BONE & JOINT TREATMENT Bisphosphates, Anti-inflammatories, radiation. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY