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.TONY JABBOUR, MD

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DISLOCATIONWhen 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.

1. Dislocations can lead to permanent instability (ACL tears, shoulder dislocations).

2. Dislocations can lead to vascular injury with complete knee dislocations. Hip dislocations can lead to osteonecrosis.TONY JABBOUR, MD

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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 SPRAINSDeltoid 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 DISLOCATIONSInferior 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 <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.

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ACL INJURIESStabilizes 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 DISLOCATIONSTraumatic 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 INJURIESBURN 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

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MUSCLE INJURIESMyositis 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.

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