Transcript What is a Fracture?

Sports conditions,injuries and
prevention
Kate Logan & Claire Prenter
Final year physio students
Sports Injuries and Conditions:
• Commonly encountered sports injuries and conditions
include:
• Fractures
• Concussion
• Bleeding
• Joint injuries
• Soft tissue injuries
– Muscle injuries
– Tendon and ligament injuries
• Skin damage
• Dehydration
• Hyperthermia (heat stroke) and hypothermia
Who has had a
fracture?.....
What is a Fracture?
• A fracture is a break in the continuity of a
bone or a loss of continuity in the substance
of a bone
Clinical signs of a fracture
• A deformity that can be seen or felt
• Pain on stressing the limb
• Abnormal movt in a limb due to movt at # site
• Crepitus or grating between bone ends
• Impaired function
• Swelling at the fracture site
• Tenderness at # site
Fractures
Causes of fractures
• Direct trauma
– caused by external forces which exceed the
strength of the bone.
– direct violence e.g. RTA, a blow
or
• Indirect trauma
– Fracture results from twisting or rotational
forces being applied to the bone
– e.g football studs planted, rotation force
applied to the limb resulting in spiral # of
the tibia
or
• Pathological fracture
– bone is already weakened or diseased
– fracture because the bone’s internal structure is
weakened
• Stress fracture
– Caused by repeated excessive loading of a bone, the
cumulative forces result in a break
Types of fracture:
• Classified by skin damage
• Or shape of fracture
• Or displacement
Classified by skin damage:
• Open: skin’s broken either by external force or
internal one
• Closed: simple fracture
Fractures
Fractures
Classified by shape
• Shape of the fracture
– Transverse or Horizontal
– Oblique / Spiral
– Comminuted (many small parts)
– Crush
– Greenstick • children, bend in immature bone with a break
in cortices
Eg transverse fracture of tibia and
oblique fracture of tibia:
Classification by displacement:
– Undisplaced
– Displaced
– Impacted
– Stable
Comminuted displaced fracture of a
femur
Stable undisplaced fracture of a radius:
Stages of fracture healing:
• Stage 1: Haematoma (0–2 wks)
• Stage 2: Cellular proliferation (2-6 wks)
• Stage 3: Callus formation
• Stage 4: Consolidation stage (6-12 wks)
Ossification occurs 12 -26 wk callus matures
• Stage 5: Stage of remodelling (1-2 yrs)
Why do physios treat fractures?
• Aim to restore the patient to optimal functional state
• Prevent fracture and soft-tissue complications
• Get the fracture to heal, and in a position which will
produce optimal functional recovery
• Rehabilitate the patient as early as possible
Who has had
concussion?
Sports Concussion:
• Head injuries in sport are common in all
contact sports, the vast majority are minor
• Common sports for these are:
– football
– Boxing
– Gymnastics
– Horse riding
– Martial arts
...impact from camogie stick
Causes:
• Direct blow to head, face, neck, or elsewhere
on the body with force transmitted to the
head
• Typically results in rapid onset of short-lived
impairment of neurological function that
resolves spontaneously
• May or may not involve loss of consciousness
Symptoms:
•
•
•
•
•
•
•
Headache
dizziness
Unsteadiness
Feeling stunned or dazed
Seeing stars or flashing lights
Tinnitus
Double vision
•
•
•
•
•
•
Sleepiness, sleep disturbance,
Poor concentration
Nausea/vomiting
Slurred speech
Personality change
Impaired playing ability
Which 2 sports have the highest
incidence of concussion?
1. Professional horse jumping jockeys
2. Australian footballers
Physio role?
• Remove player from field of play!
• Exclude the presence of serious head injury or
spinal injury
• If athlete’s unconscious assume presence of
head injury and spinal injury and manage
accordingly – hospital...for assessment and
observation...
Bleeding
• Open and closed wounds
– Incised: a cut from a sharp edge
– Laceration: rough tear or crush to the skin
– Abrasion: graze or superficial wound from a
rough surface
– Contusion: bruise or internal bleeding
– Puncture: an object entering the body
– Velocity injury: a puncture wound at
velocity will cause extensive damage, there
may be an entry and exit wound
Physio role:
• From first aid perspective, dress wound to
maintain sterile state and remove to hospital
for treatment if required
• Sports medic on pitch side can stitch wounds
as required
Joint Injuries:
Joint injuries:
• High energy impact
• Damage to:
– Menisci
– Ligaments
– Joint capsule
– Bony structures
• Knee “big three”
– Anterior cruciate ligament (ACL), medial
meniscus, medial collateral ligament (MCL)
– Traumatic knee, shoulder, elbow, wrist,
ankle injuries eg dislocations
What are the Soft Tissues?
•
•
•
•
Muscles & Tendons
Ligaments, Joint Capsules, Bursa
Cartilage
Nervous Tissue
Types of soft tissue injuries
• TRAUMATIC:
• Specific cause is identified
• Cause of injury easily identified
• OVERUSE:
• Develop slowly not attributed to one incident
• Specific injuries assoc with a particular sport
Injury Classification
• ACUTE: rapid onset, traumatic event with
a clearly identifiable cause.
• CHRONIC: slow insidious onset,
gradual development of structural
damage.
• SUB-ACUTE: period between acute and
chronic, usually 4-6 weeks post-injury.
Causes of Soft Tissue Injuries
• Intrinsic causes of injury
–factors within the sports person
• Extrinsic causes of injury
–factors outside the sports person
Muscle Injuries
• Muscle strain= tear in muscle fibres beyond its
limit
• Causes: (i) forceful contraction of the muscle
(ii) Overstretching the muscle
Muscle Injuries
• Classification of muscle strains
Grade
Extent of damage
Grade 1 5% or less muscle
Symptoms
Minimal pain
fibres
Grade 2 5% - 99%
Some muscle fibres
still present
Grade 3 Complete rupture
Moderate / severe
pain on contraction
Limited ROM
No contraction
Less pain / no pain
Muscle Injuries
Assessing a Muscle strain:
1. PAIN on mvt / resistance
2. PAIN on contraction
3. PAIN on palpation
Muscle most susceptible to injury?
Rectus femoris (quad)
Hamstrings
Gastrocnemius (calf)
Tendon Injuries
• Tendon properties:
– Connects muscle to bone
– Low blood supply
• Tendonitis –inflammation???
• Tendinopathy – Degeneration of tendon
• Healing tendon:
–
–
–
–
HEAT (increase blood supply)
DTFM
Strengthen
Stretch
Ligament Injuries
• Ligament Properties:
– Connects bone to bone
Grade 1 –minimal swelling, bruising, pain
Grade 2 – Moderate to severe swelling, bruising,
pain
Grade 3 – A lot of swelling, agony, may or may not
bruise
Management of soft tissue injuries
• Acute Injury
• PRICE:
– Protect
– Rest
– Ice
– Compression
– Elevation
Icing
• Limits Inflammatory process
• First 48-72 hours
• Methods: - Crushed ice in a towel, frozen veg, Ice
bath, Chemical ice packs (pitch-side), Freeze spray /
cryogel
• Application:
- 10 mins every 2 hours
• Dangers of leaving ice on too long
- Ice burn
- Never damage
- Increase in blood flow
The aims of early management
The management of STI in the first 72 hours:
•
•
•
•
•
•
•
•
to reduce pain
to reduce local tissue temperature
to limit and reduce inflammatory fluid
to reduce metabolic demands of the tissues
to protect the damaged tissue from further injury
to protect the newly-formed fibrin bonds from disruption
to promote collagen fibre growth and realignment
to maintain general levels of cardio-respiratory and
musculoskeletal fitness / activity
Management of medical problems
• HYPOTHERMIA
• ‘Hypo’ = Below / under
-
‘Thermia’= heat
Condition in which a person’s body temperature is sufficiently
below normal to cause distress and disorder of normal bodily
functions.
– Mental deterioration
– Loss of coordination
– Unconsciousness
– Failure of breathing and circulation
– Death
Hypothermia
• Causes:
-
Cold
Wind
Wet clothing
Perspiration
Water immersion
• Stages:
Peripheral (core 37-36)
Moderate (core 34)
Severe (core 32 or lower)
Hypothermia
• Signs / Symptoms:
-Tiredness / exhaustion
- Shivering
- White / purplish appearance
(bluish tinge to lips / fingers)
- Clumsiness / falling/ tumbling
- Weak grip and slowness in muscle contraction
- Cold rigid arms and legs
- Poor concentration, loss of interest, lethargy
- Slurred speech
Hypothermia
• Treatment:
• Removal from cold, wet, windy conditions
(shelter)
• Insulation to prevent further heat loss
• Passive or active re-warming
• Gentle and minimal handling
• Provision of nutritional and fluid support
• Transport to medical facility
Hypothermia
• Hypothermia hits stumbling Lebanese
Gloucester
30th Oct 2000
New Zealand Vs
Lebanon
Rugby League
Group2
Hyperthermia
• Hypertherma = overheating of body
• Hyper = ‘ high’, therma = ‘heat’
• Body can not effectively regulate excess heat /
elevated temperatures
• Temperature > 37.5–39.9 °C
• Causes:
– Exposure to excessive heat
– Exposure to high humidity
– High physical exertion
– Dehydration
Hyperthermia
• Signs and Symptoms
- Hot, dry skin
- Dizziness / Fainting
- Nausea / Vomiting
- Headaches
- Gastrointestinal problems e.g. Diarrhoea
- Multi-organ dysfunction
Treatment:
- Cool / tepid water immersion
- Rehydration
- Sponging head, neck, trunk with cold water
- Sit in shade
Dehydration
• Fluid Loss exceeds Fluid Intake
• Causes:
- Excessive Sweating
- insufficient fluid intake
- Hot & humid conditions
- High intensity exercise
Dehydration
• Consequences:
– Increase in perceived effort
– Reduced performance
– Impaired reaction times, judgement,
concentration and decision-making
• Electrolyte Drinks
- Sodium (speeds fluid absorption)
- Carbohydrate (provides fuel)
- Small amounts frequently (500-800ml/Hr)
Quick overview of........
•
•
•
•
•
Fractures
Concussion
Bleeding
Joint injuries
Soft tissue injuries
– Muscle injuries
– Tendon and ligament injuries
• Skin damage
• Dehydration
• Hyperthermia (heat stroke) and hypothermia
Questions: