Medications, imaging, and fractures

Imaging

X-ray (radiography)

• Best for: Bones, fractures, joint alignment, lung conditions
• How it works: Uses ionizing radiation to create images of dense structures
• Common uses:
  • Fractures & dislocations
  • Arthritis
  • Lung infections (e.g., pneumonia)
  • Foreign objects
• Limitations: Limited soft tissue visibility, radiation exposure
• Interpreting an X-Ray
  • High-density tissue (e.g., bone) – absorbs x-rays to a greater degree, and appears white on the film. Low-density tissue (e.g., the lungs) –absorbs X-rays to a lesser degree, and appears black on the film
  • Intermediate density tissue (e.g., muscle and fat) – appears as shades of grey on the x-ray film

Computed tomography (CT Scan)

• Best for: Bones, soft tissues, internal bleeding, internal organs, and the brain.
• How it works: Combines multiple X-rays to create cross-sectional images
• Common uses:
  • Bone fractures and complex injuries
  • Internal bleeding (trauma)
  • Stroke
  • Tumors
  • Lung and abdominal conditions
• Limitations: Higher radiation exposure than X-rays
• Interpreting CT scan
  • Dense structures (like bone and calcifications) appear lighter (white).
  • Lucent structures (like air and fat) appear darker (black).

Magnetic resonance imaging (MRI)

• Best for: Soft tissues, brain, muscles, ligaments, and nerves
• How it works: Uses strong magnets and radio waves to generate detailed images
• Common uses:
  • Ligament and tendon injuries
  • Brain and spinal cord conditions
  • Tumors
  • Disc herniations
• Limitations: Expensive, time-consuming, cannot be used with metal implants
• Interpreting MRI
  • T1 MRI highlights anatomy, provides crisp images, and shows fluids as dark
  • T2 MRI focuses on pathology, making fluids bright, which is ideal for visualizing inflammation, edema

Ultrasound

• Best for: Soft tissues, pregnancy, blood flow
• How it works: Uses high-frequency sound waves to create real-time images.
• Common uses:
  • Pregnancy monitoring
  • Soft tissue injuries (e.g., muscle tears)
  • Blood clots (Doppler ultrasound)
  • Organ imaging (e.g., liver, kidneys)
• Limitations: Poor image quality for bones and deep structures

Nuclear medicine imaging (e.g., PET Scan, Bone Scan)

• Best for: Organ function, cancer detection, metabolic activity
• How it works: Uses radioactive tracers to highlight metabolic activity
• Common uses:
  • Cancer detection (PET scan)
  • Bone metastases (Bone scan)
  • Stress fracture/microfracture (Bone scan)
  • Thyroid and kidney function
• Limitations: Radiation exposure, high cost

Fluoroscopy

• Best for: Real-time imaging of movement (e.g., swallowing, joint motion)
• How it works: Continuous X-ray imaging allows real-time assessment
• Common uses:
  • Barium swallow for digestive tract
  • Cardiac catheterization
  • Joint injections
• Limitations: Higher radiation exposure than standard X-rays

Medications

• Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Mechanism of Action: Decrease inflammation, fever, and pain
  • System Interactions:

    • Cardiac: High blood pressure (hypertension)

    • Circulatory: increases bleeding risk

    • Gastrointestinal: Indigestion, diarrhea, vomiting, GI ulcers, GERD

    • Neuro: Dizziness, headache

• Opioids

  • Mechanism of Action: Decreases pain in the musculoskeletal system
  • System Interactions:
    • Cardiac: Decrease heart rate, arrhythmia
    • Pulmonary: Decrease respiration rate
    • Gastrointestinal: Delayed gastric emptying (causes constipation)
    • Musculoskeletal: Muscle rigidity, muscle jerks
    • Integumentary: Itchy skin
    • General: Dry mouth, addiction

• Corticosteroids

  • Mechanism of Action: Decrease inflammation in the musculoskeletal system
  • System Interactions:
    • Cardiac: High blood pressure (hypertension)
    • Gastrointestinal: Indigestion, diarrhea
    • Musculoskeletal: Osteoporosis (high risk for fractures if taken for a long period of time)
    • General: Weight gain, diabetes
    • Integumentary: Acne

• Baclofen

  • Mechanism of action: decrease spasticity
  • Systems interactions
    • Musculoskeletal: muscle stiffness, abnormal posturing, bone/joint stiffness/pain, muscle weakness

• Muscle relaxants

  • Mechanism of action: acting on the central nervous system (CNS) to interfere with the transmission of nerve impulses to muscles, effectively reducing muscle spasms and tension by depressing neuronal activity
  • Systems interactions
    • Neuro: drowsiness, fatigue, dizziness, headache
    • Musculoskeletal: weakness
    • Gastrointestinal: nausea, constipation
    • General: dry mouth, blurred vision

Fractures

Types of fractures

• Open (compound): The bone breaks through the skin, exposing it to the environment
• Closed (simple): The bone breaks but does not penetrate the skin.
• Transverse: A straight break across the bone
• Oblique: A diagonal break at an angle to the bone
• Spiral: A twisting break that spirals around the bone
• Greenstick: A partial break that occurs in children’s flexible bones
• Comminuted: The bone breaks into multiple fragments
• Stress fracture: A small, hairline crack caused by repetitive stress
• Impacted fracture: The broken ends of the bone are driven into each other
• Avulsion fracture: A small piece of bone is pulled away by a tendon or ligament

Salter-Harris fracture

Salter-Harris fractures are classified into five types based on the location and extent of the fracture:

• Type I: Separation of the epiphysis from the metaphysis through the growth plate
• Type II: Fracture extends from the growth plate into the metaphysis
• Type III: Fracture extends from the growth plate into the epiphysis
• Type IV: Fracture extends from the growth plate through both the epiphysis and metaphysis
• Type V: Crush injury of the growth plate