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Emergency Med - Exam 2 > 16 - Lower Extremity Injuries > Flashcards

16 - Lower Extremity Injuries Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Hip fracture

A
  • ***27% mortality 1 year after a hip fracture
  • ***This increases rate of mortality THREE TIMES
  • Causes: fat embolism from break, pulmonary embolism, MI, stroke, narcotic pain killers, fall again, fuels “dementia fire”
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2
Q

Anatomy

A
  • LOTS of big vessels in the pelvis

- This means that a pelvic fracture can bleed out

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3
Q

Pelvic fractures – two types

A
  • Elderly patient/low energy (most common)

- Younger patient/high energy (most deadly)

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4
Q

Stable fractures

A
  • Single ramus
  • Single non displaced fx through pelvic ring
  • Chip off the pelvic rim
  • Usually no long term complications
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5
Q

Pubic ramus fractures

A
  • Usually elderly with ground level fall

- Pain management – Observe or home with pain meds

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6
Q

Unstable pelvic fractures

A
  • Life threatening
  • Nick a vessel
  • Bone bleed
  • Internal organ injury
  • High energy trauma (likely other injuries)
  • PE later on
  • 60% long term complications (urinary, pain, sexual complications, nerve damage)
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7
Q

Unstable pelvic fracture – MOI

A
  • MVC
  • Motorcycle
  • Fall (horse)
  • Pedestrian VS Car
  • Crush injuries
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8
Q

Emergency treatment

A
  • Rock pelvis – only once, you will feel it!
  • External fixation
  • Stabilize vitals
  • An unstable pelvic fracture NEEDS a surgeon, stabilize
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9
Q

Unstable fracture on roadside

A
  • Sheet/towel, anything used to stabilize

- You can save a life this way***

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10
Q

Hip fracture

A
  • 90% victims are people over 60
  • 300,000/year
  • Almost all get surgery
  • 1/4 die of complications
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11
Q

Hip fracture risk fractures

A
  • Age
  • Female
  • Osteoporosis
  • Medical conditions that increase fall risk
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12
Q

Complication of hip fracture

A
  • Pneumonia
  • DVTs/PEs
  • Bed sores
  • Infection
  • Nerve damage/bleed
  • Delirium
  • Death
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13
Q

Types of hip fracture

A
  • Subcapital neck fracture
  • Transcervical neck fracture
  • Intertrochanteric fracture
  • Subtrochanteric fracture
  • Fracture of great trochanter
  • Fracture of the lesser trochanter
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14
Q

Signs and symptoms of hip fracture KNOW THIS

A
  • ***Pain
  • ***Inability to ambulate
  • ***Shortened/externally rotated leg
  • ***Sometimes pain in knee (still need to get a hip x-ray to check)
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15
Q

Physical sign of hip fracture

A
  • The fractured hip is rotated way outward

- The normal hip is only slightly rotated outward

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16
Q

Imaging for hip fracture

A
  • X-ray usually enough – can get contra-lateral or pelvic X-ray to see other side
  • May need CT
17
Q

Femur fracture

A
  • Often significant force

- Can be significant blood loss

18
Q

When do you urgently reduce a fracture?

A
  • No pulse
  • No sensation
  • Pain not controlled
  • Tenting of skin
19
Q

Tibial plateau fracture

A
  • Older person ground level fall
  • OR young person with high energy or right mechanism (bumper to knee)
  • If stable, no displaced – immobilize. Otherwise ORIF
20
Q

Patella fracture

A
  • Not that difficult to break
  • 1% of fractures – not that common
  • 20-50 y/o
  • If non-displaced/stable walking cast
  • If displaced, ORIF
21
Q

Knee dislocation

A
  • Can happen in Anterior or Posterior or Lateral or Medial
  • Named for tibia location
  • High incidence nerve injury
  • 50% reduce prior to ER
22
Q

Maisonneuve fracture

A
  • Spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
  • There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament
23
Q

Compartment syndrome

A
  • Limb-threatening (rarely life threatening) condition where pressure of enclosed limb becomes so high causes ischemia, nerve damage and eventually tissue death
24
Q

Causes of compartment syndrome

A
  • Crush injuries
  • Envenomations
  • Fractures
  • Burns
  • Soft tissue trauma
25
Q

Signs and symptoms of compartment syndrome

A
  • Pain out of proportion
  • Numb/parenthesis
  • Pale/blue/cold
  • Decreased pulse
  • Tight compartment
26
Q

CASE STUDY 1

A
  • 14-year-old kid fell on knee last night off of skateboard, felt pain but walked
  • Leg is swollen, cold, no palpable pulses
  • Diagnosed with compartment syndrome of the lower extremity
  • X-ray showed tibial fracture – these fractures typically bleed, cause compartment syndrome
27
Q

CASE STUDY 2

A
  • Small rattlesnake was seen and bit her foot
  • Venemation: 25% are “dry” meaning that they were bit but no venom went in
  • First you get labs – PT, PTT, fibrinogen, EKG, CPK
  • If there is only a puncture wound and there are NO other symptoms, you can just watch them
  • Anti-venom: CroFab (no available everywhere, expensive takes a while to “swirl”)
  • Snake bites are another way to cause compartment syndrome
28
Q

CASE STUDY 3

A
  • Rolled ATV at low speed, no other injuries – Unable to bear weight, crawled over 1 mile
  • First things first – check vitals, do overall physical to check for other injuries
  • PMHx: thrown from horse 6 yrs ago and was in a coma for 1 month due to subdural hematoma
  • Left calf much firmer than the right, so do not send this patient home
  • In some injuries, the bone will stop bleeding, but you can’t bet on this

Emergency Med - Exam 2 (11 decks)

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