Acute and Complex Musculoskeletal Injuries

Question 1

What xrays would be ordered for a multi-trauma patient?

Answer 1

• Chest
• Abdo
• Pelvis
• Fractures - and joint above and below

Question 2

Which features of fractures denote orthopaedic emergencies?

Answer 2

• V - vascular compromise
• O - open fracture
• N - neurologic compromise/cauda equina
• C - compartment syndrome
• H - hip dislocation (or fracture in young person)
• O - osteomyelitis/septic arthritis
• P - unstable pelvic or long bone fractures (bleeding!)

Question 3

What warrants ORIF of a fracture?

Answer 3

NOCAST

• Non-union
• Open fracture
• NV Compromise
• Articular fracture
• Salter-Harris 3-5
• polyTrauma

Question 4

Roughly describe the Gustilo-Anderson classification of fractures

Answer 4

• I - Wound < 1 cm
• II - Wound > 1 cm
  
  • Both require 1st gen cephalosporin for 24 hours after closure
• III - comminution, periosteal stripping, arterial damage
  
  • 1 gen cephalosporin for 24 hours after closure
  • Aminoglycoside (gentamicin)
  • Penicillin if concern for anaerobes

Question 5

What are some of the early complications of fractures?

Answer 5

• Bleeding
• Infection
• Compartment syndrome
• Fat embolism (especially in long bone fractures)
• DVT/PE
• Wound issues
• NV compromise

Question 6

What are some of the late complications of fractures?

Answer 6

• Non-union
• Chronic osteomyelitis
• Wound breakdown
• AVN
• Mal-alignment