Acute MSK Injury Flashcards
1
Q
General eval of ortho trauma pt?
A
- initial w/u reqrs all initial stuff such as ABC eval and ATLS and then:
1) check Neurovascular status of extremity. Specifically check for all nerve distributions for motor and sensory in affected extremity
2) check for any breaks in skin which may represent open injury
3) check jt above and below area of injury for assoc injury
4) press on bony prominences of remainder of uninjured body to eval for unrealized injury
2
Q
When should an open fracture be considered?
A
- any injury overlying a fx bone should be considered possible open fracture but not all injuries overlying a fx bone are open fxs
- open fx: any break in skin in which there is direct communication w/ bone to outside world
3
Q
Considerations w/ open fracture?
A
1) enviro in which fx occurred (ex: clean gym vs rusty combine blade)
2) size of open injury, gross contamination in wound bed
3) assoc structures which are injured
4
Q
Open fx scale?
A
- graded on scale of severity from 1-3 by Gustillo and Anderson classification
- type 1: opening less than 1 cm in legnth
- type 2: b/t 1 cm and 10 cm in length
- type 3a: skin lac greater than 10 cm
- type 3b: greater than 10 cm w/ soft tissue loss and unclose able skin edges
- 3c: greater than 10 cm w/ vascular injury
5
Q
Most impt tx in open fx?
A
- inititiation of abx, the time to surgical debridement of these injuries has not been shown to be as impt a factor in preventing infection as early initiation of abx
- type 1 and some type 2 injuries can be safely delayed for upwards of 12 hrs w/o increasing risk of osteomyelitis
6
Q
Abx choice for open fx?
A
- check and make sure pt is up to date on tetanus prophylaxis. If they are over 10 yrs out then they should get tetanus ab as well as ag (in opp areas of body)
- abx choice determinate on open fx severity: type 1 =1st gen cep (ancef)
- type 2 and 3: ancef + gentamycin IV for gram - coverage
- all barn yard related injuries should also receive PCN G 2 mill units q 6 hrs for tetanus prone injury (concern for tetanoid toxin)
7
Q
What is compartment syndrome?
A
- condition where pressure builds up within a fascia enclosed compartment of body. The building pressure results in compression of many capillaries which service the muscles of that compartment. The possible cause of this is multi-factorial including bleeding, edema and infiltration
8
Q
Mechanism of compartment syndrome?
A
- increased pressure from blood and intracompartmental swelling leads to
- decreased venous drainage and decreased lymphatic drainage leads to
- intracompartmental pressure greater than perfusion pressure which then leads to
- muscle and nerve anoxia and then acidosis
- leads to muscle and nerve necrosis and then leaky basement membranes and transudation into tissue surrounding compartment and which again leads to increased pressure from blood and intracompartmental swelling
9
Q
MC areas for compartment syndrome?
A
- lower leg (4 compartments)
- forearm (4 compartments)
- followed by hand and foot regions
10
Q
How do you dx compartment syndrome?
A
- clinical dx, most sensitive test to check is pain w/ PROM of muscles w/in the compartment
- most sensitive clinical sign for compartment syndrome is pain out of proportion to injury
11
Q
5 P’s to eval perfusion?
A
- pain, pulse, pallor, paralysis, paresthesia
- not sensitive for dx of compartment syndrome, by time they are clinically present the damage from compartment syndrome has already been done
12
Q
Measruement of compartmental pressures?
A
- intracompartmental pressure measurements can be performed w/ hand held monometer
- if measured value is w/in 30 mmHg of pt’s diastolic pressure than compartment pressures are too high to allow for capillary perfusion
13
Q
General eval for splinting? Why do we splint?
A
- type of splint to apply for particular fx is dependent on where fx is on body
- reason we splint things is to allow for sufficient swelling to be able to occur. early casting doesn’t allow for soft tissue expansion which can elevate compartment pressures
14
Q
Splint for proximal humerus fx?
A
- coaptation
15
Q
Shoulder dislocation splint?
A
- sling/shoulder immobilizer
