APPROACH TO FRACTURES Flashcards
DOCUMENTATION
General Approach:
Life
Limb
Injury
Things to ask:
Trauma: Forces Involved, “How hard was the impact”
Mechanism: “Recreate the scene - How did the injury happen”
Events after the Injury: “What happened after – continues playing vs. stop activity”
Age: extremes of age
PMHx
Medications
Previous Injuries
Vocation / Recreation
Hand Dominance
Look for:
Address Life, Limb, Wound
Inspect:
Circumferentially – check for “open”
Compare to opposite side
Palpation:
Neurovascular exam of every compartment
Exam joints above and below
Thoroughly feel the entire bone to r/o multiple injuries Point of maximal tenderness
ROM:
Joint or limb prior to the XRAY
Neurological Exam of Upper Limb:
RADIAL:
Motor - Wrist / finger extension
Sensory - Dorsal thumb / first finger web space
ULNAR:
Motor - Flexor carpi ulnaris intrinsic hand muscles
Sensory - Fifth digit
MEDIAN:
Motor - Forearm/most wrist flexors/flexion and opposition of thumb
Sensory - Palmar thumb, first and second fingers
ANTERIOR INTEROSSEOUS (OFF MEDIAN):
Motor - Distal phalanx flexion (thumb and first finger)
AXILLARY:
Motor - Abduction of shoulder
Sensory - Lateral upper arm “regimental patch”
XRAY:
Order proper series
Order 2 views (min)
CT if unclear
DDx: Normal XRAY:
SCARED OF
Septic
Compartment Syndrome
Abuse
Referred Pain / Report is False
Dislocated / Subluxation
Operative Soft Tissue Injury
Fracture
FRACTURE DISCRIPTION
Open or closed
Location: proximal, middle, distal thirds
Fracture Pattern: Transverse, Oblique, Spiral, Comminuted; Angulation
Dislocation / Subluxation: direction of dislocation, distal anatomy relative to proximal
Displacement: degree of displacement, distal anatomy relative to proximal
Angulation: Deviation from the mid like, volar vs. dorsal, distal relative to proximal
Elements of a Bad Fracture;
Comminuted
Intra Articular
Shifted
Oblique / Spiral
Emergent Referal to Ortho
High Energy Pelvic # (hemorrhage)
Vascular Compromise
Compartment Syndrome
Infection
Septic Joint (if not in shock)
Necrotizing Fasciitis
Significant open #
Displaced fracture with neuro deficit
Particular fractures / dislocations
Urgent Referral to Ortho
Minor open fractures
Operative fractures
Septic Joint (clinically well)
