CA ortho injuries Flashcards
what are the 2 most commonly injured blood vessels?
femoral and popliteal
what are the 2 most common causes of penetrating trauma?
gunshot wounds and stab wounds
which type of penetrating trauma (gunshot vs. stab) involves a larger extent of tissue damage, with a wide range of pattern of injury?
gunshot wounds
stab wounds are most straightforward with a predictable pattern of injury
what are 5 signs of vascular injury in your trauma patient?
1) diminished distal pulses
2) expanding/pulsatile hematoma
3) audible bruit
4) palpable thrill
5) distal ischemia (pain/pallor/paralysis/paresthesias, coolness)
what should you do in the following circumstances:
1) believe vascular injury is DEFINITE
2) highly suspect vascular injury
3) no sign of vascular injury
definite = immediate vascular surgery consult
suspect = CT angiography
no signs = ABI to reassure
what lab must you draw prior to performing CT angiography with contrast?
creatinine
what lab should you order if there is significant blood loss associated with the trauma?
CBC
which type of dislocations spontaneously reduce when you straighten the leg?
patellar dislocations
a PARTIAL disruption of a joint is also known as what?
subluxation
____ is a tearing injury to the muscle fibers, while ____ is a tearing injury to the ligaments of a joint
strain = muscle
sprain = ligaments
what are the 4 orthopedic emergencies?
1) open fracture
2) subluxation or dislocation
3) neurovascular injury
4) compartment syndrome
unilateral swelling and discoloration in the leg, pain out of proportion from injury, and unilateral decreased pulses should make you think what?
compartment syndrome
since some injuries may not be radiographically evident on the first day, what testing should we consider?
CT or MRI to allow earlier dx
when imaging your injured patient, what must you be sure to do?
image joints above and below
which part of the bone, if fractured, is impossible to see on x-ray?
cartilage breaks
bilateral compression of the shoulders leads to what type of injury?
anterior or posterior sternoclavicular dislocation
direct blow to the medial clavicle leads to what type of injury?
posterior sternoclavicular dislocation
fall, landing on apex of shoulder leads to what type of injury?
AC separation
direct blow to anterior shoulder, FOOSH, seizure, or electroconvulsive muscular activity lead to what type of injury?
posterior dislocation of shoulder
sudden traction force to toddler’s arm leads to what type of injury?
nursemaids elbow (subluxed radial head)
forced dorsiflexion of the wrist leads to what types of injury? (4)
1) fracture of scaphoid
2) lunate dislocation
3) perilunar dislocation
4) colles fracture
striking the knee against the dashboard in a high-speed collision leads to what type of injury?
posterior dislocation of the hip
landing flat on your feet from height leads to what type of injury? (4)
1) calcaneus fracture
2) tibial plateau fracture
3) acetabular fracture
4) vertebral compression fracture (MC lumbar)
ankle inversion force leads to what type of injury? (2)
1) fracture of any of the three malleoli
2) fracture of base of 5th metatarsal
rotary ankle force leads to what type of injury? (2)
1) fracture of any three maleoli
2) disruption of ATF ligament with proximal fibular fracture (maissoneuve’s injury)
how is midfoot dislocation (lisfranc’s injury) typically caused?
inversion or medial or lateral stress to the forefoot; axial load on the metatarsal heads with the ankle plantarflexed
what is pathognomonic for fracture?
gross deformity
why should the area you palpate extend well beyond the location of the pain the patient complains of?
pain is very often referred
what are the four things we can do in the ED prior to ortho consult in our ortho trauma patient?
1) control pain and swelling (drugs, elevate above heart)
2) withhold oral intake if surgery
3) reduce fracture deformity
4) reduce dislocation
why do we reduce fracture deformities? (4)
1) alleviate pain
2) relieve tension on nerves or vessels
3) minimize possibility of converting closed FX into open FX
4) restore circulation if pulseless
what must you be sure to do prior and after dislocation reductions?
check neurovascular supply and get pre and post-reduction x-rays
when do we splint? (2 occasions)
fractures and after reduction of dislocated joint
a shoulder immobilizer is appropriate for which 4 conditions?
1) clavicle fracture
2) AC separation
3) shoulder dislocation
4) humeral neck fracture
an arm sling is appropriate for which condition? (1)
non-displaced radial head fracture
a long-arm gutter splint is appropriate for which 2 conditions?
1) elbow fracture
2) elbow dislocation
a sugar-tong splint is appropriate for which 2 conditions?
1) write FX
2) forearm FX
a short-arm gutter splint is appropriate for which 2 conditions?
1) metacarpal FX
2) proximal phalanx FX
a thumb spica splint is appropriate for which 3 conditions?
1) scaphoid FX
2) thumb FX (metacarpal or proximal thumb phalanx)
a knee immobilizer is appropriate for which 4 conditions?
1) patellar FX or subluxation
2) knee dislocation
3) tibial plateau fracture
4) knee ligament or meniscus injury/tear
a posterior ankle mold splint is appropriate for which 4 conditions?
1) ankle dislocation or fracture
2) unstable ankle fracture (ie high fibular fx or medial and/or posterior malleolar)
3) widened medial mortise
4) metatarsal FX
an ankle stirrup is indicated for which 2 conditions?
1) simple ankle sprain
2) stable lateral malleolar FX
a hard-soled shoe is indicated for which conditions?
toe fracture, some metatarsal fractures
a short leg walking boot is indicated for which types of conditions?
some toe or foot fractures where weightbearing is allowed
what is a fat embolus?
delayed complication of extremity injury; fat embolus usually originating in marrow of FX of large bone can result in fatal respiratory failure
what is malunion?
when an injury heals with a deformity
