casting procedures Flashcards
open fractures
high velocity trauma or missile like injury
spikes of bone pierce skin
must get surgical consult and intervention
salter harris classifications
I/S II/M III/E IV/ME V/R
I/S
slipped
complete physeal fracture w/or w/o displacement
II/M
above
physeal fracture that extends thru the metaphysis producing a chip fracture of metsaphysis which may be very small
most common
III/E
lower
a physeal fracture that extends thru epiphysis
IV/ME
thru
a physeal fracture plus epipphyseal and metaphyseal fractures
V/R
rammed and ruined
compression fracture of growth plate
why worry about salter numbers
higher the number worse the prognosis
more serious fractures can look benign
fracture reductions must be perfect
colles fracture
fracture of distal radial with dorsal displacement w/or w/o ulnar involvement
‘dinner fork’ deformity
falling on outstretched hand
assocation fracture of ulnar styloid process >60%
tri-malleolar fracture
lateral malleolus medial malleolus post tibia landing flat on the heal from height very unstable fracture surgery
early local complications of fractures
vascular injury -> hemorrhage visceral injury -> organ damage damage to surrounding tissue, blood vessels, nn, or skin hemarthrosis compartment syndrome wound infection
early systemic complications of fractures
fat embolism-long bone fractures shock thromboembolism exacerbation of underlying disease such as DM or CDA pneumonia
late local complications of fractures
delayed union nonunion mal-union joint stiffness contractures myositis ossificans avascular necoriss algodystrophy, RDS, or regional pain syndrome osteomyelitis growth disturbances/deformities
late systemic complications of fractures
gangrene, tetanus, septiciemia
fear of mobilizing
osteoarthritis
compartment syndrome
pressure inside facial compartment exceeds the blood pressure
causes compromise of circulation to soft tissue ischemia and necrosis
irreversible damage can occur in 8 hours
conditions associated with compartment syndrome
soft tissue injuries soft tissue injury w/fracture exercised induced crush injury prolonged tourniquet use electrical injury burns animal bites
Tx of compartment syndrome
fasciotomy
fracture blisters
tense vesicles or bullae that arise on markedly swollen skin directly over fracture
tibia, ankle, and elbow
arise in 6-48hrs
2 types: clear fluid filled, blood filled
caused by separation of dermis from epi
Tx of fracture blisters
benign neglect
debridement
aspiration
surgical dealy
grade I ankle sprain
mild pain and swelling
joint stiffness may be apparent w/p laxity
usually affected ant talofibular lig
min or no loss of fnx
can return to activity w/in a few days of injury
grade II ankle sprain
moderate-severe pain, swelling, and joint stiffness
partial tear of lat ligs
moderate loss of fnx w/difficulty on toe raises and walking
takes 2-3 months before full strength and stability return
grade III ankle sprain
severe pain initially followed by little or no pain d/t loss of nn fibers
swelling may be profuse with joint stiffness
complete rupture of ligs of lat complex
immobilization for weeks with crutches
managed conservatively with rehab, but some may need surgery
Tx of sprains
Rest Ice Compression Elevate may need to immobilize
benefits of splint
faster and cheaper then cast
can be adapted from surrounding material
not as likely to cause pressure problems
can be removed by pt
hazards of cast
compartment syndrome ischemia heat injury pressure scores and skin breakdown infection dermatitis joint stiffness neurological injury
materials for cast
adhesive tape bandage scissors basin of water casting gloves elastic bandage padding plaster sheets, underpads stockinetter
application of cast
-use appropriate amount and type of padding
-properly pad boney prominences and high pressure areas
-properly position extremity before, during, and after application of materials
-avoid tension and wrinkles on padding, plaster, and fiberglass
avoid excessive molding and indentations
factors that speed setting time
higher temp of water
fiberglass
reuse of dipping water
factors that slow setting time
cooler temp of dipping water
use of plaster
indications for Dx and therapeutic injections of soft tissue
bursitis tendonitis trigger points ganglion cysts neuroma entrapment syndromes fascitis
indications for Dx and therapeutic injections of joints
effusion crystalloid arthropathies synovitis inflammatory arthritis advanced osteoarthritis
absolute CIs of joint injections
local cellulits acute fracture tendinious sites at risk for rupture drug allergy septic arthritis
relative CIs of joint injections
mimimal relief after 2 attempts underlying coagulopathy/anticoagulation therapy uncontrolled DM surrounding joint osteoporosis anatomically inaccessible joint
