CCP 220 Orthopedic and Soft Tissue Injuries 🦴 Flashcards
the various complications of fractures
1) infection
2) hemorrhage
3) vascular injury
4) nerve injury
5) avascular necrosis
6) compartment syndrome
7) fat emboli
Jefferson fracture
boney fracture of the C1 vertebra
Hangman’s fracture
boney fracture of the C2 vertebra
TILE pelvic fracture staging
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- The Tile classification of pelvic fractures is the precursor of the more contemporary Young and Burgess classification of pelvic ring fractures.
- TILE takes into account stability, force direction, and pathoanatomy.
- The integrity of the posterior arch determines the grade, with the posterior arch referring to all of the pelvis posterior to the acetabulum.
- Stability is defined as the ‘ability of the pelvis to withstand physiologic force without deformation’ by the original author
- Tile “A” = Stable (posterior arch intact)
- Tile “B” = Partially stable (incomplete disruption of the posterior arch)
- Tile “C” = Unstable (complete disruption of the posterior arch)
cauda equina syndrome
Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, cutting off distal sensation and movement
potential complications of pelvic injuries
1) Major Hemorrhage
2) Urological injury
3) Neurological injury (cauda equina etc)
Pathophysiological pathway of compartment syndrome?
- High pressure in non-expanding space cuts off vascular blood supply
- progressive worsening acidosis and necrosis of structures
- Positive feedback loop whereby venous system compressed first, decrease drainage and increasing pressure
the 3 different mechanisms of compartment syndrome
- Increase contents (bleeding, hematoma)
- Decrease compartment size (fascia, cysts)
- External pressure (eschar, cast or splint too tight)
clinical diagnosis of compartment syndrome
“The five P’s”
Pain (out of proportion) Pallor Pulselessness Paresthesia Paralysis
complications arising from compartment syndrome
- rhabdomyolysis → Hyper-K + Renal Failure (Potassium + Myoglobin release)
- Infection
- Contractures (muscle tissue fibrosis → tissue shortening and hardening)
- Lactic acidosis (anaerobic tissue metabolism → lactic acid release)
crush syndrome versus compartment syndrome
crush injury - prolonged, continuous pressure on large muscles resulting in muscle disintegration → tissue destruction/rhabdo (can occur in non-traumatic patients as well; patients who have been immobilized for a long time, such as the “found down” patient)
compartment syndrome - condition in which a structure has been constricted within a space (such as d/t hematoma expansion in an isolated #)
pathway to death in crush injury
Hypovolemia (3rd spacing)
Hyper Kalemia (K+ release second to muscle tissue breakdown)
Dysrhythmias (hyper-K + progressive metabolic acidosis)
Types of necrotizing fasciitis
Type 1 - polymicrobial
Type 2 - mono microbial (typically due to group A streptococcus or staphylococci including methicillin-resistant strains/MRSA)
concerning XR finding in suspected necrotizing fasciitis
Free air in the tissue consistent with bacterial off gassing
Penetrating neck injury definition
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trauma to the neck that has breached the platysma muscle
3 zones of the neck
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1) Zone 1 - Clavicle to cricoid cartilage
2) Zone 2 - Cricoid to angle of mandible
3) Zone 3 - Angle of mandible to base of skull
Transverse fracture
straight across bone
Oblique fracture
- complete fractures that occur at a plane oblique to the long axis of the bone
- diagonal across bone
Comminuted fracture
- shattered fragments of bone
2. break or splinter of the bone into more than two fragments
Spiral fracture
- occurs when a long bone is broken by a twisting force
- also known as torsion fracture
- a type of complete fracture
- bone has been twisted apart
segmental fracture
- at least two fracture lines that together isolate a segment of bone
- floating section of broken bone
Young and Burgess classification of pelvic ring fractures
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- The Young and Burgess classification is a modification of the earlier Tile classification
- It is the recommended and most widely used classification system for pelvic ring fractures.
- It takes into account force type, severity, and direction, as well as injury instability.
- Three basic mechanistic descriptions are used, each with degrees of severity.
Anteroposterior compression
- APC I: stable
- APC II: rotationally unstable, vertically stable
- APC III: equates to a complete hemipelvis separation (but without vertical displacement); unstable
Lateral compression (Most common type)
- LC I: stable
- LC II: rotationally unstable, vertically stable
- LC III: unstable
- Vertical shear (Most severe and unstable type with a high association of visceral injuries.)
Soft tissue risk factors for wound infection (risk factors for infection with soft tissue injuries)
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- Immunocompromised (diabetic, chemotherapy, steroids, renal failure)
- Location of wound (less vascular areas are more prone to infection. shitty blood flow to bring in WBC’s to fight infection)
- Mechanism (blunt/crush are more susceptible for infections vs “clean” wounds like GSW or stab)
- inappropriate wound closure (not properly irrigated prior to closure)
what soft tissue wounds should receive prophylactic ABX
- cat bites
- grossly contaminated wounds
- through and through oral wounds
- human fight bites
- burns
- foot wounds/wounds in a less vascular area
- open fractures
- tendons and joints
Gustilo-Anderson classification system definition
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the most widely accepted classification system of open (or compound) fractures.
The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications.
Soft tissue injury is graded on a combination of:
- amount of energy dissipated
- extent of soft-tissue injury
- degree of contamination
Gustilo-Anderson grade 1
- clean wound <1 cm in length
Gustilo-Anderson grade 2
- wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions
Gustilo-Anderson grade 3
- extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture
- open fractures caused by farm injuries
- injuries requiring vascular intervention
- fractures that have been open for 8 hours prior to treatment
Gustilo-Anderson grade 3A
- adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage
Gustilo-Anderson grade 3B
- extensive soft-tissue loss, periosteal stripping and bone damage
- usually associated with massive contamination
- will often need further soft-tissue coverage procedure (e.g. free or rotational flap)
Gustilo-Anderson grade 3C
- associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury
