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othopaedics > complications of fractures and life threatening ortho emergencies > Flashcards

complications of fractures and life threatening ortho emergencies Flashcards

1
Q

5 early types of complications from fractures

A 
vascular
nerve
compartment syndrome
infection
fracture blisters
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2
Q

6 late complications from fractures

A
  • delayed/non-union
  • malunion
  • avascular necrosis
  • growth disturbance
  • stiffness, post-trauma OA
  • complex regional pain syndrome
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3
Q

general complications of fractures

A
  • fat embolism syndrome
  • DVT and PE
  • complications of immobility
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4
Q

pre-op fracture considerations

A
  • thrombophylaxis-DVT common so give LMWH
  • fat emoblism syndrome
  • hetertopic ossification
  • infection
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5
Q

fat embolism syndrome

  • symptoms
  • fracture
  • treatment
  • who most commonly
A

symptoms: hypoxia, confusion, petechiae, tachycardia
fracture: 24-72 hrs after a pelvic or femur fracture
treatment: given oxygen and early IM stabilisation
who: young men

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6
Q

heterotopic ossification

  • injury
  • treatment
  • onset
A
  • head injury, acetabular fractures, elbow surgery
  • give low dose indomethacin 25mg daily for 6 weeks or local radiation
  • develops 3-6 months after
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7
Q

what is heterotopic ossification

A

bone growing in soft tissue

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8
Q

main prophylactix antibiotic for surgery

A

cephalosporin

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9
Q

5 fractures that are watershed areas with risk of non-union

A
  • scaphoid
  • NOF femur
  • Jones of 5th metatarsal
  • head of humerus
  • talus
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10
Q

5 main orthopaedic life threatening complications

A 
open fractures
dysvascular limb 
compartment syndrome
nerve injury 
ortho infections
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11
Q

3 main ortho infections

A

septic arthritis
cellulitis
necrotising fasciitis

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12
Q

what is an open fracture definition

A

a direct communication between external environment and fracture with bone penetrating the skin

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13
Q

history for an open fracture

A
  • type of injury
  • force
  • environment
  • farmyard waste or immersion in water(contamination)
  • after injury
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14
Q

what classification is used for open fractures

A

gustilo classification

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15
Q

type 1 gustilo

A 
low energy
<1cm
simple fracture
minimal soft tissue 
minimal contamination
no NV injury
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16
Q

type 2 gustilo

A 
moderate energy
1-10cm
moderate communition 
moderate soft tissue
moderate contamination
no NV injury
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17
Q

Type 3a gustilo

A 
energy: high
>10cm
highly comminuted/seg
soft tissue requires local flap
extensive contamination
NO NV injury
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18
Q

Type 3b gustilo

A 
energy high
>10cm 
highly comminuted
soft tissue requires free flap
extensive contamination
NO NV injury
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19
Q

type 3c gustilo

A 
energy high
>10cm
highly comminuted
often requires free flap
contamination extensive
NV injury requires arterial repair
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20
Q

4 R’s for managing fracture

A

resuscitate
reduce
restrict
rehabilitate

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21
Q

what antibiotics should be given for open#

A

cefuroxime
clindamycin
gentamicin if heavy contamination

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22
Q

other consideration of infection risk for open#

A

tetany and anti-tetanus booster

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23
Q

what can be used to make a sterile saline dressing

A

poviclone iodine

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24
Q

surgical management of open#

A

-sequential operations
1. debridement and external fixation/ IM nailing
2.debridement and internal fixation if not done
depends on whether debriding can be done in 1st

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25
Q

what are dysvascular lumbs assoc too

A

high energy fracture after open#
sometimes
closed injuries eg knee dislocation and supracondylar # of humerus in children

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26
Q

what is the minimum systolic pressure needed to feel a peripheral pulse

A

80-90

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27
Q

management of dysvascular limb

A
  • resuscitate
  • realign with splint
  • reduce
  • restrict
  • closed reduction to improve circulation
  • vascular injury so use angiogram and temporary vascular shunt to perfuse limb
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28
Q

6p’s of critical ischaemia

A 
symptoms
-pain
-paraesthesia
-paralysis
signs
-pale
-pulseless
-perishingly cold
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29
Q

causes of critical ishceamia

A

-kink of major vessel in #
-disruption of vessel structure: lacerations/ transection/ dissection
-arterial spasm
-loss of blood
-thrombosis:blood in wall of artery
can be acute or delayed

30
Q

3 types of nerve injuries

A

neuropraxia
axonotemesis
neurotemesis

31
Q

what is neuropraxia

A

temporary
structure intact
need to remove pressure to relieve numbness
full recovery

32
Q

axonotemesis is and recovery

A

axon damaged but myelin sheath preserved

  • so distal axon needs to repair
  • scarred myelin sheath may prevent full recovery
33
Q

neurotemesis and recovery

A

complete nerve division
no myelin sheath to guide regeneration
irreversible without surgical repair
-no motor or sensory

34
Q

what takes place in axonotemesis and neurotemesis

A

Wallerian degeneration

35
Q

signs of nerve injury

A

paraesthesia
dyaesthesia
pain: still kink

36
Q

dermatome for

  • nipple
  • umbilicus
  • groin crease
  • radial side of hand
  • middle finger
  • ulna side of hand
  • foot dorsum
  • plant foot
  • back of knee and buttocks
A 
t4
t10
l1
c6
c7
c8
l5
s1
s3
37
Q

symptoms of a radial nerve palsy and what is it assoc too and what causes it

A

wrist drop
assoc. to numbness over the 1st web space
caused by humeral shaft#

38
Q

what area is affected in axillary nerve injury and what causes axillary nerve injury

A

regimental badge

shoulder dislocation

39
Q

anterior interosseous nerve median nerve injury symptoms and what cant they do

A

cant do an ok sign

-weakness of FPL and FDL

40
Q

what is at risk in a distal radius #

A

median nerve

41
Q

what is at risk in a posterior hip dislocation

A

sciatic nerve

42
Q

what is at risk in a knee dislocation

A

common peroneal nerve

43
Q

what is at risk in a# at the elbow

A

ulnar entrapment-cubital tunnel syndrome=

44
Q

what is the other type of ulnar injury

A

guyon’s canal nerve entrapment ulnar = motor and sensory

45
Q

what can cause upper limb nerve entrapment

A 
#
dm
alcohol
synovitis
pregnancy
myxoedema
46
Q

features of upper limb entrapment

A 
pain
paraesthesia
numbness
weakness 
swelling, soft tissue wasting
47
Q

what is compartment syndrome

A
  • increased pressure inside a fixed fascial compartment
  • result in reduced tissue perfusion
  • severe muscle pain from pressure and ischaemia
  • tissue becomes necrotic
48
Q

who is most likely to get compartment syndrome

A

young men with tibia fractures

or on a blood thinner get haematoma

49
Q

how does compartment syndrome happen

A

-injury
-tissue swelling
-increased compartment pressure
-decreased perfusion pressure
-local hypoxia
-cell membrane damage
-tissue swelling increased
=cycl

50
Q

what # is compartment syndrome usually seen with

A

-lower leg
forearm
crush injuries

51
Q

clinical signs of compartment syndrome

A
  • pain disproportionate to the injury and unresponsive to strong analgesia and resists movement
  • tightly swollen
  • paraesthesia
52
Q

important thing not to mix up in compartment syndrome

A

DISTAL PULSE DOES NOT MEAN NO COMPARTMENT SYNDROME- by this point things are v.bad and irreversible damage

53
Q

at what point do long term changes occur in compartment syndrome and when does it become irreversible

A

4-6

then 12 hours

54
Q

management of compartment syndrome

A

-split cast down to skin
-limb to heart level
-compartment monitors
-decompressive fasciotomy full length
then left open

55
Q

what pressure is indicative for fasciotomy incision

A

30-40mmHg

56
Q

4 main types of bone infections

A

cellulitis: infection of skin and subcutaneous fat
abscess: pus
septic arthritis: in joint
prosthetic: related to joint

57
Q

risk factors for cellulitis

A

immunodeficient

chronic venous insufficiency

58
Q

differentials for septic arthritis

A 
GRASP
gout
reactive
autoimmune
septic
pseudo-gout
59
Q

mortality % for septic arthritis

A

10%

60
Q

what is the most common spread pattern for septic arthritis

A

haematogenous spread

61
Q

clinical features of septic arthritis

A
  • acute monoarthritis and fever
  • swollen, hot and red joint
  • pain at rest/moving
  • throbbing, aching
  • usually lower limbs knee and hip
62
Q

most likely cause of septic arthritis

A

s.aureus

63
Q

other cause of septic arthritis

A
  • disseminated gonococcal infection from untreated gonorrhoea in young 10%
  • elderly and IV gram negative bacilli or group bc and g strep
  • haem influenzae in babies
  • pseudomonas aeruginosa in iv drug user
  • fungal in immunocompromised
64
Q

risk factors for septic arthritis

A

dm
immunosuppression
prosthetic joint

65
Q

medication for septic arthritis

A

diuretics
aspirin or anticoagulants
immunosuppressants

66
Q

SIRS stands for and 4 def

A 
systemic inflammatory response syndrome
temp>38
HR>90
resp>20
wbcc>12
67
Q

empirical iv antibiotic for septic arthritis

A

flucoxacillin

68
Q

what must be done before giving antibiotics for septic arthritis

A

joint aspiration

69
Q

what is necrotising fasciitis

A
  • cellulitis and severe systemic infection and inflammatory response
  • soft tissue destruction
70
Q

pathogens of nf

A
  • strep
  • staph
  • clostridia gas gangrene
  • e.coli
71
Q

3 measurements for nf

A

> 150 crp
wbc >15
creatinine and lactate rise

72
Q

management of nf

A 
sepsis 6
-give o2
-take blood culture
-iv antibiotics
-fluid challenge
-measure lactate
-measure urine output 
=radical surgical debridement strip off the skin

othopaedics (21 decks)

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