EM Ortho 4: Generalities, part 4 (LE) Flashcards
Reference: Tintinalli Emergency Medicine A Comprehensive Guide, 9th ed
uses of a knee immobilizer
fracture of the lateral or medial tibial plateau
fracture of the patella
meniscal injuries (provided the knee is not locked in partial flexion)
ligamentous strains or tears
uses for posterior ankle mold
fractures or severe sprains of the ankle
remarks on preparing posterior ankle mold
ankle should be maintained in a position as close as possible to neutral dorsiflexion - that is, at 90 degrees to the leg
- this may facilitate regaining range of motion after the dressing is removed
exception to the 90-degree principle in posterior ankle mold
immobilizaton for rupture of the Achilles tendon
- patients with this injury should be immobilized in plantar flexion to reduce tension on the tendon
uses for ankle stirrup
ankle sprains
minor lateral malleolus fractures
remarks on ankle sitrrup
unlike the posterior mold, this device is intended for use in conjunction with weight bearing
it limits inversion more effectively than taping but allows normal plantarflexion and dorsiflexion –>
> less swelling and edema,
> less joint stiffness,
> faster return to comfortable ambulation
uses for hard-soled shoe
intended to allow weight bearing by patients with toe fractures or certain types of metatarsal fractures
the firm sole prevents the toes from bending and provides support for the forefoot
although immobilization dressings may be warranted for some metatarsal fractures fractures, the hard-soled shoe is an accepted treatment modality for
- fracture of the 2nd, 3rd, 4th, or proximal 5th metatarsal
remarks on pneumatic walking brace
provides firm support about the foot, ankle, and lower leg
high-top walker
- moderate to severe ankle sprainis
- stable fractures of the foot or ankle
short-top walkers
- phalangeal or stable metatarsal fractures
ADV: added compression and better conformity and immobilization
remarks on axillary crutch
height is one hand width below the axilla
grip bar should be adjusted to a height at which the elbows are mildly flexed while supporting the body weight
bear the pressure of the pads against the sides of the thorax rather than in the axillae
how to use a cane?
hold the cane in the hand on the well side
- less strength required to maintain balance
- less awkward gait
advance the cane (held on the well side) and the injured extremity simultaneously, and then advance the noninjured extremity to meet them
discharge instructions for orthopedic patients
- elevate injured part above the level of the heart
- for those with LE plaster dressing, don’t rest the heel on the floor, as plaster takes about 24 hours to fully set
-
monitor fingers / toes for
- excessive swelling
- decreased sensation
- cyanosis
- significant increase in pain - proper instruction for use of crutches, cane, walker
expected blood loss in relation to fracture location
Radius and ulna: 150-250 mL
Humerus: 250 mL
Tibia and fibula: 500 mL
femur: 1,000 mL
Pelvis: 1,500 - 3,00 mL
spectrum of neurologic deficit
neuropraxia
axonotmesis
neurotmesis
normal two-point discrimination at the fingertips
4-6 mm
remarks on tibiofemoral dislocation
patients who experience tibiofemoral dislocation often undergo routine postreduction angiography to verify the integrity and patency of the popliteal vessels, regardless of whether a circulatory deficit has been observed clinically
