fractures

Question 1

TYPES OF FRACTURES (the occult fractures)

Answer 1

OCCULT: Stress and Navicular Fx’s don’t show up right away.***
PATHOLOGIC: Occur without trauma (Ca, Osteoporosis, steroids)

Question 2

COMMINUTED: (dont need to memorize)

Answer 2

COMMINUTED: > than 2 bone fragments, severe trauma

Question 3

COMPRESSED (dont need to memorize)

Answer 3

Vertebrae

Question 4

GREENSTICK (dont need to memorize)

Answer 4

Kids, bendable bone doesn’t break all the way

Question 5

avulsion (dont need to memorize)

Answer 5

Fragment of bone tears off at the tendon insertion site

Question 6

depression (dont need to memorize)

Answer 6

Blunt trauma to flat bone (Skull)

Question 7

impacted (dont need to memorize)

Answer 7

Jammed into each other

Question 8

ASSESSEMENT FOR FRACTURES

Answer 8

History: mechanism, force, and pattern of injury c/w causing a fracture.

Exam: Point tenderness, Deformity, Swelling, Discoloration, Ecchymosis, Open wounds

most important***5 P’s: Pulses, Pallor, Pain, Parasthesias, paralysis

Diagnostic Tests: X-rays, CT scans, MRI’s

Question 9

COMPLICATIONS OF FRACTURES

Answer 9

INFECTION

COMPARTMENT SYNDROME

DVT (DEEP VENOUS THROMBOSIS)

FAT EMBOLISM

Question 10

FAT EMBOLISM

Answer 10

Fat may be released from the bone marrow with a fracture.
Fat globules enter the circulation and lodge in tissues (lungs, brain, heart, kidneys, skin).

Question 11

COMPARTMENT SYNDROME

Answer 11

Normally there is edema with a fx
Increasing edema can cause tissue ischemia
Muscle and nerve cells are destroyed
Delayed dx and tx can result in irreversible muscle and nerve damage.

Question 12

SYMPTOMS Of COMPARTMENT SYNDROME

Answer 12

Throbbing pain, out of proportion to injury, not relieved by analgesia (consider ordered analgesia may not be adequate)
Inability to extend or passively stretch the digits
Firmness over compartment, numbness, tingling
Pallor, coolness, diminished or absent pulses may be present

Question 13

TREATMENT of COMPARTMENT SYNDROME (the compartment is a fascist)

Answer 13

PROMPT DIAGNOSIS IS CRITICAL
Can check tissue pressure with Stryker (usually don’t use a stryker)
Prepare for Fasciotomy

Question 14

COMPARTMENT SYNDROME - FASCIOTOMY

Answer 14

Releases pressure

Question 15

ROUTINE PLASTER CAST CARE

Answer 15

Plaster casts give a better molding than other casts
1 -3 days to dry
While wet use palms of the hands to avoid making indentations

Report:
Increasing pain, or severe pain
Excessive swelling of extremity
Blueness or whiteness of toes or fingers
Burning or tingling of extremity
Sores or foul odor under the cast
Do not stick foreign objects inside the cast to scratch
Avoid crumbs falling inside the cast

Question 16

FIBERGLASS CASTS

Answer 16

Dries within a few hours
Weight bearing within a few hours
Can be made waterproof
Fiberglass does not mold as well as plaster

Question 17

NAVICULAR FX’S

Answer 17

ETIOL: Common Fx (scaphoid/navicular)

Fresh fx’s don’t show up well on X-rays
Usually from FOOSH: Fall On Out Stretched Hand
Delayed dx’s can lead to permanent disability
Cast in position of function (beer can)

Question 18

Femoral shaft FX - tucky

Answer 18

Usually major trauma
Severe pain
Inability to bear weight
Swelling, Deformity, Angulation
Shortening of leg

Question 19

TX of FEMORAL SHAFT FRACTURES (Rod into femur)

Answer 19

Intramedullary Rod into Femur

Can start walking in a few days

Question 20

NON-SURGICAL TX of Femur Shaft FX’s

Answer 20

Skeletal traction (Balanced suspension traction with Thomas splint and Pearson attachment)

NOT THE TREATMENT OF CHOICE: (IMMOBILITY, DVT)

Question 21

PELVIC FRACTURES

Answer 21

Usually major trauma (MVC, falls, skiing)
Anticipate potential for massive bleeding.
Early stabilization helps control bleeding and ↓ post-op complications
Extreme caution in moving patients

Question 22

MAX-FACE FRACTURES

Answer 22

Concern regarding patent airway
C-Spine Precautions
Suctioning and Tracheostomy may be necessary

Question 23

orbital floor “blowout” fracture

Answer 23

clinical signs are enophthalmos (recessions of eyeball in socket) and diplopia (especially on upward gaze)

Question 24

Treatment of Mandible Fractures

Answer 24

Surgery to immobilize the jaw. (Wiring jaw shut)
Wiring
Screws or plates
Post-op complications
Airway obstruction
Aspiration
Wire cutters or scissors (for rubber bands) at bedside incase of aspiration
ET or trach available.
Suctioning equipment at bedside
NG decompression, and anti-emetics
Long term liquid – pureed diet through a straw

Question 25

EYE INJURIES
ORBITAL FX’S

Answer 25

Suspect eye injury with Orbit fx’s
Check EOMI
Extra Occular movements intact (6 cardinal fields)

IF A GLOBAL RUPTURE IS SUSPECTED STOP EXAM AND CALL OPTHO STAT. Cover gently with saline soaked gauze.

Question 26

petechial rash ONLY with (fat rash)

Answer 26

fat embolism, not pulmonary embolism

Question 27

fat embolism - s/sx

Answer 27

SX: Hypoxemia*, fever, petechial rash, restlessness

Question 28

fat embolism - after what trauma to what bones?

Answer 28

Life threatening. (usually pelvic, tibial, femur fx’s).
High mortality rate.

Question 29

femoral shaft fx - how much blood loss?

Answer 29

Blood loss 0.5- 1.5 L

Question 30

fat embolism - when does it occur? (fat for 24 hours)

Answer 30

Occurs 24 – 48 hrs after trauma