General Trauma Flashcards
are all dislocations reduced?
yes
as soon as possible
how are dislocations reduced?
closed manipulation under sedation and analgesia or sometimes general/regional anaesthetic
open reduction if delayed presentation (e.g alcoholics etc)
what can cause dislocation/increase the risk?
significant trauma
low energy injury can cause dislocation in hypermobile people (marfans, ehlers danlos etc)
what other injuries are dislocations associated with?
tendon tears nerve injury vascular injury compartment syndrome fractures (fracture-dislocation)
how are dislocations managed?
may need soft tissue repair/reconstruction or bony surgery if recurrent
ORIF may be required for fracture-dislocation if un-reducable, bony fragment in joint or unstable joint
give 4 possible soft tissue injuries which can occur with fractures
ligaments/tendon sprain, partial tear or rupture
muscle tear
how are ligament ruptures graded?
grade 1 = sprain
grade 2 = partial tear
grade 3 = complete tear
mainstay of treatment for soft tissue injury?
RICE rest ice compression elevation followed by early movement
when is surgical repair used for tendon rupture?
if complete tear of tendons essential for function (patellar, quadriceps etc)
others can be treated conservatively
what can cause division of a tendon and where is this common? how is this managed?
penetrating incised wounds
flexor and extensor tendons in hands/wrists
usually need surgical repair
what can cause septic arthritis?
spread via blood
spread from infection in adjacent tissues
direct penetration of a joint (e.g fight bite)
intra-articular surgery
what are the effects of septic arthritis?
causes irreversible damage to hyaline cartilage within 2 days
associated with endocarditis
what are the risk factors for septic arthritis?
young elderly IV drug use immunocompromised neonates/infants with metaphyseal osteomyelitis (metaphyses are intra-articular in neonates/infants)
most common causative bacteria in septic arthritis?
staph aureus = most common strep = 2nd most common haemophilus gonorrhoea - young adults E coli = elderly, IVDU, seriously ill people
management of suspected septic joint?
aspirate the joint to get sample
antibiotics - general then specific once pathogen known
surgical washout (open or arthroscopic)
serial CRP throughout treatment
what is the gustilo classification system?
describes degree of contamination, size of wound, whether wound will be able to be closed or require plastic surgery cover and presence of associated vascular injury
initial A&E management of an open fracture?
IV antibiotics - flucloxacillin - gentamicin - metronidazole application of sterile/antiseptic soaked dressing
general management of open fractures?
prompt surgery
- removal of all contamination and debridement
stabilisation with internal or external fixation providing an early and thorough debridement
when can an open fracture wound be closed primarily?
if skin is viable and uncontaminated and can be closed without skin tension - wound can be closed primarily
what is used if open fracture wound cant be closed primarily?
skin graft
local flap coverage
free flap coverage
which tissues readily accept a skin graft?
muscle fascia granulation tissue paratendon periosteum
what is done if doubt over viability of soft tissue or wound is contaminated?
leave wound open for 48 hrs to allow infection to drain out
surgical debridement of necrotic tissue after 48 hrs and secondary closure of wound
