Intro/Fractures Flashcards
Canadian C-spine Rules
High risk factor - age >/= 65 or dangerous mechanism or paresthesias in extremities = yes
Low risk factor - simple rear-end MVA or sitting in ED or ambulatory at any time or delayed neck pain or absence of midline c-spine tenderness = no
- If low risk yes, but can’t rotate neck 45 deg L and R = imaging needs to be done
- If low risk yes and can rotate neck 45 deg L and R = no imaging
Ottawa Knee Rule
- x-ray is required if any of these findings:
age 55 or older
or
isolated tenderness of patella (no bone tenderness of knee other than patella)
or
tenderness of head of fibula
or
inability to flex 90 deg
or
inability to bear weight both immediately and in the ED for 4 steps
Ottawa Ankle Rules
A) x-ray required if any pain in malleolar zone and any of these findings:
- bone tenderness at posterior edge or tip of lateral OR medial malleolus
or
- inability to bear weight both immediately and in the ED for 4 steps
B) x-ray required if any pain in midfoot and any of these findings:
- bone tenderness at base of 5th metatarsal OR navicular
or
- inability to bear weight both immediately and in ED for 4 steps
What color will air, fat, water, and bone be on x-ray?
air - black
fat - gray-black
water - gray
bone - white
more dense objects are lighter and less dense are darker
What is arthrography?
- injection of contrast within joint space
- distends capsule
- outlines internal surfaces
- commonly used w/ CT, MR, fluroroscopy
What is myelography?
- pertaining to spinal cord, dura mater, and nerve root
- injected in cerebrospinal fluid (subarachnoid space)
- column of radiopaque fluid
- may be administered w/ CT
best clinical application and limitations of CT
Best clinical application
- fracture evaluation
Limitations
- detail cannot be enhanced
- difficulty with positioning
- exposure
How to describe the alignment of a fracture?
description of distal segment in relation to proximal
greenstick vs torus fracture
greenstick - fracture on side of tensile loading
torus - impaction fracture on side of compressive loading
Pediatric Physeal Fractures Acronym
SALTR
Slipped
Above
Lower
Through
Ruined
Type I pediatric physeal fracture
Slipped
- growth plate only
Type II pediatric physeal fracture
Above
- Physis and metaphysis
Type III pediatric physeal fracture
Lower
- Physis and epiphysis
Type IV pediatric physeal fracture
Through
- Epiphysis, physis, and metaphysis
Type V pediatric physeal fracture
Ruined
- crush injury of physis
Type VI pediatric physeal fracture
Rang’s - involves perichondral ring or associated periosteum of physis
Types VII - IX pediatric physeal fracture
Ogden’s - do not directly involve physis, though may disrupt blood supply
VII - osteochondral fracture of epiphysis
VIII - fracture of metaphysics
IX - avulsion of periosteum
common immobilization/protection timelines
6-8 weeks for adults
4-6 weeks for children
What does excessive loading risk of fractures cause?
risk for pseudoarthrosis
possible complication of pelvic fracture
hemorrhage
possible complication of femur fracture
hemmorrhage - occurs with closed fractures
possible complication of multiple or crushing type fractures
fat embolism - develops 12-72 hours after fracture
possible complication of elbow fracture
brachial artery injury - associated with Supra-condylar fractures
possible complication of proximal humeral fracture
axillary nerve injury
possible complication of shoulder dislocation
axillary artery injury, brachial plexus, axillary nerve injury - can be asymptomatic but later develop occlusion
possible complication of elbow dislocation
brachial artery injury, median and ulnar nerve injury
possible complication of hip dislocation
femoral artery or nerve injury
possible complication of knee dislocation
popliteal artery injury or peroneal nerve injury
What imaging techniques are required if trauma is expected?
C-Spine is critical
Extremities:
>/= 2 views that are 90 deg from each other
AP & lateral views when possible
Include joints adjacent to bones (given heightened concern for remote injury)
