Lecture 2 Digital Trauma Dr. Bennet Flashcards
Most frequent plane of injury of the digits?
Sagittal plane most commonly through hyperextension or hyperflexion.
What is a transverse plane injury of the toes?
This would be an abduction/adduction injury.
Commonly results in transverse or short oblique fractures.
Least frequent plane of injury in the digits?
Frontal plane injuries.
Would be associated with rotational or inversion/eversion injuries.
Fractures of all proximal phalanges are usually….
Oblique or comminuted.
Transverse pathological fractures can occur in diseased bones.
What are the three treatment options for closed injuries of the digits?
RICE
Closed reduction
Immobilization
What is the systematic check for open injuries of the digits?
Considered a surgical emergency.
Asses neurovascular status.
Tetanus and antibiotics
Address soft tissue first
Address fracture second
What is the open fracture golden period?
If the fracture has been open for less than 6 hours, and if the environment is non contaminated it can be reduced with PRIMARY closure.
Walk through the Gustilo and Anderson open fracture classification.
Type I: Wound less than 1 cm.
Type II: Wound 1-10 cm moderate communution and contamination.
type IIIA: Minimal periosteal stripping.
Type IIIB: Significant periosteal stripping.
Type IIIC: Repairable vascular injury with the bone fracture.
What is indicated when a patient presents with an acute subungal hematoma?
X-ray as it is likely there might be a fracture.
It is less likely that there will be a phalangeal fracture with chronic cases such as long term runners.
What is a type A Nail trauma?
Primary onycholysis
Separation of the nail plate due to proximal nail fold friction.
Tx remove nail plate, and antibiotics.
What is a type B Nail Trauma?
Subungal Hematoma
Check for fractures with X-ray and treat as open fracture.
Remove the nail plate if hematoma >25%
What is a type C Nail trauma injury?
Simple nail bed laceration.
Use antibiotics and tetanus check.
Cleanse surgically with irrigation and aline the root and nail bed.
What is Type D Nail trauma injury?
Type D is a complex nail bed laceration.
It is the same as Type C however the proximal nail fold is also lacerated.
treat with a rotational flap, antibiotics, lavage and tetanus check.
What is a type E Nail trauma injury?
Nail bed laceration with a phalangeal fracture.
requires removal of nail spicules, and fragments with reduction.
What is Zone 1 tissue loss of the hallux?
Zone 1 runs from distal to bony phalanx.
