MSK trauma Flashcards
Blood loss from femur fracture
Up to 2L
Blood loss from tibia fracture
Up to 1.5L
Do not use traction splint for fractures if
combined femur and tibial fractures in same extremity
Stopping extremity bleeding, 4 methods in order of use:
- Manual pressure to the wound
- Pressure dressing
- Compression of the artery proximal to injury
- Tourniquet
Life threatening extremity injuries
Major arterial haemorrhage
Bilateral femoral fractures
Crush syndrome
Pelvic disruption
Management of fracture with open haemorrhaging wound
Realign and splint it
Second person applies direct pressure to open wound
Reduce joint dislocations when possible
Management of crush syndrome (traumatic rhabdomyolysis)
Early, aggressive fluid therapy
Intravascular fluid expansion
Fracture immobilisation
Apply inline traction to realign the extremit, maintain traction with an immobilisation device
Apply splint to control bleeding, reduce pain and prevent complications
(prevent motion at fracture site)
Management of open fracture
Reduce fracture
Pull bone ends back into the wound
Clean the wound
Administer antibiotics
Attempt to reduce joint dislocations if possible
Shoulder dislocation appearance
Anterior: squared off
Posterior: locked in internal rotation
Elbow dislocation appearance
Posterior: olecranon prominent posteriorly
Hip dislocation appearance
Anterior: extended, abducted, externally rotated
Posterior: flexed, adducted, internally rotated
Knee dislocation appearance
Loss of normal contour, extended
Ankle dislocation appearance
Lateral is most common: externally rotated, prominent medial malleolus
Subtalar joint dislocation appearance
Lateral is most common: laterally displaced calcaneus
Logical systematic review of each extremity
Skin
Neuromuscular function
Circulatory status
Skeletal and ligamentous integrity
Management open fracture (basic)
IV abx
Clean wound and cover with moist sterile dressing
Immobilise extremity
Request surgical consult or arrange for transfer
Signs of non occlusive vascular injury in extremity
Cool
Prolonged CRT
Diminished peripheral pulses
Abnormal ankle/brachial index
In vascular injury, operative revascularisation should happen within
6 hours
Common areas of compartment syndrome
Lower leg (tibia fracture)
Forearm
Signs and symptoms of compartment syndrome
Pain out of proportion
Pain on passive stretch of affected muscle
Tense swelling of affected compartment
Paraesthesias or altered sensation distal to affected compartment
Immobilisation of fracture must include
Joint above and below
Immobilisation guidelines for knee
Commercial immobiliser or posterior long-leg plaster splint
Allow 10 degrees of flexion
Ankle immobilisation guidance
Use a well padded splint
Forearm and wrist fracture immobilisation guidance
Padded or pillow splints
Splitn wrist and fingers in functional position if possible
Elbow immobilisation guidance
Partially flexed, with padded splints
or direct immobilisation with respect to the body usinga sling-and-swath device
Upper arm and shoulder immobilisation device
Sling-and-swath
Hand injury immobilisation guidance
Wrist dorsiflexed and fingers gently flexed 45 degrees at the MCP joint
- immobilise hand over a large roll of gauze and use a short-arm splint
How to splint a leg with both femur and tibia/fibula fractures
Long-leg posterior splint
with additional sugar tong splint for the lower leg
not traction
