Ortho 1 Flashcards
What infections are common with open fractures of the foot that damages shoes?
Pseudomonas
What ABX should be used for open fractures associated with farm injuries?
Penicillin
What general ABX should be given for open fractures?
1st gen. cephalosporin
-Larger wounds/soft tissue damage: Aminoglycoside
How are open fractures classified?
Type 1, 2, and 3
What characterizes a type 1 open fracture?
Low energy impact
- Less then 1 cm
- Inside-out
- Transverse or oblique
What characterizes a type 2 open fracture?
- More energy
- Greater than 1 cm
- Mild to moderate crushing
- Often some comminution
What characterizes a type 3 open fracture?
Greater than 10 cm
Significant fracture fragment comminution
Extensive soft tissue damage
Grossly contaminated
Which type of open fracture has 3 subtypes?
Type 3
What characterizes a type A open fracture?
Adequate tissue coverage of bone
What characterizes a type B open fracture?
Bone exposure that requires a flap or graft
What characterizes a type C open fracture?
Circulatory compromise
-Requires vascular repair or reconstruction to reperfuse the limb
What is a torus fracture?
- Bulge in cortex
- Goes all the way through
- Common in children
- Pain limits function but does not cause complaints
What is a greenstick fracture?
- A break in one cortex
- Childhood fracture; bones are softer and more flexible
Which type of fracture is known as the “toddler’s fracture”?
Spiral
What characterizes a spiral fracture?
- Break wraps around long axis of bone
- Often the tibia
What characterizes a segmental fracture?
Bone broken with distinct segment broken out
What are pathologic fractures?
Fractures caused by benign or malignant lesions
What are some common locations for compartment syndrome?
- Foot
- Leg
- Thigh
- Forearm
- Hand
- Shoulder
- Butt
After how many hours does compartment syn. cause permanent damage, including muscle and nerve death?
8 hours
After how many hours of compartment syndrome can tissues be totally viable?
4 hours
-More variable after 6 hours
What condition are the 5 Ps associated with?
Compartment syndrome
What is the most sensitive test for compartment syndrome?
Severe pain with passive ROM
What is the treatment for compartment syndrome?
Surgery:
- Fasciotomy
- Excision of necrosed tissue
What condition is associated with Virchow’s Triad?
DVT
What are Virchow’s Triad?
- Stasis
- Intimal injury
- Hypercoagulability
What is Homan’s sign?
Pain in calf during dorsiflexion of foot at ankle joint while knee is fully extended
-DVT
What are the symptoms of a PE?
- Pleuritic chest pain
- Tachypnea
- R BBB on EKG
- Tachycardia
What bacteria are associated with necrotizing fasciitis?
Group A Strep
-Also Clostridium
What is a felon?
Pulp of nail at tip of finger
-I&D
What is Kanavel’s sign?
- Sausage fingers
- Inflammation of tendon sheath
- Finger held flexed w/ pain on passive movement
Where is most common bite wound involving human-to-human contact?
3rd and 4th MC joint
-Fight bite
What bacteria are associated with human bites?
Strep. viridans
- S. aureus
- Eikenella (Augmentin)
What bacteria are associated with dog bites?
S. viridans
- Pasteurella
- S. aureus (Augmentin)
What bacteria are associated with cat bites?
Pasteurella
- S. aureus
- Augmentin
What is a C1 ring fracture called?
Jefferson’s fracture
What is a C2 isthmus fracture?
Hangman’s
What is a C6-T1 spinous process avulsion fracture?
Clay shoveler’s
What comprises the anterior column of the spinal column?
Anterior longitudinal ligament (ALL) and anterior vertebral body
What comprises the middle column of the spinal column?
The posterior vertebral body to the posterior longitudinal ligament (PLL).
What comprises the posterior column of the spinal column?
The PLL to the spinous process.
What is a compression fracture?
Failure of the anterior column w/ preservation of the middle column.
What is a burst fracture?
Failure of the anterior and middle columns w/ axial load; +/- posterior column involvement
-More likely to be unstable
Where does the spinal cord end in most adults?
L2
Treatment for a coccyx fracture?
Donut pad
Stool softener
Time
A burst fracture where can cause bladder/bowel dysfunction?
L1-L2
What drug should we give patients if we suspect a neuro deficit with a spinal injury?
IV Methylprednisolone
In whom is methylprednisolone contraindicated?
Pregnancy
Age <13
Uncontrolled DM
Open spine injury
How long should a spinal injury patient be on Methylprednisolone if they are not given it within the first 3 hours?
48 hours
How long should a spinal injury patient be on methylprednisolone if they are given it within 3 hours?
24 hours
