Ortho Flashcards
Three classic findings with fat embolism after fracture and the classic clinical story it presents after?
Fat embolism = presence of fat globules in the lungs or peripheral circulation. Syndrome is when you get systemic inflammatory reaction that gives you those characteristic findings
Symptoms occur 1-2 days after injury or nail
ARDS, neurological involvement and thrombocytopenia
CT ground glass opacities or fat in urine
Young person with long bone fracture or older person with hip fracture
5 reasons to consult ortho?
Open
Long bone
Neurovascular compromise
Joint involvement
Tendon injury
Three general classifications of fractures?
ID - open or closed, where the fracture is, direction of the line (oblique, transverse, spiral), Simple or comminuted, position (displacement and allignment
Additional modifiers - angulation, avulsion, impaction (depressed or compressed), complete or incomplete
Special situations - pathologic or stress
What does open mean?
Exposed to air at any time
What is complete and incomplete?
Interrupts both cortexes
One cortex is intact
What makes you suspect a pathologic fracture?
It is a fracture through abnormal or diseased bone
Suspect when trivial mechanism leads to fracture
What causes a stress fracture
Where do they commonly occur?
repetitive stress can lead to the resorption of normal bone. Typically in lower extremities, may not show up on XRs
RF - training schedule, equipment, nutrition, hormones , anatomic varience
Any long bone - fibula, tibia, metatarsel, femoral shaft
Navicular and calcaneous
Where are the epiphysis, metaphysis and diaphysis
Dia = shaft
Epi = below growth plate
physis - growth plate itself
Metaphysis - transition between shaft and epiphysis
5 causes of patholgic fractures
Osteogenesis imperfectica
Paget disease of bone
Rickets
Scurvy
Malignancy
OA
Why do we repeat XRs later?
Sometimes cant see fracture line right away
10-14 days more visible with inflammation, bone resportion, hyperemia
What are four varients of bad fracture healing?
Mal union - still have a deformity
Non-union - doesnt come together
Delayed union - takes longer than expected at that site
Pseduoarthrosis - flase joint caused by non-union
When can you advise someone to go back to activties?
Clinical evidence of stability (pain free WB)
Bridging of bone at cortex (actual line can still b there it takes months to go away)
5 life or limb complications per Rosens of a fracture?
Open - OM
Compartment - ischemia
Vascular disruption - amputation
Pelvis fracture - bleed out
Hip dislocation - AVN
Dosing for open fractures?
Ancef 2g q8
III gets gent at 5mg/kg daily
Farming or fecal contamination - penicillin for clostridium
Outline grading of open fractures
How much blood loss with each fracture?
Arm bones (radius, ulna, humerus) - 250ml
Tib and fib - 500cc
Femur 1 L
Pevlis up to 3L
Outline the types of nerve injury
What is normal two point discrimination at fingertips?
4mm
Nerves injured at each site
What are the 5 P’s of compartment syndrome? Why are they not the be all end of all your exam?
Pain out of proportion
Pallor
Paralysis
Paraesthsia
Pulselessness
Better signs of arterial occlusion. Other factors like Pain with passive stretch, active movement and POP are going to detect earlier
5 complications of compartment syndrome?
Ischemia
Contractures
Ambputation
Myoglobinuria
Renal failure
What number does Rosens give you for being worrisome?
> 30 or >20 from dialstolic or 30 from MAP
10 causes of compartment syndrome? List examples in each major category
Increased content
Injection of solution
Fracture
Bleeding with coagulation disorder
Seizure
Tetany
reperfusion with bypass grafting
Decreased volume
Excessive traction
Closure of fascial defect
External pressure
Lying on limb
Cast too tight
What are fracture blisters? What do you do with them, and why do you need to worry about them?
tense bulla or blisters seen after high energy injuries with lots of swelling
Happen where there is thin skin or less hair follicles
Cover with sterile dressing, ortho might change surgical approach, can be red flag for compartment syndrome
Short term and long term fracture complications?
Why do we get rib views
Cant see a fracture line if 90 degrees perpindicular. Turns with curvature of ribs to see better
What are things that look like a fracture that arent and features of it?
nutrient vessel (less radiolucent, obique, does not cross both cortices, Mach effect, calcifications)
Soft tissue
Bandages overtop
Common paired fractures?
Calcaneous and lumbar spine
Ring pelvis
Ring mandible
Distal tib and proximal fib
High risk for development of a strain?
Non athelete
Forced strech
Strong contraction
(weekend warrior pushing off of planted leg)
