Ortho Trauma and Fracture Management

Question 1

what is a cutting cone

Answer 1

a combo of osteoclasts and osteoblasts that help with bone healing when in primary stability

Question 2

what is the leading cause of death and disabiltiy worldwide

Answer 2

trauma. life time costs of trauma is 4x that of cancer and 6x that of heart disease.

Question 3

t/f there are more injury-inducing collisions due to alcohol than fatal collisions

Answer 3

false. alcohol impairment results in more FATAL collisions

Question 4

SAMPLE history

Answer 4

S= symptoms

A- allergies

M= medications

P= past medical history

L= last meal eaten

E= environment – fire, electrocution, etc.

Question 5

on exam, what skin, deformities, vascularities, and neuroassessments should be done

Answer 5

Question 6

Xrays are essential and must be taken from multiple planes, as well as the joints above and below sites of injry.

if you suspect an intra-articular fracture, do a ____

if you suspect a soft tissue or ligamentous injury, do a _____

Answer 6

if you suspect an intra-articular fracture, do a ct scan

if you suspect a soft tissue or ligamentous injury, do a mri scan

Question 7

t/f you should immobilize before imaging

Answer 7

trure.

Question 8

after immobilizing, what must you check after?

Answer 8

re-check neurovascular exam

• make sure you didn’t position the foot in the cast in a way that pinches nerve or cuts off blood flow

Question 9

soft tissue functions

Answer 9

1. protects the bone
2. barrier to infection
3. provides blood ssupply to the bone
4. powers limb for locomotion
   - splinting prevents small tissue injry. good soft tissue envelope is crucial to fracture healing and overall limb function

Question 10

compare the natural history of bone and soft tissue injury

Answer 10

bone injury is static; the extent of bony injury is known as soon as it occurs.

soft tissue injury will EVOLVE; it can get worse if you don’t stabilize it.

Question 11

a fracture is what type of injury?

Answer 11

a soft tissue injry with a broken bone inside.

Question 12

3 main steps/principles of fracture treatment

Answer 12

1. reduce deformity; realign fracture or dislocation (closed reduction vs operative intervention)
2. maintain reduction until healing occurs; (cast and internal fixation)
3. rehabilitation once healed; moving as soon as possible.

Question 13

indications for fracture surgery (6) (POJ PAC)

Answer 13

P= polytrauma

O = open fracturse
J = joint mobilization
P= patient mobilizatoin

A = articular fracture

C= correction of alignment

Question 14

would this person need surgery?

Answer 14

yes. this is an articular fracture at the tistial tibia and ankle. articular fractures require surgery (POJ PAC)

Question 15

Would this person need surgery

Answer 15

yes. this is an open fracture. open fracutres reuquire surgical intervention (POJ PAC)

Question 16

a distal radius fracture is the most common UE fracture. it presents with a classic ___ ___ deformity resulting in ___ angulation

Answer 16

dinner fork deformity (dorsal angulation)

Question 17

treatment plan of distal radius fracture

Answer 17

1. trial of casting
2. surgery if closed treatment fails.

Question 18

hip fracture imaging if it was occult

Answer 18

MRI, CT and Bone scan

X ray is mandatory; do an AP pelvis view and compare to normal hip. also lateral view as well as joint above and below

Question 19

how did this injury happen

Answer 19

this is an ankle fracture. the medial malleolus is fragmented from the distal end of the tibia. this was most likely caused by a pronation/external rotation injry

Question 20

treatment for an ankle fracture

Answer 20

1. reverse and splint– reverse the mechanism of injury while reducing it.
2. re-check neurovascular status
3. elevate, ice

Question 21

type of fracture?

Answer 21

a lateral malleolus fracture

Question 22

type of fracture?

Answer 22

bimalleolar ankle fracture

there is a fibular fracture and a medial mal fracture.

Question 23

Answer 23

trimalleolar anle fracture– the medial malleolus of the right foot,the distal fibula/lateral mal and the posterior malleolus just near the calcaneous

Question 24

10 steps to treatment of an open fracture

ATNIDSNXSSS

Answer 24

1. timely antibiotics
2. tetanus toxoid
3. neurovascular exam
4. irrigation and debridemnet– irrigate away from wound
5. sterile moist dressing
6. splint
7. repeat neuro exam
8. imaging of joint above and below
9. secondary survery
10. OFF TO SURGERY

Question 25

first line abx for open fractures

Answer 25

1st. gen sephalosporin (for 24 hours after closure). If it’s a really bad injury– consider adding gram negative coverage with an aminoglycoside.

Penicillin should be added if concern for anaerobic organism. ex/ farm injury

Question 27

what is a subluxation

Answer 27

an incomplete displaction where the articulating surfaces of the joint retain partial contact.

Question 28

complete or incomplete/subleuxation?

Answer 28

complete dislocation. looks like humerus is not attached with glenohumeral joint

Question 29

what physical exam sign would indicate a hip dislocation

Answer 29

an internal rotation and limb shortening indicates hip dislocation.

Question 30

what to do if the affected limb has a diminished pulse

Answer 30

Question 31

what is the ankle brachial index?

Answer 31

it can be used to see if there is a vascular injury on the broken limb cauisng a diminished pulse

ABI = PLEG/PARM
(BP cuff on lef and ankle). Ir Ratio <0.9 or if the ratio gets worse over the assessment, you might have a vascular injry.

Question 32

compartment syndrome

Answer 32

occurs when there is swelling and elevated tissue pressure within a closed fascial space

• this reduces tissue perfusion–> cell death –> ischemia causing necrosis.

NEED A FASCIOTOMy

Question 33

T/F you need imaging to diagnose compartment syndrome

Answer 33

false. It is often a clinical diagnosis using 5P

p - pain on Passive stretch

p = pain out of PROPORTION

p= poikilothermia

P = parasthesias

P = pallor, pulseless, paralysis –> TOO LATE

Question 34

compartment syndrome also depends on ___ pressur

Answer 34

diastolic pressure. compartment pressure would be over 30 mmHg diastolic on that limb

Question 35

5 Ps of compartment syndrome

Answer 35

p - pain on Passive stretch

p = pain out of PROPORTION

p= poikilothermia

P = parasthesias

P = pallor, pulseless, paralysis –> TOO LATE

Question 36

compartment syndrome management

Answer 36

1. Prompt evaluation/examination (high level of
   suspicion)
2. Remove cast or dressing
3. Place at level of heart
   - DO NOT ELEVATE to optimize perfusion
4. Call staff/senior resident

Question 37

Answer 37

pelvic ring fracture. life threatening. hemi pelvis is far apart.

Question 38

immediate managemnet of pelvic ring fracture

Answer 38

pelvic binder or sheet