Ortho Trauma and Fracture Management Flashcards
what is a cutting cone
a combo of osteoclasts and osteoblasts that help with bone healing when in primary stability
what is the leading cause of death and disabiltiy worldwide
trauma. life time costs of trauma is 4x that of cancer and 6x that of heart disease.
t/f there are more injury-inducing collisions due to alcohol than fatal collisions
false. alcohol impairment results in more FATAL collisions
SAMPLE history
S= symptoms
A- allergies
M= medications
P= past medical history
L= last meal eaten
E= environment – fire, electrocution, etc.
on exam, what skin, deformities, vascularities, and neuroassessments should be done
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 _____
if you suspect an intra-articular fracture, do a ct scan
if you suspect a soft tissue or ligamentous injury, do a mri scan
t/f you should immobilize before imaging
trure.
after immobilizing, what must you check after?
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
soft tissue functions
- protects the bone
- barrier to infection
- provides blood ssupply to the bone
- powers limb for locomotion
- splinting prevents small tissue injry. good soft tissue envelope is crucial to fracture healing and overall limb function
compare the natural history of bone and soft tissue injury
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.
a fracture is what type of injury?
a soft tissue injry with a broken bone inside.
3 main steps/principles of fracture treatment
- reduce deformity; realign fracture or dislocation (closed reduction vs operative intervention)
- maintain reduction until healing occurs; (cast and internal fixation)
- rehabilitation once healed; moving as soon as possible.
indications for fracture surgery (6) (POJ PAC)
P= polytrauma
O = open fracturse J = joint mobilization P= patient mobilizatoin
A = articular fracture
C= correction of alignment
would this person need surgery?
yes. this is an articular fracture at the tistial tibia and ankle. articular fractures require surgery (POJ PAC)
Would this person need surgery
yes. this is an open fracture. open fracutres reuquire surgical intervention (POJ PAC)
a distal radius fracture is the most common UE fracture. it presents with a classic ___ ___ deformity resulting in ___ angulation
dinner fork deformity (dorsal angulation)
treatment plan of distal radius fracture
- trial of casting
- surgery if closed treatment fails.
hip fracture imaging if it was occult
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
how did this injury happen
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
treatment for an ankle fracture
- reverse and splint– reverse the mechanism of injury while reducing it.
- re-check neurovascular status
- elevate, ice
type of fracture?
a lateral malleolus fracture
type of fracture?
bimalleolar ankle fracture
there is a fibular fracture and a medial mal fracture.
trimalleolar anle fracture– the medial malleolus of the right foot,the distal fibula/lateral mal and the posterior malleolus just near the calcaneous
10 steps to treatment of an open fracture
ATNIDSNXSSS
- timely antibiotics
- tetanus toxoid
- neurovascular exam
- irrigation and debridemnet– irrigate away from wound
- sterile moist dressing
- splint
- repeat neuro exam
- imaging of joint above and below
- secondary survery
- OFF TO SURGERY
first line abx for open fractures
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
what is a subluxation
an incomplete displaction where the articulating surfaces of the joint retain partial contact.
complete or incomplete/subleuxation?
complete dislocation. looks like humerus is not attached with glenohumeral joint
what physical exam sign would indicate a hip dislocation
an internal rotation and limb shortening indicates hip dislocation.
what to do if the affected limb has a diminished pulse
what is the ankle brachial index?
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.
compartment syndrome
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
T/F you need imaging to diagnose compartment syndrome
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
compartment syndrome also depends on ___ pressur
diastolic pressure. compartment pressure would be over 30 mmHg diastolic on that limb
5 Ps of compartment syndrome
p - pain on Passive stretch
p = pain out of PROPORTION
p= poikilothermia
P = parasthesias
P = pallor, pulseless, paralysis –> TOO LATE
compartment syndrome management
- Prompt evaluation/examination (high level of
suspicion) - Remove cast or dressing
- Place at level of heart
- DO NOT ELEVATE to optimize perfusion - Call staff/senior resident
pelvic ring fracture. life threatening. hemi pelvis is far apart.
immediate managemnet of pelvic ring fracture
pelvic binder or sheet
