Orthopaediac Surgery Flashcards
Define compartment syndrome
In adequate tissue oxygenation with in an osseofascial compartment resulting from intracompartmental be sure that is greater than the capillary perfusion pressure.
Initially Venus outflow is impaired and pulse may still be palpable as the cells become hypoxic and then swell a further rise in pressure compromises arterial blood flow
Describe the clinical signs of compartment syndrome
Pain out of proportion to the injury
- especially on passive stretching
- crescendo pain
Paraesthesia
Paralysis
Pulselessness
Who get compartment Syndrome?
Fractures in 69% of cases
Cash injury
Conclusions
gunshot wounds
Tight cast, Dressings
Buns
Extravasation of IV infusion
What does the indications for compartment pressure measurements?
Poly trauma patients
Patients not alert or unreliable
Inconclusive physical examination findings
What is the management of compartment syndrome?
ATLS principles
Splint the cost
Leg in a neutral position
Analgesias
Reduce fractures
Emergency fasciotomy of all four compartment - Two incisions are made:
Lateral incision: from the head of the fibula to the lateral malleolus
Medial incision: 1 cm behind the tibial plateau to the medial malleolus
What should you be aware of when making a lateral incision fasciectomy?
The peroneal nerve
Incision of the peroneal nerve can cause drop-foot
Record pre-op drop foot and post-op foot
List the four muscle compartment of the lower leg
Anterior
Lateral
Superficial posterior
Deep posterior
What is the blood supply to the femoral head?
Lateral femoral circumflex artery
Medial Femoral circumflex artery
Obturator artery
Ligamentum Terres artery
Where is the important blood supply the femoral neck located?
On the posteriorly superior aspect of the femoral neck
What are the causes of avascular necrosis of the hip (femoral head)
Femoral head fracture
Hip dislocation
Basicervical fracture
Cervicotrochanteric fracture
What does the rest factors associated with a vascular necrosis of the femoral head?
Corticosteroid use
Alcohol abuse
Coagulopathies
Gout
What is the mechanism of injury for clavicle fractures?
A direct blow to the lateral aspect of the Shoulder or fall on an outstretched arm
What is the clinical presentation of a clavicle fracture?
Shoulder pain
Deformity of the shoulder
What is the non-operative treatment of clavicle fractures?
Sling immobilisation with gentle range of motion exercises at 2 to 4 weeks
What is the operative management of clavicle fractures?
Open reduction and internal fixation
What are the indication for surgery of clavicle fractures?
Unstable fractures
Open fractures
Displaced fracture with skin tenting
Floating shoulder
Symptomatic non-union
Displaced with >2cm shortening
Define a monteggia fracture
Fracture of the proximal third of the ulnar with radial head dislocation
What are the signs and symptoms of a monteggia fracture ?
Pain and swelling at the elbow joint
Loss of range of motion at the elbow
Posterior interosseous nerve neuropathy
> radial deviation of hand with wrist extension
> weakness of thumb extension
> weakness of metacarpophalangeal extension
What is the operative management of a monteggia fracture?
ORIF of ulnar shaft fracture
If fails then;
ORIF of ulnar shaft fracture, open reduction of radial head
What are the complications of a monteggia fracture?
PIN neuropathy
Malunion with radial head dislocation
Describe a type II bado classification of a monteggia fracture
Most common in adults
Fracture of the proximal or middle third of the ulnar with posterior dislocation of the radial head
Describe a type I bado classification of a monteggia fracture
Most common in children and young adults
Fracture of the proximal or middle third of the ulnar with anterior dislocation of the radial head
Define a Galeazzi fracture
Distil third the radius shaft fracture and associated distal radioulnar joint injury
What is the mechanism of injury for a Galeazzi facture?
Direct restroom are typically dorsolateral aspect Falls onto outstretched hand with forearm in pronation
