orthopaedic emergencies Flashcards
what is the difference between primary, secondary and tertiary survey ?
1ry - treat the greatest threats to life first , then ABCDE
2ry - physical examination , obtain imaging
3ry - repeat physical examination when mental status has stabilized
which vertebrae must be visualized in lateral c spine imaging ?
c7 to T1
what is the initial management for open fractures ?
wound irrigation
removal of gross contamination
take a photo
saline soaked dressing
back slab
broad spectrum antibiotics
tetanus prophylaxis
what is the gustilo classification ?
G1- wound less than 1 cm
G2 - 1-10 cm , moderate soft tissue injury
G3a - more than 10 , high energy, extensive soft tissue damage
G3b - periosteal stripping - needs soft tissue coverage
G3c - vascular injury and requires repair
what is thee definitive management of open fractures ?
must all be assumed to be contaminated :
antibiotic prophylaxis
urgent wound debridement
temporary stabilization
definitive fixation and wound cover
what are the complications associated with fractures with vascular injury ?
organ hypoperfusion and hypovolemic shock
coagulopathy
fluid administration to replace the lost blood
what vessel is affected in 1st rib fracture ?
sbclavian arteery/ vein
what vessel is affected in shoulder dislocation ?
axillary artery
what artery is affected in humeral supracondylar fracture ?
brachial artery
what artery is affected by elbow dislocation ?
brachial artery
what artery is affected by pelvic fractures ?
presacral and internal iliac
what artery iis affectedd with femoral suprachondylar fracture ?
femoral artery
what artery is affected in knee dislocation ?
popliteal arterry/vein
what artery is affected in fracture of the proximal tibial ?
popliteal artery
what is considered a priority when managing fractures with vascular injury ?
control external haemorrhage
what is the most sensitive finding associated with compartment syndrome ?
pain with passive motion
what is the treatment for compartment syndrome ?
fasciotomy
how is a diagnosis of septic arthritis made ?
joint aspirate with a WBC of more than 50000
what is the most affected joint by septic arthritis ?
knee
what is the treatment for septic arthritis ?
joint washout in theatre
IV antibiotics followed by oral for 4-6 weeks
analgesia
splintage
what is the most common cause of cauda equina ?
acute lumbar disc herniation
what is the presentation of cauda equina ?
acute back pain
alternating or bilateral radiculopathy
saddle like paraesthesia
bowel or bladder dysfunction
how is cauda equina confirmed ?
urgent MRI
what is the treatment of cauda equina ?
prompt surgical decompression
what is the usual cause of death in traumatic amputations ?
haemorrhage or lung injury
before reducing a dislocated fracture what should be done ?
obtain an Xray
what are the causes of anterior vs posterior dislocation of the shoulder ?
anterior - fall on outstretched hand
posterior - electrocution or epilepsy
how does inferior dislocation of the shoulder happen ?
hyperabduction
risk of brachial plexus injury
what is the safest and most effective method to treat shoulder dislocations ?
traction- countertraction
what is the presentation of hip dislocations in each of the following :
posterior -
anterior -
central -
posterior - leg in internal rotation
anterior - leg in external rotation
central - acetabular fracture
what are the complications associated with hip dislocation ?
sciatic nerve palsy
avascular necrosis
what is the reduction technique used in hip dislocation ?
allis reduction technique
what is the management for a knee dislocation ?
reduction
followed by CT angio
