Orthopaedic Injuries

Question 1

How to Determine a Fracture in the Field?

Answer 1

Clinically, a history of loss of function, pain,
tenderness, swelling, abnormal motion, and deformity suggest a
fracture.

Question 2

What does open fracture mean?

Answer 2

exposed to the outside environment in any way

Question 3

Description of a Fracture

Exact Anatomical Position

Name of the bone

Left or Right of the body

Reference points along the bone (neck, tubercle, condyle)

Direction of the fracture line in relation to the long axis of the bone (see card below)

Position and alignment

Question 4

Types of Fractures

A trans-verse fracture occurs at a right angle to the long axis of the bone
(Fig. 49-1A)

An oblique fracture runs oblique to the long
axis of the bone (Fig. 49-1B)

A spiral fracture results from a rotational force and encircles the shaft of a long bone in a spiral fashion (Fig. 49-1C).

A comminuted fracture is when there are more than two fragments

Avulsion fracture refers to a bone fragment that is pulled away from its normal position by
* the forceful contraction of a
muscle
* the resistance of a tendon or ligament to a
force in the opposite direction

An avulsion fracture is a fracture that occurs through abnormal bone - it’s suggested whenever a fracture occurs from seemingly trivial trauma

Answer 4

Question 5

What does displacement mean?

Answer 5

any deviation from normal

Question 6

Valgus - denotes a deformity in which the described part is angled away from the midline of the body

Varus - denotes a deformity in which the angulation of the part is toward the midline

Answer 6

Alignment - the relationship of the longitudinal axis of one fragment to another

Angulation - deviation from the normal alignment
* the direction of angulation is determined by the direction of the apex of an angle formed by the two fracture fragments (Fig. 49-4)

Question 7

What’s Impaction?

Answer 7

forceful collapse of one fragment of bone into or onto another.

Question 8

What medical weaknesses predispose people to bone injury?

Answer 8

• primary or metastatic malignancies
• cysts
• enchondromata
• giant-cell tumors
• osteomalacia
• osteogenesis imperfecta
• scurvy
• rickets
• Paget’s disease

Question 9

Fracture Images

Answer 9

Question 10

Fracture Images

Vertebral body compression fracture

Answer 10

Greenstick fractures are incomplete angulated fractures of long bones

A torus fracture is another form of incomplete fracture, characterized by a wrinkling or buckling of the cortex

Question 11

Abnormal Unions

Answer 11

Delayed union is union that takes longer than usual for a particular fracture location

Malunion occurs when a residual deformity exists

Nonunion is the failure of a fracture to unite
* When nonunion results in a false joint, it is
termed a pseudarthrosis.

Question 12

Salter-Harris Classification

Use Image on the other side of the card to help visualize

Answer 12

Question 13

Fact - Distal radius fractures account for two thirds of fractures in pediatric patients in the ED.

Question 14

Classification and Emergency Management of Open Fractures

Question 15

Blood loss associated with Fractures in Adults

In adults, blood loss can range from 100 mL from a forearm fracture to 3 L from a pelvic fracture

Question 16

Nerve Injuries

Neurapraxia is the contusion of a nerve, with disruption of the ability to transmit impulses

Paralysis, if present, is transient, and sensory loss is slight

Axonotmesis is a more severe crush injury to a nerve

Neurotmesis is the severing of a nerve, usually requiring surgical repair.

Nerve Injuries Associated with Bone Injuries

Question 17

O’Rian Wrinkle - when your fingertips (digital pupls) wrinkle after being in water for a long period of time (approx. 20min)

This indicates there is nerve function

Answer 17

What are the most likely adverse outcomes for life threatening emergencies?

Question 18

**Compartment Syndrome **- a serious acute emergency in which the nerves and muscle tissue are the highest concern - this occurs when there is pain and parethesias in an extremity after a fracture within an enclosed osseofascial space (see below for causes)

Answer 18

The 3 main circumstances in which compartment syndrome occurs are:
1. Increased compartment contents
2. decreased compartment volume
3. external pressure

Question 19

Management of Compartment Syndrome

NEVER elevate the limb as it’s counterproductive and excaerbates the syndrome

Answer 19

Compartment Syndrome Presentation
* Pain on passive stretching
* active flextion of involved muscles
* deep, burning, and unrelenting and is difficult to localize pain

Question 20

OPTIONAL Complex Regional Pain Syndrome

Question 21

Fat embolism - refers to the presence of fat globules in the lung parenchyma and peripheral circulation after a long bone fracture or major trauma
* fat embolism syndrome usually occurs after long bone fractures
* common manifestations include respiratory distress, hypoxemia, confusion, thrombocytopenia, petchial rash
* fat is seen in 50% of pts urine within 3days

Answer 21

Fracture Blisters - tense blisters or bullae that accompany high-energy injuries in areas of relatively little skin coverage over a fracture site - Most Common Sites include:
1. Ankle
2. Elbow
3. Foot
4. Knee

Caused by increased underlying tissue pressure

Question 22

Question 23

Subluxation - partial loos of continuity

Dislocation - a complete loss of continuity
* named for the major joint involved

Fracture-dislocation is when there is loss of articulation w/fracture

Sub’s and Dis’s are described according to the direction of the distal segment relative to the proximal segment or of the displaced bone relative to the normal structures

Answer 23

Sprains - Ligamentous injuries resulting from an abnormal motion of a joint
* injury to the fibers of a supporting ligament of a joint

1. 1st degree - minor tearing of ligamentous fibers with resultant mild hemorrhage and
   swelling
2. 2nd degree - a partial tear of a ligament, meaning more fibers are torn than in the first-degree injury
3. 3rd degree - the complete tearing of a liga-
   ment

Strain - an injury to a musculotendinous unit resulting from violent contraction or excessive forcible stretch (pulled muscle)
1. (mild) strain is a minor tearing of the musculo-
tendinous unit, characterized by minor swelling, local tenderness, and minimal restriction of movement.

2. (moderate) strain, more fibers are torn, but without complete disruption; swelling, ecchymosis, and loss of strength are more marked

3.severe) strain, the muscle or tendon is completely dis-
rupted, with resultant separation of muscle from muscle, muscle from tendon, or tendon from bone

Question 24

Tendinitis - classically described as an inflammatory condition characterized by pain at tendinous insertions into bone, occurring
in the setting of overuse
* certain systemic diseases, including diabetes mellitus, chronic renal failure, rheumatoid arthritis, and systemic lupus erythematosus; steroid use; and occasionally fluoroquinolone use are associated with the development of tendinopathy

Bursitis - a painful inflammation of the bursa that may be traumatic, infectious, or related to systemic illness

Question 25

Splinting and Bandaging Pros

• reduces the risk of further neurovascular compromise
• prevents a closed injury from potentially being converted to an open one during transport
• reduces the patient’s pain
• facilitates subsequent ED assessment and imaging

Answer 25

Types of splints

Question 26

Upper Extremity Splints and Bandages:
* Sling-and-Swathe and Velpeau Bandages
* Clavicle Splint
* Plaster and Fiberglass Splints
* Forearm and Wrist Splints

Answer 26

Lower Extremity Splints

SAGAR (better than the hair traction splint)

Question 27

Ankle Immobilization

Question 28

The Hand

The back of the hand and fingers is called the dorsal surface, and the palm side is called either the palmar or the volar surface. The borders of the hand are radial and ulnar. The five digits often are designated by numerals, but common names are preferable: I (thumb), II (index finger), III (long or middle finger), IV (ring finger), and V (little finger)

Answer 28

Hand Movement prt 1

Question 29

Hand Movement prt2

Answer 29

Hand Movement prt 3