Orthopedic Emergencies Flashcards
What 4 factors tend to predict injuries?
Complaint
Age
Mechanism
Energy delivered
If there is a high suspicion for fracture but a negative x-ray, what should be done?
Treat as a fracture with rest and immobilization via sling, splint, or crutches
List types of fractures.
Transverse Oblique Spiral Comminuted Segmental Avulsed Impacted Torus Greenstick
What is a comminuted fracture?
Multiple pieces
What is an avulsion?
Results from a ligament pulling off a segment
What is an impaction?
Fractured but pushed into itself
What is a torus fracture?
Compression»_space;buckling of the cortex
What is a Greenstick fracture?
Cortical disruption on 1 side only
What is the Salter Harris classification?
For pediatrics
Involvement of cartilaginous epiphyseal plate or “physis”
Can lead to growth deformity
I - growth plate does not show up on x-ray; diagnosed if swelling of soft tissue is most prominent directly across the growth plate, treated as a fracture II - involves metaphysis + growth plate III - involves epiphysis + growth plate IV - involves both V - growth plate is completely impacted
Define open fracture.
Fracture in which there is an open wound or break in the skin near the site of the broken bone
All lacerations near a fracture site are open until proven otherwise
Other fracture descriptors?
Open or closed Exact anatomic location Direction of fracture line Simple/comminuted Displacement/alignment Involvement of articular surface (%)
Management of open fractures?
Remove gross debris Reduce if neurovascular compromise Dress Give prophylactic ABX (Ancef = cefazolin) Time limit - 6 hours for long bones
6 P’s of compartment syndrome
Pain - usually the first sign Paresthesias Pulselessness Pallor Poikilothermia Paresis
Risk factors for septic joint
Young and old IVDU Alcohol abuse DM Skin infection HIV and other immunocompromise Arthritis S/p joint injection or replacement
Dx septic joint?
Requires aspiration
Synovial lactate >10 mmol/L (LR infinity :P)
Synovial WBC 50,000, but cutoff not definite
Common bugs in septic joint?
Staph
Nesseria
Rx septic joint
IV ABX
Irrigation/drainage of joint
Who should get plain imaging in low back pain?
Direct trauma and midline spine tenderness
At risk for pathologic fracture (>50, cancer, osteoporosis, IVDU, fever)
Who should get an MRI in low back pain?
Objective weakness not related to pain
Loss of bladder function
Suspect epidural abscess (fever?)
90% of spinal cord injuries result from ___.
Blunt trauma