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18 ORR > Orthopedic Emergencies > Flashcards

Orthopedic Emergencies Flashcards

1
Q

orthopedic emergencies are acute injuries to __

A

bone, joint, or related soft tissue structures

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2
Q

orthopedic emergencies can result to ___

A

loss of life or loss of limb

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3
Q

factors for msk tissue damage

A
  • inherent blood supply
  • response to ischemia
  • susceptibility to infection
  • regenerative and reconstructive potential
  • patient characteristics
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4
Q

care prior to hospitalization

A
  • splint where they lie
  • immobilize joints above and below
  • gentle in-line traction to re-align extremities
  • tamponade bleeding
  • avoid tourniquets, unless life is in danger
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5
Q

steps in caring for a multiple injured patient

A
  • abcde
  • resuscitation
  • secondary survey (xrays)
  • definitive care
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6
Q

injury and energy dissipated

A
  • fall from curb 100
  • skiing 300-500
  • high velocity gsw 2,000
  • automobile collision 100,000
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7
Q

t/f gustilo classification can be used on any bone

A

false, only on long bones (humerus, forearm, femur, tibia)

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8
Q

signs of long bone fracture

A
  • visible bone
  • proximity to fracture
  • bleeding that is not proportionate to size
  • fat globules in blood
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9
Q

infection in the bone can lead to ___

A

osteomyelitis

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10
Q

gustilo I

A

< 1 cm
1st gen cephalosporin + tetanus prophylaxis
“inside out”

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11
Q

gustilo II

A

> 1 cm but <10 cm
1st gen cephalosporin + tetanus
comminution more likely

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12
Q

gustilo IIIA

A

> 10 cm

  • minimal periosteal stripping but with adequate coverage
  • 1st gen cehpa + aminoglycoside
  • high energy, gsw, natural disasters
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13
Q

gustilo IIIB

A
  • periosteal stripping that may need flap coverage
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14
Q

gustilo IIIC

A
  • vascular injury requiring repair

- add high dose penicillin for farm injuries

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15
Q

t/f the amount of soft tissue injury will dictate what happens to a fracture

A

true

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16
Q

infection rates per gustilo type

A 
I = 0-2%
II = 2-7%
III = 10-25%
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17
Q

gold standard for treatment of open fractures

A

immediate debridement of open fracture

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18
Q

steps of debridement of open fractures

A
  • expose adequately without causing more damage
  • remove foreign bodies/contaminants
  • 4cs: color, consistency (resilient and not easily friable), contractility (twitching), capacity to bleed
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19
Q

t/f you can leave bleeding arteries open

A

false

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20
Q

(open fractures) if proper debridement is not done, there will be ___

A

increased bacterial load –> delay in closure

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21
Q

(open fractures) if wound is clean and proper antibiotics are given, fracture can be closed at __

A

10 hour mark

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22
Q

t/f you can close a gustilo type 2 or 3 that is grossly contaminated

A

false, don’t close. pack it, make sure there’s a moist environment, wrap and elastic bandage and immobilize, and refer

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23
Q

repeat debridement in open fractures are done every __

A

24-72 hours

24
Q

in open fractures, specimens are taken from ___

A

the soft tissue envelope around injury

25
Q

t/f you can get samples before debridement

A

false!! get samples when wound looks clean

26
Q

parts of mangled extremity severity scale

A
  • skeletal soft tissue injury
  • limb ischemia
  • shock
  • age
27
Q

mess scoring

A

> 7 = might amputate

for any section with limb ischemia, the score is doubled for ischemia time of >6 hours

28
Q

common sequelae of open fractures

A
  • infection/sepsis
  • delayed union/non-union
  • joint stiffness
  • chronic post traumatic osteomyelitis
  • prolonged disability
29
Q

more common dislocations

A

shoulder: anterior
hip: posterior
patellar (vs knee)
elbow (axial load)
ankle: inversion

30
Q

emergent problems in dislocation

A
  • know what xrays
  • pain and loss of motion
  • acute neurovascular compromise
  • soft tissue necrosis
  • acute ischemia to sensitive bone structures
  • long term complications (arthritis, osteonecrosis)
31
Q

treatment for acute dislocations

A
  • early reduction
  • check neurovascular status before and after reduction
  • check with xrays to confirm
32
Q

indications for open reduction

A
  • anatomic reduction not achieved by closed reduction
  • unstable joint after reduction
  • neurologic or vascular injury
  • presence of limb ischemia
33
Q

mechanisms of neurovascular injuries

A
  • fractures or dislocations
  • sharp trauma
  • acute thrombi
  • iatrogenic (after manipulation of limb)
34
Q

presentation of anterior dislocation

A
  • internally rotated
  • adducted
  • with shortening
35
Q

presentation of posterior hip dislocation

A
  • externally rotated

- abducted

36
Q

injuries and corresponding affected vessels

A

read!!

37
Q

clinical presentation of neurovascular injuries

A
  • increase/decrease in sensation
  • numbness
  • cyanosis
  • weak/absent pulses
  • neuropraxia
  • open injuries: transection of nerves (neurotmesis)
38
Q

nerve and test for shoulder dislocation

A

axillary nerve

test sensation around deltoid area

39
Q

nerve and test for humeral shaft fracture

A

radial nerve

sensory: 1st dorsal rib space
motor: wrist drop inability to extend thumb

40
Q

nerve and test for medial epicondyle of elbow

A

ulnar nerve

test ulnar side of small finger

41
Q

nerve and test for humeral supercondylar fracture

A

radial/median nerve

test: a-ok sign and isolating tip of index muddle finger

42
Q

nerve in hip dislocation and knee dislocation

A

hip: sciatic nerve
knee: peroneal nerve

43
Q

what is acute compartment syndrome

A
  • results from elevation of interstitial pressure

- leading to microvascular compromise and dec local tissue perfusion

44
Q

sites at risk for compartment syndrome

A
  • compartments bound by non-compliant fascia or bone
  • fractures and dislocations
  • vascular injury
  • burns
  • limb compression
45
Q

pathophysiology of acute compartment syndrome

A
  • insult/injury
  • increased pressure
  • decreased capillary blood flow = ischemia
  • local tissue necrosis due to lack of oxygen
46
Q

t/f acute compartment syndrome is a clinical diagnosis

A

true

47
Q

4ps of actue compartment syndrome

A
  • pain out of proportion to that expected from inciting injury (most sensitive sign!!)
  • pulselessness
  • paresthesia/hypoesthesia
  • pallor
48
Q

intracompartmental pressure measurement is diagnostic if it’s ___

A

within 10-30 mmhg of diastolic pressure

49
Q

treatment for compartment syndrome

A
  • fasciotomy
  • make multiple incisions to allow complete decompression of all compartments
  • leads to decrease in pressure and restore perfusion
  • repeat debridement 48-72 hours
50
Q

kanavel’s signs of the hand

A
  • palpable tenderness along tendon sheath
  • pain on passive extension of the digit
  • symmetric digital swelling
  • digit fixed in a semi-flexed position
51
Q

conus medullaris ends at __

A

l1 or l2 and after is the cauda equina

52
Q

clinical presentation of cauda equina syndrome

A
  • severe low back pain
  • uni/bilateral sciatica
  • radiating pain beyond the knee
  • saddle anesthesia around anus (s3-5)
  • motor weakness and reflexes on LE
  • bladder or rectal dysfunction
53
Q

table for clinical presentation of ces

A

read

54
Q

causes of ces

A
  • sacral root injury: neurological deficit
  • compression: disc, tumor, epidural hematoma
  • should be rules out in acute radiculopathy
55
Q

acute vs insidious onset ces

A

acute: sudden, motor weakness, saddle anesthesia, urinary retention
insidious: recurrent, motor weakness, no saddle anes, gradual symptoms

56
Q

imaging of choice for ces

A

mri

57
Q

treatment for ces

A
  • immediate surgical decompression
  • wide laminectomy followed by discectomy
  • for better motor recovery, poorer bladder and bowel recovery

18 ORR (21 decks)

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