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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
t/f you can get samples before debridement
false!! get samples when wound looks clean
26
parts of mangled extremity severity scale
- skeletal soft tissue injury - limb ischemia - shock - age
27
mess scoring
>7 = might amputate for any section with limb ischemia, the score is doubled for ischemia time of >6 hours
28
common sequelae of open fractures
- infection/sepsis - delayed union/non-union - joint stiffness - chronic post traumatic osteomyelitis - prolonged disability
29
more common dislocations
shoulder: anterior hip: posterior patellar (vs knee) elbow (axial load) ankle: inversion
30
emergent problems in dislocation
- 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
treatment for acute dislocations
- early reduction - check neurovascular status before and after reduction - check with xrays to confirm
32
indications for open reduction
- anatomic reduction not achieved by closed reduction - unstable joint after reduction - neurologic or vascular injury - presence of limb ischemia
33
mechanisms of neurovascular injuries
- fractures or dislocations - sharp trauma - acute thrombi - iatrogenic (after manipulation of limb)
34
presentation of anterior dislocation
- internally rotated - adducted - with shortening
35
presentation of posterior hip dislocation
- externally rotated | - abducted
36
injuries and corresponding affected vessels
read!!
37
clinical presentation of neurovascular injuries
- increase/decrease in sensation - numbness - cyanosis - weak/absent pulses - neuropraxia - open injuries: transection of nerves (neurotmesis)
38
nerve and test for shoulder dislocation
axillary nerve | test sensation around deltoid area
39
nerve and test for humeral shaft fracture
radial nerve sensory: 1st dorsal rib space motor: wrist drop inability to extend thumb
40
nerve and test for medial epicondyle of elbow
ulnar nerve | test ulnar side of small finger
41
nerve and test for humeral supercondylar fracture
radial/median nerve | test: a-ok sign and isolating tip of index muddle finger
42
nerve in hip dislocation and knee dislocation
hip: sciatic nerve knee: peroneal nerve
43
what is acute compartment syndrome
- results from elevation of interstitial pressure | - leading to microvascular compromise and dec local tissue perfusion
44
sites at risk for compartment syndrome
- compartments bound by non-compliant fascia or bone - fractures and dislocations - vascular injury - burns - limb compression
45
pathophysiology of acute compartment syndrome
- insult/injury - increased pressure - decreased capillary blood flow = ischemia - local tissue necrosis due to lack of oxygen
46
t/f acute compartment syndrome is a clinical diagnosis
true
47
4ps of actue compartment syndrome
- pain out of proportion to that expected from inciting injury (most sensitive sign!!) - pulselessness - paresthesia/hypoesthesia - pallor
48
intracompartmental pressure measurement is diagnostic if it's ___
within 10-30 mmhg of diastolic pressure
49
treatment for compartment syndrome
- 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
kanavel's signs of the hand
- palpable tenderness along tendon sheath - pain on passive extension of the digit - symmetric digital swelling - digit fixed in a semi-flexed position
51
conus medullaris ends at __
l1 or l2 and after is the cauda equina
52
clinical presentation of cauda equina syndrome
- 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
table for clinical presentation of ces
read
54
causes of ces
- sacral root injury: neurological deficit - compression: disc, tumor, epidural hematoma - should be rules out in acute radiculopathy
55
acute vs insidious onset ces
acute: sudden, motor weakness, saddle anesthesia, urinary retention insidious: recurrent, motor weakness, no saddle anes, gradual symptoms
56
imaging of choice for ces
mri
57
treatment for ces
- 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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