Orthopedic Emergencies Lecture Powerpoint

Question 1

Immediate complications of fractures and dislocations (4)

Answer 1

• hemorrhage (pelvic, femur)
• vascular injury (axillary artery, brachial artery, popliteal artery)
• nerve injuries
• associated soft tissue/visceral injuries

Question 2

Volkmann ischemic contracture

Answer 2

Occurs when there is ischemia to the forearm, typically when there is increased pressure due to swelling such as compartment syndrome, prolonged ischemia injures nerves and muscles causing them to become stiff and shortened, muscles of forearm are severely injured leading to deformities of fingers, hands, wrists, can involve 2-3 fingers, all, or complete hand

Question 3

Shoulder dislocation placees this nerve at high risk

Answer 3

Axillary nerve

Question 4

Intermediate complications of fractures and dislocations (3)

Answer 4

• compartment syndrome
• fat embolism
• necrotizing fasciitis

Question 5

5 P’s seen in compartment syndrome

Answer 5

• pain (out of proportion)
• paresthesia
• pallor
• paralysis
• pulselessness
• polkiothermia (you found the extremely rare 6th P)

Question 6

Only treatment for acute compartment syndrome

Answer 6

Surgery (fasciotomy)

Question 7

Most common pathogen causing necrotizing fasciitis

Answer 7

Group A B hemolytic strep

Question 8

Limb threatening emergencies (4)

Answer 8

• open fracture (high risk for infection)
• major vascular disruption
• major pelvic fracture
• compartment syndrome

Question 9

Pelvic fractures protocol (4)

Answer 9

• ATLS (stop the bleeding)
• resuscitate (IV fluids and blood transfusion)
• pelvic binder
• skeletal traction

Question 10

Anatomic vs surgical neck of the femur

Answer 10

The anatomic neck is right beneath the head and above the trochanters, the surgical is also known as the subtrochanteric region and is below the trochanters

Question 11

Femur fracture management (5)

Answer 11

• IV fluids
• Pain management
• splint/immobilize using traction
• copious irrigation
• prep for surgery

Question 12

Ankylosis

Answer 12

Abnormal stiffening and immobility to joint due to fusion of bones, complication in dislocation followed by repair/reduction

Question 13

Dislocated joints that are considered emergencies (5)

Answer 13

• shoulder
• elbow
• hip
• knee
• ankle

Question 14

Neuropraxia

Answer 14

Transient episode of motor paralysis often involving he median or ulnar nerve in 20% of elbow dislocations

Question 15

Posterior hip dislocation occurs in mostly in what type?

Answer 15

Posterior

Question 16

What is anterior hip dislocation associated with?

Answer 16

Femoral head impactation or chondral injury

Question 17

Most common nerve injury in a knee dislocation

Answer 17

Common peroneal nerve

Question 18

Any wound over or near a joint should be assumed to…

Answer 18

….extend into the joint until proven otherwise (check distal nerve intact, intact functioning of flexor and extensor tendon, vascular integrity)