Orthopedic Emergncies Flashcards
What are the primary mechanisms of injury for Orthopedic Emergencies?
Motor vehicle crashes
Assaults
Falls
Sports/recreation
Injuries (other)
Occupational
What are the most common injuries for passengers in MVCs?
Pelvic and femur fractures
What are the most common injuries for drivers in MVCs?
Pelvic, femur, and ankle fractures
What are some key points about orthopedic emergencies?
- Can have significant blood loss.
- fracture with vascular compromise is a high priority.
- Fat embolism - complication of lower extremity fracture, pelvic fracture, or multiple fractures. (Usu. happens 12-24 hours post injury. Manifestations are the same as with PE but also common to have petechiae.)
- Takes a lot of force to fracture scapula and 1st and 2nd ribs. (Look for other injuries)
- Perform neuromuscular check pre and post splinting.
What should you be looking for with Neurovascular checks?
Pain
Pallor
Pulses
Paresthesia
Paralysis
Temperature
Capillary refill.
About Fingertip Injuries:
- Appear inconsequential
- Associated with fracture/crush injuries
- May need trephination for subungual hematoma.
- High Pressure Paint/grease guns can have serious outcomes (may need surgery).
- Can become limb threatening.
Specific Considerations about Impaled objects:
- Remove Surgically
- Nail Guns use nails coated twin special adhesive.
- Wood impalement may lead to infection.
Specifics related to Gunshot Wounds:
Damage depends on:
- Type of weapon
- size of ammunition
- distance from weapon
- trajectory
Forensic concerns:
- paper bag for clothes, cut clothes around holes
- paper bags on hands
- do not chart entrance/exit wound, just chart appearance of wound.
- use non metal forceps to remove bullet.
- chat what patient says in quotations.
What are some complications that can occurs with Crush Injuries?
- Myoglobinuria
- Extracellular fluid loss
- Hyperkalemia
- Renal failure
- Shock
What is a Sprain?
Stretching/tearing of ligaments.
Most common is ankle inversion.
What are the 3 categories of Sprains?
1st degree
- no joint instability
- minimal swelling/discoloration
2nd degree
- Partial tear
- joint intact
- more swelling/discoloration
3rd degree
- Complete disruption
- unstable joint
- increased swelling
What is a Strain?
Stretching or tearing of muscle.
What are the usual muscles that are involved in a Strain?
- Gastrocnemius
- Bicep
- Hamstring
- Quadriceps
What are some considerations with Amputations?
- Bleeding is often controlled by arterial spasm and retraction.
- Apply direct pressure to stump (use tourniquet if needed.)
Procedure for saving amputated Body part:
- rinse with NS/LR
- sterile 4x4 soaked in NS
- Put in plastic bag
- Place in second plastic bag with crushed ice.
What not to do with amputated body part:
DO NOT:
- use distilled water
- Place directly on ice
- place in water
- use iodine
What is Compartment Syndrome?
- Increased interstitial pressure within muscle compartment which occurs most frequently in lower leg and forearm.
- Etiologies include both internal and external sources.
- Ischemia occurs within 5 hours.
- Irreversible damage occurs in 8-12 hours.
- Normal pressure is < 20 mm Hg
What are some causes of Compartment Syndrome?
- Crush injuries
- Burns
- Traction
- Hypothermia
- Arterial Cannulation
- Fractures (most common cause)
- Bites
- Air splint/PASG
- Frostbite
- Casts
- Chronic Compartment syndrome
- High pressure injection of foreign substances
- Rhabdomyolysis
What are the manifestations of Compartment Syndrome?
- Pain
- Pallor
- Decreased sensation
- pulselessness
- weakness to extremity
- tense swelling
- Increased capillary refill
What is the treatment for Compartment Syndrome?
- Place at level of heart.
- Remove constricting factors.
- No Ice.
- Continuous monitoring.
- Hyaluronidase (provider injects to loosen fibers).
- Emergent Fasciotomy
What is a Dislocation?
- Displacement of bone ends over joints (articular surfaces of bones are no longer in contact.
- Can be partial or complete.
- Possible nerve/vein/arterial damage from compression, stretching, or ischemia.
What are the manifestations of Dislocations?
- severe pain
- joint deformity
- inability to move joint
- swelling
- point tenderness
What are some complications of Dislocations?
- Ischemia
- Aseptic necrosis (if joint is not put back in timely manner)
- Recurrent dislocations.
What are the types of Fractures:
- Transverse
- Oblique
- Spiral
- Comminuted
- Impacted
- Compression
- Greenstick
- Avulsion
- Depressed
- Torus
- Colles
- Smith
- Navicular
What is a Comminuted fracture?
Fracture with 2 or more fragments
What is a compression fracture?
No disruption of cortex
What is a Torus fracture?
Buckle on one side with no disruption of cortex.
What is a Colles fracture?
Distal radius fracture on outstretched hand.
What is a Smith fracture?
Distal radius fracture on flexed hand.
What s important about Epiphyseal Fractures?
- Can affect future growth from early closure of plates and can cause shortening of limbs or angulation.
- Salter-Harris classifications determine type of epiphyseal fracture.
What are the Manifestations of femur/hip fracture?
- Shortening of extremity.
- External/Internal rotation.
*Can be life threatening due to blood loss.
Specific considerations about Pelvic Fractures:
- Can be life threatening due to blood loss and hemorrhagic shock.
- Second most common cause of death from trauma related events.
- Mortality rate of 8-10% with closed hip fractures.
- use Pelvic binder
- Need to rule out before turning to inspect back.
What are some manifestations of Pelvic Fractures?
- Pelvic Instability
- Pain
- Muscle spasms
- Ecchymosis
- Hematuria
- Inability to bear weight
- Shock
What are some injuries associated with Pelvic Fractures?
- Bladder injuries
- Genital trauma
- Lumbosacral trauma
- Ruptured internal organs
Special Considerations with regard to Pediatric Orthopedic emergencies:
- Epiphyseal fractures - go comparison views.
- Loss of 300-1000 mL of blood can be significant.
- bones are more porous/flexible leading to incomplete fractures.
- Clavicle fracture is most prevalent.
- Limping is rare.
- Be alert for abuse.
Orthopedic Signs of pediatric abuse:
- Skull fractures
- multiple fractures in varying stages of healing.
- Rib fractures
- Scapular fractures
- Sternal fractures
- Vertebral fractures
- Distal clavicular fractures
- Spiral fractures of long bones
- Transverse fractures
- repeated fracture at same site
- Multiple, bilateral, or symmetric fracture.
Special Orthopedic Considerations with regard to Geriatric population:
- Increased degenerative bone disease leads to pathological fractures (Osteoporosis in women, Paget’s disease in men.)
- Increased risk of pressure sores.
- Be alert for abuse.
Special Orthopedic Consideration with regard to Pregnant population:
- Increased loss of balance leading to falls.
