Orthopedic Injuries and Immobilization Flashcards
How are fractures named?
Following a reduction, what management comes next?
What about after one or two unsuccessful reduction attempts?
Named by where the distal articulating surface ends up relative to the proximal articulating surfaces
Following a reduction, the joint must be splinted and proper follow up in mandatory
After one or two unsuccessful attempts of reducing a dislocation, it is necessary to reduce under general anesthesia (closed) or during surgery (open)
How do you reduce a finger dislocation?
What population are greenstick fractures more common in?
- apply traction in line with the distal portion of the finger
- the deformity should increase slightly just prior to the joint going back into place
- this should be felt as a click
Greenstick fractures are in children
Indications for splinting
- fractures (simple and stable)
- sprains
joint infections
*tenosynovitis (tendon injuries)
acute arthritis/gout
lacerations over joints
puncture wounds and animal bites of the hands or feet
infection
*other soft tissue injuries
Advantages and disadvantages of
- splinting
- casting
SPLINTING Advantages -faster -easier -static or dynamic -pressure sores/complications are less likely -easy removal
Disadvantages
- lack of pt compliance and excessive motion at injury site
- not for unstable fx like segmental or spiral or dislocated fxs
CASTING
Advantages
-mainstay of tx for most fxs
-more effective immobilization
Disadvantages
- require more skills
- more time to apply
- higher risk of complications
What is Plaster of Paris?
alternatives?
Plaster used for splinting. It has an exothermic rxn when wet, can take up to 1 day to cure
Alternatives to this are
- Plaster (OCL)
- Fiberglass (Orthoglass)
What are the specific splints for the following?
- elbow/forearm
- forearm/wrist
- hand/fingers
- knee
- ankle
- foot
- elbow/forearm
- -long arm posterior
- -double sugar tong
- forearm/wrist
- -volar forearm/cockup
- -sugar tong
- hand/fingers
- -ulnar gutter
- -radial gutter
- -thumb spica
- -finger splints
- knee
- -knee immobilizer/bledsoe
- -bulky jones
- -posterior knee splint
- ankle
- -posterior ankle
- -stirrup
- foot
- -hard shoe
What makes the double sugar tong splint better for most distal forearm and elbow fractures?
What splint should not be used for distal radius/ulnar fx and why? What splint should be used instead?
It limits flex/extension and pronation/supination
Volar aka cockup splint because they can still supinate and pronate. A forearm sugar tong splint would be indicated for distal radius and ulnar fractures
What is the correct position for most hand splints?
What are the indications for a thumb spica splint?
For most hand splints, the correct position is in the position of function, aka the neutral position
(beer can position)
Scaphoid fracture, De Quervain tenosynovitis, base of 1st metacarpal fracture “bennetts” or proximal phalanx fracture thumb
What is a jones dressing? Indications?
Jones dressing
-stockinette, webril, cotton, and an ace wrap. there is nothing hard inside of it
indications
-short term immobilization of soft tissue and ligamentous injuries to the knee of calf
CI to casting
- early: casting before maximal swelling has occurred can cause necrosis and possibly compartment syndrome
- open wound!!!!!
- unstable fractures
complications of a cast or splint
- compartment syndrome
- ischemia
- heat injury
- pressure sores and skin breakdown
- infections
- dermatitis
- joint stiffness
- neurologic injury
