Orthopedic Injuries and Immobilization Flashcards
History and Physical
- Immediately upon presentation with a dislocation or fracture, what must be checked?
- Attempt to ascertain the mechanism of injury.- How will this help? 2
- Radiographs should be obtained if what is suspected?
- Radiographs should be obtained after what?
- the neurovascular and circulatory status
2.
- may alert physician to other possibly associated injuries
- as well as provide clues as to the type of injury involved
3. fracture OR DISLOCATION
4. reduction and IMMOBILIZATION of a fracture or dislocation.
- How do you Describe This?
- How are fractures named how?
- Left Forearm fracture which is Dorsally Displaced
- Named by where the distal articulating surface ends up relative to the proximal articulating surface
e. g. Anterior shoulder dislocation
- Humeral head is anterior to the glenoid fossa
REDUCING DISLOCATIONS and SUBLUXATIONS
Three keys to success when attempting reduction?
3
- knowledge of anatomy
- analgesia and sedation
- slow and gentle procedure
REDUCING DISLOCATIONS and SUBLUXATIONS
- Following reduction, what should you do?
- After one or two unsuccessful attempts of reducing a dislocation (closed reduction) what should you do?
- the joint must be splinted and proper follow-up is mandatory
- it is necessary to reduce under general anesthesia (closed) or during surgery (open reduction)
Finger Dislocation
- Clinical exam to determine what? 2
- Imaging?
- Analgesic?
- How would you reduce the dislocation? 3
- Why would we take further xrays?
- Strap finger where?
- Warn pt about what?
- Clinical exam to determine nerve and tendon function if possible
- X-ray to confirm diagnosis
- Anesthetize with a digital block
- Reduce dislocation
i. Apply traction in line with the distal portion of the finger
ii. The deformity should increase slightly just prior to joint going back in place
iii. This should be felt as a click - Take further X-rays if necessary to rule out a “chip” fracture
- Strap injured finger to adjacent finger
- Warn patient that swelling will persist for several months
Shoulder Dislocation
- Important question to ask on Hx?
- Clinical exam? Which nerve?
- Xray to rule out? Which ones? 2
- Methods for reduction? 2
- Take a past medical history
- (i.e. has this happened before?) - Clinical exam (check for nerve function) Axillary
- X-ray to rule out possible fracture
- head of the humerus,
- bony Bankart - Several methods for reduction
- Scapular rotation
- Traction/counter traction
Describe the following types of fractions:
- Closed?
- Open?
- Multiple?
- Comminuted?
- Greenstick?
- Spiral?
What is a greenstick fracture?
an incomplete fracture in a long bone of a child (bones are not yet fully calcified and they break like a green stick)
- What is an open fracture?
- What is more common in this?
- How many grades?
- the bone breaks and pierces the overlying skin
- (osteomyelitis are more common)
- 4 grades
Spiral Fracture is what?
- a fracture that spirals part of the length of a long bone
WRIST FRACTURES
- What is Smith’s fracture?
- Colles’ fracture?
- What nerve do you have to worry about?
- Median nerve- indication for fixing it would would to save it
Collies is a dorsal displaced fragment
Scaphoid Fractures characteristics? 3
- tenuous blood supply
- high incidence of avascular necrosis in waist and proximal fractures
- often require bone grafting
Cast for at least 6 weeks, immobilization for 10
Scaphoid Fractures
- Why is follow up important?
- Tx?
- follow up important
- repeat x-rays and early bone scan vs MRI in patients with persistent pain - thumb spica with prolonged immobilization
Evidence of rudimentary splints found as early as 500 BC.
Used to temporarily immobilize fractures, dislocations, and soft tissue injuries.
Circumferential casts abandoned in the ED
why? 3
- increased compartment syndrome and other complications
- ideal for the ED – allow swelling
- splints easier to apply
Function of splints?
6
- To immobilize orthopedic injuries
- To promote healing
- Maintain bone alignment
- Diminish pain
- Protect injury
- Help compensate for surrounding muscular weakness
Indications for Splinting
8
- Fractures
- Sprains
- Joint infections
- Tenosynovitis
- Acute arthritis / gout
- Lacerations over joints
- Puncture wounds and animal bites of the hands or feet
- Infection
Splinting Vs Casting
5 factors
- Assess the stage and severity of injury
- Potential for instability
- Risk of complications
- Patient’s functional requirements
- Casting for definitive and/or complex