Orthopedic Injury Flashcards by junior penvose

Ligaments..

Hold the bone together at the joint (sprain)

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Tendon…

Holds a muscle to a bone (strain)

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Complications of scapula/clavicle fractures

Large vessel injury
Pulmonary Issues
Rib fractures
Cervical spine fractures

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Tx of scapula/clavicle

Sling and Rest

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Also look for what complications of scapula/clavicle fractures..

Brachial plexus
Splenic injuries
Humerus fractures

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Shoulder injuries

FOOSH
(falling on outstretched hand)
Older - break
Younger - dislocate

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Shoulder injuries tx

Shoulder immobilizer

Sling with swathe to body

20% Require surgical interventions

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Signs of anterior shoulder disloc.

Cannot touch ear of opposite site of disloc.

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Thing to keep in consideration w/ midshaft humerus fracture

let elbow hang so the weight of the welbo helps reduce the fracture

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Common complications of midshaft humerus fracture

Brachial artery injury (may lose up to 750 ml of blood)

Radial nerve damage

Fat emboli (24-48 hrs after the injury)

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What is it called when you dislocate the radial head?

Nurse Maid elbow

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What is nurse’s maid elbow

Can’t supinate or pronate

Can still flex or extend but won’t due to pain

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How to pop nurse’s maid elbow back in?

supinate it

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What is nurse maid elbow most common

Children whose arms are pulled or jerked

Until age 5

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Where do those with both complete elbow dislocations go?

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What is considered a complete elbow dislocation

ulna and radius dislocated

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Ways to have a complete elbow dislocation

FOOSH

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Complications of a complete elbow dislocation

Neruovascular involvement

Brachial artery lac

Median nerve impingement or damage (hand contracture)

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Non-displaced elbow fracture

sling and encouragement of early use

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Displaced elbow fracture

surgical intervention

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What to asses for w/ elbow fracture

Median Nerve

Brachial Artery

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What is Monteggia’s fracture

Fracture of the proximal 1/3 of the ulna

w/ radial head dislocation

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What is Nightstick fracture

Fracture of the midshaft of the ulna - direct blow to forearm

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Tx for forearm fx

Closed reduction

Cast applied to keep elbow 90 degrees

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What to teach pt's with forearm fx

Prevent dependency of arm Prevent drooping of wrist inside sling after cast application - prevent compartment syndrome / edema

What is it called when your wrist fracture fall is like a fork

Colle's fracture Downward displacement of the distal radius

What is it called when your wrist fracture fall is like a hoe

Smith's fracture "Farmer smith had a hoe down" Upward displacement of the distal radius

Scaphoid fracture is where?

Base of the thumb bone

If a scaphoid fracture doesn't heal well what can you loose use of?

Thumb

What is coopernail sign

Bruising and swelling in the scrotum or labial folds from pelvic bleeding

Kidney trauma classic signs

Hematuria | Eccymosis over the flank

Bladder trauma classic sign

Pt has to void but when the push nothing comes out yet it hurts to push Abd distention Lack of urine flowing from indwelling catheter

Pelvic fracture tx supplies

Pelvic binder Venous bleed - pelvic binder will pull the space smaller and tamponade the bleeding Call tight enough where toes point in like a pigeon

Pelvic fracture tx fluid

Aggressive fluid resuscitation

Pelvic fracture be careful w/???

Cath 1st check site with retrograde urethrogram You can completely tear it - don't put anything in if there is blood

IF pt doesn't improve after application of pelvic binder?

Possibly arterial bleed

What is the only way to stop a pelvic arterial bleed?

Radiology for embolization or OR

Where do you put the pelvic binder?

Level of greater trochanter and sympysis pubis

Things to consider w/ hip dislocations

Reduce in six hours yo prevent femoral head nerosis

Posterior hip dislocation

Leg rotated inward toward other leg

Femur bone normally...

takes those big thigh muscles and stretches them out to make your leg longer So when you break it.. MUSCLES CONTRACT sharp ends = lac

On average what is the blood loss after a femur bone fracture..

1 L but can exceed 3L

What happens to the leg during a femur fracture?

Leg becomes short and fat = can hold more blood

What do you want on a femur fracture quickly?

Traction splint to stretch it out to tamponade bleeding

Do not apply traction splint on femur if..

there is a tibia or fibula fracture Or serious injuries to the foot

Can a traction splint be applied to a pelvic fracture?

Yes as long has it does not cause severe pain

What nerves to assess w/ a knee fracture/dislocation

Peroneal | Tibial

Tx for knee fracture / dislocation

surgery - dislocation | long leg splint

What artery must you watch w/ knee fracture/dislocation

Popliteal artery

What holds the patella in place?

A ligament that goes down in front of the leg

Way to relocate a dislocated patella?

Straighten the leg... pulls ligament down and pops it into place

Fracture the patella tx?

Surgery - poor healing process due to lack of blood supply

Fracture tib/fib are usually open due to?

Closeness to skin

Open fractures have highest risk of...

blood loss and infection Less to tamponade bleeding

Tibia is ...

non weight bearing Cannot walk into ER

Fibula is ...

weight bearing Can walk into ER still pain

Tib/Fib fracture tx

Cast

What medication can increase risk of achilles tendon rupture

Fluoroquinolone Levaquin Cipro Avelox Or direct steroid injection into the tendon

Achilles tendon rupture pt's cannot what with he foot?

Stand on ball of foot | Plantar flex the foot

3 things you do for achilles tendon rupture?

Splint the foot Crutches OR referal

Calcaneus rupture usually happens from

falling from a great height

Calcaneus classic triad?

Lover's fracture - jump off balcony COMPRESSION fracture L spine and tibial plateau

3 things for Calcaneus fracture tx

1. Compression dressing 2. Crutches 3. Surgery

General ice and heat rule for tx of orthopedic injuries

Apply ice 20 minutes once an hour Change to heat 48 hrs after injury Compartment syndrome? no ice

Where do you elevate an extremity?

Above the heart

How do you elevate the extremity if their is compartment syndrome

TO the level of the heart If you do it above the heart it dec oxygen delivery

Apply a splint ...

how the injury was found UNLESS there is poor circ and you need to readjust it

Immobilize what part of the fracture?

above and below If there is movement it can increase risk of injury and fat emboli

Cover open fractures w/

Saline soaked dressings

When you take a solid or a liquid and turn it into a gas. it takes up how much room??

WAY more than a solid or liquid GAS WAVE Hurricanes are like 200-300mph, Gas wave can be thousands