Orthopedic Surgery

Question 1

What are “hard signs” of traumatic arterial injury?

Answer 1

1. Distal limb ischemia
2. Absent distal pulse
3. Active hemorrhage or rapidly expanding hematoma
4. Bruit or thrill at site of injury

Question 2

What are “soft signs” of traumatic arterial injury?

Answer 2

1. Diminished distal pulses
2. Unexplained hypotension
3. Stable hematoma
4. Documented hemorrhage at the time of injury
5. Associated neurological deficit

Question 3

The middle third of the clavicle overlies what structures?

Answer 3

1. Brachial plexus
2. Subclavian artery and vein

This is known as the thoracic outlet and requires further neurovascular evaluation if a clavicular break occurs.

Neurological damage warrants nerve conduction studies. This may be noted with numbness distally.

Arterial damage requires CT angiogram or other imaging. This may be noted with weak or absent distal pulse.

Venous damage requires venous duplex. This may be noted if patient has upper extremity edema or cyanosis.

Question 4

“Soft signs” means what?

Answer 4

Signs indicating that more imaging s/a CT angiography is required

No need for surgery yet

Question 5

“Hard signs” means what

Answer 5

Signs indicating immediate surgery

Question 6

An uncomplicated calvicle break is managed with what?

** emphasis on uncomplicated

Answer 6

Figure of eight bandage