Principles Flashcards
What is the antibiotic coverage of Gustillo & Anderson grading of open fractures?
Type 1: 1st generation cephalosporin
Type 2: +- add aminoglycoside
Type 3: add aminoglycoside
Farm injuries: add penicillin and an aminoglycoside
ALL GET TETANUS PROPHYLAXIS
Describe the Gustillo & Anderson classification of open fractures:
Type 1: clean wound 1cm long with extensive soft tissue damage
Type 3: usually >10cm laceration with high contamination
3A: adequate bone coverage
3B: extensive soft tissue injury with periosteal stripping and bone exposure requiring grafting to close
3C: associated vascular injury requiring repair
What is the Tscherne classification used for? Describe it:
Used to describe soft tissue integrity in fracture.
- Grade 0: minimal soft tissue damage, indirect trauma to limb (torsion injury), simple fracture pattern
- Grade 1: superficial contusion or abrasion. Mild trauma pattern
- Grade 2: deep abrasion, skin or muscle contusion, seve fracture pattern, direct trauma to limb
- Grade 3: extensive skin contusion or muscle damage, crush injury, severe damage to underlying muscle, compartment syndrome, subcutaneous avulsion
Define compartment syndrome in terms of compartment pressure:
Absolute pressure of 30mmHg
Within 30mmHg of diastolic pressure
New studies show 18-19mmHg starts to occlude capillary pressure and can lead to compartment syndrome. = Pre-compartment syndrome
How far proximally do you have to go to release the deep posterior compartment?
High enough to release soleus from tibia.
This releases soleal bridge and the possibility of the 5th compartment
Describe the 2 incision technique for lower leg fasciotomy:
Anterolateral: halfway between fibula and tibial crest
- Allows access to anterior and lateral compartments
Posteromedial: 1-2cm posterior to lateral aspect of tibia
- Allows access to superficial and deep posterior compartments
Describe the fasciotomy technique for the forearm:
True Volar Henry approach allows release of the superficial and deep anterior compartments
Thompson approach allows release of the mobile wad
What x-rays constitute a trauma series?
Lateral c-spine
CXR
AP Pelvis
Describe the Injury Severity Score:
Sum of the square of the abbreviated injury score (AIS) of the 3 most injured body regions
Score >18 suggests multiply injured patients and indicates transfer to the trauma department
How much pressure is released by univalving a cast? Bivalving?
Univalve: 30% pressure drop
Bilvalve: 60% pressure drop
Cut cast padding to release more pressure
What is the position of function for the ankle?
Neutral (no dorsiflexion)
What is the position of function of the hand?
Intrinsic plus position
MCP flexed 70-90 degrees, IP joints extended
How much weight can be applied to skin traction?
10lbs
What is the maximum weight that can be applied to skeletal traction?
20% of body weight for the lower extremity
What size pin should you use for skeletal traction?
Largest available (5-6mm)
What is the location for tibial traction pin? What are the dangers?
1cm distal and 2cm posterior to the tibial tubercle.
Placed from lateral to medial, away from common peroneal nerve
Try to stay out of the anterior compartment
What is the location of a femoral traction pin? What are the dangers?
At the adductor tubercle, 2 fingerbreadths proximal to the femoral condyle (in metaphyseal bone), in the middle of the femur (AP direction).
Use the proximal edge of patella in an extended knee as your landmark
Go medial to lateral to avoid neurovascular bundle
What needs to be done after delayed reperfusion (>6hrs) of any vascularly damaged extremity?
Prophylactic fasciotomies
What is the location of a calcaneal traction pin? The dangers?
2cm posterior and inferior to the medial malleolus
Go medial to lateral to avoid the neurovascular bundle
What is the location for olecranon traction?
1.5cm from the tip of the olecranon.
Go medial to lateral to avoid ulnar nerve
Rarely used
What are the principles of tendon transfers?
SEACOAST Synergistic transfers Expendable donor muscle Adequate strength Contractures need releasing One tendon, one function Adequate amplitude (length) Straight line of pull Tissue equilibrium
Risk factors for non-union:
Infection Diabetes Smoking Vascular disease Steroids Immunosuppressed
What are 3 risk factors to failure of arthrodesis?
Poor blood supply: - Smoking - Diabetes - Avascular necrosis Other - Failure of previous fusion - Too much motion through the joint - Adjacent joint fusion
Name 5 indications for surgery on any fracture:
Open fracture Unacceptable displacement or deformity Polytrauma Failure of closed reduction Unstable fracture Failed non-operative management
What is the Seddon classification of nerve injuries?
Neuropraxia
Axontmesis
Neurontmesis
What is the most common endocrine abnormality in nonunion?
Vitamin D deficiency (for all comers)
