Stasio Sprains and Splints Flashcards
CLINICAL SIGNS AND SYMPTOMS OF A FRACTURE
PAIN
SWELLING
DEFORMITY
ECCYMOSIS
LOSS OF FUNCTION
THE MOST RELIABLE SIGN OF FRACTURE IS?
PAIN
Types of fractures
oblique
comminuted
spiral
compound
transverse, oblique, segmental, avulsted, impacted, torus, greenstick
OPEN Fractures
Definition: a fracture that has communicated with the outside environment.
Two ways:
- High velocity trauma or missile injury
- Spikes of bone pierce the skin
Do not get fooled by the size of the injury, whether a small or larger wound, must get a surgical consult and intervention.
SALTER
Slipped- 1 Above- 2 Lower- 3 Through- 4 Rammed and Ruined- 5
WHY WORRY ABOUT SALTER NUMBERS?
THE HIGHER THE SALTER NUMBER THE POORER THE PROGNOSIS FOR RECOVERY.
THE MORE SERIOUS FRACTURES CAN LOOK BENIGN
FRACTURE REDUCTIONS MUST BE PERFECT FOR BEST RESULTS
SALTER TYPE I
(SLIPPED)
TRANSVERSE FRACTURE THROUGH GROWTH PLATE OR
PHYSIS
ONLY 6% OF FRACTURES
SALTER TYPE II
(ABOVE)
FRACTURE THROUGH THE METAPHYSIS SPAREING THE EPIPHYSIS
** MOST COMMON
70% OF GROWTH PLATE FRACTURES
SALTER TYPE III
(LOWER)
FRACTURE THROUGH THE GROWTH PATE AND EPIPHYSIS SPARING THE METAPHYSIS
ONLY 8% OF FRACTURES
SALTER TYPE IV
(THROUGH)
EXTEND THROUGH ALL THREE ELEMENTS
GROWTH PLATE EPIPHYSIS AND METAPHYSIS
10% INCIDENCE
SALTER TYPE V
(RAMMED AND RUINED)
COMPRESSION FRACTURE OF THE GROWTH PLATE
LUCKLY RARE 1% INCIDENCE
PIT FALLS WITH FRACTURES
Not all fractures are apparent
fall with snuff box pain, e.g.
COLLES’ FRACTURES
Fracture of the distal radius with dorsal displacement, with or without ulnar involvement.
“Dinner fork” deformity.
Falling on an outstretched hand.
Associated fracture of the ulnar styloid process >60% of the time.
Tri-malleolar Fracture
Involves:
- Lateral malleolus
- Medial malleolus
- Posterior tibia
Landing flat on the heal from significant
height.
Very unstable fracture.
Treatment:
Surgery (ORIF)
Open Reduction
Internal Fixation
FRACTURE COMPLICATIONS- one of the most important things
ischemic injuries
always check distal neurovascular issues
Early Complications
Local
Vascular injury causing hemorrhage, internal or external
- Visceral injury causing damage to structures such as the brain, lung or bladder
- Damage to surrounding tissue, blood vessels, muscle, nerves or skin
- Hemarthrosis
- Compartment syndrome (or Volkmann’s ischemia)
- Wound Infection - more common for open fractures
Early Complications
Systemic
- Fat embolism – long bone / pelvic fractures from bone marrow
- Shock – extensive bleeding
- Thromboembolism (pulmonary or venous)
- Exacerbation of underlying diseases such as diabetes or coronary artery disease (CAD)
- Pneumonia
Late Complications- Local
Delayed union
Nonunion
Mal-union
Joint stiffness
Contractures
Myositis ossificans – calcifications and bony masses can form in muscle
Avascular necrosis – loss of blood supply
Algodystrophy (or Sudeck’s atrophy) – RSD or Regional pain syndrome
Osteomyelitis - infection
Growth disturbance or deformity – children’s growth plates
Late Complications
Gangrene, tetanus, septicemia
Fear of mobilizing
Osteoarthritis
COMPARTMENT SYNDROMES
- Medical Emergency
The pressure inside the fascial compartment exceeds the blood (arterial) pressure.
Causes compromise of the circulation to the soft tissue, ischemia and necrosis.
Irreversible damage can occur in 8 hours.
Conditions Associated with COMPARTMENT SYNDROMES
Soft tissue injuries Soft tissue injury with fracture Exercised induced Crush injury Prolonged tourniquet application Electrical injury Burns Animal bites
How do you know if compartment syndrome is happening? What is the treatment?
if pressure exceeds systolic BP, then blood isn’t getting into that area
Fasciotomy
FRACTURE BLISTERS
Tense vesicles or bullae that arise on markedly swollen skin directly over a fracture.
- Tibia, ankle and elbow.
- Arise in 24-48 hours post injury, early as 6 hours.
-Two types:
Clear fluid filled
Blood filled
- Caused by separation of the dermis from the epidermis.
- Can result in increased infection rate.
-Treatment: Benign neglect Debridement Aspiration Surgical delay
MALALIGNMENT OF FRACTURES
WILL STRAIGHTEN
IN KIDS IF ANGLE LESS THAN
15 DEGREES
types of ankle sprains/ ligament tears
inversion
eversion
high ankle sprain
Degree of Severity of Ankle Sprains:
Grade I
Mild sprain, * mild pain, little swelling, and * joint stiffness may be apparent without laxity (loosening)
Usually affects the anterior talofibular ligament
* Minimum or no loss of function
Can return to activity within a few days of the injury (with a brace or taping)
Grade II
* Moderate to severe pain, swelling, and joint stiffness are present
Partial tear of the lateral ligament(s)
* Moderate loss of function with difficulty on toe raises and walking
Takes up to 2-3 months before regaining close to full strength and stability in the joint
Grade III
Severe pain may be present initially, * followed by little or no pain due to total disruption of the nerve fibers
Swelling may be profuse and joint becomes stiff some hours after the injury
Complete rupture of the ligaments of the lateral complex (severe laxity)
Usually requires some form of immobilization lasting several weeks
* Complete loss of function (functional disability) and necessity for crutches
Usually managed conservatively with rehabilitation exercises, but a small percentage
* may require surgery
Recovery can be as long as 4 months
TREATMENT OF ACUTE SPRAINS IS
R= REST I= ICE C= COMPRESSION E= ELEVATE NOTE: MAY NEED IMMOBILIZATION WITH GRADE III SPRAINS
BENEFITS OF A CAST
BETTER IMMOBILIZATION IN FIXED POSITION
LESS MOVEMENT AT THE FRACTURE SITE
LASTS FOR WEEKS TO MONTHS
CAN’T BE REMOVED BY THE PATIENT
BENEFITS OF A SPLINT
FASTER AND CHEAPER
CAN BE ADAPTED FROM SURROUNDING MATERIAL
NOT AS LIKELY TO CAUSE PRESSURE PROBLEMS
CAN BE REMOVED BY THE PATIENT
HAZARDS OF CASTING
compartment syndrome ischemia heat injury pressure sores and skin breakdown infection dermatitis joint stiffness neurologic injury
Always document a neruo/ motor/ vascular exam pre and post cast application
MATERIALS NEEDED FOR CASTING
adhesive tape (to prevent slippage of elastic wrap used with splints)
bandage scissors
basin of water at room temperature (dipping water)
casting gloves (necessary for fiberglass)
elastic bandage (for splints)
padding
plaster or fiberglass casting material
sheets, underpads (to minimize soiling of the patient’s clothing)
sockinette
APPLICATION:
use appropriate amount and type of padding
properly pad bony prominences and high-pressure areas
properly position the extremity before, during and after application of materials
avoid tension and wrinkles on padding, plaster, and fiberglass
avoid excessive molding and indentations
Factors that affect setting times for casts and splints
speeding up:
higher temperature of dipping water
use of fiberglass
reuse of dipping water
slowing down:
cooler temperature of dipping water
use of plaster
types of splints
posterior
stirrup
gutter
sugar tong
wrapping a splint or cast
always wrap distal to proximal
warnings
ALWAYS WEAR GLOVES WHEN WORKING WITH THE RESIN CASTING TAPE
WE DO NOT HAVE A POWER GRINDER TO GET IT OFF YOUR HANDS.
Indications for Diagnostic and Therapeutic Injections
Soft tissue conditions: Bursitis Tendonitis Trigger points Ganglion cysts Neuroma Entrapment syndromes Fasciitis
Joint conditions: Effusion Crystalloid arthropathies Synovitis Inflammatory arthritis Advanced osteoarthritis
contraindications to joint injections
Absolute contraindications:
Local cellulitis
Acute fracture
Tendon sites are at a high risk for rupture
Drug allergy
Septic arthritis – for therapeutic injection, not aspiration
Relative contraindications:
Minimal relief after 2 previous injections
Underlying coagulopathy / anticoagulation therapy
Uncontrolled diabetes
Surrounding joint osteoporosis
Anatomically inaccessible joint
