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PCM IV Exam I > Stasio Sprains and Splints > Flashcards

Stasio Sprains and Splints Flashcards

1
Q

CLINICAL SIGNS AND SYMPTOMS OF A FRACTURE

A

PAIN

SWELLING

DEFORMITY

ECCYMOSIS

LOSS OF FUNCTION

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2
Q

THE MOST RELIABLE SIGN OF FRACTURE IS?

A

PAIN

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3
Q

Types of fractures

A

oblique
comminuted
spiral
compound

transverse, oblique, segmental, avulsted, impacted, torus, greenstick

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4
Q

OPEN Fractures

A

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.
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5
Q

SALTER

A 
Slipped- 1
Above- 2
Lower- 3
Through- 4
Rammed and Ruined- 5
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6
Q

WHY WORRY ABOUT SALTER NUMBERS?

A

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

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7
Q

SALTER TYPE I

A

(SLIPPED)

TRANSVERSE FRACTURE THROUGH GROWTH PLATE OR
PHYSIS
ONLY 6% OF FRACTURES

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8
Q

SALTER TYPE II

A

(ABOVE)

FRACTURE THROUGH THE METAPHYSIS SPAREING THE EPIPHYSIS
** MOST COMMON

70% OF GROWTH PLATE FRACTURES

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9
Q

SALTER TYPE III

A

(LOWER)

FRACTURE THROUGH THE GROWTH PATE AND EPIPHYSIS SPARING THE METAPHYSIS
ONLY 8% OF FRACTURES

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10
Q

SALTER TYPE IV

A

(THROUGH)

EXTEND THROUGH ALL THREE ELEMENTS
GROWTH PLATE EPIPHYSIS AND METAPHYSIS
10% INCIDENCE

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11
Q

SALTER TYPE V

A

(RAMMED AND RUINED)

COMPRESSION FRACTURE OF THE GROWTH PLATE
LUCKLY RARE 1% INCIDENCE

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12
Q

PIT FALLS WITH FRACTURES

A

Not all fractures are apparent

fall with snuff box pain, e.g.

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13
Q

COLLES’ FRACTURES

A

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.

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14
Q

Tri-malleolar Fracture

A

Involves:

  1. Lateral malleolus
  2. Medial malleolus
  3. Posterior tibia

Landing flat on the heal from significant
height.

Very unstable fracture.

Treatment:
Surgery (ORIF)
Open Reduction
Internal Fixation

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15
Q

FRACTURE COMPLICATIONS- one of the most important things

A

ischemic injuries

always check distal neurovascular issues

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16
Q

Early Complications

Local

A

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
17
Q

Early Complications

Systemic

A
  • 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
18
Q

Late Complications- Local

A

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

19
Q

Late Complications

A

Gangrene, tetanus, septicemia
Fear of mobilizing
Osteoarthritis

20
Q

COMPARTMENT SYNDROMES

A
  • 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.
21
Q

Conditions Associated with COMPARTMENT SYNDROMES

A 
Soft tissue injuries
Soft tissue injury with fracture
Exercised induced 
Crush injury
Prolonged tourniquet application
Electrical injury
Burns
Animal bites
22
Q

How do you know if compartment syndrome is happening? What is the treatment?

A

if pressure exceeds systolic BP, then blood isn’t getting into that area

Fasciotomy

23
Q

FRACTURE BLISTERS

A

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
24
Q

MALALIGNMENT OF FRACTURES

A

WILL STRAIGHTEN
IN KIDS IF ANGLE LESS THAN
15 DEGREES

25
Q

types of ankle sprains/ ligament tears

A

inversion
eversion
high ankle sprain

26
Q

Degree of Severity of Ankle Sprains:

A

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

27
Q

TREATMENT OF ACUTE SPRAINS IS

A 
R= REST
I= ICE
C= COMPRESSION
E= ELEVATE
  NOTE:  MAY NEED IMMOBILIZATION WITH GRADE III SPRAINS
28
Q

BENEFITS OF A CAST

A

BETTER IMMOBILIZATION IN FIXED POSITION
LESS MOVEMENT AT THE FRACTURE SITE
LASTS FOR WEEKS TO MONTHS
CAN’T BE REMOVED BY THE PATIENT

29
Q

BENEFITS OF A SPLINT

A

FASTER AND CHEAPER
CAN BE ADAPTED FROM SURROUNDING MATERIAL
NOT AS LIKELY TO CAUSE PRESSURE PROBLEMS
CAN BE REMOVED BY THE PATIENT

30
Q

HAZARDS OF CASTING

A 
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

31
Q

MATERIALS NEEDED FOR CASTING

A

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

32
Q

APPLICATION:

A

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

33
Q

Factors that affect setting times for casts and splints

A

speeding up:
higher temperature of dipping water
use of fiberglass
reuse of dipping water

slowing down:
cooler temperature of dipping water
use of plaster

34
Q

types of splints

A

posterior
stirrup
gutter
sugar tong

35
Q

wrapping a splint or cast

A

always wrap distal to proximal

36
Q

warnings

A

ALWAYS WEAR GLOVES WHEN WORKING WITH THE RESIN CASTING TAPE

WE DO NOT HAVE A POWER GRINDER TO GET IT OFF YOUR HANDS.

37
Q

Indications for Diagnostic and Therapeutic Injections

A 
Soft tissue conditions:
Bursitis
Tendonitis
Trigger points
Ganglion cysts
Neuroma
Entrapment syndromes
Fasciitis 
Joint conditions:
Effusion
Crystalloid arthropathies
Synovitis
Inflammatory arthritis
Advanced osteoarthritis
38
Q

contraindications to joint injections

A

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

PCM IV Exam I (4 decks)

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