Trauma Flashcards
SIRS
- T > 38 or < 36
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC > 12k or < 4k
Absence of plantar sensation in a mangled extremity at the time of injury does…
NOT predict function or presence of plantar sensation or function at 2 year follow up.
What is linked to improved patient reported outcome after a mangled limb?
ability to return to work (no diff between salvage and amp).
Is function of thru knee or AKA better?
AKA
Metabolic change of syme amp
15%
Metabolic change of traumatic BKA
unilateral 10%
bilateral 40%
Metabolic change of traumatic AKA
70%
What is the rate of MRSA in orthopedic trauma patients?
3%
Foot compartment syndrome incisions
dual dorsal incision (1 medial to 2nd MT and 1 lateral to 4th MT)
*9 compartments
OTA Strong Recommendations re VTE ppx (3)
- LMWH w/i 24 hours for inpatients with MSK injury
- mechanical compression in addition to LMWH
- Against routine use of IVC filters unless pt has documented PE or DVT despite appropriate ppx
ASA MOA
irreversible blocking of thromboxane, platelet active
Heparin MOA
indirect thrombin inhibition by binding to ATIII
Heparin has a faster onset than LMWH bc…
it also inhibits Xa and IIa (thrombin)
Apixaban and Rivaroxaban MOA
direct Factor Xa inhibitors
Dabigatran MOA
direct thrombin inhibitor
Pregnant trauma patients should be positioned…
left lateral decubitus (left side down).
Aorta/IVC compression can decrease CO by 25%.
Domestic violence victim risk factors
female
19-29 yo
pregnant
Most common injury pattern in IPV
- facial fractures
2. UE injuries
Tile Classification
A: stable, avulsions
B: rotationally unstable
C: rotationally and vertically unstable
LC I and LC II associated injury
brain (50%)
LC III associated injury
bowel (20%)
Obturator outlet view is good for…
anterior column screws and supra-acetabular screws/pins
Obturator inlet view is good for…
ensuring screws are between the inner and outer tables.
If blood at meatus or mobile prostate with pelvic ring fx, perform….
retrograde urethrogram.
Women with pelvis fx are at increased risk for…
future C-section and dyspareunia.
Most common sequelae for males with pelvic injury and genitourinary injury is…
urethral stricture.
XR view for SC dislocation
serendipity view
(40 degree cephalic tilt)
**Posterior dislocations look caudal.
Treat symptomatic, chronic AC joint dislocation with…
medial clavicle resection and costo-clavicular ligament recon.
Indications for ORIF Scapula (5)
- coracoid/acromion displaced > 1 cm
- glenoid displaced > 2-5 mm (or GH instability)
- glenopolar angle < 20
- body angle > 45
- lateral border displacement > 2 cm
Treatment of Fracture-Dislocation posterior shoulder
- if 20-40% defect size, transpose LT w/ subscap into defect
- if > 45% (or chronic), tx w/ arthroplasty
Acceptable alignment for non-op tx of humeral shaft fractures
- 20 degrees A/P angulation
- 30 degrees varus/valgus angulation
- 15 degrees malrotation
- 3 cm shortening
Nerve at risk with distal lateral to medial interlock screws (humeral nail)
radial
Nerve at risk with distal anterior to posterior interlock screws (humeral nail)
musculocutaneous
Kocher Approach
Between anconeus (radial) and ECU (PIN)
**avoid LUCL injury by opening capsule above the equator
Kaplan’s Approach
between EDC (PIN) and ECRB (radial)
**Close to PIN anteriorly (pronate to protect)
Rehab protocol for terrible triad post-op
30-130 degrees active flex/ext in PRONATION 48 hrs post-op
Timed Up and Go test
time to rise from chair, walk 3m, walk back to chair and sit down
(normal is less than or equal to 12 seconds)
**predictive of need for assistive aid and fall risk
What is the malreduction seen in unstable left-sided intertroch fractures?
anterior flexion spike of proximal fragment due to screw torque
What is a significant predicotr of re-operation in unstabl eintertrochs?
integrity of lateral femoral cortex
CMN with helical blade (vs lag screw) is associated with…
higher incidence of medial migration.
