Trauma Flashcards
What position has the lowest effect on compartment syndrome of the lower extremity
30 deg of ankle plantarflexion
What percentage of femoral neck fractures are missed with ipsilateral shaft fracture
5% incidence
30% missed
need to use fine cut CT to find it
What is the most optimal inferior screw placement for femoral neck fractures
posterior and adjacent to the femoral neck
Where can you avoid injury to the femoral nerve for retrograde femoral nailing
A-P proximal to the LT
Calculation of ISS and MISS
square of the largest 3 numbers
compare medial to lateral subtalar dislocations
medial are more common
lateral are more likely to be open with fractures
medial are more likley to be stable
predictor of sacral fracture nonunion
vertical fracture pattern
what factor most likley increases mortality in head injury patients
intra-operative hypotension
risk of infection in calcaneus fractures
smoking
open
diabetes
what parameter in pilon fractures determines poor outcome and return to work
lower level of education
gull sign on obturator oblique
posterior wall
spur sign on obturator oblique
ABC
imaging require for percutaenous column screws
obturator oblique - joint penetration
inlet iliac oblique - position of screw in pubic ramus
inlet obturator oblique - position of screw in iliac table
how much saline should you inject to diagnose traumatic arthrotomy of the knee
155 mL
indications of pre-ganglionic injury
loss of paraspinal muscles on EMG
horners
positive histamine test
medially winged scapula
benefits of blocking screws
obtain and maintain reduction
increase construct stiffness
neutralize translation forces
appropriate tibial alignment
50% cortical apposition
incidence of vascular injury in knee dislocation
40%
leading cause of death in pelvic ring fracture
hemmorhage overall
head injury in lateral compression
factors associated with increased mortality in pelvic ring fractures
systolic BP 60 years
increased Injury Severity Score (ISS) or Revised Trauma Score (RTS)
need for transfusion > 4 units
risk of anterior S1 plating
L4/5 injury
fresh water wounds
cipro
salt water wounds
doxycycline or ceftazidime
normal syndesmosis widening
decreased tibiofibular overlap
normal >6 mm on AP view
normal >1 mm on mortise view
increased medial clear space
normal less than or equal to 4 mm
increased tibiofibular clear space
normalmost important factor with outcome following amputation or reconstruction
ability to return to work
no difference in treatment
factors associated with wound healing
albumin > 3.0 g/dL ischemic index > .5 transcutaneous oxygen tension > 30 mm Hg toe pressure > 40 mm Hg ankle-brachial index (ABI) > 0.45 total lymphocyte count (TLC) > 1500/mm3
complications of scapulothoracic dissociation
flail extremity (50%) - requires ampuation early amputation (20%) death (10%)
air bag decreases the rate of
closed head injuries
facial fractures
thoracoabdominal injuries
need for extraction
indications of adequate resusitation
MAP > 60
HR 7.2
base deficit - normal -2 to +2
pusle pressure > 15
parameters to consider DCO
ISS >40 (without thoracic trauma) ISS >20 with thoracic trauma multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock bilateral femoral fractures pulmonary contusion noted on radiographs hypothermia
when do fix DCO fractures
7-10 days for pelvic fractures
within 3 weeks for femur fractures
7-10 days for tibia fractures
predictors of good outcomes in acetabular fractures
increasing patient age time from injury to surgery (>3 weeks) intraoperative complications femoral head bone or cartilage injury fracture reduction > 1-2mm
risk factors for spousal abuse
younger age shorter length of relationship emotional abuse psychological abuse, sexual abuse drug dependency alcohol dependency
the medial femoral circumflex is
medial to glut maximus
