Trauma

Question 1

What are the top 10 reasons for malpractice claims?

Answer 1

1. medication errors
2. diagnostic failures
3. negligent supervision
4. delayed tx
5. failure to obtain consent
6. lack of proper credentialing or technical skill
7. unexpected death
8. iatrogenic injury, wound infections, fractures
9. pain and suffering
10. lack of teamwork/communication

Question 2

Define open fracture.

List and describe the different open fracture types.

Answer 2

Def: any break in the skin in which there is direct communication with the bone to the outside world.

*an injury overlying a fractured bone should be considered a possible open fx but not all injuries overlying a fx bone are open fx.

Fx Types:

• Type1: opening is less than 1 cm in length
• Type 2: skin opening is between 1cm and 10cm in length
• Type 3a: skin lac is greater than 10cm
• Type 3b: skin lac is greater than 10cm with soft tissue loss and unclose-able skin edges
• Type3c: skin lac is greater than 10cm with vascular injury.

Question 3

What is the most important tx in open fxs?

Which abx are used in each of the following open fxs:

• type 1
• type 2
• type 3
• barn yard related injuries

Answer 3

Most important tx in open fxs is initiation of abx.

Type1: 1st gen cephalosporins (ancef)

Type 2&3: ancef AND gentamycin

Barn yard related injuries should receive all of the above plus PCN G

**make sure the pt is up-to-date on their tetanus.

Question 4

Compartment Syndrome:

• what is this?
• consequences
• causes
• pathophys

Answer 4

What: a condition where pressure builds up within a fascia enclosed compartment of the body.

Consequences:building pressure results in compression of the capillaries that service the muscles of that compartment.

Causes:
-multifactorial, bleeding, edema, and infiltration

Pathophys:

1. increased pressure from blood and intracompartmental swelling
2. decreased venous andd lymphatic drainage
3. intracompartmental pressure greater than perfusion pressure
4. muscle and nerve anoxia
   5a. acidosis (anaerobic cellular respiration)
   5b. muscle and nerve necrosis
5. leaky basement membranes
6. transudation into tissue surrounding compartment…
7. the cycle repeats.

Question 5

Compartment Syndrome:

• MC areas of occurrence
• most sensitive test for dx
• most sensitive clinical sign for dx?
• dx at what compartment pressure?

Answer 5

MC area of occurrenc is the lower leg and forearm.

most sensitive test: pain with passive ROM of the muscles within the compartment.

Most sensitive clinical sign: pain out of proportion to the injury.

if the measured value of the compartment with within 30mmHg of the patients DBP than compartment pressures are too high to allow for capillary perfusion

Question 6

What are the 6P’s of perfusion?

Why do we splint instead of cast?

Answer 6

Pain, pallor, pulse, poikilothermia, paresthesias, paralysis

The reason we splint things is to allow for sufficient swelling to be able to occur, its not until day 5 that swelling has peaked. Early casting does not allow for soft tissue expansion which can elevate compartment pressures.

Question 7

What type of splint is used in the following:

• proximal humerus
• shoulder dislocation
• humerus/elbow
• forearm
• wrist
• scaphoid
• metacarpals
• hip dislocation
• femur neck
• femur shaft
• distal femur
• tibial shaft
• ankle
• foot

Answer 7

• proximal humerus: coaptation splint
• shoulder dislocation: sling
• humerus/elbow: long arm posterior splint
• forearm: sugartong splint
• wrist: sugartong splint
• scaphoid: thumb spica splint
• metacarpals: ulnar or radial sided gutter splint
• hip dislocation: knee immobilizer
• femur neck: traction
• femur shaft: traction
• distal femur: knee immobilizer
• tibial shaft: long leg posterior splint
• ankle: short leg post splint +/- stirrups
• foot: short leg splint

Question 8

What is the garden classification of hip fx?

Answer 8

Grade 1: part of the femoral neck is fx

Grade 2: fx throughout the femoral neck

Grade 3: fx throughout the femoral neck w/ the
femoral head falling off forward. (tilted forward)

Grade 4: fx throughout the femoral neck w/ the femoral head sliding off.

Question 9

T/F, open fx tend to bleed more profusely. The color of the blood is dark like venous blood.

Which bones in the body have retrograde blood flow? (Distal to proximal)

Answer 9

True.

Retrograde blood flow:
-scaphoid, capitellum of elbow, femoral head, talus

Question 10

Describe each of the following Fx:

• bennet
• rolando
• night stick
• Galeazzi
• Monteggia
• Holstein-lewis
• tibial pilon
• Maisonneuve
• tongue type
• Lisfranc

Answer 10

Bennett: carpal/metacarpal fx at the base of the thumb.

Rolando: identical to bennett except its more comminuted.

Night stick: fx of the ulna

Galeazzi: distal 3rd of radial shaft, distal radial ulnar joint dislocation.

Monteggia: fx of ulnar shaftw with dislocation of radiocapitellar joint at the elbow.

Holstein-lewis: distal 3rd of humerus. WOrry about radial nerve injury.

Tibial pilon: occurs from falling from high height. Crush injury in which foot is driven into the tiba (e.g falling off ladder)

Maisonneuve: ankle fx in which there has been rotational injury that causes fx of proximal fibula. The syndesmotic ligaments between the tibia and fibula are ruptured causing the talus to slide out from underneath the tibia.

Tongue type: calcaneous fx, where the achillies tendon attaches to the calcaneous breaks off part of the calcaneal bone, its flipped up

Lisfranc: fx at tarsal-metatarsal joint. Looks like metatarsals slipped sideways off the tarsals. in lateral view, the mid foot has slipped down. usually a hyper-dorsalfelxion injury