Trauma Flashcards
DCO - in regards to hemorrhagic shock classification when do patients present with hypotension?
Type 3. has 30% blood loss, hypOtensive, tx with IV fluids + TRANSFUSION
Hemorrhagic shock classification:
• 1. 10% EBL = normal vitals, tx with IVF
• 2. 20% EBL = tachycardic, tx with IVF
• Type 3. 30% EBL = “ + hyp0tensive, tx wth IVF + transfusion
• 4. >40% EBL = “ + “ + lethargic, tx with IVF + transfusion
Average adult blood volume = 5L
What are the indications for DCO?
SToP!
- Systolic BP <90
- Temp <32C/90F
- Platelets <70
- Treatment is ex-fix only
DCO - Indicators of adequate resuscitation?
Lactate <2.0
Base deficit -2 to 2
UOP 0.5ml/kg/hr
Indications for operative management of proximal humerus fractures? and associated treatments?
Indications:
- 2 part with significant varus angulation (if young, operate)
- 3 and 4 part (greater tuberosity displaced >5mm)
- Head split fx
• Patient factors (age) with range of appropriate surgeries:
- 18-60 yrs old: ORIF
- 40-60 yrs old: hemi (high ORIF failure risk, 4-part, head split)
- > 65 years old: reverse TSA
- > 90 years old: non op
- No role for TSA to treat prox humerus fx!
For pelvic ring injury requiring ex-fix, what are the pin placement options and which is preferred?
Iliac wing: weaker, get in way of ex lap and lateral window incisions.
Supracetabular: preferred, stronger, not in way of lateral window approach, beware of injury to LFCN
*Note: neither are able to control posterior ring injuries, only control anterior ring.
Anterior approaches for acetabular fractures and their associated risks?
Anterior intrapelvic = Stoppa = ilioinguinal
Beware of see corona mortis - need to ligate it!
-Vascular anastomosis between obturator artery and external iliac artery
-Present in 30% of people, between 3-6 cm from symphysis
Risk of mortality from femoral neck fracture in elderly patient?
In hospital 6%, 1 year 20-30%
Rate of ipsilateral femoral neck fx associated with femoral shaft fx? How do you treat?
5-10% Treat with two implants! Perc pinning vs. DHS AND Retrograde IMN
Goals of surgery for femoral shaft fx?
- Length
- Rotation (can tolerate up to 15 deg of malrotation)
- Alignment
How do you measure and compare rotation after the treatment of femoral shaft fractures?
CT scanogram and measure:
-Femoral neck anterversion (horizontal to angle of femoral neck)
-Posterior condyle to horizontal
Rotation = FNA - PC
Then compare difference between legs:
= surgery leg - normal leg
*if positive then surgical leg is internally rotated
*if negative then surgical leg is externally rotated
*Can tolerate 15 deg of malrotation.
Most common associated injuries with tibial plateau fx based on Schatzker classification.
Schatzker 1 = lateral split
Schatzker 2 = lateral split + depression –> Lateral Meniscus injury
Schatzker 3 = lateral depression
Schatzker 4 = medial –> Medial meniscus, vascular injury (ABIs, +/- angio, knee dislocation equivalent)
Schatzker V = bicondylar
Schatzker VI = meta-diaphyseal dissociation –> ACL inury
For correcting tibial plateau fracture depression this material is used and why?
Calcium Phosphate (Osteoconductive)
- lower subsidence (degrades slowly)
- higher compressive strength (contains hydroxyapatite)
At what time point after tibial shaft fracture treatment can you officially diagnose a nonunion?
6 months postop
Concepts of reaming for tibia and femur fractures
ALWAYS REAM, never don’t ream (it improves biology within the bone for healing)
Do not over ream as can lead to bone necrosis
A tight nail can decrease cortical perfusion.
Do not ream with tourniquet inflated due to higher rates of lung complications (mico-emboli all released at once)
Bottom line: over ream 1-2mm then place IMN diameter of native canal
Ex: measure 10 mm canal (XR), ream 11.5 (or til you hear “chatter”), 10 mm nail
Proximal 1/3rd tibial shaft fractures have this deformity
Procurvatum and valgus
*place blocking screws on concave side of deformity
