Trauma and Injury to the Extremities - CA Flashcards
Isolate trauma to an extremity with associated vascular injury has ______ percent rate of mortality or limb loss?
10
Are injuries involving the LE or UE more common?
Lower extremity
What are the two most common injured blood vessels?
Femoral and popliteal
What four things do we look at to evaluate the extent of an injury?
Nerves, bones, soft tissues, vascular supply
What are two most common causes of penetrating trauma?
Gunshot wounds and Stab wounds
Do gunshot or stab wounds have a more predictable pattern of injury?
Stab wounds
Absent or diminished distal pulses, obvious arterial bleeding, large expanding or pulsatile hematoma, audible bruit, palpable thrill, and distal ischemia are all signs of?
Vascular trauma
If you are 1000% sure your patient has vascular injury to an extremity, what should you do?
Vascular surgery consult!
If you are highly suspicious of vascular injury, what step should you take?
CT angiography
If your patient has no signs of vascular injury, what test should you do?
Granted, if your patient has no signs of injury i don’t know why you would do this – think about peripheral vascular disease
ABI’s
What test should you get before CT angiography with contrast?
Creatinine
If concern for significant blood loss, what lab should you order?
CBC
Complete disruption of the joint
Dislocation
partial disruption of a joint
Subluxaiton
Tearing injury to muscle fibers
Strain
Tearing injury to ligaments of a joint
Sprain
What are four examples of orthopedic emergencies?
- Open fracture
- Subluxation and dislocation
- Neurovascular injury
- Compartment syndrome
Is it possible for pain of fracture or dislocation to be referred to another area?
Yes
Are all dislocations visible on standard x-ray series?
No – some require special views
What signs may indicate that a fracture is being missed?
Exquisite tenderness to palpation, pain on weightbaring, and passive ROM
What would Shayne Foley say about x-raying injuries?
Always look above and below – x-ray those joints as well because injury may coexist with long bone fracture
Gross deformity is pathognomonic for?
Fracture
When palpated, what are some things you can look for that indicate a fracture?
Point tenderness, bony step-off
Which three nerves extend into the hand?
Radial, median, and ulnar
When describing a fracture, what 6 things need to be in your description?
- Open vs closed
- Location
- Orientation of fracture line
- Displacement and separation
- Shortening
- Angulation
Before you reduce a dislocation what should you do?
Get x-rays!
and then get x-rays after
Why is it important to reduce a fracture deformity quickly?
Alleviate pain, relieve tension on nerves and vessels, minimize possibility of converting an open fracture to a closed fracture, and restore circulation to pulseless distal extremity
What are two examples of when we splint?
- fracture
2. after reduction of a dislocated joint
A clavicle fracture, AC separation, shoulder dislocation, and humeral neck fracture should have what type of immobilizer?
Shoulder immobilizer
Nondisplaced radial head fracture should have what type of arm displacement?
Arm sling
Elbow fractures and elbow dislocations should get what type of splint?
Long-arm gutter splint
Wrist or forearm fracture should get what type of splint?
Sugar tong splint
Metacarpal or proximal phalanx fracture should get what type of splint?
Short-arm gutter splint
Scaphoid fracture, thumb metacarpal or proximal thumb phalanx fracture should get what type of splint?
Thumb spica splint
Patellar fracture or subluxation, knee dislocation, tibial plateau fracture, knee ligament or meniscus injury/tear should get what type of immobilizer?
Knee immobilizer
Ankle dislocation, unstable ankle, widened medial mortise, or metatarsal fracture should get what type of splint?
Posterior ankle mold splint
Simple ankle sprain or stable lateral malleolar fracture should get what type of immobilizer?
Ankle stirrup
Toe fracture or metatarsal fracture should get what type of immobilizer?
Hard-soled shoe
What type of immobilizer can be used for some toe or foot fractures where weightbearing is allowed?
Short-leg walking boot
What are your typical discharge instructions?
RICE!
Rest, elevate, ice, remain non weightbearing until cleared by ortho
Use pain medication as needed
when is it necessary for patients to return to ED immediately after discharge?
Pain is severe or increasing
Numbness is new or worsening
Skin discoloration distal to the splint
Neurologic deficit, vascular injury, compartment syndrome are all?
complications of extremity injury
What is a delayed complication that can result in fatal respiratory failure?
Fat embolus – usually originating from marrow of fracture in large bones. Occurs within first few days of injury
