Trauma To The Extremities

Question 1

Clinical Manifestations of Extremity Vascular Trauma

Hard signs

Answer 1

• Absent or diminished distal pulses
• Obvious arterial bleeding
• Large expanding or pulsatile hematoma
• Audible bruit
• Palpable thrill
• Distal ischemia (pain, pallor, paralysis, paresthesias, coolness)

Question 2

Clinical Manifestations of Extremity Vascular Trauma

Soft signs

Answer 2

• Small, stable hematoma
• Injury to anatomically related nerve
• Unexplained hypotension
• History of hemorrhage
• Proximity of injury to major vascular structures • Complex fracture

Question 3

Disposition if with hard signs

Answer 3

If any hard signs of vascular injury are present, then consult vascular surgery immediately.

Question 4

Disposition if with soft signs

Answer 4

If there are any soft signs of vascular injury and/or if the ankle-brachial index is <0.9, then

1. order imaging tests to evaluate for associated vascular injuries, or
2. transfer to an institution with vascular care capability

Question 5

four types of fracture patterns associated with low-energy gunshots

Answer 5

1. Drill-hole wound track pattern
   — appears in lower-density cancellous bone
   —most common in the distal femur, pelvis, and proximal humerus
2. Unicortical fractures
   — appear in the metaphyses of long bones
3. Comminuted fractures
   —occur most frequently in diaphyseal bone; multiple bone fragments are common
4. Distal spiral fracture
   — occurs most commonly in the femur

Question 6

primary diagnostic study for the evaluation of vascular injuries to the extremities

Answer 6

CT angiography

Question 7

Algorithm for penetrating extremity trauma

Answer 7