Traumatic Injuries to Extremities Flashcards
Approximately ___% of injuries seen in the Joint Theater Trauma Registry (JTTR) involve extremities
50%
As extremities are evaluated each of the 4 functional components must be considered and evaluated together.
If 3 out of 4 are damaged, then the patient it is defined as a “mangled extremity”
Nerves
Vessels
Bones
Soft tissue
Systemic antibiotics started for any open fracture
Ertapenem
Cefazolin
Cefoxitin
Should be anticipated with high voltage injuries and consultation for emergent fasciotomy should be made
Compartment syndrome
Hard signs of arterial injury
- Active hemorrhage
- Expanding or pulsatile hematoma
- Bruit or thrill over wound
- Absent distal pulses
- Extremity ischemia
- Pain
- Tenderness
- Deformity
- Hematomas
- Swelling
- Crepitus
Closed fractures
Splints for femur fracture
Traction splint
Contraindications for traction femur splint
Pelvic fracture
Femoral neck fracture
Amputation of foot/ankle
Suspected fracture adjacent to knee
Antibiotic prophylaxis for a open fracture
Cefoxitin
Cefazolin
Ertapenem
Most common sites for internal hemorrhage from a fracture
Femur
Pelvic
Pelvic ring fracture is classified into what 3 types?
Lateral compression
Anterior posterior compression fracture
Vertical shear
Accounts for the majority of pelvic ring fractures
Lateral compression
Intervention used for pelvic fracture
Pelvic binder
Fascia compartments
for forearm
for calf
3 forearm
4 calf
Two most common causes of compartment syndrome
Hemorrhage from fracture
Edema following reperfusion injury
Occurs with pressure in the compartment exceeds that of the capillary (30mmHg), pressure increases and subsequently can lead to impaired blood flow
Compartment syndrome
Paresthesia’s (most common)
Pain (most common) pain often described as out of proportion
Pulselessness – uncommon, late finding
Pallor
Paralysis
Compartment syndrome
Intervention used in the treatment for compartment syndrome
Fasciotomy
The avulsion of skin from the underlying structures is usually a result of trauma
Degloving
Degloving occurs when the hand is caught by a fore and pulled at a ____ velocity
Low velocity
Most common causes of degloving
Road traffic accidents
Conveyor belt injuries
Ring avulsion injuries
Degloving occurs at which skin level?
Subcutaneous
Field management for degloving injuries
Irrigate and clean wound
Antibiotics to cover skin flora (staph & strep)
- Cefazolin
- Augmentin
- Doxycycline
- Ciprofloxacin
- Ertapenem
Majority of pelvic fractures are due to:
High energy blunt trauma
Pelvic fracture
Life threatening hemorrhage is typically from:
Venous plexus
Most common vertebrae affected with pelvic ring fracture
L5 & S1
Bony pelvis consists of:
Sacrum
Coccyx
3 innominate bones (ilium, ischium, pubis)
Forms together to form the acetabulum
Ilium
Ischium
Pubis
Pelvic fracture types
Pelvic ring
Lateral compression
Anterior posterior
Vertical shear
Open book
Common term to describe pelvic ring disruptions. Widening of symphysis pubis or rami fractures, and posterior ligamentous injury.
Open book
When the anterior pelvic ring widens more than ___ cm, the posterior pelvis (especially the anterior portion of the sacroiliac ligamentous complex) is frequently injured, increasing the risk of hemorrhage.
2.5
This reduces pelvic volume and stabilizes fracture fragments, thereby reducing the risk of major hemorrhage
Pelvic binder
Gold standard in identifying pelvic fractures
CT scan
Landmark for pelvic binder
Greater trochanter
