Vascular occulsion Flashcards

Question

When would surgery be required in frostbite?

Answer 1

1) **Circumferentia**l frostbite-\> **Immediate surgical escharotomy** 2) **Surgical debridement +/- amputation** - once demarcating is complete - may take 1-3 months

Answer 2

_Adults_ **Cold intolerance** **Vasopasic disease**- Ca channel blockers or surgical sympathetectomy _Children_ **Premature Growth plate closure** **Joint laxity, short digits, degenerative disease- **seen in patients \>10 yrs with earlier disease.

Answer 3

**Sustained sympathetic activity** in perpetuated reflex arc characterised by **pain out of proportion** to phsical examination findings When a defined nerve is involved

Answer 4

**Trauma** from an exageratted response to trauma- common poor outcome post crush injury ( foot) **Surgery** **Prolonged Immobilisation** **Possible maligering**

Answer 5

**Vitamin C 500 mg daily** is an effective prophylactic agent in distal radius fractures treated with conservative management- **Vitamin C** also has been shown to decrease the incidence of **CRPS (type I)** following **foot and ankle surgery** **Avoid tight dressings and immobilisation** **Vitamin C is thought to reduce lipid peroxidation, scavenge free hydroxyl radicals, protect the capillary endothelium, and inhibit vascular permeability.** **RCT by Zollinger** in Lancet 1999- 115 adults with 119 fractures treated with conservative management. They found that RSD/CRPS occurred in four (7%) wrists in the vitamin C group (500mg daily for 50 days) and 14 (22%) in the placebo group. 2nd study by **Zollinger** in JBJS Br317 adult patients sustaining 328 distal radius fractures treated conservatively. They had allocated treatment groups to 200mg, 500mg, or 1500mg vitamin C dosages for 50 days. RSD/CRPS occurrence was 4.2% in the 200mg group, 1.8% in the 500mg group, and 1.7% in the 1500mg group and thus the **500mg dosage for 50 days** was recommended at the conclusion of the study. surgically - Cazanueve et al belgium Acta orthop 2002- evaluated 195 patients who underwent open reduction internal fixation of a distal radius fracture. The first 100 did not receive vitamin C postoperatively. The next 95 patients received oral vitamin C for 45 days beginning the first day after surgery. The patients who received **vitamin C** had **5 times less incidence (2% vs. 10%) of reflex sympathetic dystrophy.**

Answer 6

**Lankford and Evans** ( bonnie lankford had red hair- red hands) ## Footnote **1) Acute** 0-3 months, Pain, swelling, warmth, redness, decreased ROM, **hyperhidrosis** - picture- Normal xrays but _positive 3 phase bone scan_ 2) **Sub- Acute,** 3-12mo, **Worse pain,** cyanosis, dry skin, **stiffness**, skin atrophy. xray= **Osteopenia** **3) Chronic** \>12 mo, Di**mished pain,** fibrosis, glossy skin, **joint contractures**. xray- **Extreme osteopenia**

Answer 7

Type 1- CRPS without demonstrated nerve lesion=Most common Type 2= CRPS with nerve damage

Answer 8

Exacerated Pain Swelling Stiffness Skin discolouration

Answer 9

Trophic skin changes Hyperhydrosis vasomotor disturbance Flamingo gait if knee involved

Answer 10

Xrays- define level of ostepenia **3 Phase bone scan**- Phase 1 ( 2 mins)= arteriogram Phase 2 (5-10mins) cellulitis/synovial inflammation phase 3 ( 2-3rs) bone images phase 4- (24hrs) differentiates Osteomyelitis from adjacent cellulitis RSD shows positive phase 3 not correlation to phase 1/2

Answer 11

Successful early diagnosis

Answer 12

_Non operative:_ **Analgesia-** refer to pain team early: **NSAIDs, alpha blocking agents( phenozybenzamine), antidepressants, anticonvulsants,GABA agonists, Ca channel blockers. bisophonates for osteopenia.** **Physical therapy**- gentle stretchings ( type 1), tactile discrimination training, graded motor imagery, **Nerve stimulation-** only for **type 2 **if one nerve effected can place on that nerve area **Chemical sympathectomy**- when other consx tx fail _Surgical_ **Sympathectomy**- failed consx mx