casting procedures

Question 1

open fractures

Answer 1

high velocity trauma or missile like injury
spikes of bone pierce skin
must get surgical consult and intervention

Question 2

salter harris classifications

Answer 2

I/S
II/M
III/E
IV/ME
V/R

Question 3

I/S

Answer 3

slipped

complete physeal fracture w/or w/o displacement

Question 4

II/M

Answer 4

above
physeal fracture that extends thru the metaphysis producing a chip fracture of metsaphysis which may be very small
most common

Question 5

III/E

Answer 5

lower

a physeal fracture that extends thru epiphysis

Question 6

IV/ME

Answer 6

thru

a physeal fracture plus epipphyseal and metaphyseal fractures

Question 7

V/R

Answer 7

rammed and ruined

compression fracture of growth plate

Question 8

why worry about salter numbers

Answer 8

higher the number worse the prognosis
more serious fractures can look benign
fracture reductions must be perfect

Question 9

colles fracture

Answer 9

fracture of distal radial with dorsal displacement w/or w/o ulnar involvement
‘dinner fork’ deformity
falling on outstretched hand
assocation fracture of ulnar styloid process >60%

Question 10

tri-malleolar fracture

Answer 10

lateral malleolus
medial malleolus
post tibia 
landing flat on the heal from height
very unstable fracture
surgery

Question 11

early local complications of fractures

Answer 11

vascular injury -> hemorrhage 
visceral injury -> organ damage
damage to surrounding tissue, blood vessels, nn,  or skin
hemarthrosis 
compartment syndrome
wound infection

Question 12

early systemic complications of fractures

Answer 12

fat embolism-long bone fractures
shock
thromboembolism
exacerbation of underlying disease such as DM or CDA
pneumonia

Question 13

late local complications of fractures

Answer 13

delayed union
nonunion
mal-union
joint stiffness
contractures
myositis ossificans
avascular necoriss
algodystrophy, RDS, or regional pain syndrome
osteomyelitis
growth disturbances/deformities

Question 14

late systemic complications of fractures

Answer 14

gangrene, tetanus, septiciemia
fear of mobilizing
osteoarthritis

Question 15

compartment syndrome

Answer 15

pressure inside facial compartment exceeds the blood pressure
causes compromise of circulation to soft tissue ischemia and necrosis
irreversible damage can occur in 8 hours

Question 16

conditions associated with compartment syndrome

Answer 16

soft tissue injuries
soft tissue injury w/fracture
exercised induced
crush injury
prolonged tourniquet use
electrical injury
burns
animal bites

Question 17

Tx of compartment syndrome

Answer 17

fasciotomy

Question 18

fracture blisters

Answer 18

tense vesicles or bullae that arise on markedly swollen skin directly over fracture
tibia, ankle, and elbow
arise in 6-48hrs
2 types: clear fluid filled, blood filled
caused by separation of dermis from epi

Question 19

Tx of fracture blisters

Answer 19

benign neglect
debridement
aspiration
surgical dealy

Question 20

grade I ankle sprain

Answer 20

mild pain and swelling
joint stiffness may be apparent w/p laxity
usually affected ant talofibular lig
min or no loss of fnx
can return to activity w/in a few days of injury

Question 21

grade II ankle sprain

Answer 21

moderate-severe pain, swelling, and joint stiffness
partial tear of lat ligs
moderate loss of fnx w/difficulty on toe raises and walking
takes 2-3 months before full strength and stability return

Question 22

grade III ankle sprain

Answer 22

severe pain initially followed by little or no pain d/t loss of nn fibers
swelling may be profuse with joint stiffness
complete rupture of ligs of lat complex
immobilization for weeks with crutches
managed conservatively with rehab, but some may need surgery

Question 23

Tx of sprains

Answer 23

Rest
Ice
Compression
Elevate
may need to immobilize

Question 24

benefits of splint

Answer 24

faster and cheaper then cast
can be adapted from surrounding material
not as likely to cause pressure problems
can be removed by pt

Question 25

hazards of cast

Answer 25

compartment syndrome
ischemia
heat injury
pressure scores and skin breakdown
infection
dermatitis
joint stiffness
neurological injury

Question 26

materials for cast

Answer 26

adhesive tape 
bandage scissors
basin of water
casting gloves
elastic bandage
padding
plaster
sheets, underpads
stockinetter

Question 27

application of cast

Answer 27

-use appropriate amount and type of padding
-properly pad boney prominences and high pressure areas
-properly position extremity before, during, and after application of materials
-avoid tension and wrinkles on padding, plaster, and fiberglass
avoid excessive molding and indentations

Question 28

factors that speed setting time

Answer 28

higher temp of water
fiberglass
reuse of dipping water

Question 29

factors that slow setting time

Answer 29

cooler temp of dipping water

use of plaster

Question 30

indications for Dx and therapeutic injections of soft tissue

Answer 30

bursitis
tendonitis
trigger points
ganglion cysts
neuroma
entrapment syndromes
fascitis

Question 31

indications for Dx and therapeutic injections of joints

Answer 31

effusion
crystalloid arthropathies
synovitis
inflammatory arthritis
advanced osteoarthritis

Question 32

absolute CIs of joint injections

Answer 32

local cellulits
acute fracture
tendinious sites at risk for rupture
drug allergy
septic arthritis

Question 33

relative CIs of joint injections

Answer 33

mimimal relief after 2 attempts
underlying coagulopathy/anticoagulation therapy
uncontrolled DM
surrounding joint osteoporosis
anatomically inaccessible joint