what is the usual cause of hand sepsis?
what is the most common bacterial cause?
in human bites?
dog and cat?
- follows penetrating injury or a bite
- Staph. aureus
- strep
- Elkenella corrodens
- pasteurella spp
how should hand sepsis be managed?
- I+D of collections
- tetanus prophylaxis
- IV co-amoxiclav 1g TDS
- Plain XR
- early cellulitis treated with splint, elevation and abx
what are femoral shaft fractures caused by usually?
- high energy injury e.g. RTA
- pathological fracture
- malignant disease
how might a femoral shaft fracture present?
- severe pain with supporting history of injury
- tense, swollen, tender things
- inability to weight bear
- deformity and shortening on affected side
what investigations would you do for a suspected femoral fracture?
- xray: AP and lateral views of femoral shaft, knee and hip
- monitor neurovascular supply
how should it be managed?
- Thomas’ Splint
- open or closed reduction
- IMN most common
what complications are there?
- neurovascular damage
- blood loss
- compartment syndrome
- infection
- problems with union
- fat embolus
- DVT/PE
how long does it take to classify delayed union and non union?
- 3 months
- 9 months
what is worrying about a humeral shaft fracture aetiology?
- Non-accidental injury <3 years
- usually a simple fall
what investigations should you do humeral shaft fracture?
- neurovascular exam
- pay attention to radial nerve
- AP and lateral X-ray of humerus (shoulder and elbow)
how should you manage humeral shaft fracture?
when are you likely to require surgical fixation?
- mostly non-surgical with hanging arm cast/ splint
- segmental fracture or neurovascular compromise
what are the complications of humeral shaft fractures?
- radial nerve injury
- brachial artery injury
- non-union
- standard orthopaedic complications
