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Flashcards in Ortho Deck (88):
1

what does ortho not include?

Skull
Mandible
Ribs
Sternum
Osteoporosis (except associated fractures)

2

what should always be first in a trauma eval?

airway

3

what should you look for a trauma eval?

Deformities
Wounds
Lacerations / Punctures
Joint Pain/Swelling
DNVF (distal neurovascular function)
Isolated areas of Tenderness
Laxity

4

i very high trauma, you should look at what else besides the affected joint?

joints above and below

5

how do you treat open fractures until surgery?

Sterile dressings

6

what are important prophylaxis in trauma accidents?

tetanus and abx prophylaxos

7

A disruption in the continuity of a bone

fracture

8

how many view do you need for an x-ray?

at least 2 views at 90 degrees from one another

9

do all mal or nonunions need to be fixed?

not necessarily, if it is painless and functional

10

what are big complications of LE fractures?

DVTs/ PEs

11

what is between the epiphysis and metaphysis?

physeal plate of cartilage

12

The skin overlying the fracture site is intact – no vector for entry of foreign objects / bacteria

closed fracture

13

Skin is disrupted overlying the site of the fracture (something could have gone in or out) not a scratch

open fracture

14

what to mention when describing a fracture

open vs. closed
type
displacement
angulation
location
other

15

when do open fractures need to be treated?

OR within 4-8 hours (ideally less than 6)

16

What does initial OR treatment for an open fracture include?

I&D
+/- Fixation
+/- skin closure
repair of vascular / nerve injuries (if possible)

17

what abx do you give for open fractures?

1st generation cephalosporins

18

for a larger wound/ soft tissue damage what abx should you consider?

add aminoglycoside

19

what abx is good for farm injuries

penicillin

20

what is a common infection w/ a tennis show injury

pseudomonas

21

what is an open type I injury

low energy MOI
often inside out (not penetrating)
bone pops out then slides back in
less than 1 cm in length

22

what type fracture are open type 1 typically?

transverse or show oblique fractures

23

What is an open type II?

Greater than 1 cm
greater injury
more of a crush type injury

24

what is an open type III fracture?

greater than 10 cm
significant soft tissue injury
high energy
closely contaminated

25

what is an open type III a fracture

adequate bone coverage of reamining tissue

26

what is an open type III b fracture?

bone exposure that requires a flap or graft

27

What is an open type IIIc fracture?

circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb

28

A “bulge” in the cortex of the bone
Does go all the way thru
only seen in children

Torus fracture

29

when do torus fractures hurt?

day it happens, not anymore

30

what view are torus fractures seen most easily on

lateral

31

a fracture that is a break in one cortex
childhood fracture

greenstick fracture

32

fracture through the bone horizontally

transverse

33

Fracture runs at an oblique angle to the long axis of the bone

oblique fracture

34

Wraps in a spiral fashion along the long axis of the bone
classic is a toddler's fracture (tibia)

spiral fracture

35

a spiral fracture in a femur in child that isn't weight bearing is.....

child abuse

36

a fracture that is in pieces

comminuted

37

a distinct segment is "broken out"

segmental fracture

38

Bone is pulled off by ligament or tendon
common in runners

avulsion fracture

39

Bone fragments driven into one another
common in elderly

impacted fracture

40

injuries in or through the growth plates

salter-harris fracture

41

SH fracture physis + metaphysis

Itype II

42

SH fracture through physis

type I

43

SH fracture through metaphysis, physis and epiphysis

type IV

44

SH fracture through physis + epiphysis

type III

45

_________ is more susceptible to injury than ligaments in children

physis

46

SH type with impaction of physeal plate

type V

47

what does SALTER stand for?

Separated (through physis)
Above (the physis)
Lower (than the physis)
Thru (the physis)
ER- Everything is ruined

48

Two ends of the fracture or not separated from each other

non-displaced

49

fracture where Bone ends are separated

displaced

50

fracture near a joint imprant

periprosthetic fracture

51

how long can ischemic nerves survive?

4 hours w/o irreversible injury
(nerve death w/i 8 hours)

52

settings for compartment syndrome?

crush injuries
multiple fractures
burns
casting
dislocations (especially knee)

53

what are the 5 Ps of compartment syndrome

Pulselessness
Paresthesias
paralysis
Pallor
pain

54

what is the most sensitive test for compartment syndrome?

passive stretch of the muscle w/i the compartment
patient should be in extreme pain

55

what are late findings of compartment syndrome

pulseless extremity
nerve deficit

56

what drugs can cause compartment syndrome in a relatively underwhelming fracture?

anti-coagulated patients
(plavix, coumadin, xarelto, ASA, etc)

57

what do you need to monitor head injury patients for?

DIC

58

what is the first sign of DIC

H&H good then plummets

59

Tx for compartment syndrome

fasciotomy
excision of necrotic tissue

60

how do you monitor compartment syndrome?

take pressure in compartment and compare to BP

61

what is the most common type of amputation?

fingers

62

how to tx an amputation

stop bleeding, salvage if possible
wrap in sterile gauze- soak in lactated ringer's, place in plastic bag and then place on ice

63

what is Virchow's triad?

stasis
intimal injury
hyper coagulability

64

what PE signs are significant for DVT

Homan's Sign (+/-) unreliable
palpable cords (feels like guitar strand)
tenderness
edema

65

what is the gold standard for DVT

venography

66

what is the typical imaging for DVT

venous doppler (US)

67

Signs of a PE

pleuritic chest pain
tachypnea
tachycardia
EKG R BBB

68

tx for PE

IV heparin

69

what usually causes necrotizing fascitis

Group A Strep > clostridia

70

best places to treat nacrotizing fascitis

burn center

71

most common hand infection – at nail fold – nail bitters

paronchyia

72

what shows an infection, will be tender along sheath proximally – finger held flexed with pain on passive ext., sausage digit

Kanavel Sign's

73

what abx do you use for a "fight bite"

Augmentin

74

Abx to use for dog or cat bites?

augmentin

75

All trauma pts. should remain in a cervical collar until c

complete C-Spine XR from occiput to T1 are (-), including AP, LAT, Odontoid Views
awake, sober, alert, and full range of motion w/o pain and no neuro deficits

76

if a trauma patient has an ALOC what should you get?

XR of entire spine

77

what is a C1 ring fracture called

Jefferson's

78

What is a C2 isthmus fx known as

hangman's fracture

79

What is an avulsion fracture of the spinous process from C6-T1 known as?

Clay shoveler's

80

what are the three columns of spine injury?

anterior
middle
posterior

81

failure of the anterior column with preservation of the middle column

compression fracture

82

fracture of the anterior and middle column with axial load +/- posterior column involvement (more likely to be unstable)

Burst fracture

83

where does the spinal cord usually end?

L2

84

sacral fracture have a high incidence of what?

neuro injury (check for drop foot)

85

what is the gold standard for coccyx fracture?

pain w/ rectal exam and defecation

86

tx for coccyx fracture

stool softener
donut pad
time

87

what drug can you give to trauma patients for any neuro deficit

methylprednisolone

88

who is methylprednisolone C/I in

Pregnancy
Age < 13
Open Spine Injury
Uncontrolled DM