Flashcards in Ortho Deck (88):
what does ortho not include?
Osteoporosis (except associated fractures)
what should always be first in a trauma eval?
what should you look for a trauma eval?
Lacerations / Punctures
DNVF (distal neurovascular function)
Isolated areas of Tenderness
i very high trauma, you should look at what else besides the affected joint?
joints above and below
how do you treat open fractures until surgery?
what are important prophylaxis in trauma accidents?
tetanus and abx prophylaxos
A disruption in the continuity of a bone
how many view do you need for an x-ray?
at least 2 views at 90 degrees from one another
do all mal or nonunions need to be fixed?
not necessarily, if it is painless and functional
what are big complications of LE fractures?
what is between the epiphysis and metaphysis?
physeal plate of cartilage
The skin overlying the fracture site is intact – no vector for entry of foreign objects / bacteria
Skin is disrupted overlying the site of the fracture (something could have gone in or out) not a scratch
what to mention when describing a fracture
open vs. closed
when do open fractures need to be treated?
OR within 4-8 hours (ideally less than 6)
What does initial OR treatment for an open fracture include?
+/- skin closure
repair of vascular / nerve injuries (if possible)
what abx do you give for open fractures?
1st generation cephalosporins
for a larger wound/ soft tissue damage what abx should you consider?
what abx is good for farm injuries
what is a common infection w/ a tennis show injury
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
what type fracture are open type 1 typically?
transverse or show oblique fractures
What is an open type II?
Greater than 1 cm
more of a crush type injury
what is an open type III fracture?
greater than 10 cm
significant soft tissue injury
what is an open type III a fracture
adequate bone coverage of reamining tissue
what is an open type III b fracture?
bone exposure that requires a flap or graft
What is an open type IIIc fracture?
circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb
A “bulge” in the cortex of the bone
Does go all the way thru
only seen in children
when do torus fractures hurt?
day it happens, not anymore
what view are torus fractures seen most easily on
a fracture that is a break in one cortex
fracture through the bone horizontally
Fracture runs at an oblique angle to the long axis of the bone
Wraps in a spiral fashion along the long axis of the bone
classic is a toddler's fracture (tibia)
a spiral fracture in a femur in child that isn't weight bearing is.....
a fracture that is in pieces
a distinct segment is "broken out"
Bone is pulled off by ligament or tendon
common in runners
Bone fragments driven into one another
common in elderly
injuries in or through the growth plates
SH fracture physis + metaphysis
SH fracture through physis
SH fracture through metaphysis, physis and epiphysis
SH fracture through physis + epiphysis
_________ is more susceptible to injury than ligaments in children
SH type with impaction of physeal plate
what does SALTER stand for?
Separated (through physis)
Above (the physis)
Lower (than the physis)
Thru (the physis)
ER- Everything is ruined
Two ends of the fracture or not separated from each other
fracture where Bone ends are separated
fracture near a joint imprant
how long can ischemic nerves survive?
4 hours w/o irreversible injury
(nerve death w/i 8 hours)
settings for compartment syndrome?
dislocations (especially knee)
what are the 5 Ps of compartment syndrome
what is the most sensitive test for compartment syndrome?
passive stretch of the muscle w/i the compartment
patient should be in extreme pain
what are late findings of compartment syndrome
what drugs can cause compartment syndrome in a relatively underwhelming fracture?
(plavix, coumadin, xarelto, ASA, etc)
what do you need to monitor head injury patients for?
what is the first sign of DIC
H&H good then plummets
Tx for compartment syndrome
excision of necrotic tissue
how do you monitor compartment syndrome?
take pressure in compartment and compare to BP
what is the most common type of amputation?
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
what is Virchow's triad?
what PE signs are significant for DVT
Homan's Sign (+/-) unreliable
palpable cords (feels like guitar strand)
what is the gold standard for DVT
what is the typical imaging for DVT
venous doppler (US)
Signs of a PE
pleuritic chest pain
EKG R BBB
tx for PE
what usually causes necrotizing fascitis
Group A Strep > clostridia
best places to treat nacrotizing fascitis
most common hand infection – at nail fold – nail bitters
what shows an infection, will be tender along sheath proximally – finger held flexed with pain on passive ext., sausage digit
what abx do you use for a "fight bite"
Abx to use for dog or cat bites?
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
if a trauma patient has an ALOC what should you get?
XR of entire spine
what is a C1 ring fracture called
What is a C2 isthmus fx known as
What is an avulsion fracture of the spinous process from C6-T1 known as?
what are the three columns of spine injury?
failure of the anterior column with preservation of the middle column
fracture of the anterior and middle column with axial load +/- posterior column involvement (more likely to be unstable)
where does the spinal cord usually end?
sacral fracture have a high incidence of what?
neuro injury (check for drop foot)
what is the gold standard for coccyx fracture?
pain w/ rectal exam and defecation
tx for coccyx fracture
what drug can you give to trauma patients for any neuro deficit