Ortho general Flashcards
(24 cards)
The amount of angulation is the degree of “unbending” needed. But how does descripting the direction of angulation different between a mid shaft vs a fracture near the end of the bone?
Direction of angulation for shaft is where two fractured ends are pointing
Direction of angalation at end of bone is direction distal fragment is deviated towards
What is the difference between a segmental fracture and communted?
Segmental is single free floating segment of bone between two well defined fracture lines
Comminuted = splintered or shattered bone
When assessing nerves function in a limbi injury , peripheral nerves (not dermatomes) should be checked. What peripheral nerve area is shaded in yellow?
saphenous nerve
When assessing nerves function in a limbi injury , peripheral nerves (not dermatomes) should be checked. What peripheral nerve area is shaded in brown and which one is purple?
Brown = sural
Purple = medical calcanea (tibial)
What is the term used to descrie the movement of the distal fracture to the right in the picture below?
Displacement
This fracture is both
- shortened and
- displaced 100%
there there are two other common terms used to describe this type of fracture. What are they?
Bayonette apposition or
overiding
What would the opposite to an impacted fracture be?
Separated (or distracted)
What two terms would be used to describe the fracture below?
Left fracture = oblique
Right fracture = spiral
How do you tell if a fracture has a rotational deformity?
Assess the pt and look for it
Generally not apparent on xray
There is more than just a very displaced fracture here. What term must be used when describing this injury?
fracture dislocation
Describing is displaced undersells the severity of injury
What is the gustilo-anderson classification system?
A way to classify open fractures
whether antibiotics are necessary for type 1 and 2 is controversial
What antibiotics should be used for a high energy open fracture with extensive soft tissue injury?
cefazolin 2g IV 8 hrly+
metronidazole 500mg IV 12 hrly
Cefazolin 50mg/kg (needs renal adjustment)
Metronidazole 12.5mg/kg
If a patient has an open fracture that has been immersed in water what antibiotics and dosage/route/frequency do you give
Cefepime 2g IV 8 hrly
Add metronidazole if severe injury/ obvious constaminatin
If delay in sourcing cefepime give cefazoin while waiting
Cefepime is for fresh and marine water
A patient present with a suspected infected open fracture from a few days ago. What antibioitics incl route and dose and frequency
piptaz 4.5g IV 6 hrly
piptaz 100/12.5mg/kg
Give as infusion is shocked and needing ICU
A patient present with a suspected infected open fracture after they had a boating injury a few days ago. What antibioitics incl route and dose and frequency
cefepime 2g IV 8 hrly +
metronidazole 500mg IV 12 hrly
Cefazolin 50mg/kg (needs renal adjustment)
Metronidazole 12.5mg/kg
Add metronidazole if severe injury/ obvious constaminatin
What is the maximum time a knee immobiliser should be left on?
A week
After a few days in elderly or 2 weeks in young pesons, painful knee from stiffness will begin
Refer to ortho/physio within 1 week as may be able to change to brace that allows some ROM
How often shoud a pt remove their knee immobilisater to do gentle extercises?
A few times a day
What are some late complications of a missed vascular injury sustained from a dislocation?
- thrombosis
- arteriovenous fistula
- aneurysm
- false aneurysm
Perform angiogram on high risk fractures/dislocation even if pulse present e.g tibiofemoral or tibiotalar dislocations
What nerve injury is common to these fractures: femoral shat and laterl tibial plateau
Peroneal/fibular nerve injury
What nerve is often injury with an acetabular fracture?
sciatic
In addition to the axilary nerve, what other nerve is commonly injured from an anterior shoulder dislocation?
musculocutaneous
At what compartment pressures does tissue ischaemia begin
30 mmHg
roughly
What are signs and symptoms of fat embolism?
Confusion
SOB/hypoxia
APO
petechial rash
Peak a few days after long bone fracture
