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Orthopaedics > Orthopaedic emergencies > Flashcards

Orthopaedic emergencies Flashcards

1
Q

define open fractures

A

disruption of the bony cortex associated with a breach in overlying skin

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2
Q

what should always be suspected a s an open fracture

A

any wound present in the same limb as a fracture

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3
Q

what can be damaged in an open fracture 3

A

skin (is relatively resistant to trauma)

underlying muscle can be damaged or devitalised

nerves, blood vessels and periosteum may be disrupted
-degree correlates with the severity of the injury and outcome

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4
Q

what classification system is used for open fractures

A

Gustilo classification

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5
Q

regarding the gustilo classification for open fractures:
define grade 1

A

low energy wound <1cm

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6
Q

regarding the gustilo classification for open fractures:
define grade II

A

low energy wound ≥1cm with moderate soft tissue damage

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7
Q

regarding the gustilo classification for open fractures:
define grade IIIA

A

All high-energy injuries irrespective of wound size

IIIA- fractures have adequate soft tissue damage

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8
Q

regarding the gustilo classification for open fractures:
define grade IIIB

A

All high-energy injuries irrespective of wound size

IIIB- fractures have inadequate soft tissue coverage

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9
Q

regarding the gustilo classification for open fractures:
define grade IIIC

A

all high-energy injuries irrespective of wound size

IIIC- fractures have arteiral injury needing repair

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10
Q

what can be used to predict the need for amputation in an open fracture

A

MESS [52]
-mangled
-extermity
-scoring
-system

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11
Q

Initial management of open fractures 3

A

careful patient examination to check for associated injuries, control of haemorrhage & extent of injuries

Give IV Abx ASAP

assess neurovascular status

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12
Q

ABx regime for open fractures 3

A

given within 3hrs of injury

co-amox 8hrly
-continue for 72hrs or definitive wound closure

consider tetanus status

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13
Q

when would surgery be considered for open fractures 3

A

immediate surgery if vascular impairment
or
compartment syndrome
or
wound is heavily contaminated (sewage)

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14
Q

how should the wound in. an open fracture be managed 4

A

debridement by plastics & orthosurgeroens within 24hrs of injury

cover wound in saline-soaked gauze to prevent desiccation
-only handle to remove gross contamination and allow photography

splint the limb

definitive skeletal stabilisation & wound cover achieved withn72hrs

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15
Q

define neuropraxia

A

implies temporary loss of nerve conduction often via iscahemia following pressure
-eg common peroneal nerve as it crosses the neck of the fibula (foot drop)

in mixed nerves, motor component is the more vulnerable compoenetnet
-saturday night palsy

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16
Q

define axonotmexisi

A

means damage to the nerve fibre
-but the epineural tube is intact

provides guidance to the regrowing nerve
-1-3mm/day

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17
Q

define neurotmesis

A

means divison of the whole nerve

no guidance from endonerual tube
-regrowing fibrils cause a traumatic neuroma if they are unable to bridge the gap

current surgical repair is epineural repair with nylon sutures

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18
Q

what can cause compartment syndrome 2

A

following fractures
or
ischaemic repurfusion injury

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19
Q

important point about comparment syndroem 1

A

is life and limb threatening

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20
Q

basic pathophys of compartment syndrome 3

A

raised pressure within a closed anatomical space

-raised pressure will eventually compromise tissue perfusion resulting in necrosis
-subsequent rhabdomyolysis can cause renal failure

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21
Q

2 main fractures causing compartment syndrome 2

A

supracondylar fracture

tibial shaft fracture

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22
Q

features of compartment syndrome 4

A

pain- especially on movement
-disproportionate to injury

paraesthesia, swelling, redness, mottling
-pallor may be present

arterial pulsation may still be felt

paralysis of muscle group

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23
Q

diagnosis of compartment syndrome 1

A

measure intracompartmental pressure measurements
>20mmHg= abnormal
>40mmHg= diagnostic

typically NO pathology on XR

24
Q

management of compartment syndrome 4

A

prompt and extensive fasciotomies

correct hypovolaemic vigorously

debride and amputate any frankly necrotic muscle

keep an eye out for hyperkalemia

25
Q

define cauda equina syndrome

A

lumbar and sacral nerve roots arise from the cauda equina
-arises from the conus medullaris at L1 in adults

compression of cauda ewuina causes the syndrome

26
Q

causes of cauda equina syndrome 4

A

most common- large prolapses/ hernitation of lumbar discs

extrinsic tumours

primary cord tumours

spondylosis, spinal stenosis

27
Q

features of cauda equina syndrome 5

A

clinically produces a LMN lesion:

-poor anal tone (perform PR)

-saddle anaesthia

-lower severe back pain

-incontinence/ retention of faeces or urine

-paralysis ± sensory loss

28
Q

management of cauda equina syndrome 2

A

URGENT MRI

REFER TO NEUROSURGERY - surgical decompression

29
Q

define major trauma

A

any injury that has potential to cause prolonged disability/ death

30
Q

define polytrauma

A

syndrome of multiple injuries exceeding a defined severity with sequential systemic reactions that may lead to dysfunction/ failure of remote organs and vital systems

31
Q

how can a major trauma be calculated using a scoring system

A

an injury severity score >15 [53]

32
Q

aim of a primary survey in a major trauma

A

inital assessment

detect and treat actual or imminent life threats
-prevent complications

systemic process

33
Q

asepcts of airway in a-e 3

A

if ptx can talk airway patent

adjuncts for airway protection
-chin lift & jaw thrust

if not able to maintain airway- definitive airway
-call anaethetics

34
Q

indications for intubation 5

A

GCS<9 (8=intubate)

sustained seziure activity

facial or airway trauma

high aspiration risk

flail segments or respiratory failure

35
Q

overveiw of c-spine stabilisation 3

A

ALL major trauma patients MUST be managed as potentially unstable

manual inline stabilisation

triple immonilisation (hard collar, tape, blocks)

36
Q

aspects of breathing in a-e 4

A

look at neck and chest
-trachea position
-accessory muscles
-asymmetry

palpate for rib fractures or surgical emphysema

percuss & ausculate

O2 saturations

37
Q

aspects of circulation in a-e 5

A

central and peripheral perfusion- CRT

HR

BP

urine output

any source of bleeding
-head,chest, abdo, PELVIS, long bones

38
Q

aspects of disability in a-e 2

A

assess GCS

Glucose

39
Q

asepcts of exposure in a-e 2

A

full exposure , maintain dignity and reduce heat loss

blogroll to examine patients back

40
Q

define shock

A

life threatening condition of circulatory failure resulting in cellular injury and inadequate tissue function

-usually secondary to haemorrhage in trauma

41
Q

classifications of shock

A

[54]

42
Q

sources of blood loss 5

A

on the floor and 4 more

Obvious on the ground
Long bones
Pelvis #
abdomen
chest

43
Q

aspects of secondary survey in major trauma

A

once ABCD / vitals stable

thourough head to toe
-check for minor injuries

careful documentation of secondary survey injuries

further imaging as warranted by examination
-US, angiography, peripheral XR

focused history

44
Q

pelvic injury overview

A

single fracture often stbale

≥2 fractures in pelvis renders the ring unstable (serious injury)
>25% have internal injuries

Tile classification of pelvic fracture

45
Q

associated complications of major trauma patients

A

sepsis, adult respiratory distress syndrome, acute renal failure, or multiple systems organ failure.

compartment syndrome

fat emoblism syndrome

46
Q

life threatning complciations of major trauma patients

A

acute respiraorty distress syndrome (ARDS)

systemic inflammatory response syndrome (SIRS)

47
Q

cause of fat embolism syndrome 1

A

pelvis/long bone fracture or significant soft tissue injury

48
Q

syx of fat emoblism syndrome 4

A

respiraory-SOB, hypoxia

neurological- confusion, delirium

dermatological- petechial rach

haematomological
-anaemia
-low platelets

49
Q

cause of septic arthritis

A

most common is staph A

-in sexually active N. gonorrhoea is the most common organism

50
Q

how does septic arhitis spread to joint

A

most common is hematogenous spread
-from distant bacterial infections eg abscessess

51
Q

most common location of septic arthitis in adults

A

knee

52
Q

features of septic arthitis 2

A

acute, swollen joint
-restricted movemvent in 80% of patients
-examination findings - warm to touch/fluctuant

fever- present in majority of patients

53
Q

Ix for septic arthtis 3

A

synovical fluid sampling obligatory
-should be done prior to administration of ABx if necessary
-may need to be done under radiographic guidance

blood cultures
-remember most common cause is hematogenous spread

joint imaging

54
Q

Mx of septic arthritis 3

A

IV ABx cover gram +ve occic
-usually fluclox or clindamycin if penicillin allergic
-given for 4-6wks
-switched to oral after 2wks

needle aspiration to decompress joint

arthorosopic lavavge may be required

55
Q

describe the Koche criteria for diagnosis of septic arthritis 4

A

fever >38.5 degrees

non-weight bearing

raised ESR

raised WCC

56
Q

complications of septic arthitis 7

A

Chronic pain.
Osteomyelitis (inflammation or swelling in the bone).
Osteonecrosis (bone tissue dies due to lack of blood flow).
A difference in leg length.
Sepsis (widespread inflammation in the body).
Death.
osteoarthritis

57
Q

complications of cauda equina syndrome

A

permanent paralysis

permanent incontience

Orthopaedics (15 decks)

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