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CM EM II Ortho
CM EM II
| Question | Answer |
|---|---|
| MESS Score > ____ needs trauma center | >7 |
| Hemodynamically Unstable Fx imaging/look for: | AP lateral xray: Inspect inner/ outer main ring cortices; 2 small rings; SI joint spaces (equal); symphysis pubis should align, < 5mm joint space; acetabulum |
| Hemodynamically Unstable Fx: if fx identified or suspected: | CT (+/- MRI) |
| True Orthopedic Emergencies | Pelvis, Femoral neck; Extremity Arterial Injury; Compartment Syndrome; Mangled Extremity and Traumatic Amputations; Threatened Soft Tissues / Open Fx; Hip Dislocation ; Septic Joint / Osteomyelitis |
| Open fx Type I | <1 cm, clean; minimal mx contusion; simple transverse/oblique fx |
| Open fx Type II | Lac >1 cm; extensive tissue damage; min crushing |
| Open fx Type IIIA | extensive ST damage w/mx, skin, neurovasc |
| Open fx Type IIIB | ext ST damage with periosteal stripping & bone exposure |
| Open fx Type IIIC | High energy features with art damage |
| Septic joint/osteo: orgs: bone | Bone: GAS, S. aureus |
| Septic joint/osteo: orgs: joint | H. flu, GAS, E. coli, NG |
| Septic joint/osteo: sx | Fever, joint or bone pain, leukocytosis |
| Septic joint/osteo: Dx tests | Bone scans localize osteomyelitis; Joint aspiration to identify organism |
| MS trauma complications | Most common: Nerve compression, compartment syndrome, DVT, fx comps; Other = Rhabdomyolysis; Reflex Sympathetic Dystrophy; Myositis Ossificans |
| Fx complications | Delayed union; nonunion; infxn; N/V injury |
| MS Imaging | Plain films (at least 2 views); consider joints above/below injury; CT (bony); MRI (ST); nuc med (tumors); EMG/NCS |
| Trauma x-ray series | Lateral C-Spine; PA Chest; AP Pelvis |
| ____ are prone to avascular necrosis | Femoral neck fractures and hip dislocations |
| Injuries assoc w/arterial damage: | Knee dislocations, displaced tibial plateau fx, floating joint, GSW or knife wounds, mangled extremity |
| Compartment syndrome: compartment pressure of ____ warrants decompression with fasciotomy | > 30 mm Hg |
| Time from amputation to replantation | Warm ischemia: 6 hrs; Cold ischemia: 12 hrs; up to 30 hrs for digits |
| Septic joint/ Osteomyelitis Rx: | Parenteral Abx, I&D |
| MS injuries: plain films | At least 2 views; Check entire film; Consider joint above & below injury |
| Nuclear med studies to: | define tumors, etc |
| Dislocations | shoulder 95% ant; hip 90% posterior |
| Avulsion of the antero-inferior glenoid labrum = | Bankart lesion |
| Compression fx of posterior humeral head = | Hill-Sachs lesion |
| Shoulder dislocation: xray & reduction maneuvers (3): | Rowe (opposite ear over head), Stimson (prone), Hippocratic (traction) |
| Shoulder xrays | AP Grashey (30 deg), scap Y, axillary |
| Posterior fat pad is always: | pathologic |
| Hand lac: close within: | 8 hrs |
| Kanavel sx (fusiform swelling, tendon TTP, passive extension pain) = | septic tenosynovitis (staph, strep); I&D, Abx; tetanus/rabies prn |
| High pressure injection injury: paint vs grease | Paint: tissue necrosis; Grease causes fibrosis |
| Hip dislocation tx | Allis maneuver |
| Femur fx tx | usually ORIF; femoral fx = closed reduction & Nail; femoral neck fx: Garden III & IV need prosthetic |
| Bucket-handle or corner fracture on xray = | Metaphyseal Corner fx; less common, more specific for abuse than diaphyseal fx; represent planar fx through primary spongiosa |
| Vertebral fx & child abuse | spinous process avulsions > vertebral fractures; most are Asx; consequent neuro or kyphosis rare |
| Epiphyseal Separation | True physeal injuries unusual in the abused child; result of violent traction or rotation; MRI or arthrogram may be needed for dx |
| planar fx through primary spongiosa = | Metaphyseal Corner fx |
Created by:
Abarnard
on 2010-05-20