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Ortho Emergencies


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: Adam Barnard Adam Barnard