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ER Orthopedic
ER Orthopedic Emergencies
| Question | Answer |
|---|---|
| AMPLE | allergies, meds, past hx, last meal, events of the trauma |
| Trauma X-ray series | Lateral cervical spine, PA chest, AP pelvis |
| Second Survey | Neuro for LOC (GCS), Head and Neck (lacerations, pain over C-spine), Thorax and Abdomen, Pelvis (back or pubic pain, compress iliac spine), Spine (log roll pt, palpate enter spine control c-spine), Extremeties (crepitation, palpate, PROM) |
| Ortho Emergencies include: Hemodynamically unstable fx, Extremity arterial injury, compartment syndrome, plus | mangled extremity and Traumatic amputations, threatened soft tissues/open fx, hip dislocations, septic joint, osteomyelitis |
| Pelvic ring fx | commonly disrupted in 2 places |
| Pelvic x-ray | AP |
| Femoral neck fractures and hip dislocations are prone to | avascular necrosis |
| Vascular repair of warm ischemia within | 6 hours. |
| Arteriogram may be useful for | multilevel arterial injury |
| Signs of arterial injury | Pulsatile hemorrhage, Expanding hematoma, Audible bruit, Pulseless limb |
| Most common place for compartment syndrome | lower leg and forearm |
| Sx of compartment syndrome | pain out of proportion to injury, pain with passive stretch, paresthesias, pulselessness (late finding) |
| Diagnosis compartment syndrome | measure compartment pressures: >30mmHg warrants decompression with fasciotomy |
| MESS score (for compartment syndrome) that requires trauma center | >7 |
| Mangled Extremity and Traumatic amputations | Proximal stump pressure dressed with Ringer’s Lactate. Avoid tourniquets. Time from amputation to replantation (warm ischemia: 6 hours, cold ischemia: 12 hrs, up to 30 hrs for digits). Absolute indications: thumb, pediatric amputations |
| open fractures | Reduce displaced fractures and dislocations that are tenting or opening skin to relieve vascular, neurologic, & skin compromise.open fx covered with saline moistened dressings and brought to the OR for repair |
| Common organisms causing osteomyelitis | Group A strep, S. aureus |
| Septic joint organisms | H. influenze, group a strep, E. coli, N. gonorrhea |
| Sx of Septic joint and osteomyelitis | fever, joint or bone pain, leukocytosis |
| Dx of septic joint | aspiration to identify organism |
| Dx of osteomyelitis | bone scans localize osteomyelitis |
| Comlications of Musculoskeletal Trauma | Rhabdomylolysis, nerve compression syndrome, compartment syndrome, reflex sympathetic dystrophy, venous thromboembolism, myositis ossificans, fracture complications |
| Fracture Management | Splinting, Casting (fiberglass, after swelling subsides, check NV status), Closed reduction (hematoma block, traction), CRPP (pinning), ORIF (screws, plates) |
| MS Imaging | Plain films (at least 2 views), consider joint above and below injury, stress films, CT: bone anatomy, MRI: soft tissues, Nuclear medicine studies (defines tumors), EMG: evaluates denervation of muscle units, NCS (evaluat conduction velocities) |
| NCS | nerve conduction studies |
| Distal clavicle in kids | can be treated conservatively. In high end athletes, can screw it in place temporarily. |
| Supracondylar fx | look for in kids. Anterior sail sign or posterior fat pad sign. (periosteum is thick in kids so hard to see fx) |
| Radial head | as long as not significantly displaced, you don't need to cast. Try not to cast elbows unless supracondylar fx |
| Monteggia | A Monteggia fracture is a variant of an ulna fracture of the forearm. In addition to the fracture of the ulna, these patients also have a dislocation of the radial head within the elbow joint. |
| Galeazzi | A Galeazzi fracture is a variant of a radius fracture of the forearm. In addition to the fracture of the radius, these patients also have an injury of the distal radio-ulnar joint of the wrist. |
| Colle's fx | Distal radial fx with dorsal angulation of the distal fragment |
| Smith's fx | Distal radial fx with volar angulation of the distal fragment |
| Greenstick | A "greenstick fracture" means that one side of the fracture has broken and one side is bent; therefore it is classified as an incomplete break |
| Torus Fx | buckle fx |
| Lisfranc fx | Disruption of tarsometatarsal joint between first and second metatarsal |
| Maisonneuve Fx | Proximal 1/3 fibula fx associated with medial ankle fx |
| Bankart lesion | avulsion of the anterior-inferior glenoid labrum. |
| Hill-Sachs lesion | compression fx of posterior humeral head. (top of the HILL, top of the Humerus) |
| Standard shoulder radiographs | AP (grashey), Scapular Y, Axillary views |
| Elevated humeral head | rotator cuff tear |
| Large anterior fat pad | sail sign; pathologic |
| Posterior fat pad | always pathologic |
| Wrist Imaging | PA view. No more than 2mm of space between the carpal bones. Lateral view |
| Hand Lacerations | close w/in 8 hours, tetanus status, "no man's land" between distal palmar crease and PIP joint crease (may involve tendons, so check tendon integrity). Skin closure in ER for tendon laceration |
| bacterial infxn of a tendon and tendon sheath | septic tenosynovitis. Etiology: Staph, Strep. Hx of puncture woulnd, bit or tooth wound (punch). Progressive swelling and pain over 24-48 hrs. |
| Kanavel Sx | fusiform swelling of the finger, significant tenderness along the course of the tendon, marked pain on passive extension, flexed finger at rest |
| Rx of Septic Tenosynovitis | IV abx, I&D if progressing. Consider tetanus and rabies prophylaxis |
| Grease causes | fibrosis |
| Paint causes | tissue necrosis |
| rx of High Pressure Injection Injury with Grease or Paint | Immediate I&D of sheath and deep space. Wound may be left open for serial debridement, amputation for severe digit injection |
| 90% of hip dislocations are | posterior. Possible N/V entrapment. |
| Allis Maneuver used to | relocate a hip |
| Garden types used to describe | femoral neck fracture severity |
| Garden type I | Incomplete fx with valgus impaction, ORIF |
| Tibial/fibula Fx | If < 1cm shortened: Long leg splint for 2 weeks then fracture brace. If >1cm: ORIF interlocking nail |
| Pain Management | Ibuprofen 800 q6-8h pc (post cibum: after eating) |
| Garden Type II | complete fx wtihout placement, ORIF |
| Garden Type III | Complete fx/partial displacement. Prosthetic replacement |
| Garden Type IV | Complete fx with total displacement, prosthetic replacement |
| Types of femur fractures | femoral, intertrochaniteric, subtrochanteric, femoral shaft, distal femur |
Created by:
ltm12