Orthopedic Emergencies Flashcards
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Questions and Answers

What are the 3 Orthopedic Emergencies per Tintinalli?

  • Soft tissue injury
  • Open fracture (correct)
  • Neurovascular Injury (correct)
  • Subluxation and dislocation (correct)
  • What neurovascular structures can be injured in an anterior shoulder dislocation?

  • Musculocutaneous nerve (correct)
  • Radial nerve
  • Axillary artery (correct)
  • Axillary nerve (correct)
  • What neurovascular structures can be injured in a humeral shaft injury?

    Radial nerve

    What neurovascular structures can be injured in a medial epicondylar fracture?

    <p>Ulnar nerve</p> Signup and view all the answers

    What neurovascular structures can be injured in a supracondylar fracture or elbow dislocation?

    <p>Ulnar nerve</p> Signup and view all the answers

    What neurovascular structures can be injured in a hip dislocation?

    <p>Femoral nerve</p> Signup and view all the answers

    What neurovascular structures can be injured in knee dislocation?

    <p>Popliteal artery</p> Signup and view all the answers

    What neurovascular structures can be injured in a lateral tibial plateau fracture?

    <p>Peroneal nerve</p> Signup and view all the answers

    What are signs of neurovascular complication in an orthopedic injury?

    <p>Decreased motor function, decreased capillary refill, numbness, tingling, parasthesia</p> Signup and view all the answers

    What are 5 situations where you need an orthopedic consultation, per Tintinalli?

    <p>Compartment syndrome</p> Signup and view all the answers

    What are signs of cauda equina syndrome?

    <p>Incontinence, focal lower extremity weakness, subtle paresthesia</p> Signup and view all the answers

    What medications are often used for procedural sedation?

    <p>Morphine/versed</p> Signup and view all the answers

    What IV medications are used for acute pain management?

    <p>Dilaudid</p> Signup and view all the answers

    What PO medications are used for acute pain management?

    <p>Oxycodone</p> Signup and view all the answers

    How are open fractures defined?

    <p>Osseus disruption with overlying skin and soft tissue injury allowing direct communication to fracture and its hematoma</p> Signup and view all the answers

    What is the definition of a type I open fracture according to the Gustillo-Anderson classification?

    <p>10 cm opening, comminuted/segmental fx, subclassifications: A, B, C</p> Signup and view all the answers

    What is the definition of a type IIIa open fracture according to the Gustillo-Anderson classification?

    <p>Minimal soft tissue damage, large wound</p> Signup and view all the answers

    What is the definition of a type IIIb open fracture according to the Gustillo-Anderson classification?

    <p>Severe periosteal stripping/bone exposure, massive contamination</p> Signup and view all the answers

    What is the definition of a type IIIc open fracture according to the Gustillo-Anderson classification?

    <p>Major vascular injury</p> Signup and view all the answers

    For open fractures, what needs to be evaluated on physical exam?

    <p>Soft tissue - lac size and nature, contamination, communication; extremity quality, DNV assessment, Mangled Extremity Assessment</p> Signup and view all the answers

    What is the initial treatment for open fractures?

    <p>Remove obvious large foreign bodies, copious irrigation, cover in soaked sterile saline, compression dressing</p> Signup and view all the answers

    What is the IV antibiotic treatment recommendation for open fractures?

    <p>Start them early! Increased rates of infection have been shown in delay of over 3 hours.</p> Signup and view all the answers

    What are the characteristics of an open fracture tetanus-prone wound?

    <p>Gross contamination</p> Signup and view all the answers

    For an open fracture, what are the recommendations for I&D (Irrigation and Debridement)?

    <p>Should be done in 6-8 hours, attempt to debride tissue during early bacterial growth</p> Signup and view all the answers

    When can bone grafts be done on an open fracture?

    <p>Early at 1-2 weeks or late at 6-8 weeks</p> Signup and view all the answers

    What is compartment syndrome?

    <p>End capillary perfusion pressure is less than the compartment pressure</p> Signup and view all the answers

    What are the five P's of compartment syndrome?

    <p>Pain, paresthesia, pallor, paralysis, pulselessness</p> Signup and view all the answers

    What is an independent predictor of septic arthritis?

    <p>CRP &gt;2</p> Signup and view all the answers

    What is the gold standard for the treatment of septic joints?

    <p>Joint fluid aspirate, allows directed antibiotic treatment</p> Signup and view all the answers

    What are characteristics of fluid aspirated from a septic joint?

    <p>Cloudy or purulent appearance; cell count with WBC &gt;50,000 considered diagnostic</p> Signup and view all the answers

    Study Notes

    Orthopedic Emergencies

    • Key orthopedic emergencies include open fractures, subluxations and dislocations, and neurovascular injuries.

    Neurovascular Injuries by Fracture Type

    • Anterior shoulder dislocation can injure the axillary nerve, axillary artery, and musculocutaneous nerve.
    • Humeral shaft injuries primarily affect the radial nerve.
    • Medial epicondylar fractures may injure the ulnar nerve.
    • Supracondylar fractures and elbow dislocations can damage the brachial artery, radial nerve, ulnar nerve, and median nerve.
    • Hip dislocations mainly affect the femoral nerve.
    • Knee dislocations can injure the popliteal artery, peroneal nerve, and tibial nerve.
    • Lateral tibial plateau fractures often involve the peroneal nerve.

    Signs of Neurovascular Complications

    • Indicators include decreased motor function, capillary refill issues, numbness, tingling, and paresthesia.

    Situations Requiring Orthopedic Consultation

    • Conditions include compartment syndrome, irreducible dislocations, circulatory compromise, open fractures, and injuries needing surgical intervention.

    Cauda Equina Syndrome Symptoms

    • Signs include incontinence, focal lower extremity weakness, and subtle paresthesia.

    Medications for Procedural Sedation

    • Common agents include propofol, morphine/versed, dilaudid/valium, and ketamine.

    Acute Pain Management

    • IV options include morphine, dilaudid, fentanyl, and toradol.
    • Oral options include hydrocodone, oxycodone, tramadol, and NSAIDs.

    Open Fractures

    • Defined as compound fractures where skin and soft tissue injury allows communication with the fracture hematoma.
    • Associated concerns include infection and poor vascular supply.

    Gustilo-Anderson Classification for Open Fractures

    • Type I: 10 cm opening, comminuted/segmental fractures.
    • Type IIIa: Minimal soft tissue damage with a large wound.
    • Type IIIb: Severe periosteal stripping and bone exposure with massive contamination.
    • Type IIIc: Associated major vascular injury.

    Management of Open Fractures

    • Evaluate soft tissue injury, extremity quality, and vascular status during physical examination.
    • Initial treatment focuses on removing large foreign bodies, copious irrigation, splinting, IV antibiotics, and tetanus vaccination.
    • Avoid exploration of the wound and removal of bone fragments initially.

    Tetanus-Prone Wound Characteristics

    • Features include being larger than 2 cm, having a stellate pattern, gross contamination, or being greater than 12 hours old.

    Tscherne Classification for Closed Fractures

    • Classification ranges from negligible soft tissue injury (Type 0) to extensive crush injury with possible compartment syndrome (Type 3).

    Osteomyelitis

    • Defined as infection of bone leading to inflammatory destruction and new bone formation.
    • Common in dialysis patients at the spine and ribs, in IV drug users at the clavicles, and in diabetics at the foot and ulcers.

    Mechanisms of Spread for Osteomyelitis

    • Includes hematogenous spread, contiguous spread from nearby infections, and direct inoculation due to injury or surgery.

    Diagnosis and Treatment of Septic Joints

    • Commonly affected joints: knee, hip, elbow, ankle, sternoclavicular joint.
    • Diagnosis involves imaging, fluid aspiration for culture, and lab markers such as elevated WBC, ESR, and CRP.
    • Treatment involves joint fluid aspiration and directed antibiotic therapy.

    Compartment Syndrome

    • Resulting from pressure exceeding capillary perfusion, leading to muscle and nerve injury.
    • Etiologies include fractures, crush injuries, and burns.
    • Key indicators (the five P's): pain, paresthesia, pallor, paralysis, pulselessness; pain and paresthesia are early signs.

    Fat Embolism Syndrome (FES)

    • Occurs predominantly after pelvic or long-bone fractures, presenting with pulmonary distress, mental status changes, and petechial rash.
    • Prevention strategies focus on early stabilization and operative treatment.
    • Main treatment is supportive care, similar to ARDS management.

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    Description

    This quiz focuses on key concepts related to orthopedic emergencies as outlined in Tintinalli. It covers essential definitions, including open fractures, subluxations, and neurovascular injuries. Perfect for medical students and professionals needing a quick review of emergency conditions.

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