Questions and Answers
What are the 3 Orthopedic Emergencies per Tintinalli?
What neurovascular structures can be injured in an anterior shoulder dislocation?
What neurovascular structures can be injured in a humeral shaft injury?
Radial nerve
What neurovascular structures can be injured in a medial epicondylar fracture?
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What neurovascular structures can be injured in a supracondylar fracture or elbow dislocation?
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What neurovascular structures can be injured in a hip dislocation?
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What neurovascular structures can be injured in knee dislocation?
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What neurovascular structures can be injured in a lateral tibial plateau fracture?
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What are signs of neurovascular complication in an orthopedic injury?
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What are 5 situations where you need an orthopedic consultation, per Tintinalli?
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What are signs of cauda equina syndrome?
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What medications are often used for procedural sedation?
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What IV medications are used for acute pain management?
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What PO medications are used for acute pain management?
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How are open fractures defined?
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What is the definition of a type I open fracture according to the Gustillo-Anderson classification?
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What is the definition of a type IIIa open fracture according to the Gustillo-Anderson classification?
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What is the definition of a type IIIb open fracture according to the Gustillo-Anderson classification?
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What is the definition of a type IIIc open fracture according to the Gustillo-Anderson classification?
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For open fractures, what needs to be evaluated on physical exam?
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What is the initial treatment for open fractures?
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What is the IV antibiotic treatment recommendation for open fractures?
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What are the characteristics of an open fracture tetanus-prone wound?
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For an open fracture, what are the recommendations for I&D (Irrigation and Debridement)?
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When can bone grafts be done on an open fracture?
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What is compartment syndrome?
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What are the five P's of compartment syndrome?
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What is an independent predictor of septic arthritis?
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What is the gold standard for the treatment of septic joints?
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What are characteristics of fluid aspirated from a septic joint?
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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.
