Trauma Evaluation Priorities PDF

# Trauma Evaluation Priorities - Saving life - Major abdominal and head injuries - Pelvic fractures - unable to see the bleeding - Saving extremity - Vascular injury - Open fracture - Joint dislocation and fracture reduction - Initial Assessment - Assessment and resuscitation - Trau...

# Trauma Evaluation Priorities - Saving life - Major abdominal and head injuries - Pelvic fractures - unable to see the bleeding - Saving extremity - Vascular injury - Open fracture - Joint dislocation and fracture reduction - Initial Assessment - Assessment and resuscitation - Trauma ABCDE: Airway, Breathing, Circulation Disability, Exposure ## Tissues Damaged in Fracture - Bone, periosteum, muscle, subcutaneous fat tissue, skin ### Importance of Soft Tissue - Skin: Primary barrier against infection - Muscle: Helps circulation - Periosteum: Bone blood supply (outer 1/3), osteoprogenitor cell source ### Bone Blood Supply - Feeding artery, metaphyseal-epiphyseal artery system, periosteal artery system. ## Fracture - Bone integrity impaired, soft tissue injury - **Diagnosis:** Plain radiograph - In two planes at 90 degrees to each other - One upper one lower joint should be visible ## Fracture Types - Normal - Transverse - Oblique - Spiral - Avulsion - Impacted - Fissure - Greenstick ## Fracture Findings - Pain and tenderness - Deformity - Swelling and ecchymosis - Limited ROM - Pathological movement ## Open Fracture - Fracture hematoma is soft tissue injury communicating with external environment without skin barrier. - ~3% in extremities (femur, humerus.) - Rapid wound assessment, removal of gross contamination, sterile, moist, loose dressing for single use - **Antibiotic Treatment:** - For gram (+) Cephalosporins - For gram (-) If type 3 injury aminoglycosides - If contaminated w/ fecal or soil add penicillin - **Tetanus Prophylaxis:** - Tetanus toxoid - < 5 years: No vaccination needed - > 5 years: Vaccination booster - None vaccinate T16 ## Gustillo and Anderson Classification - **Type 1:** <1cm - **Type 2:** 1-10cm - **Type 3:** - **A:** Dirty, segmental, adequate soft tissue coverage - **B:** Very dirty, periosteum, inadequate soft tissue coverage - **C:** Vascular injury requiring repair - **Type 3C:** 50% Probability of amputation ## Primary Surgery Fracture Fixations - **Plates:** Usually for upper extremity, metaphyseal fractures - **IM nails:** With or without reaming, type 3B usage - **EF:** Most common, temp/permanent ## Secondary Surgery Soft Tissue - As soon as possible (7 days) - Type 1 , 2, 3A: Primary closure - Type 3B: Soft tissue transfer for bone closure ## Secondary Surgery Bone Tissue - Internal fixation transition (14 days) - Closure of defects - < 6cm: Grafting (8-12 weeks) - >6cm: Bone transport/vascularized bone grafting - Delayed union/non union - Osteomyelitis ## Healing Phases ### 1. Inflammation Phase 1-4 days - Fragments w/o soft tissue connection become devascularized - **Vasodilation:** IL-1, BMP, TGFB - Macrophages (mainly), neutrophils, stem cells, cytokines - Osteoclasts begin clearing necrotic bone fragments - Coagulation - Fibrin fibers stabilize hematoma (hematoma callus) ### 2. Repair Phase 2-40 days - Primary callus response - Angiogenesis - Fibroblasts produce collagen fibers - Collagen loosely bind fracture fragments - Endochondral ossification - Bone formation - Soft callus turn to hard callus ### 3. Remodeling Phase 25 -100 days - Begins in the middle of repair - Can last years - Bone to regain normal shape - Ends w/ formation of medullary cavity ## Factors Affecting Fracture Healing - Age - Chronic diseases - Vascular damages - Smoking - Nerve function - Degree of bone loss - Sterility (open fracture) - Corticosteroids inhibit bone formation ## Rotator Cuff Tears - Tendon/muscle rupture - Deep bruises - hematoma formation ## Soft Tissue Injuries - **1st Degree/Grade:** Mild injury - Microscopic structural damage - Slight local tenderness - **2nd Degree/Grade:** Moderate injury - Partial rupture of issue - Visible swelling, tenderness - Joint stability not affected - **3rd Degree/Grade:** Severe injury - Complete rupture of tissue - Significant swelling - Significant instability ## Ligament Injuries - Bruising, swelling, tenderness - Pain on movement/loading, palpation - Instability depending on severity - MRI scan for conformation ## Strains - **1st Degree:** - Minimal strength and movement loss - Pain on active movement/passive stretching - In athletes can be distressing as more severe injury - **2nd and 3rd Degree:** - Significant function loss - Pain aggravated by any attempt - May be palpable - In 3rd, muscle may bunch up resembling a tumor - **Diagnosis:** - Pain felt at moment of injury - Pain w/ rest, ↑ by attempted contraction - Palpable defects when superficial - Tenderness, swelling - Bruising after 24hr w/ spasm ## Contusions - Ezilme - Muscle is pressed against bone - Caused by direct blow on muscle - Muscle tears, heavy bleeding - muscular hematoma ## Intramuscular Hematoma - Bleeding within fascia covering muscle - Intramuscular pressure: Counteract further bleeding - Swelling lasts >48hr, tenderness, pain, mobility - Swelling increase due to osmosis ## Intermuscular Hematoma - Damage includes fascia & adj. blood vessels - Bleeding occuring between muscles - No pressure buildup - Bruising and swelling appear distally to damage within 24-48h - Muscle function returns - Prognosis better than intramuscular ## Treatment: PRICE - Protection, Rest, Ice, Compression, Elevation ### Cubitus Valgus - Forearm angled laterally ### Cubitus Varus - Forearm angled medially ### Genu Varum - Bowed legs ### Genu Valgum - Knocked knees | Grade | Description | |---|---| | 0 | No movement or flickering of contraction | | 1 | Movement with gravity eliminated | | 2 | Movement against gravity | | 3 | Movement against resistance | | 4 | Normal power or ROM | ## b: Exaggerated lordosis ## c: Rounded kyphosis ## d: Knuckle kyphosis with gibbus