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Clinical Medicine Musculoskeletal Trauma Month 3 Week 2
Clinical Medicine Musculoskeletal Trauma Month 3 Week 2
41
Medical
Graduate
07/11/2018

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Cards

Term
Current US standard for Trauma Care
Definition
– General Surgery Trauma
– Orthopaedic Trauma
– Neurosurgery
– Midlevel Providers at all junctions
Term
Trauma in the US
Definition
•Death in < 45 yrs old
• Blunt trauma accounts for 80% of mortality in the < 34 yrs
• $75 billion loss annually
• Major modern epidemic
Term
Trauma Epidemiology
Definition
•Polytrauma patients increasing
– Speed limits
– Aggressive driving – Air bags
•Regional trauma centers lack adequate funding
• Trauma affects all Orthopaedists regardless of subspecialty and interest
Term
Trauma Centers
Definition
• 1 per population of 5 million
• Studies demonstrate a 30-40% preventable death rate due to inadequate trauma systems
Term
Trauma Mortality phases
Definition
• Early phase - immediate death
– severe brain injury, disruption of great vessels, cardiac disruption

• Second phase - minutes to hours – Subdural, epidural hematomas,
– Hemopneumothoraces,
– Severe abdominal injuries,
– Multiple extremity injuries (bleeding)

• Third phase – delayed – Multisystem organ failure – Sepsis
Term
Orthopaedic Subspecialties
Definition
• Trauma
• Pediatrics
• Hand
• Foot and Ankle
• Spine
• Oncology
• Shoulder and Elbow • Adult Reconstruction
Term
The Ortho Traumatologist handles
Definition
• Polytrauma
• Pelvic fractures
• Acetabular fractures • Intraarticular fractures
• Fracture problems – Infection
– Malunion – Nonunion
Term
Fracture Description is based on
Definition
• Location
• Open/Closed
• Quality
• Neurovascular status
Term
fracture loaction
Definition
diaphyseal (middle), metaphyseal (end), Intraarticular (in joint)
Term
Quality of fracture
Definition
oblique (angled), transverse (straight across), comminuted (lots of breaks)
Term
Primary / Type 1 Bone Healing
Definition
– Intraarticular Fractures – Compression plating
– Compression technique
Term
Secondary Bone Healing / Type II
Definition
– Diaphyseal fractures
– Comminuted fractures
– Cast treatment, external fixation, intramedullary nails, plate fixation
Term
Immobilization modes
Definition
casting, external fixation, internal fixation (plating, nailing), Distraction Osteogenesis/Ilizarov (stabilized w structure on outside)
Term
What is compartment syndrome?
Definition
A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space
Term
etiology of compartment syndrome
Definition
Compartment Size
• Tight dressing; Bandage/Cast
• Localised external pressure; lying on limb • Closure of fascial defects

Compartment Content
• Bleeding; Fracture, vascular injury, bleeding disorders
• Capillary Permeability;
» Ischemia / Trauma / Burns / Exercise / Snake Bit / Drug Injection / IVF
Term
who gets compartment syndrome
Definition
• Pre-op patients
• Post-op patients
• Non-op patients
• Overall 9.1% of tibia fracture patients
• Non-Ortho surgery patients – Burn patients
– Gunshot wounds
– IV infiltration
Term
Can open fracture patients get compartment syndrome?
Definition
• YES
• Most common compartment syndrome with tibia fractures is Type III open
Term
Who do we really worry about w compartment syndrome?
Definition
• Everyone
• Tibia fractures
• Forearm fractures
Term
What are the symptoms of compartment syndrome?
Definition
• Paralysis
• Paresthesia
• Pallor
• Pulselessness
• Pain out of proportion
Term
How to diagnose compartment syndrome
Definition
• Clinical diagnosis
• Intracompartmental measuring
Term
What to do if worried about compartment syndrome
Definition
• Need to keep limb elevated at the level of the heart
• Need to ice the limb
• Release circumferential dressing
• Stop PCA
• Minimize narcotics and chart carefully
• Document vitals
Term
Positive Findings of compartment syndrome
Definition
• Intracompartmental pressure >40mmHg
• Within 30mmHg of the diastolic blood pressure
Term
Compartment Syndrome Tissue Survival
Definition
• Muscle
– 3-4 hours - reversible changes – 6 hours - variable damage
– 8 hours - irreversible changes
• Nerve
– 2 hours - looses nerve
conduction
– 4 hours - neuropraxia
– 8 hours - irreversible changes
Term
why are dislocations emergencies?
Definition
soft tissue damage, vascular injury
Term
anterior vs posterior hip dislocation
Definition
anterior- leg angled out
poster-leg angled ing
Term
Treatment for hip dislocation
Definition
• Urgent closed reduction
• Stabilization with well padded splint or traction
Term
types of lacterations, Gustilo & Anderson
Definition
• Type I <1cm soft laceration
• Type II 1cm-10cm laceration
• Type IIIA >10cm, no coverage
• Type IIIB >10cm requires coverage
• Type IIIC repair >10cm requires vascular
Term
Treatment of Open Fractures by type
Definition
UIV antibiotics
Type I First Generation Cephalosporin
Type II First Generation Cephalosporin maybe Aminoglycoside

Type III Penicillin if contaminated

-Debridement in OR
Term
Criteria for Level One Triage types of injuries
Definition
– Motorcycle vs car
– Pedestrian struck
– Intrusion into car >12inches
– Death in same passenger compartment
– Fall> 10 ft
Term
Polytrauma Patient is what
Definition
• Injury Severity Score >18
• Hemodynamic instability
• Coagulopathy
• Closed head injury • Pulmonary injury
• Abdominal injury
Term
Resuscitation treatment
Definition
• Large bore IVs
• Crystalloid bolus
• Monitor
– Blood pressure
– Urinary output
– Base deficit
– Initial Hematocrit/Hem oglobin - unreliable
Term
Pelvic Ring Injuries & Hemorrhage
Definition
High energy Morbidity/Mortality Hemorrhage
Anterior Posterior Compression Type I, II, III, based on how much space between pubic symphysis

Lateral compressiong, Type I, II, II based on severity and how many components involved

Vertical Shear break entirely thorugh one side
Term
Hemorrhage Control
Definition
-Pelvic Containment & Stabilization: Sheet, Pelvic Binder, External Fixation
-Angiography
-Laparotomy
-Pelvic Packing
Term
Epidemiology of hip fractures
Definition
• 250,000Hipfracturesannually
– Expected to double by 2050 • Atriskpopulations:Elderly
– Elderly
• Poor balance&vision, • Osteoporosis
• White
• Slender
– Young: high energy trauma
Term
types of hip fractures
Definition
subcapital neck fracture (at top of neck), transcervical neck fracture (in middle of neck), intertrochanteric fracture (at bottom of neck), subtrochanteric fracture (at top of shaft), fracture of the greater trochanter, fracture of the lesser trochanter
Term
Femoral Neck Fractures
Definition
• Garden [1961]
I Valgus impacted or
incomplete
II Complete: Non-displaced
III Complete: Partial displacement
IV Complete: Full displacement
** Portends risk of AVN and Nonunion
Term
stable hip fractures
Definition
impacted (Garden I)
non-displaced (Garden II)
Term
unstable hip fractures
Definition
displaced (Garden III and IV)
Term
hip fracture treatment options
Definition
– Non-operative
• very limited role
• Activity modification • Skeletal traction
– Operative • ORIF
• Hemiarthroplasty
• Total Hip Replacement
Term
Keys to Treatment of Hip Fractures
Definition
• Diagnosis
• Medical optimization
• Minimally invasive surgery • Mobilization
• Weight bearing
Term
Conclusion about trauma
Definition
• Fractures can control physiology of trauma • Trauma systems remain stressed
• Trauma volume increasing
• Team approach critical
• Vigilance of care rewarding
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