Term
| Current US standard for Trauma Care |
|
Definition
– General Surgery Trauma
– Orthopaedic Trauma
– Neurosurgery
– Midlevel Providers at all junctions |
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Term
|
Definition
•Death in < 45 yrs old
• Blunt trauma accounts for 80% of mortality in the < 34 yrs
• $75 billion loss annually
• Major modern epidemic |
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Term
|
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 |
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Term
|
Definition
• 1 per population of 5 million
• Studies demonstrate a 30-40% preventable death rate due to inadequate trauma systems |
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Term
|
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 |
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Term
| Orthopaedic Subspecialties |
|
Definition
• Trauma
• Pediatrics
• Hand
• Foot and Ankle
• Spine
• Oncology
• Shoulder and Elbow • Adult Reconstruction |
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Term
| The Ortho Traumatologist handles |
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Definition
• Polytrauma
• Pelvic fractures
• Acetabular fractures • Intraarticular fractures
• Fracture problems – Infection
– Malunion – Nonunion |
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Term
| Fracture Description is based on |
|
Definition
• Location
• Open/Closed
• Quality
• Neurovascular status |
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Term
|
Definition
| diaphyseal (middle), metaphyseal (end), Intraarticular (in joint) |
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Term
|
Definition
| oblique (angled), transverse (straight across), comminuted (lots of breaks) |
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Term
| Primary / Type 1 Bone Healing |
|
Definition
– Intraarticular Fractures – Compression plating
– Compression technique |
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Term
| Secondary Bone Healing / Type II |
|
Definition
– Diaphyseal fractures
– Comminuted fractures
– Cast treatment, external fixation, intramedullary nails, plate fixation |
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Term
|
Definition
| casting, external fixation, internal fixation (plating, nailing), Distraction Osteogenesis/Ilizarov (stabilized w structure on outside) |
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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 |
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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 |
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|
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 |
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|
Term
| Can open fracture patients get compartment syndrome? |
|
Definition
• YES
• Most common compartment syndrome with tibia fractures is Type III open |
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Term
| Who do we really worry about w compartment syndrome? |
|
Definition
• Everyone
• Tibia fractures
• Forearm fractures |
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|
Term
| What are the symptoms of compartment syndrome? |
|
Definition
• Paralysis
• Paresthesia
• Pallor
• Pulselessness
• Pain out of proportion |
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Term
| How to diagnose compartment syndrome |
|
Definition
• Clinical diagnosis
• Intracompartmental measuring |
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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 |
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Term
| Positive Findings of compartment syndrome |
|
Definition
• Intracompartmental pressure >40mmHg
• Within 30mmHg of the diastolic blood pressure |
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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 |
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Term
| why are dislocations emergencies? |
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Definition
| soft tissue damage, vascular injury |
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|
Term
| anterior vs posterior hip dislocation |
|
Definition
anterior- leg angled out
poster-leg angled ing |
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|
Term
| Treatment for hip dislocation |
|
Definition
• Urgent closed reduction
• Stabilization with well padded splint or traction |
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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 |
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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 |
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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 |
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Term
| Polytrauma Patient is what |
|
Definition
• Injury Severity Score >18
• Hemodynamic instability
• Coagulopathy
• Closed head injury • Pulmonary injury
• Abdominal injury |
|
|
Term
|
Definition
• Large bore IVs
• Crystalloid bolus
• Monitor
– Blood pressure
– Urinary output
– Base deficit
– Initial Hematocrit/Hem oglobin - unreliable |
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|
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 |
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Term
|
Definition
-Pelvic Containment & Stabilization: Sheet, Pelvic Binder, External Fixation
-Angiography
-Laparotomy
-Pelvic Packing |
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|
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 |
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Term
|
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 |
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Term
|
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 |
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Term
|
Definition
impacted (Garden I)
non-displaced (Garden II) |
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Term
|
Definition
| displaced (Garden III and IV) |
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|
Term
| hip fracture treatment options |
|
Definition
– Non-operative
• very limited role
• Activity modification • Skeletal traction
– Operative • ORIF
• Hemiarthroplasty
• Total Hip Replacement |
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|
Term
| Keys to Treatment of Hip Fractures |
|
Definition
• Diagnosis
• Medical optimization
• Minimally invasive surgery • Mobilization
• Weight bearing |
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|
Term
|
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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