General Principles of Orthopedic Injuries
Fractures
Terminology of fx
- anatomic location-divide bone into thirds
- direction of fx lines (transverse, oblique, spiral, comminuted, butterfly, impacted)
- relationship of fragments to each other-alignment, apposition, distraction if longitudinal arrangement. Talk about distal fragment in relation to proximal
- Stability
- Assoc. soft tissue injury.
Back to top
Antibiotics for Open Fractures
East Practice Guideline 2011
Level I
- Systemic antibiotic coverage directed at gram-positive organisms should be initiated as soon as possible after injury.
- Additional gram-negative coverage should be added for type III fractures.
- High-dose penicillin should be added in the presence of fecal or potential clostridial contamination (e.g., farm-related injuries).
- Fluoroquinolones offer no advantage compared with cephalosporin/aminoglycoside regimens. Moreover, these agents may have a detrimental effect on fracture healing and may result in higher infection rates in type III open fractures.
Level II
- In type III fractures, antibiotics should be continued for 72 hours after injury or not >24 hours after soft tissue coverage has been achieved.
- Once-daily aminoglycoside dosing is safe and effective for types II and III
(J Trauma 2011;70(3):751)
Ligamentous injury
1st degree-no swelling, minimal fibers torn
2nd-1/3 to almost complete, swelling, tenderness, no abnormal motion
3rd-abnormal joint motion.
Back to topRSD
Constant itching or burning. Cool or glossy skin. Leads to bone demineralization
Traumatic Myositis Ossificans
bone formation in injured muscle. forms
mass preventing full range.
Myositis:
Polymyositis-elevated ck, purple rash around eyes, anti-jo1 consistent
with dermatomyositis. scaly red rash on knuckles.
Baker’s cyst-
Atlanto-axial subluxation
Rheumatoid Arthritis and Down’s folks prone to this, incidence ~5%.
How to apply a fiberglass cast (Am J EM 2005;23:347)
| | |