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.

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)

1st degree-no swelling, minimal fibers torn

2nd-1/3 to almost complete, swelling, tenderness, no abnormal motion

3rd-abnormal joint motion.

Constant itching or burning. Cool or glossy skin. Leads to bone demineralization

bone formation in injured muscle. forms

mass preventing full range.

Polymyositis-elevated ck, purple rash around eyes, anti-jo1 consistent

with dermatomyositis. scaly red rash on knuckles.

Rheumatoid Arthritis and Down’s folks prone to this, incidence ~5%.

How to apply a fiberglass cast (Am J EM 2005;23:347)

How to tell whether a laceration involves a joint

Put 2ml of methylene blue into 500 ml bottle of NS

Inject ~20ml into the joint. Use 4×4 to see if blue in the cut

Try to pull it back out when done