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General Principles of Orthopedic Injuries

July 14, 2011 by CrashMaster

 

 

General Principles of Orthopedic Injuries

 

Fractures

Terminology of fx

  1. anatomic location-divide bone into thirds
  2. direction of fx lines (transverse, oblique, spiral, comminuted, butterfly, impacted)
  3. relationship of fragments to each other-alignment, apposition, distraction if longitudinal arrangement.  Talk about distal fragment in relation to proximal
  4. Stability
  5. Assoc. soft tissue injury.

 

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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)

 

Gustilo Classification of Open Fractures

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Ligamentous injury

1st degree-no swelling, minimal fibers torn

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

3rd-abnormal joint motion.

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RSD

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)

 

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Joint Injection

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

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Filed Under: 06. Trauma, orthopedics

Section Index

  • Fractures
  • Antibiotics for Open Fractures
  • Ligamentous injury
  • RSD
  • Joint Injection

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