General Principles of Orthopedic Injuries
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
- Assoc. soft tissue injury.
Antibiotics for Open Fractures
East Practice Guideline 2011
- 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.
- 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
Traumatic Myositis Ossificans
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