{"id":5413,"date":"2011-07-14T20:26:19","date_gmt":"2011-07-14T20:26:19","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5413.htm\/"},"modified":"2012-06-10T12:51:51","modified_gmt":"2012-06-10T16:51:51","slug":"general-orthopedics","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/trauma\/general-orthopedics.htm\/","title":{"rendered":"General Principles of Orthopedic Injuries"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>General Principles of Orthopedic Injuries<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Fractures\"><\/span>Fractures<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Terminology of fx<\/p>\n<ol>\n<li>anatomic location-divide bone into thirds<\/li>\n<li>direction of fx lines (transverse, oblique, spiral, comminuted, butterfly, impacted)<\/li>\n<li>relationship of fragments to each other-alignment, apposition, distraction if longitudinal arrangement.\u00a0 Talk about distal fragment in relation to proximal<\/li>\n<li>Stability<\/li>\n<li>Assoc. soft tissue injury.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Antibiotics_for_Open_Fractures\"><\/span>Antibiotics for Open Fractures<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>East Practice Guideline 2011<\/p>\n<p><strong>Level I<\/strong><\/p>\n<ul>\n<li>Systemic antibiotic coverage directed at gram-positive organisms should be initiated as soon as possible after injury.<\/li>\n<li>Additional gram-negative coverage should be added for type III fractures.<\/li>\n<li>High-dose penicillin should be added in the presence of fecal or potential clostridial contamination (e.g., farm-related injuries).<\/li>\n<li>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.<\/li>\n<\/ul>\n<p><strong>Level II\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li>In type III fractures, antibiotics should be continued for 72 hours after injury or not &gt;24 hours after soft tissue coverage has been achieved.<\/li>\n<li>Once-daily aminoglycoside dosing is safe and effective for types II and III<\/li>\n<\/ul>\n<p>(J Trauma 2011;70(3):751)<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"\/wp-content\/images\/part2\/openfx.gif\"><img decoding=\"async\" src=\"\/wp-content\/images\/part2\/open-fx.gif\" alt=\"Gustilo Classification of Open Fractures\" \/><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Ligamentous_injury\"><\/span>Ligamentous injury<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>1st degree-no swelling, minimal fibers torn<\/p>\n<p>2nd-1\/3 to almost complete, swelling, tenderness, no abnormal motion<\/p>\n<p>3rd-abnormal joint motion.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"RSD\"><\/span>RSD<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Constant itching or burning.\u00a0 Cool or glossy skin.\u00a0 Leads to bone demineralization<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Traumatic_Myositis_Ossificans\"><\/span>Traumatic Myositis Ossificans<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>bone formation in injured muscle.\u00a0 forms<\/p>\n<p>mass preventing full range.<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Myositis\"><\/span>Myositis:<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Polymyositis-elevated ck, purple rash around eyes, anti-jo1 consistent<\/p>\n<p>with dermatomyositis.\u00a0 scaly red rash on knuckles.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Bakers_cyst\"><\/span>Baker&#8217;s cyst-<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>&nbsp;<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Atlanto-axial_subluxation\"><\/span>Atlanto-axial subluxation<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Rheumatoid Arthritis and Down&#8217;s folks prone to this, incidence ~5%.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>How to apply a fiberglass cast\u00a0 (Am J EM 2005;23:347)<\/p>\n<p>&nbsp;<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Joint_Injection\"><\/span>Joint Injection<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>How to tell whether a laceration involves a joint<\/p>\n<p>Put 2ml of methylene blue into 500 ml bottle of NS<\/p>\n<p>Inject ~20ml into the joint. Use 4&#215;4 to see if blue in the cut<\/p>\n<p>Try to pull it back out when done<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[7,17],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>General Principles of Orthopedic Injuries - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/trauma\/general-orthopedics.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/trauma\/general-orthopedics.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/trauma\/general-orthopedics.htm\/\",\"name\":\"General Principles of Orthopedic Injuries - 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