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Chapter 40. Orthopedic Surgery

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Open fractures, defined as a break in the bone with violation of the skin and soft tissues requires the following management:

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A. Splinting

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B. Bedside irrigation and splinting

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C. Formal irrigation and debridement in the ­operating room with stabilization of fracture and antibiotics

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D. VAC dressing

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E. Plastic surgery consultation

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C. An open fracture is defined as an osseous disruption with a break in the overlying skin and soft tissues resulting in communication between the fracture and the external environment. Open fractures can be classified using the Gustillo and Anderson classification: Grade 1, clean skin opening less than 1.0 cm, Grade 2, traumatic wound greater than 1.0 cm but less than 10 cm in size, and Grade 3, extensive soft tissue injury requiring flap and/or vascular repair. Antibiotic treatment, tetanus prophylaxis and urgert irrigation and debridement in the operation is necessary. Fractures should be stabilized with internal or external fixation and/or splinting to minimize additional soft tissue injury.

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A 37-year-old man is involved in a motor cycle accident at a high rate of speed. Upon arrival to the emergency room he reports that he has no feeling below the waist and cannot move his legs. The bulbocavernosis reflex is intact. According to the American Spinal Injury Association, he would be considered:

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A. Asia A

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B. Asia B

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C. Asia C

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D. Asia D

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E. Asia E

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C. The clinical findings in spinal cord injury depend on the level, mechanism and severity of injury. Injuries are classified as complete or incomplete. A complete spinal cord injury refers to lack of motor or sensory function below the level of the lesion. Incomplete spinal cord injuries may demonstrate a variable pattern of sensory and motor preservation. The American Spinal Injury Association published a scale to classify the severity of SCI: ASIA A – complete, ASIA B- sensory incomplete, ASIA C- motor incomplete, ASIA D- motor incomplete, more than half muscles below lesion have > grade 3 strength, ASIA E – normal. Spinal shock is a spinal cord dysfunction due to physiologic disruption, resulting in hypotonia, areflexia and paralysis. Resolution usually occurs within 24 hours and the bulbocavernosis reflex is the first to come back.

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A 57-year-old woman is involved in a motor vehicle collision. She is transferred to the Emergency Department where radiographs confirm a closed pelvic fracture with symphyseal widening. She becomes ...

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