Stasio Sprains and Splints

Question 1

CLINICAL SIGNS AND SYMPTOMS OF A FRACTURE

Answer 1

PAIN

SWELLING

DEFORMITY

ECCYMOSIS

LOSS OF FUNCTION

Question 2

THE MOST RELIABLE SIGN OF FRACTURE IS?

Answer 2

PAIN

Question 3

Types of fractures

Answer 3

oblique
comminuted
spiral
compound

transverse, oblique, segmental, avulsted, impacted, torus, greenstick

Question 4

OPEN Fractures

Answer 4

Definition: a fracture that has communicated with the outside environment.

Two ways:

• High velocity trauma or missile injury
• Spikes of bone pierce the skin

Do not get fooled by the  
   size of the injury, 
   whether a small or 
   larger wound, 
   must get a surgical consult 
   and intervention.

Question 5

SALTER

Answer 5

Slipped- 1
Above- 2
Lower- 3
Through- 4
Rammed and Ruined- 5

Question 6

WHY WORRY ABOUT SALTER NUMBERS?

Answer 6

THE HIGHER THE SALTER NUMBER THE POORER THE PROGNOSIS FOR RECOVERY.
THE MORE SERIOUS FRACTURES CAN LOOK BENIGN
FRACTURE REDUCTIONS MUST BE PERFECT FOR BEST RESULTS

Question 7

SALTER TYPE I

Answer 7

(SLIPPED)

TRANSVERSE FRACTURE THROUGH GROWTH PLATE OR
PHYSIS
ONLY 6% OF FRACTURES

Question 8

SALTER TYPE II

Answer 8

(ABOVE)

FRACTURE THROUGH THE METAPHYSIS SPAREING THE EPIPHYSIS
** MOST COMMON

70% OF GROWTH PLATE FRACTURES

Question 9

SALTER TYPE III

Answer 9

(LOWER)

FRACTURE THROUGH THE GROWTH PATE AND EPIPHYSIS SPARING THE METAPHYSIS
ONLY 8% OF FRACTURES

Question 10

SALTER TYPE IV

Answer 10

(THROUGH)

EXTEND THROUGH ALL THREE ELEMENTS
GROWTH PLATE EPIPHYSIS AND METAPHYSIS
10% INCIDENCE

Question 11

SALTER TYPE V

Answer 11

(RAMMED AND RUINED)

COMPRESSION FRACTURE OF THE GROWTH PLATE
LUCKLY RARE 1% INCIDENCE

Question 12

PIT FALLS WITH FRACTURES

Answer 12

Not all fractures are apparent

fall with snuff box pain, e.g.

Question 13

COLLES’ FRACTURES

Answer 13

Fracture of the distal radius with dorsal displacement, with or without ulnar involvement.
“Dinner fork” deformity.
Falling on an outstretched hand.
Associated fracture of the ulnar styloid process >60% of the time.

Question 14

Tri-malleolar Fracture

Answer 14

Involves:

1. Lateral malleolus
2. Medial malleolus
3. Posterior tibia

Landing flat on the heal from significant
height.

Very unstable fracture.

Treatment:
Surgery (ORIF)
Open Reduction
Internal Fixation

Question 15

FRACTURE COMPLICATIONS- one of the most important things

Answer 15

ischemic injuries

always check distal neurovascular issues

Question 16

Early Complications

Local

Answer 16

Vascular injury causing hemorrhage, internal or external

• Visceral injury causing damage to structures such as the brain, lung or bladder
• Damage to surrounding tissue, blood vessels, muscle, nerves or skin
• Hemarthrosis
• Compartment syndrome (or Volkmann’s ischemia)
• Wound Infection - more common for open fractures

Question 17

Early Complications

Systemic

Answer 17

• Fat embolism – long bone / pelvic fractures from bone marrow
• Shock – extensive bleeding
• Thromboembolism (pulmonary or venous)
• Exacerbation of underlying diseases such as diabetes or coronary artery disease (CAD)
• Pneumonia

Question 18

Late Complications- Local

Answer 18

Delayed union
Nonunion
Mal-union
Joint stiffness
Contractures
Myositis ossificans – calcifications and bony masses can form in muscle
Avascular necrosis – loss of blood supply
Algodystrophy (or Sudeck’s atrophy) – RSD or Regional pain syndrome
Osteomyelitis - infection
Growth disturbance or deformity – children’s growth plates

Question 19

Late Complications

Answer 19

Gangrene, tetanus, septicemia
Fear of mobilizing
Osteoarthritis

Question 20

COMPARTMENT SYNDROMES

Answer 20

• Medical Emergency
  The pressure inside the fascial compartment exceeds the blood (arterial) pressure.
  Causes compromise of the circulation to the soft tissue, ischemia and necrosis.
  Irreversible damage can occur in 8 hours.

Question 21

Conditions Associated with COMPARTMENT SYNDROMES

Answer 21

Soft tissue injuries
Soft tissue injury with fracture
Exercised induced 
Crush injury
Prolonged tourniquet application
Electrical injury
Burns
Animal bites

Question 22

How do you know if compartment syndrome is happening? What is the treatment?

Answer 22

if pressure exceeds systolic BP, then blood isn’t getting into that area

Fasciotomy

Question 23

FRACTURE BLISTERS

Answer 23

Tense vesicles or bullae that arise on markedly swollen skin directly over a fracture.

• Tibia, ankle and elbow.
• Arise in 24-48 hours post injury, early as 6 hours.

-Two types:
Clear fluid filled
Blood filled

• Caused by separation of the dermis from the epidermis.
• Can result in increased infection rate.

-Treatment:
	Benign neglect
	Debridement
	Aspiration
	Surgical delay

Question 24

MALALIGNMENT OF FRACTURES

Answer 24

WILL STRAIGHTEN
IN KIDS IF ANGLE LESS THAN
15 DEGREES

Question 25

types of ankle sprains/ ligament tears

Answer 25

inversion eversion high ankle sprain

Question 26

Degree of Severity of Ankle Sprains:

Answer 26

Grade I Mild sprain, * mild pain, little swelling, and * joint stiffness may be apparent without laxity (loosening) Usually affects the anterior talofibular ligament * Minimum or no loss of function Can return to activity within a few days of the injury (with a brace or taping) Grade II * Moderate to severe pain, swelling, and joint stiffness are present Partial tear of the lateral ligament(s) * Moderate loss of function with difficulty on toe raises and walking Takes up to 2-3 months before regaining close to full strength and stability in the joint Grade III Severe pain may be present initially, * followed by little or no pain due to total disruption of the nerve fibers Swelling may be profuse and joint becomes stiff some hours after the injury Complete rupture of the ligaments of the lateral complex (severe laxity) Usually requires some form of immobilization lasting several weeks * Complete loss of function (functional disability) and necessity for crutches Usually managed conservatively with rehabilitation exercises, but a small percentage * may require surgery Recovery can be as long as 4 months

Question 27

TREATMENT OF ACUTE SPRAINS IS

Answer 27

``` R= REST I= ICE C= COMPRESSION E= ELEVATE NOTE: MAY NEED IMMOBILIZATION WITH GRADE III SPRAINS ```

Question 28

BENEFITS OF A CAST

Answer 28

BETTER IMMOBILIZATION IN FIXED POSITION LESS MOVEMENT AT THE FRACTURE SITE LASTS FOR WEEKS TO MONTHS CAN’T BE REMOVED BY THE PATIENT

Question 29

BENEFITS OF A SPLINT

Answer 29

FASTER AND CHEAPER CAN BE ADAPTED FROM SURROUNDING MATERIAL NOT AS LIKELY TO CAUSE PRESSURE PROBLEMS CAN BE REMOVED BY THE PATIENT

Question 30

HAZARDS OF CASTING

Answer 30

``` compartment syndrome ischemia heat injury pressure sores and skin breakdown infection dermatitis joint stiffness neurologic injury ``` Always document a neruo/ motor/ vascular exam pre and post cast application

Question 31

MATERIALS NEEDED FOR CASTING

Answer 31

adhesive tape (to prevent slippage of elastic wrap used with splints) bandage scissors basin of water at room temperature (dipping water) casting gloves (necessary for fiberglass) elastic bandage (for splints) padding plaster or fiberglass casting material sheets, underpads (to minimize soiling of the patient's clothing) sockinette

Question 32

APPLICATION:

Answer 32

use appropriate amount and type of padding properly pad bony prominences and high-pressure areas properly position the extremity before, during and after application of materials avoid tension and wrinkles on padding, plaster, and fiberglass avoid excessive molding and indentations

Question 33

Factors that affect setting times for casts and splints

Answer 33

speeding up: higher temperature of dipping water use of fiberglass reuse of dipping water slowing down: cooler temperature of dipping water use of plaster

Question 34

types of splints

Answer 34

posterior stirrup gutter sugar tong

Question 35

wrapping a splint or cast

Answer 35

always wrap distal to proximal

Question 36

warnings

Answer 36

ALWAYS WEAR GLOVES WHEN WORKING WITH THE RESIN CASTING TAPE | WE DO NOT HAVE A POWER GRINDER TO GET IT OFF YOUR HANDS.

Question 37

Indications for Diagnostic and Therapeutic Injections

Answer 37

``` Soft tissue conditions: Bursitis Tendonitis Trigger points Ganglion cysts Neuroma Entrapment syndromes Fasciitis ``` ``` Joint conditions: Effusion Crystalloid arthropathies Synovitis Inflammatory arthritis Advanced osteoarthritis ```

Question 38

contraindications to joint injections

Answer 38

Absolute contraindications: Local cellulitis Acute fracture Tendon sites are at a high risk for rupture Drug allergy Septic arthritis – for therapeutic injection, not aspiration Relative contraindications: Minimal relief after 2 previous injections Underlying coagulopathy / anticoagulation therapy Uncontrolled diabetes Surrounding joint osteoporosis Anatomically inaccessible joint