Ottawa knee rule
- Αge above 55 years
- Τenderness at the head of the fibula
- Ιsolated tenderness of the patella
- Ιnability to flex the knee to 90 degrees
- Ιnability to bear weight (take four steps) immediately and in the ED
Second fracture
A tibial plateau avulsion fracture at the site of lateral capsular ligament insertion
- important marker of ACL disruption +/- medial meniscus injury- indicate severe rotatory instability
Knee dislocation
- Orthopedic emergency associated with vascular damage, requires urgent reduction
- high rate of popliteal artery (20-80%) and peroneal nerve injury
- involves rupture of both cruciate ligaments and one collateral ligament
- anterior dislocations most common (described as displacement of tibia in relation to femur)
- risk of developing compartment syndrome increased when reduction is not performed within 6hours
- CTA for those with abnormal ankle-brachial index
Adjunctive procedures able to be performed with an emergency thoracotomy
- Pericardiotomy for tamponade
- Control cardiac bleeding
- Compress/ clamp pulmonary trunk
- Compress/ clamp descending aorta
- Open cardiac massage
- Right atrial access for blood or fluid administration
Possible complications of tube thoracostomy
a) Trauma to the intercostal neuromuscular bundle
b) Extrapleural placement
c) Intra-fissural placement
d) Intra-pulmonary placement
e) Mediastinal impingement or penetration
f) Trans diaphragmatic placement
g) Infection
Complications or problems with cervical immobilisation
- Patient discomfort- headache, mandibular pain
- Increased intracranial pressure- average of 2-3mm Hg up to 15mm Hg
- Cutaneous pressure ulceration- decubitus ulcers
- Worsening neurological function
- Reduced access to neck and occiput: masks life threatening injuries
- Restricts pulmonary function
- Need for ongoing spinal nursing
- Increased difficulty of intubation
- Aspiration risk
- DVT risk
Components of anterior, middle and posterior column of cervical spine
Anterior: anterior longitudinal ligament, anterior 1/2 of vertebral bodies and discs
Middle column: posterior longitudinal ligament, posterior 1/2 of the vertebral bodies and discs
Posterior: Facet joints, pedicles, laminae, ligamentum flavum, spinous process, interspinous ligament
