Open fractures– Dr. Gosser

1. Gustilo-Anderson classification: type 1-3
2. Management: if vascular compromise > attempt reduction, irrigate wound, immobilize in splint, abx, tdap, ortho consult
3. Antibiotics: cefazolin, add gentamycin for complex, add fluoroquinolones for fresh water, add doxy for salt water wounds
4. Complications: surgical site infection, osteomyelitis, surgical amputation, neurovascular injury, compartment syndrome

Splinting- Dr. Rizzo

1. Proximal humerus: cuff and collar
2. Supracondylar: posterior long arm
3. Distal radius and ulnar: sugar tong
4. Distal tibia: posterior short leg w or w/o stirrups
5. 5th metacarpal: ulnar gutter

Room 9 Follow up- Dr. Roberts

1. Aortic dissection
2. Symptoms: chest pain, abdo pain, syncope, stroke-like symptoms, paraplegia
3. Widened mediastinum on CXR in 40% of patients
4. Tx: BP control- short-acting beta blockers > long-acting, such as esmolol or labetalol; vasodilators such as nicardipine, clevidipine, nitroglycerine, nitroprusside
5. Ruptured aortic aneurysm
6. Symptoms: hypotensions, abdominal pain, pulsatile mass
7. Unstable > bedside ultrasound vs stable > CT w/ contrast
8. Tx: SBP 80-90, esmolol if HTN
9. Bowel perforation
10. Tx: fluids, NPO, abx, ppi, surgery consult, pain control
11. Decompensated cirrhosis
12. SBP tx: third gen cephalosporin, fluoroquinolone, carbapenem

Eponymous Fractures- Dr. Eisenstat

1. LeFort 1: horizontal maxillary, teeth from face
2. Lefort 2: pyramidal fracture, maxilla, orbital wall, nasal bone
3. LeFort 3: craniofacial disjunction, assox with CSF leak, temporalis muscle disruption
4. Chance: involves all 3 columns, assox with seat belt injury
5. Clay Shoveler: lower C spine process (usually C7), stable
6. Jefferson: C1 burst fx from axial loading (diving)
7. Bennett vs Rolando: 2 vs 3 fx fragments of 1st metacarpal > thumb spica
8. Bankart: glenohumeral avulsion with ant shoulder dislocation
9. Hill Sachs: humeral head depression fx
10. Monteggia: proximal ulna, dislocation of radial head; peds FOOSH
11. Galeazzi: distal radius fx with radio/ulnar dislocation
12. Boxer: distal metacarpal fx, no rotation accepted
13. Chauffer: radial styloid, direct blow to back of wrist
14. Colles: FOOSH, elderly women, distal radius, indication for DEXA scan
15. Smith: fall on flexed wrist
16. Game-keeper/Skier thumb: rupture of ulnar collateral ligament, caused by forced abduction, thumb spica > possible OR
17. Jones: base of 5th metatarsal, NWB 6-8 wks
18. Lisfranc: separation between tarsal bones, ligamentous injury in midfoot joint
19. Maisonneuve injury: tib/fib syndesmosis, proximal fib fracture
20. Pilon: comminuted distal tib
21. Segond: avulsion fracture assox with ACL tear
22. Weber classification of lateral malleolus fracture: A below, B @, C above syndesmosis
23. Salter harris classification of physeal fractures