Conference Notes 8/7

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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

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