Orthopedic & Soft-Tissue Injuries

Abrasions

• Watch for the tattooing effect (embedding debris in the skin).
• Debridement should be done within 6-8 hours.
• Betadine is an option but must be thoroughly rinsed with normal saline (NS) or sterile water.

Amputations – Prioritize ABCs!

• Viability without cooling:
  • Digits: Up to 12 hours.
  • Other limbs: Up to 6 hours.
• With cooling:
  • Digits: Can last 24 hours.
  • Proximal to wrist: Up to 12 hours.
• Key considerations: Can the patient rehabilitate? (Decision between reattachment or full amputation.)
• Treatment: Splint, elevate, irrigate using only NS.

Avulsion Injuries

• Cannot approximate wound edges—requires a moist NS dressing.
• May need surgical intervention for repair.

Carpal Tunnel Syndrome – Median Nerve Involvement

• Tinel’s Sign: Tapping the wrist reproduces symptoms.
• Phalen’s Test: Pressing the backs of hands together in maximum wrist flexion elicits symptoms.

Compartment Syndrome

• Fascial layers do not stretch with swelling, leading to circulatory compromise.
• Can result in rhabdomyolysis.
• Fasciotomy is the last resort.
• Key symptom: Pain disproportionate to the injury.

Sprains (Ligament Injury)

(Tip: Both “sprain” and “ligament” have letters that extend below the baseline!)

• Grade 1: Stretching of ligament fibers.
• Grade 2: Partial tear, but the joint remains stable.
• Grade 3: Complete tear, resulting in joint instability.

Muscle Strain

• Injury to muscle fibers due to overstretching or excessive force.

Suture Removal Guidelines

• Joints: 14 days
• Trunk: 7 days
• Extremities: 8-10 days
• Face: 3-4 days
• Scalp: 5-8 days
• Staples are preferred in non-visible areas to minimize cosmetic concerns.

Volkmann’s Ischemic Contracture

• Irreversible flexion deformity of the hand and wrist, giving a claw-like appearance.
• Commonly linked to supracondylar humerus fractures due to compromised circulation.

Types of Fractures

Basic Classifications:

• Open (Compound): Bone breaks through the skin.
• Closed (Simple): Bone is fractured, but skin remains intact.

Specific Fracture Patterns:

• Greenstick: Incomplete break; one side of the bone bends.
• Transverse: Straight-line fracture across the bone.
• Spiral: Twists around the bone; often from rotational injuries.
• Oblique: Diagonal break across the bone.
• Compression: Bone is crushed, appearing wider or flatter.
• Comminuted: Bone shatters into three or more fragments.
• Segmental: Bone breaks in two places, leaving a detached “floating” section.

Notable Named Fractures:

• Monteggia Fracture: Proximal ulnar fracture with radial head dislocation.
• Boxer’s Fracture: Break at the neck of the 5th metacarpal.
• Colles’ Fracture: Distal radius fracture causing dinner fork or bayonet deformity.
• Navicular (Scaphoid) Fracture: Identified by snuffbox tenderness.
  • Treatment: Thumb spica splint; may take 4-6 weeks to appear on X-ray.

Pelvic fractures

Osteoarthritis (Degenerative Joint Disease)

• Affects large weight-bearing joints and hands.
• Morning stiffness is brief.
• Can be unilateral or bilateral.
• Bony nodules:
  • Heberden’s nodes → Affects DIP (distal interphalangeal) joints.
  • Bouchard’s nodes → Affects PIP (proximal interphalangeal) joints.

Management:

• Lifestyle Modifications:
  • Exercise 3x per week (isometric, tai chi).
  • Weight loss and smoking cessation.
• Pain Relief Options:
  • Acetaminophen (Tylenol).
  • NSAIDs (if no contraindications).
  • Topical treatments: Diclofenac, capsaicin cream.
  • Alternative therapies: Acupuncture.

Nursemaid’s Elbow (Radial Head Subluxation)

• Common in young children due to sudden pulling of the arm.
• The radial head slips under the annular ligament, causing pain and limited forearm supination.
• Frequently caused by pulling a child up by the arm (e.g., preventing a fall).
• Typically resolves easily with proper reduction.