Chapter 32 - Trauma

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Chapter 32 - Trauma
2011-12-21 20:12:25
Podiatry boards II

Pocket podiatrics - Chapter 32 trauma
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  1. Patient presents to ED with an open fracture. The wound is 1.4 cm in length. The fracture happened 2 hours ago. There is minimal or no comminution. Wound is clean. How would you classify this and how would you treat?
    This is a gustillo and anderson type II

    • Type I
    • fx with open wound <1cm
    • clean, minimal soft tissue necrosis
    • fx is usually transverse or short oblique
    • minimal or no comminution

    • Type 2
    • Same as above but > 1 cm

    • Type 3
    • Fx with extensive open wound
    • contamination and/or necrosis of skin, muscle, N/V structures and soft tissue
    • Often comminution
    • A: Adequate soft tissue coverage of bone
    • B: Extensive soft tissue loss with periosteal stripping and bone exposure
    • C: Injury with arterial injury requiring microvascular repair

    • Treatment:
    • C&S
    • wound debridement/irrigation
    • Fx stabilization
    • tetanus prophylaxis
    • antibiotics (cefazolin 1-2 g IV followed by 1g IVPB q8h until cultures are available)
    • VASCULAR EVAL: Fluroescein, a non-toxic dye, administered IV and observed under UV light after 10-20 minutes.
  2. What is an incomplete fracture in which cortex on only one side is disrupted; seen in children due to their soft bones?
    Greenstick fracture
  3. What is the JAHSS classification used for?
    • To classify turf toe.
    • Type 1
    • -dorsal dislocation of the proximal phalanx in which the metatrsal head punctures through the plantar capsule.
    • -intersesamoidal ligament is intact and there are no fractures
    • -deformity is tight and difficult to close reduce

    • Type IIA
    • Same as above except:
    • the intersesamoidal ligament is ruptured
    • the deformity is loose and easier to close reduce