Surgery Summary

orthopedic surgery

- varus

- valgus

- comminution: fracture with fragments

- displaced:

o minimal, moderate, completely,

- open fractures

- reduction: restor proper alignment of a joint, fracture,

o bring not back pulse distal→ torn artery

o technique

 open

 closed

- unstable

- splinting and casting

o splints: d to w; if swelling to avoid compartment syndrome,

o casts: w to m;

- emergency

o compartment syndrome

 mostly: leg, forearm,

 pain: passive range of motion; out of proportion

 5ps

 as intracompartmental pressure: below arterial pressure → pink limb,
normal pulse

 >30mmHg→ op

 leave wound open

o open fractures

 ABCDE

 hemorrhage: direct pressure

,  only remove obvious foreign fragments, not bone fragments

 reduction, splint, neuro examination,

 no use iodine → saline covering

 angiogram if

 knee dislocation, cool, pale hand or foot, poor distal capillary refill,
high energy, ABI <0.9

 Gustilo and Anderson classification

 Grade I -> clean skin opening less than 1 cm

 Grade II -> Laceration more than 1 cm, less than 10 cm, soft tissue
damage without significant fracture comminution or crush
component

 Grade IIIA -> extensive soft tissue damage

 Grade IIIB -> extensive soft tissue injury + periosteal stripping or
bone exposure requiring flap coverage

 Grade IIIC -> concominant vascular injury requiring repair

 antibiotic (cephalosporine, ceftriaxone, evtl penicillin), tetanus

o septic arthritis, acute dislocations,

- fractures, dislocation of spine

o vulnerable by thoracolumbar junction

o 3 columns for stability

 anterior: 50% vertebral body, disk, anterior longitudinal ligament

 middle: 50% vertebral, disk, posterior longitudinal ligament

 posterior: facet joints, lateral masses, intraspinous ligaments, supraspinous
ligaments, spinous process,

o nasotracheal intubation,

o methylprednisolone for motor recovery

o rectal exam for resting tone

o bulbocavernous reflex: glans of penis squeeze→ anal sphincter contract

o incomplete

 brown sequard syndrome

,  central cord syndrome

 anterior cord syndrome

 posterior cord syndrome

 conus modularis syndrome

o cauda equina syndrome

 saddle anesthesia

 bilateral radicular pain

 numbness, weakness, hyporeflexia,

 loss of voluntary bladder, bowel function

o classification of neurologic injury

 spinal shock

 hypotonia, areflexia, paralysis,

 bulbocavernous reflex 1st who come back

o determination of sensory level

o determination of motor level

o ASIA impairment scale

o imaging studies

 cervical spine

 CT: AP, lateral, open mouth

 thoracolumbar spine

 AP, lateral

- cervical spine injuries

o injuries to occiput C1-C2 complex

 occipital condyle fractures

 stable- potentially unstable- unstable

 cervical collar, halo immobilization

 occipitoatlantal dislocation

 always fatal, motorbike, halo

,  atlas fractures

 transverse ligament rupture

 fatal

 fracture of odontoid process (dens)

 C2 lateral mass fractures

 traumatic spondilisthesis of C2

 Hangmans fracture

o orthosis; halo; halo+op

o injuries to C3-C7

 teardrop fractures

 anterior body of vertebra

 burst fractures

 vertical compression

 clay shovelers fracture

 spinous process avulsion fracture

 sentinel fracture

 lamina fracture

 traction contraindicated in type IIa spondolisthesis injury of C2 and
distractive cervical spine injury

o halo application

 1cm above ears,

 anterior above supraorbital ridge

 posterior variable

o thoracolumbar spinous injuries

 compression fractures

 anterior column

 stable

 unstable >50% loss of body height; angulation >20-30°; multiple
fractures