0071643192.pdf

ORTHOPEDICS

The 5 Ps of com-

partment syndrome:

Pain (most common

symptom)

Paresthesias

Pallor

Paralysis

Pulselessness (late

finding!)

■ Talus fracture
■ Proximal humerus fracture
■ Infection
■ Vascular injury or hemorrhage
■ Nerve injury: Pain, paresthesias, weakness, or paralysis
■ Soft-tissue or organ injury
■ Compartment syndrome
■ Fat emboli syndrome
■ Most common afterlong bone and pelvic fractures
■ See petechiae, altered mental status, hypoxia.
■ Volkmann ischemic contracture
■ Flexion contracture of hand/wrist due to untreated forearm compart-
ment syndrome and resultant muscle ischemia.
■ Reflex sympathetic dystrophy (complex regional pain syndrome)

INJURIES TO THE UPPER EXTREMITIES

A football player snags his index finger in another player’s jersey and finds

it difficult to catch the football for the rest of the game. When you immobi-

lize the PIP and MCP joints in extension, he is no longer able to flex the

DIP joint. What is injured and how is it treated?

The football player has a flexor digitorum profundus (FDP) tendon avulsion,

or ”jersey finger,” which is treated by splinting the finger in a comfortable posi-

tion and referral to orthopedics as soon as possible.

Digits

AMPUTATED DIGITS

■ Require immediate hand surgery consultation
■ Wrap in sterile gauze soaked in normal saline (NS) and surround with plastic
bag, then place bag with digit(s) in ice water.

TABLE 4.1. Common Injuries and Associated Neurovascular Complications

TYPES OFFRACTURES ORDISLOCATIONS NEUROVASCULARCOMPLICATIONS

Anterior shoulder dislocation Axillary nerve and artery injury

Musculocutaneous nerve injury

Extension supracondylar fracture Brachial artery injury

Posterior elbow dislocation Ulnar and median nerve injury

Radial nerve injury for supracondylar fracture

Knee dislocation Popliteal artery injury

Peroneal and tibial nerve injury

Humeral shaft injury Radial nerve injury

Medial epicondylar fracture Ulnar nerve injury

Lateral tibial plateau fracture Peroneal nerve injury