Orthopedic Emergencies
Compartment Syndrome
• An increase in compartment pressure to the point where tissue perfusion is impaired.
• Initial Management
- Remove all circumferential dressings/casts
- Ensure leg is at level of the heart - the affected part should not be elevated above the level of the heart because this maneuver does not improve venous outflow and reduces arterial inflow
- Remove any traction
• Definitive management:
- Compartment fasciotomy-2 incisions, 15 cm long
- Delay>12 hr. often results in irreversible muscle and nerve damage in that compartment
Fat Embolism Syndrome
• Syndrome caused by presence of fat globules in the lung parenchyma and peripheral circulation. Usually subclinical event after long bone fractures in young adults (tibia/fibula) and hip fractures in elderly. Syndrome usually appear in 1-2 days after an acute injury or after IM nailing.
• Management: 1. Oxygenation 2. Fluid resuscitation 3. Surgical Care - early stabilization of long bone fractures
Necrotizing Fasciitis
Rapidly progressive inflammatory infection of the fascia, with secondary necrosis of
the subcutaneous tissues. The speed of spread is directly proportional to the thickness
of the subcutaneous layer. Necrotizing fasciitis moves along the fascial plane.
• Diagnosis: requires a high degree of suspicion
- H/O antecedent trauma or surgery
- Intense pain over the involved skin and underlying muscle; over the next several hours to days, the local pain progresses to anaesthesia.
- Fever, malaise, and myalgia
- Edema extending beyond the area of erythema, skin vesicles, and crepitus.
- Comorbid factors, including DM
• Treatment
- Prompt surgical debridement is continued until tissue necrosis ceases and the growth of fresh viable tissue is observed.
- Antibiotic (broad spectrum covering both gram positive and negative)
- Hyperbaric oxygen therapy (HBOT)
Spinal Shock
• Temporary loss of spinal cord function and reflex activity below the level of spinal cord injury, characterised by bradycardia, hypotension (due to loss of sympathethic tone), and an absent bulbocarvenosus reflex
• Spinal shock vs Neurogenic Shock vs Hypovolemic Shock
#Orthopedics #Emergencies #diagnosis #management #treatment
