Trauma

Spring 2011

FINAL

Some Trauma Stats

1. Most common cause of death for those 1. 1-44 years of age

2. Medical costs for trauma1. 200 billion annually

3. Mostly results from MVA, unintentional accidents, gunshot wounds, stabbing, fights, domestic violence

Trimodal Distribution

ImmediateEarly

Late

Immediate Deaths

Lacerations of the

_________________

Lacerations of the

_________________

Early Deaths

1. Within first __ hours

2. _______hemorrhage

3. Lacerations of _____or _________

4. Significant ____ lossLiver laceration with extravasation

Late Deaths1. ________after injury

2. ____________ and ______ ____ failure

Level I, II & III Trauma Centers

1. Level 11. Usually in _____

metro areas and serve as both primary and tertiary care institutions

2. Must be avail _____3. Must treat

______admissions or ______major trauma patients per year

1. Level II1. __________to level I

when necessary2. Serve ________cites

and towns3. Must be avail ___ hrs

2. Level III1. __________&______2. ______________ on

nights and weekends

Skeletal Trauma

Fracture Classifications

FRACTURE TYPES

_____________ reduction

__________ Reduction

_________ FRACTURES

Open Fracture

1. Bone has _____________ skin

2. May lead to infection

3. Precautions must be taken to _______ ___________from setting into the bone

Closed Fracture

1. __________ is not penetrated

2. Fractures can be classified by the _______ of the stress that caused the break1. ________2. ________3. ________

16

Closed Fracture- Clavicle

Forearm Closed fracture

____________Fracture- Wrist

• When the fractured bone is ________into the cancellous tissue of another fragment

Impacted Fracture- Hip

Fibular Impacted Fracture

Comminuted Fracture

1. Do not represent the full thickness of the bone.

2. Usually extensively ________________

3. Particularly apt to be open fractures

Comminuted Fracture

Comminuted Fracture

Non-Comminuted Fracture

Non-Comminuted Fracture

1. _________ fracture in which the bone is separated into to fragments

2. Can be classified according to the direction of its fracture line1. ______________2. ______________

________________ Fracture

1. Fragment of the bone is __________ from the shaft

2. Occur around the joints because of ligaments, tendons, muscles, associated with sprain or dislocation

Avulsion Fracture

Avulsion Fracture

Incomplete Fracture

1. Part of bony structure gives way with ________or no ________________1. Common example is

a _________ fracture

2. Torus fracture

Greenstick :Incomplete Fracture

1. Cortex breaks on one side without separation or breaking of the opposite cortex

2. Found almost exclusively in children under the age of 10

Incomplete Fracture

Greenstick Fracture

Greenstick Fracture

Greenstick Fracture

________: Incomplete Fracture

1. AKA _____ Fracture

2. It is a greenstick fracture

3. Cortex bulges _______producing a slight irregularity

Torus Fracture

Growth Plate Fracture

1. Involve the end of the long bone

2. Not visible unless displacement occurs

3. Classified according to severity1. ____________________

1. I-IV2. Based on degree of

epiphysis involvement

Growth Plate Fracture

Growth Plate Fracture

_____________ Fracture

1. Results from an _________degree of repetition

2. Generally found where __________ attachments are1. EX: runners at tib/fib

3. Not always seen on plain x-ray

Stress Fracture

Stress Fracture

Occult Fracture

1. Gives ______________ without radiologic evidence

2. ____ days later may show repairing itself or displacement

Occult Fracture

Occult Fracture

Colles Fracture

1. Fracture through distal inch of the __________

2. Distal fragment angled ________on the shaft

3. Impaction along dorsal aspect

4. Avulsion fx of the______________process

Colles Fracture

Boxer’s Fracture

Monteggia’s Fracture

____________________________________________________

Galeazzi Fracture

_________________________________________________________________________________

____________ Fracture

1. Both ____________

2. ____________of the ankle joint

3. ______________fx1. Medial and post.

malleoli of the tibia and lat. Malleolus of the fibula

Pott’s Fracture

____________ Fracture

• Severe ankle ______

• Disruption of the _________________between the distal tibia & fibula

• Fracture at prox third of the fibula, often missed

Maisonneuve Fracture

______________

• No definitive fx is seen but the fat pads indicate an underlying fracture

Dislocations

Dislocations

Subluxation

Subluxation

Skeletal Trauma Suspicious for Child Abuse

• Distal femur, wrist, ankle– Metaphyseal corner

fractures

• Multiple– Fx’s in different stages of

healing

• Femur, humerus, tibia– Spiral fx’s <1 year old

• Multiple skull fx’s– Occipital bone

• Post ribs, avulsed spinous processes, metacarpal & metatarsal fx’s, sternal& scapular fx’s, vertebral body fx’x and subluxation– Unusually naturally

occurring fx’s <5 years old

• Fx’s with abundant callous formations– Implies repeated trauma

with no immobilization

Battered Child Syndrome

Battered Child Syndrome

Battered Child Syndrome

Battered Child Syndrome

Trauma of Chest and Thorax

PNEUMOTHORAX

Common causes include a penetrating would such as: gun shot stabbing fractured ribs,thoracentesis

Atelectasis

Refers to a condition with diminished air within lungs associated with reduced air volume

Incomplete expansion of the lung caused by a partial or total collapse

Often occurs from a penetrating wound in the chest

Abdominal Trauma

Abdominal Trauma1. Can include GI tract, liver, spleen, kidneys,

pancreas, aorta and pelvic organs.

2. Initially may show minimal symptoms

3. LLD is best for demonstrating small amounts of air fluid levels1. Lay on side 10 minutes

4. CT very valuable to catch subtle abnormalities not detected with x-ray

Pneumoperitoneum1. Presence of air in the

peritoneum

2. LG amounts indicate a colon perforation

3. SM amounts indicate a duodenal perforation

4. Can be from trauma rupture or nontraumatic bowel perforation

5. Has a football sign

Pneumoperitoneum

Imaging Considerations

1. Radiography1. First imaging modality for trauma

2. Portables often used

3. Primary means of evaluating skeletal trauma

2. MRI 1. For muscle, tendons, ligaments and soft

tissue

Imaging Considerations

1. CT1. Is excellent form imaging acute cerebral

hemorrhage & fx's of the skull & facial bones1. Quickly replacing x-ray as the standard for

evaluating C-spine trauma2. Better to visualize transverse processes of L-

spine

2. Blunt trauma to abdomen can use CT or US1. CT preferred for urinary trauma2. Sometimes angio is used