ATLS MODULE 8 MUSCULOSKELETAL TRAUMA
• what do you do if delay in obtaining x-rays is unavoidable with a
fracture/dislocation?
Answer: immediately reduce or realign the extremity to reestablish arterial blood
flow and reduce pressure on skin
• what CT finding is highly specific and sensitive for identifying an open joint
injury?
Answer: presence of intraarticular gas on the affected extremity
• how do you treat all patients with open fractures?
Answer: start IV antibiotics usingweight based dosing ASAP
*first generation cephalosporins
*delay of tx >3 hours is related to increased risk of infection
• when does muscle necrosis begin?
Answer: When there is a lack of arterial blood flowfor more than 6 hours
• how do you manage a fracture deformity?
Answer: gently pull limb out to length,realigning the fracture, and splinting into the
injured extremity
*this often restores blood flow to an ischemic extremity when the artery is kinked by
shortening and deformity of the fracture site
• compartment syndrome can occur when there is an increase in the com-
partment content (bleeding/swelling) or decrease in compartment size (con- strictive
dressing)... it can occur wherever muscle is contained within a closedfascial space...
what do you have to remember about the skin?
Answer: skin can act asa restricting layer in certain circumstances
• what are the common areas for compartment syndrome?
Answer: lower leg, fore-arm, foot, hand, gluteal region, thigh
• what injuries are high risk for compartment syndrome?
Answer:
-tibia & forearm fx
, -injuries immobilized in tight dressings or casts
-severe crush injury to muscle
-localized, prolonged external pressure to extremity
-increased capillary permeability secondary to reperfusion of ischemic muscle
-burns
-excessive exercise
• when measuring intracompartmental pressure, what pressures suggestdecreased
capillary blood flow?
Answer: >30mm Hg
*remember, lower systemic pressure, lower the compartment pressure that causesa
compartment syndrome
*: compartment syndrome is a clinical dx... pressure measurements areonly an
adjunct to aid dx
• what might occur if you delay a fasciotomy in the tx of compartment
syndrome?
Answer: other than neuromuscular damage... there is a risk of myoglobinuriawhich
may decrease renal function
*if compartment syndrome is suspected, immediately obtain surgical consultation
• what are the risk factors for tetanus?
Answer:
>6 hours oldcontused or abraded
>1cm deep wounds
from high velocity missilesdue to burns or cold
significantly contaminated... particularly wounds with denervated or ischemic tissues
• when taking x-rays, how do you exclude occult dislocation and concomitant
injury?
Answer: include joints above and below suspected fracture site
• how do you manage fractures?
Answer: immobilization including the joint above andbelow fx
*after splinting, reassess neurologic and vascular status of extremity
• what are potentially life threatening extremity injuries?
Answer: major arterial hemorrhage, bilateral femoral fractures, crush syndrome
• what long bone fractures can be significant?
• what do you do if delay in obtaining x-rays is unavoidable with a
fracture/dislocation?
Answer: immediately reduce or realign the extremity to reestablish arterial blood
flow and reduce pressure on skin
• what CT finding is highly specific and sensitive for identifying an open joint
injury?
Answer: presence of intraarticular gas on the affected extremity
• how do you treat all patients with open fractures?
Answer: start IV antibiotics usingweight based dosing ASAP
*first generation cephalosporins
*delay of tx >3 hours is related to increased risk of infection
• when does muscle necrosis begin?
Answer: When there is a lack of arterial blood flowfor more than 6 hours
• how do you manage a fracture deformity?
Answer: gently pull limb out to length,realigning the fracture, and splinting into the
injured extremity
*this often restores blood flow to an ischemic extremity when the artery is kinked by
shortening and deformity of the fracture site
• compartment syndrome can occur when there is an increase in the com-
partment content (bleeding/swelling) or decrease in compartment size (con- strictive
dressing)... it can occur wherever muscle is contained within a closedfascial space...
what do you have to remember about the skin?
Answer: skin can act asa restricting layer in certain circumstances
• what are the common areas for compartment syndrome?
Answer: lower leg, fore-arm, foot, hand, gluteal region, thigh
• what injuries are high risk for compartment syndrome?
Answer:
-tibia & forearm fx
, -injuries immobilized in tight dressings or casts
-severe crush injury to muscle
-localized, prolonged external pressure to extremity
-increased capillary permeability secondary to reperfusion of ischemic muscle
-burns
-excessive exercise
• when measuring intracompartmental pressure, what pressures suggestdecreased
capillary blood flow?
Answer: >30mm Hg
*remember, lower systemic pressure, lower the compartment pressure that causesa
compartment syndrome
*: compartment syndrome is a clinical dx... pressure measurements areonly an
adjunct to aid dx
• what might occur if you delay a fasciotomy in the tx of compartment
syndrome?
Answer: other than neuromuscular damage... there is a risk of myoglobinuriawhich
may decrease renal function
*if compartment syndrome is suspected, immediately obtain surgical consultation
• what are the risk factors for tetanus?
Answer:
>6 hours oldcontused or abraded
>1cm deep wounds
from high velocity missilesdue to burns or cold
significantly contaminated... particularly wounds with denervated or ischemic tissues
• when taking x-rays, how do you exclude occult dislocation and concomitant
injury?
Answer: include joints above and below suspected fracture site
• how do you manage fractures?
Answer: immobilization including the joint above andbelow fx
*after splinting, reassess neurologic and vascular status of extremity
• what are potentially life threatening extremity injuries?
Answer: major arterial hemorrhage, bilateral femoral fractures, crush syndrome
• what long bone fractures can be significant?
