Soft tissue, nail, and digital trauma

quickster2008's version from 2015-12-30 04:07

Section 1

Question Answer
In a puncture wound with a retained foreign body, how long does it take an infection to manifest?Infection often manifests in 24 hours but may take three to four days.
Why are structures such as intrinsic tendons, extrinsic tendons, intermetatarsal bursa, and MTPJ capsule of worry with puncture wounds'!If a puncture wound extends to structures such as these, infection can be established easily due to their decreased vascularity and slower metabolic rate.
Can glass be visualized on plain radiographs?Yes. Glass does not have to contain lead to be visualized.
What type of imaging study is best for detecting wood fragments?CT with use of narrow window.
When does osteomyelitis become evident radiographically? 10-14 days after establishment of bone infection.
What are the indications for incision and drainage following a puncture wound?Wound infection, presence of an abscess, and if a reactive foreign object is retained in the wound.
What are the most common pathogens associated with soft tissue infections?Staphylococcus aureus, Staphylococcus epidennidis, and Streptococcus.
What is the most common organism isolated from puncture wounds caused by cat and dog bites and first line treatment?Pasteurella muItocida treated by Augmentin.
What organism is most commonly isolated in osteomyelitis following a puncture wound?Pseudomonas aeruginosa.
What is the most common object to cause a puncture wound? Nails are the most common at 98%. Other objects include wood, metal, and glass.
What are some possible complications of puncture wounds?Soft tissue infection, osteomyelitis, foreign body granuloma, premature epiphyseal closure, joint degeneration, and residual deformity.
How often is cellulitis seen after a puncture wound?8.4% ofpatients seen within the first 24 hours after injury, present with cellulitis within four days. Ifthe patient is seen 1-7 days after injury, 57% develop cellulitis.
What are the goals of puncture wound treatment?Conversion o f contaminated wound to a clean wound and prevention o f tetanus.
Tetanus prophylaxis is based on what four components?Wound care, tetanus toxoid, immune globulin, and antibiotics.
How often should tetanus boosters be administered?
What is the most commonly encountered foreign body in the foot?A pin or needle.
What are some possible complications of animal bites? Cellulitis, lymphangitis, abscesses, osteomyelitis, subcutaneous gas, meningitis, endocarditis, tularemia, and syphilis.
Necrotic arachnidism is seen in what type of bite? brown recluse spider bites of the genus Loxosceles.
Necrotic arachnidism is described as severe necrotic tissue destruction.
A blue-gray halo appears peri-puncture site which progresses to necrosis, eschar formation, and a large ulceration.Necrotic arachnidism
What is the treatment for brown recluse spider bites?Treatment is controversial but may include intralesional and oral steroids, surgical debridement, and the use of dapsone.
What is the difference between a low velocity and a high velocity projectile?Low velocity is < or = 2,000 ft/second, high velocity is < or = 2000ft/second
According to the kinetic energy theory, what formula describes the amount of energy possessed by a projectile?KE=1/2mv^2
Describe the classification for shotgun wounds
Ordog's classification
What are the basic tenants for simple low velocity missile wound care?
What are the basic tenants for complex low velocity missile wound care?
What are the basic tenants or shotgun wound care?
Generally, low velocity gunshot wounds are considered what type in Gustilo's classification?type 1
What is lead intoxication called?Plumbism.
What is the antibiotic of choice for Type I gunshot wounds?Cephalosporin.
Is "Cavitation" associated with low or high velocity gunshot wounds?High velocity.
What are the factors, which determine the size and extent of damage produced by a projectile?The type of tissue the projectile penetrates, the bullet's composition, the bullet or bone fragmentation creating secondary missiles, and the amount o f energy that the projectile dissipates in the tissue.
What is the largest organ in the body?The integumentary system is the largest organ in the body, comprising 15% of the total body weight.
Describe the classification for burn injury.
What is used for fluid replacement for the first 24 hours after a burn and how much?
Describe the stages of skin graft healing?
Describe tbe differentiation of split tbickness skin grafts.
What are some possible complications of skin grafts that will cause a graft to fail?Seroma; Hematoma; Infection.
Who classified injuries about the nail?Rosenthal
Rosenthal suggested treatment options based on the zone of injury.
Rosenthal classification zone 1injuries to the bony phalanx
Rosenthal classification zone 2injuries distal to the lunula,
Rosenthal classification zone 3injures proximal to the distal end of the lunula
What is a "clean" or "tidy" wound?involve minimal soft tissue damage or contamination and do not require extensive debridement prior to closure. Clean wounds are unlikely to become infected.
What is the number of organisms per gram of tissue that define infection of soft tissue?10^5
What is the number of organisms per gram of tissue that define infection of bone?10^6
What is the number of organisms per gram of tissue that define infection of soft tissue or bone when a foreign body is present?10^2
Why are extreme dorsiflexion injuries of the digits especially worrisome with children?Extreme hyperflexion injuries in children can traumatically avulse the distal growth plate and produce a compound fracture.
What are some radiographic signs that can differentiate a bipartite sesamoid from a fractured sesamoid?
What is the sequela of removing an injured tibial sesamoid?Hallus valgus deformity.
What adjunctive procedures should be considered when an injured tibial sesamoid is removed?Medial capsulorrhaphy and abductor hallucis tendon advancement will help to prevent a hallux valgus deformity.
What is the most common fracture orientation in a lesser digit?Closed spiral oblique fracture.
What is the easiest way to close reduce a digital fracture?Chinese finger trap apparatus.
Why is the area around the ankle prone to the formation of fracture blisters?area around the ankle is characterized by flatter epidermal papillae, sparse subcutaneous tissue, extensive arborizing veins, and lack ofepidermal anchoring structures such as hair follicles and sweat glands.
What locations other than the foot are prone to fracture blister formation?Elbow, foot, and distal tibia.
What are the two types offracture blisters?Clear (serous) fracture blisters are more prevalent while hemorrhagic blisters are thought to represent a more severe injury.
Is the fluid in a fracture blister sterile?yes
Between what two skin layers do fracture blisters form:dermal-epidermal junction.
Histologically, a fracture blisters is very similar to what type of burn.type 2 burn
What type of internal fixation is best suited when crossing the physis in a digit?smooth K wires
What name is given to an osteochondrosis of the base of the phalanges?Thiemann osteochondroses.
What measures can be taken to prevent the formation of fracture blisters?PRICE
Wbat are tbe two broad categories of compartment syndrome etiology?Those that cause an increase in compartment content and those that decrease compartment size.
Wbat is the most common etiology of compartment syndrome?Fracture.
What are the five P's that describe the symptoms of compartment syndrome? Pain out of proportion, paresthesias, paralysis, pulselessness, and pallor.
How many compartments are present in the foot'! Name them.There are four compartments in the foot: medial, lateral, central, and interosseous.
What percentage of nail plate should be involved with subungual hematoma before the nail plate is avulsed and the nail bed is inspected for lacerations?< or = 25% of the nail plate.
laceration of nail plate txrepaired w/fine suture
What is tbe greatest predisposing factor for the development of an infection following a puncture wound to tbe bottom of the foot?Retained foreign body.
What percentage of puncture wounds to the bottom of tbe foot develop complications?10%
What percentage of complications, following puncture wounds to the bottom of the foot, develop osteomyelitis?< or = 2 %
Under wbat circumstances is the use oftetanus immune globulin considered following a puncture wound to tbe foot?In a case where basic active immunity has not been attained, or where is has been attained but is greater than 10 years old with no boosters given since then, and the wound is very dirty and tetanus prone.
In terms of trauma. what does the "Golden Period" refer to?The first 6-8 hours after an injury before significant contamination develops.

Section 2