1 - General Complications of Fractures - D3

1 - General Complications of Fractures - D3 - General...

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Unformatted text preview: General complications of fractures fractures presented by: Anas AL-Karasneh www.icareunit.com G e ne ra l c o m p lic a tio ns ** De e p ve in th ro m b o s is a nd p ulm o na ry e m b o lis m . **T e ta nus . **G a s g a ng re ne . ** Fa t e m b o lis m s y nd ro m e . .h y p o vo le m ic S h o c k ** ** **.c rus h s ynd ro m www.icareunit.com Deep vein thrombosis and .pulmonary embolism pulmonary DVT is ve ry c o m m o n c o m p lic a tio n a fte r fra c ture a nd ** DVT ** .m a jo r o rth o p e d ic o p e ra tio n .Site: le g , th ig h a n d p e lvic ve in ** Site :Risk factors** Kne e a n d h ip re p la c e m e n t Eld e rly Im m o b ility Ma lig na n c y a n d C V d is e a s e T ra um a ( fra c tu re o f s p ine , p e lvis , fe m u r a n d tib ia ) h yp e rc o a g u la b le s ta tu s www.icareunit.com www.icareunit.com Symptoms and signs Symptoms P a in a nd te nd e rne s s in c a lf o r th ig h . 1 us ua lly unila te ra l s we lling . 2 h o tne s s .3 .p o s itive h o m a n ’s s ig n . 4 p ulm o na ry e m b o lis m a s p rim a ry . 5 p re s e nta tio n ( d y s p ne a , h e m o p ty s is , (.ta c h yp ne a a nd fe ve r www.icareunit.com Dia g no s is : Dia Dup le x ultra s o no g ra p h y , V­Q s c a n, s p ira l C T a nd a ng io g ra p h y . P re ve ntio n: 1 .Ela s tic s to c king s . 2 .Ele va tio n th e fo o t. 3 .Ea rly m o b iliza tio n. .4 .Lo w m o le c ula r we ig h h e p a rin 4 0 m g \ a y d www.icareunit.com T e ta nus . Is wound infection caused by C.tetani** C.tetani** Tetanus toxin passes to anterior horn cells** Tetanus ** where it fixed and can’t be neutralized so produces hyper excitability and reflex muscle produces .spasm spasm :Symptoms **Tonic and clonic contractions of esp. jaw, face, **Tonic around the wound itself ,neck ,trunk, finally spasm of the diaphragm and intercostal muscles leads to asphyxia and death. muscles www.icareunit.com Prophylaxis: :…DTP for general population :…DTP (pediatrics) (pediatrics) …>10 years booster dose of toxoid after …>10 all trivial skin wound all …Not immunized and wounded ? wound toilet and antibiotic ( consider antitoxin if contaminated wound and give the toxoid (immunization immunization www.icareunit.com www.icareunit.com T re a tm e nt: 1 . IV a ntito xin. 2 . IV a ntib io tic s (p e nic illin) . 3 . Mus c le re la xa nt. 4 . T ra c h e a l intub a tio n. .5 . C o ntro l re s p ira tio n www.icareunit.com www.icareunit.com G a s g a ng re ne :C a us e It c a us e d b y c lo s trid ium (p e rfring e ns ) a nd th is o rg a nis m s urvive a nd m ultip ly o nly in tis s ue with lo w o xy g e n te ns io n. C h a ra c te rize d b y ra p id a nd e xte ns ive ne c ro s is o f m us c le a c c o m p a nie d b y g a s fo rm a tio n a nd .s y s te m ic to xic ity Its a s s o c ia te d with tra um a tic wo und s th a t a re d e e p , ne c ro tic a nd with o ut c o m m unic a tio n .to th e s urfa c e www.icareunit.com :C linic a l fe a ture s s ud d e n o ns e t o f p a in lo c a lize d to th e . 1 .infe c te d a re a s we lling , e d e m a . 2 (no p y re xia (c o o l.3 p ro fus e s e ro us d is c h a rg e with s we e tis h .4 .a nd m o us y o d o r G a s p ro d uc tio n . 5 www.icareunit.com :T re a tm e nt .e a rly d ia g no s is . 1 s urg ic a l inte rve ntio n a nd d e b rid e m e nt a re . 2 .th e m a ins ta y o f tre a tm e nt IV a ntib io tic s . 3 IV a .fluid re p la c e m e nt.4 h y p e rb a ric O xy g e n . 5 www.icareunit.com www.icareunit.com Fa t e m b o lis m Fa Us ua lly o c c urs in y o ung a d ult a fte r c lo s e d .fra c ture s o f lo ng b o ne C h a ra c te rize d b y o c c lus io n o f th e s m a ll .b lo o d ve s s e ls b y fa t g lo b ule s Risk factors -C lo s e d fra c ture s -Multip le fra c ture s Multip P ulm o na ry c o ntus io n Lo ng b o ne /p e lvis /rib fra c ture s Lo www.icareunit.com www.icareunit.com www.icareunit.com :Clinical feature Clinical Sudden onset dyspnoeaSudden HypoxiaHypoxia - tachypnea and tachycardia tachypnea Confusion, coma, convulsionsConfusion, Transient red-brown petechial rash affecting- Transient upper body, especially axilla upper no defenitive test, but hypoxia* no <60mmHg after major trauma is suspicious suspicious www.icareunit.com www.icareunit.com T re a tm e nt : ­ S up p o rtive tre a tm e nt ­ O2 administrated. -Blood, fluid replacement ­ Iv steroid + heparin ( may Iv reduce pulmonary edema and IV clotting ) clotting ­S urg ic a l s ta b iliza tio n o f fra c ture www.icareunit.com www.icareunit.com shock shock A g e ne ra lize d s ta te o f d e c re a s e d tis s ue ** .p e rfus io n If p ro lo ng e d it m a y le a d to irre ve rs ib le ** .d a m a g e o f th e life s up p o rting o rg a ns :causes causes Cardiogenic:direct injury to heart, the :direct pump is not working properly ( massive .(MI MI www.icareunit.com II. Neurogenic: injury to brain stem Neurogenic injury (vasomotor center) spinal cord loss of loss sympathetic tone increase venous capacitance low venous return low cardiac output ( but bradycardia ) cardiac III.Hypovolaemic: reduction of blood volume reduction …the most important one to be dealt with firstly …the www.icareunit.com www.icareunit.com www.icareunit.com www.icareunit.com C linic a l fe a ture s T h irs t, ra p id s h a llo w b re a th ing , th e lip s a nd s kin a re p a le a nd th e e xtre m itie s fe e l c o ld ,if th e c o m p a ns a tio n fa ils ….. im p a ire d re na l func tio n te s t a nd d e c re a s e d urina ry .o utp ut www.icareunit.com treatment treatment IV morphine and oxygen: to arrest.1 IV .bleeding and replace blood loss bleeding Early reduction and splinting of.2 Early .fracture fracture Restoration of blood volume by rapid.3 Restoration .infusion of crystalloid solution infusion .Keep monitoring of vital signs.4 www.icareunit.com If no quick respond, blood transfusion If is mandatory ( we can use O blood group Rh (-) until cross matching is available available www.icareunit.com CRUSH syndrome Serious medical condition characterized by major Serious shock & renal failure following a crushing injury to skeletal muscles or tourniquet left too long… skeletal It’s a re-perfusion injury seen after the release of It’s crushing pressure, there will be release of muscular breakdown products(myoglobin,k+,p) which have nephrotoxic effect on the kidney… nephrotoxic www.icareunit.com www.icareunit.com Alternative mechanism : renal artery spasm tubular necrosis www.icareunit.com www.icareunit.com Clinically: Shock Pulsless limb redness swelling Pulsless Loss of muscle sensation and power Decrease renal secretion Uremia, acidosis www.icareunit.com www.icareunit.com CRUSH syndrome: prognosis If renal secretion return within 1 If week the patient survive week But most of them die within 14 But days days www.icareunit.com www.icareunit.com CRUSH syndrome : treatment Avoid the disaster by amputation Avoid above the site of compression and before compression release before If compression is already released If cool the limb and treat for shock and renal failure (dialysis) renal www.icareunit.com www.icareunit.com www.icareunit.com www.icareunit.com ...
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