- •Dedication
- •Editors and Contributors
- •Foreword
- •Preface
- •Contents
- •PREPARING FOR THE SURGERY CLERKSHIP
- •SURGICAL NOTES
- •COMMON ABBREVIATIONS YOU SHOULD KNOW
- •RETRACTORS (YOU WILL GET TO KNOW THEM WELL!)
- •SUTURE MATERIALS
- •WOUND CLOSURE
- •KNOTS AND EARS
- •INSTRUMENT TIE
- •TWO-HAND TIE
- •COMMON PROCEDURES
- •NASOGASTRIC TUBE (NGT) PROCEDURES
- •CHEST TUBES
- •NASOGASTRIC TUBES (NGT)
- •FOLEY CATHETER
- •CENTRAL LINES
- •MISCELLANEOUS
- •THIRD SPACING
- •COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
- •CALCULATION OF MAINTENANCE FLUIDS
- •ELECTROLYTE IMBALANCES
- •ANTIBIOTICS
- •STEROIDS
- •HEPARIN
- •WARFARIN (COUMADIN®)
- •MISCELLANEOUS AGENTS
- •NARCOTICS
- •MISCELLANEOUS
- •ATELECTASIS
- •POSTOPERATIVE RESPIRATORY FAILURE
- •PULMONARY EMBOLISM
- •ASPIRATION PNEUMONIA
- •GASTROINTESTINAL COMPLICATIONS
- •ENDOCRINE COMPLICATIONS
- •CARDIOVASCULAR COMPLICATIONS
- •MISCELLANEOUS
- •HYPOVOLEMIC SHOCK
- •SEPTIC SHOCK
- •CARDIOGENIC SHOCK
- •NEUROGENIC SHOCK
- •MISCELLANEOUS
- •URINARY TRACT INFECTION (UTI)
- •CENTRAL LINE INFECTIONS
- •WOUND INFECTION (SURGICAL SITE INFECTION)
- •NECROTIZING FASCIITIS
- •CLOSTRIDIAL MYOSITIS
- •SUPPURATIVE HIDRADENITIS
- •PSEUDOMEMBRANOUS COLITIS
- •PROPHYLACTIC ANTIBIOTICS
- •PAROTITIS
- •MISCELLANEOUS
- •CHEST
- •ABDOMEN
- •MALIGNANT HYPERTHERMIA
- •MISCELLANEOUS
- •OVERVIEW
- •CHOLECYSTOKININ (CCK)
- •SECRETIN
- •GASTRIN
- •SOMATOSTATIN
- •MISCELLANEOUS
- •GROIN HERNIAS
- •HERNIA REVIEW QUESTIONS
- •ESOPHAGEAL HIATAL HERNIAS
- •PRIMARY SURVEY
- •SECONDARY SURVEY
- •TRAUMA STUDIES
- •PENETRATING NECK INJURIES
- •MISCELLANEOUS TRAUMA FACTS
- •PEPTIC ULCER DISEASE (PUD)
- •DUODENAL ULCERS
- •GASTRIC ULCERS
- •PERFORATED PEPTIC ULCER
- •TYPES OF SURGERIES
- •STRESS GASTRITIS
- •MALLORY-WEISS SYNDROME
- •ESOPHAGEAL VARICEAL BLEEDING
- •BOERHAAVE’S SYNDROME
- •ANATOMY
- •GASTRIC PHYSIOLOGY
- •GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- •GASTRIC CANCER
- •GIST
- •MALTOMA
- •GASTRIC VOLVULUS
- •SMALL BOWEL
- •APPENDICITIS
- •CLASSIC INTRAOPERATIVE QUESTIONS
- •APPENDICEAL TUMORS
- •SPECIFIC TYPES OF FISTULAS
- •ANATOMY
- •COLORECTAL CARCINOMA
- •COLONIC AND RECTAL POLYPS
- •POLYPOSIS SYNDROMES
- •DIVERTICULAR DISEASE OF THE COLON
- •ANATOMY
- •ANAL CANCER
- •ANATOMY
- •TUMORS OF THE LIVER
- •ABSCESSES OF THE LIVER
- •HEMOBILIA
- •ANATOMY
- •PHYSIOLOGY
- •PATHOPHYSIOLOGY
- •DIAGNOSTIC STUDIES
- •BILIARY SURGERY
- •OBSTRUCTIVE JAUNDICE
- •CHOLELITHIASIS
- •ACUTE CHOLECYSTITIS
- •ACUTE ACALCULOUS CHOLECYSTITIS
- •CHOLANGITIS
- •SCLEROSING CHOLANGITIS
- •GALLSTONE ILEUS
- •CARCINOMA OF THE GALLBLADDER
- •CHOLANGIOCARCINOMA
- •MISCELLANEOUS CONDITIONS
- •PANCREATITIS
- •PANCREATIC ABSCESS
- •PANCREATIC NECROSIS
- •PANCREATIC PSEUDOCYST
- •PANCREATIC CARCINOMA
- •MISCELLANEOUS
- •ANATOMY OF THE BREAST AND AXILLA
- •BREAST CANCER
- •DCIS
- •LCIS
- •MISCELLANEOUS
- •MALE BREAST CANCER
- •BENIGN BREAST DISEASE
- •CYSTOSARCOMA PHYLLODES
- •FIBROADENOMA
- •FIBROCYSTIC DISEASE
- •MASTITIS
- •BREAST ABSCESS
- •MALE GYNECOMASTIA
- •ADRENAL GLAND
- •ADDISON’S DISEASE
- •INSULINOMA
- •GLUCAGONOMA
- •SOMATOSTATINOMA
- •ZOLLINGER-ELLISON SYNDROME (ZES)
- •MULTIPLE ENDOCRINE NEOPLASIA
- •THYROID DISEASE
- •ANATOMY
- •PHYSIOLOGY
- •HYPERPARATHYROIDISM (HPTH)
- •PARATHYROID CARCINOMA
- •SOFT TISSUE SARCOMAS
- •LYMPHOMA
- •SQUAMOUS CELL CARCINOMA
- •BASAL CELL CARCINOMA
- •MISCELLANEOUS SKIN LESIONS
- •STAGING
- •INTENSIVE CARE UNIT (ICU) BASICS
- •INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW
- •SICU DRUGS
- •INTENSIVE CARE PHYSIOLOGY
- •HEMODYNAMIC MONITORING
- •MECHANICAL VENTILATION
- •PERIPHERAL VASCULAR DISEASE
- •LOWER EXTREMITY AMPUTATIONS
- •ACUTE ARTERIAL OCCLUSION
- •ABDOMINAL AORTIC ANEURYSMS
- •MESENTERIC ISCHEMIA
- •MEDIAN ARCUATE LIGAMENT SYNDROME
- •CAROTID VASCULAR DISEASE
- •CLASSIC CEA INTRAOP QUESTIONS
- •SUBCLAVIAN STEAL SYNDROME
- •RENAL ARTERY STENOSIS
- •SPLENIC ARTERY ANEURYSM
- •POPLITEAL ARTERY ANEURYSM
- •MISCELLANEOUS
- •PEDIATRIC IV FLUIDS AND NUTRITION
- •PEDIATRIC BLOOD VOLUMES
- •FETAL CIRCULATION
- •ECMO
- •NECK
- •ASPIRATED FOREIGN BODY (FB)
- •CHEST
- •PULMONARY SEQUESTRATION
- •ABDOMEN
- •INGUINAL HERNIA
- •UMBILICAL HERNIA
- •GERD
- •CONGENITAL PYLORIC STENOSIS
- •DUODENAL ATRESIA
- •MECONIUM ILEUS
- •MECONIUM PERITONITIS
- •MECONIUM PLUG SYNDROME
- •ANORECTAL MALFORMATIONS
- •HIRSCHSPRUNG’S DISEASE
- •MALROTATION AND MIDGUT VOLVULUS
- •OMPHALOCELE
- •GASTROSCHISIS
- •POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
- •APPENDICITIS
- •INTUSSUSCEPTION
- •MECKEL’S DIVERTICULUM
- •NECROTIZING ENTEROCOLITIS
- •BILIARY TRACT
- •TUMORS
- •PEDIATRIC TRAUMA
- •OTHER PEDIATRIC SURGERY QUESTIONS
- •POWER REVIEW
- •WOUND HEALING
- •SKIN GRAFTS
- •FLAPS
- •SENSORY SUPPLY TO THE HAND
- •CARPAL TUNNEL SYNDROME
- •ANATOMY
- •MISCELLANEOUS
- •NOSE AND PARANASAL SINUSES
- •ORAL CAVITY AND PHARYNX
- •FACIAL FRACTURES
- •ENT WARD QUESTIONS
- •RAPID-FIRE REVIEW OF MOST COMMON CAUSES OF ENT INFECTIONS
- •THORACIC OUTLET SYNDROME (TOS)
- •CHEST WALL TUMORS
- •DISEASES OF THE PLEURA
- •DISEASES OF THE LUNGS
- •DISEASES OF THE MEDIASTINUM
- •DISEASES OF THE ESOPHAGUS
- •ACQUIRED HEART DISEASE
- •CONGENITAL HEART DISEASE
- •CARDIAC TUMORS
- •DISEASES OF THE GREAT VESSELS
- •MISCELLANEOUS
- •BASIC IMMUNOLOGY
- •CELLS
- •IMMUNOSUPPRESSION
- •OVERVIEW OF IMMUNOSUPPRESSION MECHANISMS
- •MATCHING OF DONOR AND RECIPIENT
- •REJECTION
- •ORGAN PRESERVATION
- •KIDNEY TRANSPLANT
- •LIVER TRANSPLANT
- •PANCREAS TRANSPLANT
- •HEART TRANSPLANT
- •INTESTINAL TRANSPLANTATION
- •LUNG TRANSPLANT
- •TRANSPLANT COMPLICATIONS
- •ORTHOPAEDIC TERMS
- •TRAUMA GENERAL PRINCIPLES
- •FRACTURES
- •ORTHOPAEDIC TRAUMA
- •DISLOCATIONS
- •THE KNEE
- •ACHILLES TENDON RUPTURE
- •ROTATOR CUFF
- •MISCELLANEOUS
- •ORTHOPAEDIC INFECTIONS
- •ORTHOPAEDIC TUMORS
- •ARTHRITIS
- •PEDIATRIC ORTHOPAEDICS
- •HEAD TRAUMA
- •SPINAL CORD TRAUMA
- •TUMORS
- •VASCULAR NEUROSURGERY
- •SPINE
- •PEDIATRIC NEUROSURGERY
- •SCROTAL ANATOMY
- •UROLOGIC DIFFERENTIAL DIAGNOSIS
- •RENAL CELL CARCINOMA (RCC)
- •BLADDER CANCER
- •PROSTATE CANCER
- •BENIGN PROSTATIC HYPERPLASIA
- •TESTICULAR CANCER
- •TESTICULAR TORSION
- •EPIDIDYMITIS
- •PRIAPISM
- •ERECTILE DYSFUNCTION
- •CALCULUS DISEASE
- •INCONTINENCE
- •URINARY TRACT INFECTION (UTI)
- •MISCELLANEOUS UROLOGY QUESTIONS
- •Rapid Fire Power Review
- •TOP 100 CLINICAL SURGICAL MICROVIGNETTES
- •Figure Credits
- •Index
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Chapter 74 / Orthopaedic Surgery 701 |
ORTHOPAEDIC TRAUMA |
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What are the major |
1. |
Open fractures/dislocations |
orthopaedic emergencies? |
2. |
Vascular injuries (e.g., knee |
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dislocation) |
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3. |
Compartment syndromes |
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4. |
Neural compromise, especially spinal |
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injury |
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5. |
Osteomyelitis/septic arthritis; acute, |
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i.e., when aspiration is indicated |
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6. |
Hip dislocations—require immediate |
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reduction or patient will develop avascu- |
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lar necrosis; “reduce on the x-ray table” |
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7. |
Exsanguinating pelvic fracture (binder, |
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external fixator) |
What is the main risk when |
Infection |
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dealing with an open fracture? |
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Which fracture has the |
Pelvic fracture (up to 50% with open |
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highest mortality? |
pelvic fractures) |
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What factors determine the |
1. |
Age: suggests susceptible point in |
extent of injury (3)? |
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musculoskeletal system: |
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Child—growth plate |
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Adolescent—ligaments |
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Elderly—metaphyseal bone |
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2. |
Direction of forces |
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3. |
Magnitude of forces |
What is the acronym for |
“NO CAST”: |
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indications for OPEN |
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Nonunion |
reduction? |
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Open fracture |
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Compromise of blood supply |
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Articular surface malalignment |
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Salter-Harris grade III, IV fracture |
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Trauma patients who need early |
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ambulation |
Define open fractures by |
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Gustilo-Anderson |
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classification: |
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Grade I? |
1-cm laceration |
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Grade II? |
1 cm, minimal soft tissue damage |
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702 Section III / Subspecialty Surgery |
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Grade IIIA? |
Open fracture with massive tissue |
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devitalization/loss, contamination |
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Grade IIIB? |
Open fracture with massive tissue |
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devitalization/loss and extensive |
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periosteal stripping, contamination, |
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inadequate tissue coverage |
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Grade IIIC? |
Open fracture with major vascular injury |
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requiring repair |
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What are the five steps in |
1. |
Prophylactic antibiotics to include IV |
the initial treatment of an |
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gram-positive anaerobic coverage: |
open fracture? |
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Grade I—cefazolin (Ancef ®) |
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Grade II or III—cefoxitin/gentamicin |
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2. |
Surgical débridement |
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3. |
Inoculation against tetanus |
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4. |
Lavage wound 6 hours postincident |
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with high-pressure sterile irrigation |
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5. |
Open reduction of fracture and stabi- |
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lization (e.g., use of external fixation) |
What structures are at risk with a humeral fracture?
What must be done when both forearm bones are broken?
How have femoral fractures been repaired traditionally?
What is the newer technique?
What are the advantages?
What is the chief concern following tibial fractures?
What is suggested by pain in the anatomic snuff-box?
What is the most common cause of a “pathologic” fracture in adults?
Radial nerve, brachial artery
Because precise movements are needed, open reduction and internal fixation are musts
Traction for 4 to 6 weeks
Intramedullary rod placement
Nearly immediate mobility with decreased morbidity/mortality
Recognition of associated compartment syndrome
Fracture of scaphoid bone (a.k.a. navicular fracture)
Osteoporosis
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Chapter 74 / Orthopaedic Surgery 703 |
COMPARTMENT SYNDROME |
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What is acute compartment |
Increased pressure within an osteofascial |
syndrome? |
compartment that can lead to ischemic |
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necrosis |
How is it diagnosed? |
Clinically, using intracompartmental |
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pressures is also helpful (especially in |
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unresponsive patients); fasciotomy is |
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clearly indicated if pressure in the |
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compartment is 40 mm Hg (30 to |
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40 mm Hg is a gray area) |
What are the causes? |
Fractures, vascular compromise, |
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reperfusion injury, compressive dressings; |
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can occur after any musculoskeletal |
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injury |
What are common causes |
Supracondylar humerus fracture, brachial |
of forearm compartment |
artery injury, radius/ulna fracture, crush |
syndrome? |
injury |
What is Volkmann’s |
Final sequela of forearm compartment |
contracture? |
syndrome; contracture of the forearm |
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flexors from replacement of dead muscle |
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with fibrous tissue |
What is the most common site of compartment syndrome?
What situations should immediately alert one to be on the lookout for a developing compartment syndrome (4)?
What are the symptoms of compartment syndrome?
What are the signs of compartment syndrome?
Calf (four compartments: anterior, lateral, deep posterior, superficial posterior compartments)
1.Supracondylar elbow fractures in children
2.Proximal/midshaft tibial fractures
3.Electrical burns
4.Arterial/venous disruption
Pain, paresthesias, paralysis
Pain on passive movement (out of proportion to injury), cyanosis or pallor, hypoesthesia (decreased sensation, decreased two point discrimination), firm compartment
704 Section III / Subspecialty Surgery |
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Can a patient have a |
YES! |
compartment syndrome |
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with a palpable or Doppler- |
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detectable distal pulse? |
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What are the possible |
Muscle necrosis, nerve damage, |
complications of |
contractures, myoglobinuria |
compartment syndrome? |
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What is the initial treatment |
Bivalve and split casts, remove |
of the orthopaedic patient |
constricting clothes/dressings, place |
developing compartment |
extremity at heart level |
syndrome? |
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What is the definitive |
Fasciotomy within 4 hours (6–8 hours |
treatment of compartment |
maximum) if at all possible |
syndrome? |
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MISCELLANEOUS TRAUMA INJURIES AND COMPLICATIONS
Name the motor and sensation tests used to assess the following peripheral nerves:
Radial
Ulnar
Median
Axillary
Musculocutaneous
How is a peripheral nerve injury treated?
What fracture is associated with a calcaneus fracture?
Wrist extension; dorsal web space; sensation: between thumb and index finger
Little finger abduction; sensation: little finger-distal ulnar aspect
Thumb opposition or thumb pinch sensation: index finger-distal radial aspect
Arm abduction; sensation: deltoid patch on lateral aspect of upper arm
Elbow (biceps) flexion; lateral forearm sensation
Controversial, although clean lacerations may be repaired primarily; most injuries are followed for 6 to 8 weeks (EMG)
L-spine fracture (usually from a fall)