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43 Cards in this Set
- Front
- Back
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Describ ethe Patzakis classification for zones of the plantar aspect of the foot
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zone 1 - extends fro mthe neck to the metatarsals to the end of the digits
Zone 2 - includes the area between the distal end ofthe calcaneus and the metatarsal necks. Zone 3 - the area occupied by the calcaneus Zoen 1 and 3 are associated with an increased incidence of osseous invilvement and complications followinga puncture wound. |
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In a puncture wound witha retained foreign body, how long odes it atake an infection to manifest?
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Infection often manifests in 24 hours, but may take three to four days
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Why are structures suc as intrinicsic tendos, extrinsic tendons, intermetarsalo bursa, and aMTPJ capsule of worry iwht puncture wounds/
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If punctue wound extends to structures such as threse, infection can be established easily due their decresed vascularity and slower metabolic rate.
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Can glass be visualized on plain radiographs?
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Yes. Glass does not have ot contain lead to be visualized. The size of the glass fragment is the limiting factor
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What type of imating study is best for detecting wood fragments?
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CT with useo f narrow windo?
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When does osteomyelitis becom evident radiogrpahically?
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10-14 days after establisment of bone infection. Tc-pp MDP bone scans demonstrate a focal uptake within 24 hours; however, they have low specificity. For better specificty, use a Tc-99 labeled leukocyte scan (HMPAO).
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How does osteomyelitis appear on MRI?
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T1 demonstrates decreased signal intensity.
T2 demonstrates increased signal intensity. |
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What is the gold standard for diagnosis of ostoemyelitis?
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Bone biopsy
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What are the indications for incision and drainage following a puncture wound?
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wound infection, presence of an abscess, and if a reactive foreign object is retained i the wound.
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What are the most common pathogens associated with soft tissue infections?
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Staphylococcus, aureus, staphylococcus epdiermidis, an dstreptococcus.
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What is the most common organis isolated from punctue wounds caused by cat and and dog bites and what is the treatment?
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Pasturilla multicoda terated by augmenting
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What organism is most commonly isolated in osteomyelitis following a punctue wound?
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pseudomonas aerugions.
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What is the most common site for osteomyelits followning pucnture woundot he foot?
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the calcaneus
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What is the most common object to casue a puncture wound
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naisl are the most common at 98%. Othe robjects include wood, metal, and glass
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What are some possible complications of puncture wounds?
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Soft tissue infection, osteomyelits, foreign body granuloma, premature epiphysieal closure, joint degeneration , nda residual deformity
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How often is cellulitis seen after a punctue wound?
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8.4% of patients een within the first 24 hours after injury, present with cellulitis within four days. IF the patient is seen 1-7 days after injury, 57% develop cellulits.
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What are the three classes of pseudomonas infection children described by Green and Bruno?
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Type I - early diagnosis and surgical drainage wth antibiotic coverage results in complete healing
Type II - diagnossi delayed by 9-14 days. Debridement and antibiotics ereadicate infection but patient may have resdiual bone or joint deformity. Type II - diagnosis delayed over three weeks results in chronic infection with necessary bone resection. |
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What rae the gals of puncture wound treamtnet?
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Conversion of contaminated wound to a clean wound and preventin o f tetanus.
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Tetan us prophylaxis is based on what four components?
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wound care
tetanus toxoid immune glbulin, antibotics |
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How often should tetanus boosters be admistered?
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For patients with an indeterminate number of toxoid injections, last injection was greater than one year and the wound is tetanus brone, adminsiter the booster.
If hte wound is non-tetanus prone, a booster should be adminsted at intervals of five years. |
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What is the most commonly encountred foeign body in the foot?
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A pin or needle
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What are some possible complcations of animal bites?
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cellulitis , lymphangitis, abscesses, osteomyelitis, subcutaneous gas, meningitis, endocarditis, tularemia, and syphilis
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necrotic arachnidism is seen in what tipe of bit?
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necrotic arachnidismis seen in brown recluse spider bites of the genus Loxosceles.
necrotic arachnidismis described as sever necrotic tissue destruction. A blue-gray halo appears peri-punctue site which progresses to necrsis, eschar formation, and a largeulcertation. |
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What is the treatment for brown recluse spider bits?
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treatment is controversial but may include intralesional and oral steroids, surgical debridement, and the use of dapsone.
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What is the difference between a low velocity and a high velocity projectile?
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low velocity is </= 2000 ft/second, high velocity is </= 2000 ft/second
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What is the most commonly encountred foeign body in the foot?
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A pin or needle
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What are some possible complcations of animal bites?
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cellulitis , lymphangitis, abscesses, osteomyelitis, subcutaneous gas, meningitis, endocarditis, tularemia, and syphilis
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necrotic arachnidism is seen in what tipe of bit?
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necrotic arachnidismis seen in brown recluse spider bites of the genus Loxosceles.
necrotic arachnidismis described as sever necrotic tissue destruction. A blue-gray halo appears peri-punctue site which progresses to necrsis, eschar formation, and a largeulcertation. |
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What is the treatment for brown recluse spider bits?
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treatment is controversial but may include intralesional and oral steroids, surgical debridement, and the use of dapsone.
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What is the difference between a low velocity and a high velocity projectile?
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low velocity is </= 2000 ft/second, high velocity is </= 2000 ft/second
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According to thekinetic energy theory, what formula describes the amountof enrgy by a projectile?
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KE - 1/2mv^2
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DEscribe the classfication for shotgun wounds and nameit develpers.
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Sherman and Parrish descrbed a classification for shto gun wounds
Type I - penetrates sbucutaneous tissue or deep fascia: occur at ditances greater than 7 yards. Type II occur at 3- 7 yards. Viscera, bones, and vascular system viloated. type III - occur at less than 3 yards. Sever local destruction adn loss of tissue. |
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Describe Ordog's classification for gusnhot wounds.
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Type 0 - No injury
Type I - Blunt injury (nonpentrating gushot wound). Type II - Graze njury (abrasion, injury to epeidermis, superfical dermis). Type III - Blast effect wihout missile penetration (bullet missed, blank ammo). Type IV - Blast effect with missile pentration. Type V - Pentarating A. lacertqatin through dermis B - subctaneous, C all deep structures D body cavity E more than on ebody region Type VI perforatin. ABCDE Type VII - penetration with missile embolizaiton |
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What are the basic tenants for for simplelow velocity missile wound care?
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adquate nonoperative stabilization of fractues
adequate devridemnt of exosed necrotic tissue clenasign of the wound withirrigation closure without tension wound observation for 49-72 hours |
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What are the basic tenants for complex low velocity missile wound care?
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cleansing wiht antisepitc/jet lavage
open reduction of fracture sites utilizing internal/external fixation intravenous broad spectrum antibiotics daily owound observation adn care until clinically unifected and viale |
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What are the basic tenants of shotgun wound care?
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arteriography
rapid debridement sharp dissection broad fascitomy pressure irrigation tetanus rpohylaxis bony stabilization vascualr, neural, musculotendinous repai, inclding gstrocnemius flaps delyaed closure antibiotic impregnated materails to fill dead space syntthetic skin substiutes frequent redebridement. clsure/s;oit thickness skin graft at 7-10 days |
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Generally, low velocity gunshot wounds are consdiered whta type in Gustilo's classification?
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Type I
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What is lead intoxication called?
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plumbism
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What is the antibiotic of choice for type I gunshot wouds?
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cephalosporin
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I "caviation" associated with low or high velocity gunshot wounds?
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high velocity
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Whata re the facgtors, which determin the size and extent of damage produced by a projectile?
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The type of tissue the projectile penetrates, the bullet's composition, the bullet or bone fragmentation creating secondary missiles,and the amount of energy that the projectile dissipates in the tissue.
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What is the largest organ in the body?
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The inegumentary system is the largest organ inthe body, coprising 15% of the toal body wight.
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Escribe the calssification for burn injury.
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First Degree - characterized by erythema without blister formation and are partial thicness (sunburns).
Second degree - ar partial thicness but can be dived into sueprfial and deep. Superfical affect the depe layers of the epidermsi but do not affect the basal cell ayer nd present iwth blisters |
