Trauma

Spring 2013

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Some Trauma Stats

1. Most common cause of death for those 1. 1-44 years of age

2. Medical costs for trauma1. 200 billion annually

3. Mostly results from MVA, unintentional accidents, gunshot wounds, stabbing, fights, domestic violence

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Trimodal Distribution

ImmediateEarly

Late

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Immediate Deaths

Lacerations of the

brain and spinal cord

Lacerations of the

heart or great vessels

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Early Deaths

1. Within first 4 hours

2. Intracranial hemorrhage

3. Lacerations of liver or spleen

4. Significant blood loss Liver laceration with extravasation

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Late Deaths1. Weeks after injury

2. Infection and multiple organ failure

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Level I, II & III Trauma Centers

1. Level 11. Usually in large

metro areas and serve as both primary and tertiary care institutions

2. Must be avail 24 hrs3. Must treat 1200

admissions or 240 major trauma patients per year

1. Level II1. Can transport to level

I when necessary2. Serve smaller cites

and towns3. Must be avail 24 hrs

2. Level III1. Remote and rural

areas2. On call on nights and

weekends7

Skeletal Trauma

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Fracture Classifications

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FRACTURE TYPES

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Closed reduction

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Open Reduction

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OPEN FRACTURES

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Open Fracture

1. Bone has penetrated skin

2. May lead to infection

3. Precautions must be taken to prevent infection from setting into the bone

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Closed Fracture

1. Skin is not penetrated

2. Fractures can be classified by the mechanics of the stress that caused the break1. Torsion2. Transverse linear3. Spiral

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Closed Fracture- Clavicle

Forearm Closed fracture

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Impacted Fracture- Wrist

• When the fractured bone is jammed into the cancellous tissue of another fragment

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Impacted Fracture- Hip

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Fibular Impacted Fracture

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Comminuted Fracture

1. Do not represent the full thickness of the bone.

2. Usually extensively shattered

3. Particularly apt to be open fractures

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Comminuted Fracture

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Comminuted Fracture

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Non-Comminuted Fracture

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Non-Comminuted Fracture

1. Complete fracture in which the bone is separated into to fragments

2. Can be classified according to the direction of its fracture line1. Spiral or oblique2. Transverse

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Avulsion Fracture

1. Fragment of the bone is pulled away from the shaft

2. Occur around the joints because of ligaments, tendons, muscles, associated with sprain or dislocation

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Avulsion Fracture

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Avulsion Fracture

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Incomplete Fracture

1. Part of bony structure gives way with little no displacement1. Common example is

a greenstick fracture

2. Torus fracture

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Greenstick :Incomplete Fracture

1. Cortex breaks on one side without separation or breaking of the opposite cortex

2. Found almost exclusively in children under the age of 10

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Incomplete Fracture

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Greenstick Fracture

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Greenstick Fracture

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Greenstick Fracture

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Torus: Incomplete Fracture

1. AKA Buckle Fracture

2. It is a greenstick fracture

3. Cortex bulges outward producing a slight irregularity

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Torus Fracture

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Growth Plate Fracture

1. Involve the end of the long bone

2. Not visible unless displacement occurs

3. Classified according to severity1. Salter-Harris System

1. I-IV2. Based on degree of

epiphysis involvement

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Growth Plate Fracture

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Growth Plate Fracture

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Stress Fracture

1. Results from an abnormal degree of repetition

2. Generally found where muscle attachments are1. EX: runners at tib/fib

3. Not always seen on plain x-ray

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Stress Fracture

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Stress Fracture

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Occult Fracture

1. Gives clinical symptoms without radiologic evidence

2. 10 days later may show repairing itself or displacement

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Occult Fracture

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Occult Fracture

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Colles Fracture

1. Fracture through distal inch of the radius

2. Distal fragment angled backward on the shaft

3. Impaction along dorsal aspect

4. Avulsion fx of the styloid process

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Colles Fracture

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Boxer’s Fracture

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Monteggia’s Fracture

Fx of the proximal1/3 of the ulnar shaft

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Galeazzi Fracture

Occurs at proximal radius with a dislocation of the distal radial-ulnarJoint

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Pott’s Fracture

1. Both malleoli

2. Dislocation of the ankle joint

3. Trimalleolar fx1. Medial and post.

malleoli of the tibia and lat. Malleolus of the fibula

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Pott’s Fracture

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Maisonneuve Fracture

• Severe ankle sprain

• Disruption of the syndemosis between the distal tibia & fibula

• Fracture at prox third of the fibula, often missed

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Maisonneuve Fracture

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Fat Pad Sign

• No definitive fx is seen but the fat pads indicate an underlying fracture

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Dislocations

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Dislocations

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Subluxation

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Subluxation

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Skeletal Trauma Suspicious for Child Abuse

• Distal femur, wrist, ankle– Metaphyseal corner

fractures

• Multiple– Fx’s in different stages of

healing

• Femur, humerus, tibia– Spiral fx’s <1 year old

• Multiple skull fx’s– Occipital bone

• Post ribs, avulsed spinous processes, metacarpal & metatarsal fx’s, sternal& scapular fx’s, vertebral body fx’x and subluxation– Unusually naturally

occurring fx’s <5 years old

• Fx’s with abundant callous formations– Implies repeated trauma

with no immobilization

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Battered Child Syndrome

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Battered Child Syndrome

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Battered Child Syndrome

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Battered Child Syndrome

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Trauma of Chest and Thorax

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PNEUMOTHORAX

Common causes include a penetrating would such as: gun shot stabbing fractured ribs,thoracentesis

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Atelectasis

Refers to a condition with diminished air within lungs associated with reduced air volume

Incomplete expansion of the lung caused by a partial or total collapse

Often occurs from a penetrating wound in the chest67

Abdominal Trauma

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Abdominal Trauma1. Can include GI tract, liver, spleen, kidneys,

pancreas, aorta and pelvic organs.

2. Initially may show minimal symptoms

3. LLD is best for demonstrating small amounts of air fluid levels1. Lay on side 10 minutes

4. CT very valuable to catch subtle abnormalities not detected with x-ray

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Pneumoperitoneum1. Presence of air in the

peritoneum

2. LG amounts indicate a colon perforation

3. SM amounts indicate a duodenal perforation

4. Can be from trauma rupture or nontraumatic bowel perforation

5. Has a football sign70

Pneumoperitoneum

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Imaging Considerations

1. Radiography1. First imaging modality for trauma

2. Portables often used

3. Primary means of evaluating skeletal trauma

2. MRI 1. For muscle, tendons, ligaments and soft

tissue

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Imaging Considerations

1. CT1. Is excellent form imaging acute cerebral

hemorrhage & fx's of the skull & facial bones1. Quickly replacing x-ray as the standard for

evaluating C-spine trauma2. Better to visualize transverse processes of L-

spine

2. Blunt trauma to abdomen can use CT or US1. CT preferred for urinary trauma2. Sometimes angio is used

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