Spinal Cord Injury
What are the two most common causes of spinal cord injury?
MVC (50%) and falls
In a tendon repair, at least how many core suture strands should run across the repair?
4
In general, a patient with an open fracture, how soon should they be irrigated/debrided?
Within 24 hours - though the size, volume, contamination, soft tissue involvement, and vascular injury may increase urgency
What is the rate of peripheral nerve regeneration?
1mm per day
Name the 6 Ps of limb ischemia
Pain, pulseless, pallor, paresthesias, poikilothermia, paralysis
What are the goals of spinal decompression or fusion?
1. Maintain alignment
2. Provided spinal stability to any unstable segments
3. Decompress neurologic structures that are compressed or compromised
What is the optimal timing for primary repair of a flexor tendon injury?
What ankle-brachial index value suggests the need for further vascular imaging in a trauma?
<0.9
A 62 yo M presents to your surgery clinic for evaluation of an umbilical hernia. On exam, you note that his right arm is adducted and internally rotated with extension of the forearm. The wrist and fingers are also flexed. What is the name of this palsy and what level did this injury occur? Bonus 100 points for naming the most common cause of this palsy.
Erb's palsy
C5, C6, and sometimes C7
MCC: Traumatic birty - Shoulder dystocia
Blood products - though this patient may be in neurogenic shock secondary to a spinal cord injury, shock in a trauma patient is hemorrhagic until proven otherwise. Once hemorrhagic shock is ruled out and SCI is confirmed, you can then transition to IV fluids and vasopressors (levo)
Above which vertebral level are patients with SCI at risk for autonomic dysreflexia? What signs or symptoms might a patient exhibit (give 3)?
T6
Headache, diaphoresis, nausea, bradycardia or tachycardia, hypertension
What type of incision is classically used to repair tendon injuries of the hand and why?
Midlateral or Bruner (zigzag) incisions
Provides adequate exposure and avoids incisions that cross flexion creases perpendicularly to decrease flexion contracture formation
What is a delta pressure? How do you calculate it, and what pressure is diagnostic of acute compartment syndrome?
Delta pressure is the difference between the diastolic blood pressure and the intracompartmental pressure. A delta pressure < 30 mmHg is highly indicative of compartment syndrome
Describe the symptoms of Horner syndrome. This results from damage to which nerve roots?
Ptosis, miosis, and anhidrosis
C8-T1
A 62 yo F presents with a posterior knee dislocation after she tripped over her dog. What two neurovascular structures are at risk?
Popliteal artery and peroneal nerve
Physiologically, what causes neurogenic shock?
Loss of sympathetic impulses to the cardiovascular system -> vasodilation, decreased venous return and cardiac output
In neutral anatomic position, the neurovascular bundles of the fingers run on the *** and *** aspects of each digit, with the nerve lying *** relative to the artery
Radial/ulnar or medial/lateral
Volar/anteriorWhat are two exam findings that are early predictors of acute compartment syndrome?
1. Pain out of proportion to an injury that progresses despite adequate analgesia/immobilization
2. Pain that worsens with passive stretch of a compartment
What types of brachial plexus injuries require immediate operative intervention?
Penetrating and open injuries, high-veloxity gunshot wounds should be explored and repaired. May delay reinnervation for up to 6-12m in blunt/traction injuries.
What are the components of the NEXUS criteria? What is it used for?
1. No evidence of AMS
2. Must be awake, alert, and oriented
3. No painful or distracting injuries
4. No spinal tenderness
5. No neurologic deficitsA 76 yo F is involved in an MVC and there is concern for SCI at the level of L2. On examination, she has partial preservaiton of sensation over the upper and mid thigh. On motor exam, she is able to flex her hip only against gravity, but is unable to actively extend her knee or dorsiflex the ankle against gravity. What ASIA class is her injury?
Class C - sparing of some muscle movement below the level of the injury, but no movement against gravity in 50% of the muscles
During a hand trauma evaluation, a patient is asked to flex the DIP joint while the PIP is held in extension. Which tendon does this isolate?
Flexor digitorum profundus
What are the four components of the Mangled Extremity Severity Score?
1. Skeletal/soft tissue injury (energy level) - low, medium, high, or very high
2. Limb ischemia - pulse reduced/absent but perfusion normal -> pulseless with paresthesias, diminished cap refill -> cool, paralyzed, numb
3. Shock - not present, transient SBP < 90, persistently < 90
4. Age - <30, 30-50, > 50
A 22 yo F presents to trauma clinic following discharge s/p MVC with fracture of her humerus and distal radius. She is complaining of hand weakness. On examination, she is unable to extend her wrist against gravity and has weakness with extension of her fingers at the MCP joint. Which nerve was likely injured?
Radial nerve
Name the myofascial compartments of the lower leg
Anterior, lateral, superficial posterior, and deep posterior