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Trauma and Orthopaedics (Intramedullary Nail (Complications of the…

- - - - Pain due to inadequate analgesia
      - Haemorrhage due to NV bundle damage
      - Organ perforation
      - Incorrect location: e.g. abdomen
    - - Failure: bronchopleural fistula
      - Long-thoracic N. damage → winged scapula
      - Wound infection
      - Blockage
  - - - Traumatic
      - Ventilated
      - Following needle decompression of tension
      - Persistent after aspiration
- - - - Infection
      - Failure
      - Malposition of the remodelled fracture
- - - - Cement reaction
      - Deep infection
      - Fracture
      - Dislocation (3%): squatting and adduction
    - - Loosening: septic or aseptic
      - Failure: stem #
      - Revision: most replacements last 10-15yrs
- - - - Indication: NEXUS Criteria
        
        Neurological deficit
        
        Spinal tenderness in the midline
        
        Altered consciousness
        
        Intoxication
        
        Distracting injury
      - Method
        
        Examine for bruising or deformity
        
        Palpate for deformity and tenderness
        
        Ensure pain-free active movement
    - - Indications
        Pt. doesn’t meet criteria for clinical clearance
      - Modalities
        
        Radiograph initially
        Clear if normal radiograph and clinical
        exam
        
        CT C-spine if abnormal radiograph or clinical
        exam
  - - - Indications
      - Used c¯ two sandbags and tape
    - - Comes flat packed and must be assembled
      - Hole at front allows access to the trachea
    - - Sized by measuring the number of fingers from the
        clavicle to the angle of the mandible
      - “Key dimension” then compared to the sizing peg on the
        hard collar.
    - - Incorrect placement
      - Neck not in neutral alignment
      - Chin not flush w/ end of chin piece
- - - - Nerve injury
      - Fracture
      - Cement reaction
    - - DVT: up to 50% w/o prophylaxis
      - Deep infection
      - Must remove metalwork before revision.
      - Dislocation (3%): squatting and adduction
    - - Loosening: septic or aseptic
      - Failure: stem #, wear
      - Revision: most replacements last 10-15yrs
- - - - Fat Embolism Syndrome
        
        Presentation: SOB, petechial rash, confusion
        
        Typically 24-72h between injury and onset
        
        Resp: dyspnoea ± chest pain
        
        Petechial rash: upper anterior trunk, arms, neck
        
        CNS: headache, confusion, agitation
        
        Renal: oliguria, haematuria
        
        Ix
        
        ABG: hypoxia, hypocapnoea
        
        FBC: ↓ plats, ↓Hb
        
        CT chest
        
        Mx
        Supportive: O2, volume resuscitation
        Steroids
  - - - ↑ loading of fracture site → quicker union