Trauma by hedongchenchen



Spring 2010
         Some Trauma Stats
1. Most common cause of death for those
  1. 1-44 years of age

2. Medical costs for trauma
  1. 200 billion annually

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

Immediate Deaths

               Lacerations of the
            brain and spinal cord

              Lacerations of the
           heart or great vessels
                Early Deaths
1. Within first 4 hours

2. Intracranial

3. Lacerations of liver
   or spleen

4. Significant blood      Liver laceration with extravasation

                Early Deaths
1. Within first 4 hours

2. Intracranial

3. Lacerations of liver
   or spleen

4. Significant blood      Liver laceration with extravasation

1. Weeks after injury
                            Late Deaths
2. Infection and
   multiple organ failure
Level I, II & III Trauma Centers
1. Level 1                   1. Level II
  1. Usually in large           1. Can transport to level
     metro areas and               I when necessary
     serve as both primary      2. Serve smaller cites
     and tertiary care             and towns
     institutions               3. Must be avail 24 hrs
  2. Must be avail 24 hrs
  3. Must treat 1200
     admissions or 240       2. Level III
     major trauma               1. Remote and rural
     patients per year             areas
                                2. On call on nights and
Skeletal Trauma
Fracture Classifications
Closed reduction
Open Reduction
Open Fracture
       1. Bone has penetrated

       2. May lead to infection

       3. Precautions must be
          taken to prevent
          infection from setting
          into the bone
Closed Fracture
        1. Skin is not

        2. Fractures can be
           classified by the
           mechanics of the
           stress that caused
           the break
          1. Torsion
          2. Transverse linear
          3. Spiral
Closed Fracture- Clavicle

Forearm Closed fracture
Impacted Fracture- Wrist
               • When the
                 fractured bone is
                 jammed into the
                 cancellous tissue
                 of another
Impacted Fracture- Hip
Fibular Impacted Fracture
Comminuted Fracture
          1. Do not represent the
             full thickness of the

          2. Usually extensively

          3. Particularly apt to be
             open fractures
Comminuted Fracture
Comminuted Fracture
Non-Comminuted Fracture
    Non-Comminuted Fracture
1. Complete fracture in
   which the bone is
   separated into to

2. Can be classified
   according to the
   direction of its
   fracture line
  1. Spiral or oblique
  2. Transverse
           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
Avulsion Fracture
Avulsion Fracture
          Incomplete Fracture
1. Part of bony
   structure gives way
   with little no
  1. Common example is
     a greenstick fracture
  2. Torus fracture
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
Incomplete Fracture
Greenstick Fracture
Greenstick Fracture
Greenstick Fracture
    Torus: Incomplete Fracture
1. AKA Buckle Fracture

2. It is a greenstick

3. Cortex bulges
   outward producing a
   slight irregularity
Torus Fracture
         Growth Plate Fracture
1. Involve the end of the
   long bone

2. Not visible unless
   displacement occurs

3. Classified according to
   1. Salter-Harris System
      1. I-IV
      2. Based on degree of
         epiphysis involvement
Growth Plate Fracture
Growth Plate Fracture
              Stress Fracture
1. Results from an
   abnormal degree of
2. Generally found
   where muscles
   attachments are
  1. EX: runners at tib/fib
3. Not always seen on
   plain x-ray
Stress Fracture
Stress Fracture
             Occult Fracture
1. Gives clinical
   symptoms without
   radiologic evidence

2. 10 days later may
   show repairing itself
   or displacement
Occult Fracture
Occult Fracture
            Colles Fracture
1. Fracture through
   distal inch of the
2. Distal fragment
   angled backward on
   the shaft
3. Impaction along
   dorsal aspect
4. Avulsion fx of the
   styloid process
Colles Fracture
Boxer’s Fracture

              Fx of the proximal
              1/3 of the ulnar shaft
                                         Galeazzi Fracture

Occurs at proximal radius with a
dislocation of the distal radial-ulnar
               Pott’s Fracture
1. Both malleoli

2. Dislocation of the
   ankle joint

3. Trimalleolar fx
  1. Medial and post.
     malleoli of the tibia
     and lat. Malleolus of
     the fibula
Pott’s Fracture
        Maisonneuve Fracture
• Severe ankle sprain

• Disruption of the
  syndemosis between
  the distal tibia & fibula

• Fracture at prox third
  of the fibula, often
Maisonneuve Fracture
               Fat Pad Sign
• No definitive fx is
  seen but the fat pads
  indicate an underlying
Skeletal Trauma Suspicious for Child Abuse

• Distal femur, wrist, ankle       • Post ribs, avulsed
   – Metaphyseal corner              spinous processes,
     fractures                       metacarpal & metatarsal
                                     fx’s, sternal& scapular
• Multiple                           fx’s, vertebral body fx’x
   – Fx’s in different stages of     and subluxation
     healing                          – Unusually naturally
                                        occurring fx’s <5 years old
• Femur, humerus, tibia
   – Spiral fx’s <1 year old       • Fx’s with abundant
                                     callous formations
• Multiple skull fx’s                 – Implies repeated trauma
                                        with no immobilization
   – Occipital bone
Battered Child Syndrome
Battered Child Syndrome
Battered Child Syndrome
Battered Child Syndrome
Trauma of Chest and Thorax

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

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 chest
Abdominal Trauma
           Abdominal Trauma
1. 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 levels
   1. Lay on side 10 minutes

4. CT very valuable to catch subtle abnormalities
   not detected with x-ray
1. Presence of air in the

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 sign
     Imaging Considerations
1. Radiography
  1. 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
        Imaging Considerations
1. CT
  1. Is excellent form imaging acute cerebral
     hemorrhage & fx's of the skull & facial bones
    1. Quickly replacing x-ray as the standard for
       evaluating C-spine trauma
    2. Better to visualize transverse processes of   L-

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

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