Surgical

General
Twilight (Midasolam 'Versed')
Epidural
Spinal (subarachnoid)

Intubation
Spinal

Spinal: Small volume, Fast onset, no redosing, negligible blood levels, lumbar only
Epidural: large volume, slow onset, can redose through catheter, significant blood levels, any vertebral level

Less Medication used
No assistance from a ventilator
Wake quicker and feel fewer residual effects
provide pain relief after the surger is over
Reduce the need for opiods!!!
Patients experience: reduced stress, less blood loss, lower incidence of blood clots (you can move!)

Arthrotomy
Arthoscopy

Open procedure

through camera and scope

Joint Replacement
Hemi Replacement (one side)

TJR - total joint replacement
TKR - total knee replacement
THR - total hip replacement

surgical repair of fracture, usually with screws and plates or with intramedullary rod (IM)

resection
repair
reconstruction
plication
debridement
capsulorrhaphy

Cut damaged tissue out
easier to recover from and can start WB immediately

stitch the tissue back together

replace the tissue

take out a loose piece

tighten the tissue
Suture of a joint capsule to prevent recurring dislocation of the articulation

Allograft - donor tissue
Autograft - self

unthreaded segment of extruded wire drilled into bone
-very small and relatively noninvasive
-through articular surface or physeal plate
-can be temporary or final
often used in comminuted fracture to piece fragments together (lots of little pieces)
-used before placement of final fixation device, especially with intra-articular fracture

using the tension wire you can bring two ends closer together to promote more direct healing

used to remove fluid bild up in an area of the body after surgery

Plaster
fiberglass
waterproof
3D Printed

the joint above and below the injury

wrist movements, pronation/supination

easier to get up and move

transverse
linear
oblique
spiral
comminuted
greenstick
avulsion

the broken bone is not completely separated

the break is in a straight line across the bone

the break spirals around the bone; common in a twisting injury

diagonal break across the bone

the bone is crushed, causing the broken bone to be wider or flatter in appearance

a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone

segmental - broken in 2
comminuted - multiple pieces

which bone
displacement, angulation, rotation, shortening
open or closed
blood supply
patient factors - high level athete vs older adults

FOOSH
usually carpal bone injured
tenderness in anatomic snuff box
Blood Supply
-dorsal carpal branch of radial artery
-retrograde
-high risk for avascular necrosis or nonunion
Proximal Fracture or Displaced Fracture - surgery

most common upper extremity fracture
young patients: high energy
old patients: low energy (osteoporosis)
treatment: closed reduction and casting

anatomic reduction of radial bone is required for forearm pronation/supination
surgery required in skeletally mature patients

higher speed
damage to soft tissue envelope
comminution of bone
Blood supply vital for healing
Predictor of outcome: limb repair/limb loss

Tibial Plateau
Pilon
Femoral Neck Fracture young patient

First Aid!
-ABC's
Get Help + get them to hospital
Calm the patient
Physical Exam
-pulses, neuro, open wounds
Control Bleeding
Dress Wounds + remove contamination (maybe)

Patient Counseling
-living situation
-medication pick up
-support system
-review of pre op MD meeting: stopping anticoagulant
What the surgery, recovery and rehab will look like
Opioid Counseling

Effect of Opioid on CNS
Risk factors for development of addiction
-anxiety, depression, family history of addiction/chronic pain, history of trauma
Pain control strategies