1. Trauma
Spring 2012
FINAL

2. Some Trauma Stats Most common cause of death for those
1-44 years of age
Medical costs for trauma
200 billion annually
Mostly results from MVA, unintentional accidents, gunshot wounds, stabbing, fights, domestic violence

3. Trimodal Distribution
Immediate Early
Late

4. Immediate Deaths Lacerations of the brain and spinal cord
heart or great vessels

5. Early Deaths Within first 4 hours Intracranial hemorrhage
Lacerations of liver or spleen
Significant blood loss
Liver laceration with extravasation. An enhanced axial CT scan of the upper abdomen shows a large laceration through the right lobe of the liver (blue arrow), blood in the peritoneal cavity (black arrows) and active extravasation of the intravenous contrast (red arrow). The stomach is labeled "S."
Liver laceration with extravasation

6. Weeks after injury
Infection and multiple organ failure
Late Deaths

7. Level I, II & III Trauma Centers
Usually in large metro areas and serve as both primary and tertiary care institutions
Must be avail 24 hrs
Must treat 1200 admissions or 240 major trauma patients per year
Level II
Can transport to level I when necessary
Serve smaller cites and towns
Must be avail 24 hrs
Level III
Remote and rural areas
On call on nights and weekends

8. Skeletal Trauma

9. Fracture Classifications

10. FRACTURE TYPES

11. Closed reduction

12. Open Reduction

13. OPEN FRACTURES

14. Open Fracture Bone has penetrated skin May lead to infection
Precautions must be taken to prevent infection from setting into the bone

15. Closed Fracture Skin is not penetrated
Fractures can be classified by the mechanics of the stress that caused the break
Torsion
Transverse linear
Spiral

16. Closed Fracture- Clavicle

17. Forearm Closed fracture

18. Impacted Fracture- Wrist
When the fractured bone is jammed into the cancellous tissue of another fragment

19. Impacted Fracture- Hip

20. Fibular Impacted Fracture

21. Comminuted Fracture Do not represent the full thickness of the bone.
Usually extensively shattered
Particularly apt to be open fractures

22. Comminuted Fracture

23. Comminuted Fracture

24. Non-Comminuted Fracture

25. Non-Comminuted Fracture
Complete fracture in which the bone is separated into to fragments
Can be classified according to the direction of its fracture line
Spiral or oblique
Transverse

26. Avulsion Fracture Fragment of the bone is pulled away from the shaft
Occur around the joints because of ligaments, tendons, muscles, associated with sprain or dislocation

27. Avulsion Fracture

28. Avulsion Fracture

29. Incomplete Fracture
Part of bony structure gives way with little no displacement
Common example is a greenstick fracture
Torus fracture

30. Greenstick :Incomplete Fracture
Cortex breaks on one side without separation or breaking of the opposite cortex
Found almost exclusively in children under the age of 10

31. Incomplete Fracture

32. Greenstick Fracture

33. Greenstick Fracture

34. Greenstick Fracture

35. Torus: Incomplete Fracture
AKA Buckle Fracture
It is a greenstick fracture
Cortex bulges outward producing a slight irregularity

36. Torus Fracture

37. Growth Plate Fracture Involve the end of the long bone
Not visible unless displacement occurs
Classified according to severity
Salter-Harris System
I-IV
Based on degree of epiphysis involvement

38. Growth Plate Fracture

39. Growth Plate Fracture

40. Stress Fracture Results from an abnormal degree of repetition
Generally found where muscle attachments are
EX: runners at tib/fib
Not always seen on plain x-ray

41. Stress Fracture

42. Stress Fracture

43. Occult Fracture Gives clinical symptoms without radiologic evidence
10 days later may show repairing itself or displacement

44. Occult Fracture

45. Occult Fracture

46. Colles Fracture Fracture through distal inch of the radius
Distal fragment angled backward on the shaft
Impaction along dorsal aspect
Avulsion fx of the styloid process

47. Colles Fracture

48. Boxer’s Fracture

49. Monteggia’s Fracture
Fx of the proximal
1/3 of the ulnar shaft

50. Galeazzi Fracture Occurs at proximal radius with a
dislocation of the distal radial-ulnar
Joint

51. Pott’s Fracture Both malleoli Dislocation of the ankle joint
Trimalleolar fx
Medial and post. malleoli of the tibia and lat. Malleolus of the fibula

52. Pott’s Fracture

53. Maisonneuve Fracture Severe ankle sprain
Disruption of the syndemosis between the distal tibia & fibula
Fracture at prox third of the fibula, often missed

54. Maisonneuve Fracture

55. Fat Pad Sign
No definitive fx is seen but the fat pads indicate an underlying fracture

56. Dislocations

57. Dislocations

58. Subluxation

59. Subluxation

60. 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

61. Battered Child Syndrome
Frontal radiograph of the chest demonstrates multiple rib fractures with callous formation, including a fracture of the left 2nd and 6th ribs posteriorly. Posterior rib fractures are highly suggestive of child abuse (from forceful squeezing)

62. Battered Child Syndrome

63. Battered Child Syndrome

64. Battered Child Syndrome

65. Trauma of Chest and Thorax

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

67. Atelectasis
Refers to a condition with diminished air within lungs associated with reduced air volume. Most commonly this results fro a bronchial obstruction. Air cannot enter that part of the lung supplied by the obstructed bronchus.
X-ray commonly demonstrates local increase in density caused by airless lung. Thin plate like streaks to lobar collapse.
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

68. Abdominal Trauma

69. Abdominal Trauma
Can include GI tract, liver, spleen, kidneys, pancreas, aorta and pelvic organs.
Initially may show minimal symptoms
LLD is best for demonstrating small amounts of air fluid levels
Lay on side 10 minutes
CT very valuable to catch subtle abnormalities not detected with x-ray

70. Pneumoperitoneum Presence of air in the peritoneum
LG amounts indicate a colon perforation
SM amounts indicate a duodenal perforation
Can be from trauma rupture or nontraumatic bowel perforation
Has a football sign

71. Pneumoperitoneum

72. Imaging Considerations
Radiography
First imaging modality for trauma
Portables often used
Primary means of evaluating skeletal trauma
MRI
For muscle, tendons, ligaments and soft tissue

73. Imaging ConsiderationsCT
Is excellent form imaging acute cerebral hemorrhage & fx's of the skull & facial bones
Quickly replacing x-ray as the standard for evaluating C-spine trauma
Better to visualize transverse processes of L-spine
Blunt trauma to abdomen can use CT or US
CT preferred for urinary trauma
Sometimes angio is used