Extremity and Orthopedic Injuries

First Things First (assess and treat the following)

• Follow ATLS/ABCs:
  • Primary Survey – quantify obvious injuries and “plug” holes; perform orderly exam (head to toe, front to back, left to right); log roll all patients; assess and provisionally cover open wounds; order/obtain x-rays of injured limbs along with trauma series
  • Secondary Survey – more detailed examination of patient; diagnose the non-obvious orthopaedic injury; obtain correct x-rays; palpate every bone, move every joint
• Potential orthopaedic emergencies (life- and/or limb-threatening) to be recognized early:
  • Unstable pelvic fracture associated w/ hemodynamic instability
  • Extremity injury w/ vascular injury
  • Acute compartment syndrome
  • Open fracture
  • Joint dislocation
  • Septic arthritis/acute osteomyelitis in clinically septic patient
  • Acute spinal cord injury/neurologic compromise w/ associated spine fracture