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Fat Embolism Syndrome

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Introduction Fat embolism syndrome follows long bone fractures . Its classic presentation consists of an asymptomatic interval followed by pulmonary and neurologic  manifestations combined with petechial hemorrhages . The syndrome follows a biphasic clinical course . The initial symptoms are probably caused by mechanical occlusion of multiple blood vessels with fat globules that are too large to pass through the capillaries. ✫ Unlike other embolic events, the vascular occlusion in fat embolism is often temporary or  incomplete since fat globules do not completely obstruct capillary blood flow because of their  fluidity and deformability. • The late presentation is thought to be a result of hydrolysis of the fat to more irritating free fatty  acids which then migrate to other organs via the systemic circulation .  Etiology Many aspects of the fat embolism syndrome remain po...
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Hemorrhagic (Hypovolemic) Shock

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Hemorrhagic shock is a condition of reduced tissue perfusion, resulting in the inadequate delivery of oxygen and nutrients that are necessary for cellular function.  Whenever cellular oxygen demand outweighs supply, both the cell and the organism are in a state of shock. Classes Of Shock Class 1 – < 15 % loss blood volume (< 750 mL in a male weighing 70 kg) (No change in BP, pulse pressure, respiratory rate or capillary refill) Minimal tachycardia < 100 bpm Skin pallor possible Class 2 – 15–30 per cent loss blood volume ( 750–1500 mL) (No change in systolic blood pressure) ↓ Peripheral perfusion with cool, pale, clammy skin Capillary refill > 2 seconds Tachycardia > 100 bpm ↓ Pulse pressure as diastolic bp rises Increased respiratory rate (tachypnoea) of 20–30 /min Subtle mental status changes: anxiety, fear, aggression Class 3 – 30–40 per cent loss blood volume ( 1500– 2000 mL ) Marked tachycardia > 120 bpm Measurable fall in s...
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Factors Influencing Fracture Healing

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I. Systemic Factors     1. Age 2. Activity level including     General immobilization Space flight   3. Nutritional status 4. Hormonal factors     Growth hormone Corticosteroids (microvascular osteonecrosis) Others (thyroid, estrogen, androgen, calcitonin, PTH, prostaglandins) 5. Diseases: DM, anemia, neuropathies, tabes 6. Vitamin deficiencies: A, C, D, K 7. Drugs: nonsteroidal antiinflammatory drugs (NSAIDs), anticoagulants, factor XIII, calcium channel blockers (verapamil), cytotoxins, diphosphonates, phenytoin (Dilantin), sodium fluoride, tetracycline 8. Other substances (nicotine, alcohol) 9. Hyperoxia 10. Systemic growth factors 11. Environmental temperature 12. Central nervous system trauma II. Local Factors      A. Factors independent of injury, treatment, or complications     1. Type of bone 2. Abnormal bone     Radiatio...
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Hanging Cast

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Indications 1.      For displace fracture of the humeral shaft with shortening, and also for oblique and spiral fractures –(Caldwell, 1933)  2.      Used for comminuted humeral fracture, distal humeral shaft fracture. ·       Cast must be lightweight and must extend from at least 1 inch proximal to the fracture site to wrist, with elbow at right angle & forearm in neutral rotation. ·        Arm must lie dependent to provide a traction force. ·        Patient must sleep erect or semi-erect to avoid supporting elbow when seated. ·        Erect position is maintained during the day as much as possible. ·     There should be no support under the elbow, and nothing should compress the arm against the body (such as clothing). It is frequently exchanged for functional b...
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Skeletal Traction: Common sites

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1. Olecranon Site: 1.25 inches (3 cm) distal to the tip of olecranon just deep to the subcutaneous border of upper end of the ulna. Direction:  Medial to lateral at right angles to the longitudinal axis of ulna. Avoid: Ulnar nerve injury. 2. Second & Third Metacarpals Site:  About 1 inch (2-2.5 cm) Proximal to the distal end of Second metacarpal Direction:  The wire traverses 2nd and 3rd metacarpals transversely at right angles to the longitudinal axis of the radius. 3. Greater trochanter (upper end of femur ) Site: ...
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SOMI Brace

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Sternal-Occipital-Mandibular Immobiliser  (SOMI) Brace  Cervico-Thoracic Orthoses (CTOs) provide greater motion restriction from C5-C7 spine from the increased leverage on the person’s body. The upper cervical spine has less motion restriction. CTOs are used in minimally unstable fractures . All CTO’s tend to control flexion better than extension . Parts 1. The SOMI is a rigid, 3-poster CTO that has an padded anterior chest plate extending to the xiphoid process, as well as two padded shoulder extension which hook over tops of the shoulder. 2. From these shoulder extension two Straps which cross in the interscapular region, pass downward and around the chest wall to attach to the lower part of the chest plate. 3. There are three adjustable uprights , which pass upward from the chest plate, two to the padded occipital support and one to the mandibular support. 4. A removable chin piece attaches...
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