4th Year Trauma

Question 1

define polytrauma

Answer 1

more than one major long bone is injured or where a major fracture is associated with significant chest or abdo trauma

Question 2

three types of nerve injuries associated with fractures

Answer 2

1. neurapraxia
2. axonotmesis
3. neurotmesis

Question 3

what is neurapraxia?

Answer 3

temporary compression causes temporary conduction block/ demyelination
should resolve in 28 days

Question 4

what is axonotmesis?

Answer 4

sustained compression causes nerve cell death distal to injury (Wallerian degeneration). regenerates 1mm per day
NCS gives prognosis

Question 5

what is neurotmesis?

Answer 5

complete transection of the nerve

needs grafts or tendon transfers

Question 6

what does a bumper injury to the lateral knee risk?

Answer 6

common peroneal nerve injury

Question 7

what nerve do supracondylar fractures risk injuring?

Answer 7

brachial artery

ulnar nerve

Question 8

classification for supracondylar fractures

Answer 8

Gartland classification

Question 9

Gartland classification

Answer 9

1= undisplaced
2= displaced with intact cortex
3= completely displaced
4= multidirectional instability

Question 10

what criteria must be met to clear a C-spine?

Answer 10

no history of LOC
GCS 15 with no alcohol
no significant distracting injury e.g. head, chest, other fractures
no neurological symptoms
no midline tenderness on palpation of C-spine
no pain on neck movement

Question 11

what to do if C-spine criteria not met?

Answer 11

get XR or CT

Question 12

how to assess pressure in compartment syndrome?

Answer 12

needle manometry

Question 13

initial management of compartment syndrome

Answer 13

escalation to reg or consultant
remove external bandages or dressings
elevate leg to heart level
maintain good BP

Question 14

what are thoracolumbar fractures associated with?

Answer 14

wedge insufficiency in elderly

burst fractures in the young

Question 15

what does diagnosis of a fracture require?

Answer 15

2 XR views

Question 16

what is complex regional pain syndrome associated with?

Answer 16

regional sympathetic dystrophy

Sudeck’s atrophy

Question 17

what is a fat embolism?

Answer 17

occurs following fracture of long bones and can lodge in blood vessels cuasing inflammatory response

Question 18

when do fat embolism present?

Answer 18

24-72 hours post-fracture

Question 19

what criteria is used in fat embolism?

Answer 19

Gurd’s

Question 20

Gurd’s criteria

Answer 20

major= respiratory distress, petechial rash, cerebral involvement
minor= jaundice, thrombocytopenia, fever, tachycardia

Question 21

what reduces the risk of fat embolism?

Answer 21

operating early

Question 22

types of fractures

Answer 22

1. compound= skin broken
2. stable
3. pathological (abnormal bone)
4. compression (vertebra)
5. fragility (OP)

Question 23

how to predict fracture risk in patients with OP?

Answer 23

FRAX tool

DEXA scan

Question 24

management of OP

Answer 24

1. calcium + vitamin D + alendronic acid

2. denosumab

Question 25

what is torticollis?

Answer 25

waking up with unilateral stiff and painful neck due to muscle spasm