5- Trauma Flashcards
What is the medical term for a broken bone?
Fracture
Give examples of situations that would cause high-energy fractures
RTA
gunshot
fall from height
bomb blast
What is meant by a pathological fracture?
Underlying bone disease/weakness causes the fracture
What is meant by primary/first-intention bone healing?
Minimal fracture gap (hairline) is bridged by new bone formation by osteoblasts
What is meant by secondary bone healing?
Gap needs to be filled to act as a scaffold for new bone formation
Ourline the fracture process of secondary bone healing
Fracture Haematoma + inflammation Macrophages + osteoclasts remove debris Granulation tissue forms + angiogenesis Chondroblasts form soft cartilage callus Osteoblasts lay down type 1 collagen Calcium mineralisation produces hard callus Remodelling with organisation
When does soft callus usually form by?
2-3weeks
When does hard callus usually form by?
6-12weeks
What lifestyle habit may severely impair fracture healing?
Smoking
List the 5 basic fracture patterns
Transverse Oblique Spiral Comminuted Segmental
Describe a transverse fracture
Bending force causing horizontal break
Describe an oblique fracture
Shearing force causing diagonal break
Describe a spiral fracture
Tortional force causing diagonal + circular break
Describe a comminuted fracture
Has 3 or more fragments, usually due to high-energy injury
Describe a segmental fracture
Bone fractures in two separate places
What is meant by an intraarticular fracture?
Fracture at the end of a long bone extending into a joint
When describing a fracture, displacement is described by the tranlation of the proximal fragment. True/False?
False
Displacement describes direction of translation of the distal fragment
How is anterior/posterior and medial/lateral displacement in the forearm/hand described?
Volar/dorsal
Ulnar/radial
What does angulation of a fracture describe?
Which way the distal fragment points
List clinical signs of a fracture
Localised tenderness
Swelling
Deformity
Crepitus
List the factors that should be considered when assessing an injured limb
Open/closed
Neurovascular status
Compartment syndrome
Skin/soft tissue status
List ways of checking neurovascular status
Capillary refill Pulses Temperature Colour Sensation Motor power
Which XRAY views are usually used to assess the personality of a fracture?
AP
Lateral
When is CT useful for assessing fractures?
Complex bones (vertebrae, pelvis, feet)
Outline initial management of a long bone fracture
Clinical assessment
Analgesia
Splint/immobilise
Imaging
What type of splint is useful for femoral shaft fractures?
Thomas splint
Describe a fracture that would be considered “stable” and be treated with a period of splintage + rehab
Undisplaced
Minimally displaced
Minimally angulated
How can unstable/acceptable fractures be treated?
Reduction
Cast application
Surgical stabilisation
List materials that can be used in surgical stabilisation/open reduction and internal fixation
Plates and screws
Intramedullary nails
Cerclage wires
List early local complications of fractures
Compartment syndrome
Vascular injury/ischaemia
Nerve damage
Skin necrosis
What is compartment syndrome?
Increased pressure (inflammatory exudate, bleeding) compresses the venous system, causing congestion within muscle compartments and ischaemia since arterial blood cannot get through
List the cardinal clinical signs of compartment syndrome
Increased pain on passive stretching of muscle
Severe pain outwith severity of context
Swollen/tender limb
What is the urgent surgery for compartment syndrome?
Fasciotomy
What is the name of the fibrotic contracture that can develop from necrotised muscle in compartment syndrome?
Volkmann’s ischaemic contracture
What is the mainstay of treatment for most soft tissue trauma?
RICE Rest Ice Compression Elevation
