6- Adult Regional Trauma Flashcards
When spinal shock occurs, loss of motor function and sensation occurs above the level of the injury. True/False?
False
BELOW the level of the injury
What normal body reflex is absent in spinal shock?
Bulbocavernous reflex
Describe complete spinal cord injury
No sensory or voluntary motor function below level of injury
Describe incomplete spinal cord injury
Some neurologic function present distal to level of injury
The presence of sacral spinal cord sparing in spinal cord injury indicates a better prognosis. True/False?
True
Pelvic fractures are more common in which age groups?
Young patients (high energy) Old patients (osteoporosis)
Name the bones that form the pelvic ring
Sacrum
Ilium
Ischium
Pubic bones
How is the pelvic ring like a polo mint?
If it breaks in one place, it will inevitably break in another part
What happens in lateral compression fracture of pelvis? Give an example
One half of pelvis is displaced medially
e.g. RTA
What happens in vertical shear fractures of the pelvis? Give an example
One half of pelvis is displaced superiorly
e.g. fall from height
What happens in anteroposterior compression injury of the pelvis? Give an example
Disruption of pubic symphysis (open-book-pelvis)
e.g. motorcycle accident
What neurovascular structures are at risk in pelvic fractures?
Branches of internal iliac artery
Venous plexus
Lumbo-sacral plexus
A PR exam is mandatory in pelvic fractures. True/False?
True
Assess sacral nerve root function, check blood
What is the most common mechanism of injury in proximal humerus fractures?
Low energy osteoporotic injury due to FOOSH
Which part of the proximal humerus is most commonly fractured?
Surgical neck
In which direction does the humeral shaft usually displace in proximal humerus fractures?
Medially (due to pull of pectoralis major)
What is the mainstay treatment for proximal humerus fractures?
Sling immobilisation
Internal fixation if recurrent displacement
Which direction of shoulder dislocation is most common?
Anterior
What is a Bankart lesion?
Anterior shoulder dislocation causes detachment of glenoid labrum and capsule
What is a Hill-Sachs lesion?
Posterior humeral head impacts anterior glenoid, causing impaction fracture of posterior humeral head
Which nerve is at risk in shoulder dislocation?
Axillary nerve
Also other nerves of brachial plexus
What is the characteristic sign on XRAY in posterior shoulder dislocation?
Lightbulb sign
What is the principle sign of axillary nerve injury?
Loss of sensation in badge-patch area
What is the mainstay of treatment for anterior shoulder dislocation?
Closed reduction under sedation/anaesthetic
Sling 2-3wks
Describe the relationship between risk of recurrent shoulder dislocation and age of the patient
Patients under 20yrs have 80% risk of re-dislocation; patients over 30yrs have 20% risk
What is involved in Bankart repair?
Reattach torn labrum and capsule via arthroscopy/open repair
How do injuries of the ACJ usually occur?
Fall onto the point of the shoulder
In subluxation of the ACJ, what is usually ruptured?
Acromioclavicular ligaments
In dislocation of the ACJ, what is usually ruptured?
Coracoclavicular ligaments
Up to how many degrees of angulation are accepted in humeral shaft fractures? Why?
30’
Mobility of shoulder and elbow joint aid union
Which nerve is susceptible to injury in humeral shaft fractures? What pathology can damage to this nerve cause?
Radial nerve
Wrist drop + loss of sensation in first dorsal web space
How are intraarticular fractures generally treated?
ORIF (open reduction, internal fixation)
Describe the usual mechanism of injury in olecranon fractures
Fall onto the point of the elbow + contraction of triceps
Most elbow dislocations occur in which direction?
Posteriorly
The forearm acts as a ring because of the tight ligaments around the radio-ulnar joints. What significance does this have in fractures? (psst, think about polo mints)
If one bone fractures, there is usually a fracture in the other bone as well
What is a nightstick fracture?
Fracture of the ulnar shaft
What is the name given to a fracture of the ulnar shaft?
Nightstick fracture
How is a diaphyseal fracture of both forearm bones treated?
ORIF with plates and screws
Intramedullary nail if very unstable
Describe a Monteggia fracture
Fracture of ulna + dislocation of radial head at the elbow
What is the name given to a fracture of ulna with dislocation of radial head at the elbow?
Monteggia fracture
Describe a Galeazzi fracture
Fracture of radius + dislocation of ulna at distal radioulnar joint
What is the name given to a fracture of radius with dislocation of ulna at distal radioulnar joint?
Galeazzi fracture
What is the usual mechanism of injury in distal radial fractures?
FOOSH
Describe a Colles fracture
Extra-articular fracture of distal radius, within an inch of the articular surface, with dorsal displacement
Which nerve can be damaged in Colles fracture?
Median nerve
Describe a Smith’s fracture
Extra-articular fracture of distal radius with volar displacement
All Smith’s fractures should undergo what treatment?
ORIF with plate and screws
Describe a Barton’s fracture
Intra-articular fracture of distal radius, where carpal bones sublux
What is another name for a dorsal Barton’s fracture?
Intra-articular Colles fracture
What is another name for a volar Barton’s fracture?
Intra-articular Smith’s fracture
List clinical signs of a scaphoid fracture
Tender anatomical snuffbox
Pain on compressing thumb metacarpal
How many XRAY views of a suspected scaphoid fracture are taken?
4
AP, lateral + 2 oblique views
How are undisplaced scaphoid fractures usually treated?
Plaster cast for 6-12 weeks
Fractures of the 5th metacarpal usually occur how?
Punching injury (Boxer’s fractures)
How many degrees of angulation can be tolerated in a Boxer’s fracture?
Up to 45’
What is the most common cause of hip fractures in the elderly?
Osteoporosis
The majority of hip fractures occur in males. True/False?
False
Females
Nearly all patients with hip fracture undergo surgery. True/False?
True
Risk of non-op just as high as risk of op
What are the 2 broad categories of hip fractures?
Intracapsular
Extracapsular
What is the blood supply to the head of the femur?
Branch of obturator artery
What is the blood supply to the neck of the femur?
Femoral circumflex artery (medial and lateral)
The arterial supply of the femoral head is more at risk of disruption in extracapsular fractures. True/False?
False
Intracapsular
Describe the position of intracapsular fractures
Subcapital/above trochanteric line
What is the mainstay of treatment for intracapsular hip fractures?
Hemiarthroplasty
Total hip replacement
Extracapsular hip fractures can be repaired with internal fixation. True/False?
True
High union rate + low risk of AVN
Compression/dynamic hip screw
Which type of embolism can occur with femoral shaft fractures?
Fat embolism
Which type of splint is recommended for femoral shaft fractures?
Thomas splint
A knee dislocation is a surgical emergency. True/False?
True
High risk of neurovascular injury
Virtually all patellar dislocations occur in which direction?
Lateral dislocation
Patellar dislocation is more common in females. True/False?
True
Are proximal tibia (plateau) fractures intra- or extra- articular?
Intra-articular
Which nerve may be injured in proximal tibia fractures?
Common fibular nerve
can cause foot-drop
Which fracture is the commonest cause of compartment syndrome after trauma?
Tibial shaft fracture
What is the extent of displacement and angulation acceptable for conservative management of tibial shaft fractures?
Up to 50% displacement
5% angulation
What is the commonest method of surgical stabilisation in tibial shaft fractures?
Intramedullary nail
What is another name for a distal tibia fracture?
Pilon fracture (refers to intra-articular fracture)
Pilon fractures are treated how?
ORIF generally
What is the most common mechanism of injury in ankle fractures?
Inversion injury
Rotational force on planted foot
Name the lateral ankle ligaments
Anterior + posterior talofibular ligaments
Calcaneofibular ligaments
What is another name for a midfoot fracture?
Lisfranc fracture
Describe a Lisfranc fracture
Fracture of base of 2nd metatarsal with/without dislocation of other metatarsals at the TMJs
Which tendon is involved in avulsion fracture of the 5th metatarsal?
Peroneus brevis