6- Adult Regional Trauma Flashcards by Ben Young

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

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What normal body reflex is absent in spinal shock?

Bulbocavernous reflex

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Describe complete spinal cord injury

No sensory or voluntary motor function below level of injury

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Describe incomplete spinal cord injury

Some neurologic function present distal to level of injury

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The presence of sacral spinal cord sparing in spinal cord injury indicates a better prognosis. True/False?

True

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Pelvic fractures are more common in which age groups?

Young patients (high energy)
Old patients (osteoporosis)

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Name the bones that form the pelvic ring

Sacrum
Ilium
Ischium
Pubic bones

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How is the pelvic ring like a polo mint?

If it breaks in one place, it will inevitably break in another part

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What happens in lateral compression fracture of pelvis? Give an example

One half of pelvis is displaced medially

e.g. RTA

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What happens in vertical shear fractures of the pelvis? Give an example

One half of pelvis is displaced superiorly

e.g. fall from height

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What happens in anteroposterior compression injury of the pelvis? Give an example

Disruption of pubic symphysis (open-book-pelvis)

e.g. motorcycle accident

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What neurovascular structures are at risk in pelvic fractures?

Branches of internal iliac artery
Venous plexus
Lumbo-sacral plexus

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A PR exam is mandatory in pelvic fractures. True/False?

True

Assess sacral nerve root function, check blood

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What is the most common mechanism of injury in proximal humerus fractures?

Low energy osteoporotic injury due to FOOSH

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Which part of the proximal humerus is most commonly fractured?

Surgical neck

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In which direction does the humeral shaft usually displace in proximal humerus fractures?

Medially (due to pull of pectoralis major)

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What is the mainstay treatment for proximal humerus fractures?

Sling immobilisation

Internal fixation if recurrent displacement

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Which direction of shoulder dislocation is most common?

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What is a Bankart lesion?

Anterior shoulder dislocation causes detachment of glenoid labrum and capsule

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What is a Hill-Sachs lesion?

Posterior humeral head impacts anterior glenoid, causing impaction fracture of posterior humeral head

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Which nerve is at risk in shoulder dislocation?

Axillary nerve

Also other nerves of brachial plexus

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What is the characteristic sign on XRAY in posterior shoulder dislocation?

Lightbulb sign

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What is the principle sign of axillary nerve injury?

Loss of sensation in badge-patch area

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What is the mainstay of treatment for anterior shoulder dislocation?

Closed reduction under sedation/anaesthetic

Sling 2-3wks

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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