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MSK CORTEXT > 6- Trauma > Flashcards

6- Trauma Flashcards

1
Q

What is involved in the primary survey in a trauma case

A

Quick assessment of vital functions and any appropriate management
ABCDE

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2
Q

What is involved in the secondary survey in a trauma case

A

Head to toe survey to detect any other injuries

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3
Q

What are the presentations of hypovolemia

A

Tachycardia
Hypotension
Confusion and lethargy

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4
Q

What score determines level of consciousness

A

Glasgow Coma score

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5
Q

Define polytrauma

A

More than one ling bone injured
OR
major fracture and associated chest or abdominal trauma

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6
Q

Describe primary healing of a fracture

A

Occurs when there is minimal fracture gap

Bone simply bridges gap with new bone from osteoblasts

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7
Q

Describe secondary healing of a fracture

A

Gap at fracture site is filled temporarily to act as a scaffold for new bone
Involves an inflammatory response

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8
Q

List the steps of secondary bone healing

A

Haematoma and inflammation occur
Macrophages & osteoclasts remove debris and resorb bone ends
Granulation tissue forms from fibroblasts
Chondroblasts form cartilage (soft callus)
Osteoblasts lay down bone matrix
Calcium minerlisation produces hard callus (woven bone)
Remodelling occurs into lamellar bone

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9
Q

How long does it take the hard callus to form in a fracture

A

6-12 weeks

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10
Q

Smoking impairs fracture healing - true or false

A

True

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11
Q

What is a transverse fracture

A

Occurs with pure bending force

Snaps across bone (horizontal)

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12
Q

What is an oblique fracture

A

Occurs with shearing force - fall from height

Diagonal fracture

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13
Q

What causes a spiral fracture

A

Torsional forces

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14
Q

What is a comminuted fracture

A

Fracture with 3 or more fragments
Very unstable
Usually very high energy

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15
Q

What is a segmental fracture

A

Bone fractures in 2 separate places

Very unstable

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16
Q

What is the angulation of a fracture

A

Describes the direction in which the distal fragment points and the degree of deformity

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17
Q

What are the clinical signs of a fracture

A

Localised bony tenderness
Swelling
Deformity
Crepitus

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18
Q

List some early local complications of fractures

A

Compartment syndrome
Vascular injury with ischaemia
Nerve compression or injury
Skin necrosis

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19
Q

List some early systemic complications of fractures

A 
Hypovolemia 
Fat embolism 
ARDS 
SIRDS 
acute renal failure 
MODS 
Death
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20
Q

List some late local complications of fractures

A

stiffness, loss of function, Chronic Regional Pain Syndrome, infection, non‐union, mal‐union, Volkmann’s ischaemic contracture, post traumatic osteoarthritis and deep vein thrombosis.

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21
Q

List late systemic complications of fractures .

A

Pulmonary embolism

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22
Q

What are the signs of compartment syndrome

A

Increased pain on stretching
Severe pain out with the clinical context
Swelling
Tender to touch

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23
Q

What causes compartment syndrome

A

Bleeding and exudate (due to fracture or other injury) compresses the venous system
This results in congestion in the muscle and secondary ischaemia

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24
Q

Which injuries are associated with vascular injury

A

Knee dislocation
Supracondylar fracture of elbow in kids
Shoulder trauma
Pelvic fractures

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25
Q

What is degloving

A

Avulsion of skin from underlying blood vessels

Can result in skin ischaemia and necrosis

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26
Q

What are the clinical signs of fracture non-union

A

ongoing pain
ongoing oedema
movement at fracture site
Bridging callus on imaging

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27
Q

What are the symptoms and signs of a fracture healing

A

Resolution of pain and function
Absence of point tenderness
No local oedema
Resolution of movement at fracture site

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28
Q

What can lead to non-union of a fracture

A 
Instability 
Excessive movement at fracture site 
Lack of blood supply
Chronic disease 
Soft tissue problems 
Infection
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29
Q

What is complex regional pain syndrome

A

Heightened chronic pain response that occurs after injury

poorly understood and hard to treat

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30
Q

What is the major complication with an open fracture

A

Infection

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31
Q

How do you prevent infection with an open fracture

A

IV broad spectrum antibiotics in A&E

Prompt surgery

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32
Q

What does delayed presentation of dislocation increase risk of

A

Requirement of open reduction

Recurrent instability

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33
Q

What is the mainstay of treatment for soft tissue injuries

A

RICE

rest, ice, compression and elevation

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34
Q

How do you grade ligament ruptures

A

Grade 1 - sprain
Grade 2 - partial tear
Grade 3 - complete tear

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35
Q

How does septic arthritis present

A

Red, hot, tender, swollen joint

Severe pain

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36
Q

Who is the most prone to septic arthritis

A

More common in kids than adults

Elderly, IVDU, immunocompromised patients

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37
Q

What is the most common cause of C spine fractures

A

High energy injury

E.g. RTA or fall from height

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38
Q

What is the most common cause of thoracolumbar fractures

A

Car accidents
Falls from height

In elderly with osteoporosis - compression or wedge

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39
Q

What is spinal shock

A

Physiologic response to injury

Complete loss of sensation, motor function and reflexes below level of injury

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40
Q

How long does it usually take spinal shock to resolve

A

24 hours

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41
Q

What reflex is lost in spinal shock

A

bulbocavernous

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42
Q

When does neurogenic shock occur

A

Secodnary to temporary shutdown of sympathetic outflow from the spinal chord from T1-L2
Usually due to cervical or thoracic chord injury

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43
Q

How do you treat neurogenic shock

A

IV fluid therapy

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44
Q

What are the classifications of spinal cord injury

A

Complete or incomplete

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45
Q

Describe a complete spinal cord injury

A

There will be no sensory or voluntary motor function below level of injury
Poor prognosis for recovery

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46
Q

Describe an incomplete spinal cord injury

A

Some neurological function is present distal to injury

Better prognosis for recovery

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47
Q

How do you treat a spinal cord injury

A

Appropriate immobilisation
Traction - if dislocated or unstable
Surgery - relieve pressure

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48
Q

What is the most common injury mechanism for proximal humerus fractures

A

low energy injuries in osteoporotic bone due to fall onto outstretched hand or shoulder

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49
Q

What is the most common fracture pattern for proximal humerus

A

Fracture of the surgical neck

Medial displacement of humeral shaft

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50
Q

How do you treat a proximal humeral fracture

A

Minimally displaced - sling and gradual mobilisation

Displaced - internal fixation

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51
Q

What is a Bankart lesion

A

Detachment of the anterior glenoid labrum and capsule

Common in anterior shoulder dislocation

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52
Q

What is the main sign of axillary nerve injury

A

Loss of sensation in the regimental badge area

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53
Q

How do you manage a dislocated shoulder

A

Closed reduction under sedation or anaesthetic

If delayed presentation then it may need to be an open reduction

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54
Q

How ACJ injuries occur

A

Fall onto the point of the shoulder

Common in sport

55
Q

What type of injury can occur in the ACJ

A

Sprain
Subluxation - ruptures the acromioclavicular ligaments
Dislocation - disrupts coraclavicular ligaments as well as AC

56
Q

How do you treat injury to the ACJ

A

Sling for a few weeks followed by physio

Surgery in those with chronic pain

57
Q

What can cause a humeral shaft fracture

A

Direct trauma - gives transverse of comminuted fracture

Fall with or without twist - oblique or spiral

58
Q

How do you treat humeral shaft fractures

A

Humeral brace - most cases

Internal fixation

59
Q

How do olecranon fractures occur

A

Fall onto the point of elbow

With contraction of the triceps

60
Q

What is a Nightstick fracture

A

Fracture to ulnar shaft caused by direct blow

61
Q

How do you treat a fracture of both arms of the forearm

A

ORIF with plates and screws

62
Q

What is ORIF

A

open reduction with internal fixation

63
Q

What is a Monteggia fracture dislocation

A

Fracture of the ulna with dislocation of radial head at elbow

64
Q

How do you treat a Monteggia fracture dislocation

A

ORIF of ulnar fracture

reduction of joint

65
Q

What is a Galeazzi fracture dislocation

A

fracture of the radius with dislocation of the ulna at the distal radioulnar joint

66
Q

How do you treat a Galeazzi fracture dislocation

A

ORIF of radius

should allow radioulnar joint to reduce

67
Q

What is a Colles fracture

A

Extra‐articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation

68
Q

What causes a Colles fracture

A

FOOSH with extended wrist

69
Q

How do you treat a Colles fracture

A

Minimally displaced - splint
Casts
Percutaneous wires

70
Q

What is a Smith’s fracture

A

volarly displaced or angulated extra‐articular fracture of the distal radius
Very unstable

71
Q

What causes a Smith’s fracture

A

Falling onto the back of a flexed wrist

72
Q

How do you treat a Smith’s fracture

A

ORIF with plates and screws

73
Q

What usually causes a scaphoid fracture

A

FOOSH

74
Q

What are the signs of a scaphoid fracture

A

Tenderness in anatomical snuffbox

Pain on compression of thumb metacarpal

75
Q

How do you treat a scaphoid fracture

A

Plaster cast for 6-12 weeks

76
Q

List some potential complications of scaphoid fractures

A

Non-union

AVN

77
Q

What are the risks of a penetrating injury to the volar aspect of the hand

A

Damage to the flexor tendons, digital nerves and digital arteries

78
Q

What are the risks of a penetrating injury to the dorsal aspect of the hand

A

Damage to extensor tendons

79
Q

How do you treat an extensor tendon injury

A

Surgical repair

6 weeks in the splint

80
Q

What is mallet finger

A

Avulsion of the extensor tendon from its insertion into the terminal phalanx

81
Q

What causes mallet finger

A

Forced flexion of the extended DIPJ, often from a ball at sport

82
Q

How does mallet finger present

A

Pain
Drooped DIPJ
Inability to extend at the DIPJ

83
Q

How do you treat mallet finger

A

Mallet splint for 4 weeks

84
Q

What is the most common cause of a 5th metacarpal fracture

A

Punching injury

also called Boxer’s fracture

85
Q

What is a fight bite?

A

Occurs in association with Boxer’s fracture
Laceration on puncher’s hand from victims teeth
Can get infected

86
Q

How do you treat metacarpal fractures

A

Strapping to neighbouring digit

87
Q

How do you treat a phalangeal fracture

A

Neighbour strapping or splintage

May need wires or fixing if unstable

88
Q

Children’s fractures heal faster than adults fractures - true or false

A

True

89
Q

Why do children’s fractures heal faster

A

Thicker periosteum which has a rich source of osteoblasts

Much better at remodelling

90
Q

What are the benefits of the remodelling potential in children

A

Need surgical stabilisation less

Greater degrees of displacement and angulation can heal

91
Q

What is the major risk with fractures around the physis

A

Potential to disturb growth

Can lead to a shortened limb or angular deformity

92
Q

How do you treat buckle fractures

A

3-4 weeks of splintage

93
Q

How do you treat greenstick fracture

A

May need manipulation and casting

94
Q

Why are supracondylar fractures common in kids

A

Weak point in the growing upper limb

Occurs on FOOSH or less commonly fall onto flexed elbow

95
Q

How do you treat an undisplaced supracondylar fracture

A

Stable so treated with a splint

96
Q

How do you treat an displaced or angulated supracondylar fracture

A

Closed reduction and pinning with wires to stop deformity

97
Q

How do femoral shaft fractures in children occur

A

Fall onto flexed knee

Indirect bending Rotational forces

98
Q

How do you treat a femoral shaft fracture in kids

A 
By age 
<2 - gallows traction and hip cast 
2-6 - Thomas splint or cast 
6-12 flexible intermedullary nails 
12> - adult type intermedullary nail
99
Q

What must you consider with femoral shaft fractures in the under 2’s

A

non-accidental injury

100
Q

How do you treat a tibial fracture in kids

A

Casting for a short time

Nails etc if very unstable

101
Q

How do hip fractures usually occur

A

Young - high energy injury (RTA)

Elderly - low energy falls if osteoporotic

102
Q

What is a lateral compression fracture

A

Occurs with side impact
One half of pelvis is displaced medially
Often accompanied by sacral compression fracture or SI joint issues

103
Q

What is a vertical shear fracture

A

Occurs due to axial force on one hemipelvis
Affected hemipelvis is displaced superiorly
High risk of injury to sacral nerve roots or lumbosacral plexus

104
Q

What is a anteroposterior compression injury

A

Results in wide disruption of pubic symphysis
Pelvis opens like book
Leads to substantial bleeding

105
Q

What is the acetabulum

A

The intra-articular section of the pelvis

Forms the ‘cup’ in the hip joint

106
Q

How do acetabular injuries usually occur

A

High energy injury in young or low energy in elderly

Associated with hip dislocation as femoral head breaks it when it pops out

107
Q

How do you treat acetabular fractures

A

Undisplaced - conservatively
May need reduction and fixation
THR in elderly

108
Q

What is the most common cause of hip fractures

A

Osteoporosis in the elderly

109
Q

What sex is more prone to hip fractures

A

Females

110
Q

Is management of hip fractures surgical or conservative

A

Almost always surgical - within 24 hrs

111
Q

How do you classify hip fractures

A

Intracapsular or extracapsular

112
Q

What normally causes femoral shaft fractures

A

High energy injury

Stress fracture in those with underlying bone disease

113
Q

What is the major risk with displaced femoral shaft fractures

A

Significant blood loss

114
Q

How do you manage a femoral shaft fracture

A

Analgesia
Thomas splint
Closed reduction and stabilisation with intramedullary nail

115
Q

How do you treat a true knee dislocation

A

It is a surgical emergency due to vascular risk
Urgent reduction
If unstable then use fixation

116
Q

what predisposes you to a patellar fracture

A

Generalised ligamentous laxity
Valgus alignment of the knee
Rotational malalignment (including femoral neck anteversion), Shallow trochlear groove.

117
Q

Describe a tibial plateau fracture

A

Intra‐articular fractures with either a split in the bone, a depression of the articular surface or a combination of both

118
Q

How do you treat a tibial plateau

A

Surgery to reduce the articular surface and fix it for stabilisation

119
Q

What are some of the other risks with tibial plateau fractures

A

Neurovascular injury

Compartment syndrome

120
Q

What usually causes a tibial shaft fracture

A

Indirect force Bending (transverse fracture) or rotational energy (spiral fracture), compressive force from deceleration (oblique fracture) or a combination

121
Q

What is the commonest cause of compartment syndrome after trauma

A

Tibial shaft fracture

122
Q

Describe the non-operative treatment of tibial shaft fracture

A

Repositioning Above knee cast

123
Q

Describe the operative treatment of tibial shaft fracture

A

Internal fixation
Surgical stabilisation - ORIF
Intermedullary nails

124
Q

What are Pilon fractures

A

Intra-articular fractures of the distal tibia

125
Q

What movement most commonly causes ankle injury

A

inversion injury and/or rotational force on a planted foot.

126
Q

What is the key symptom of ankle sprain

A

Pain, bruising and mild to moderate tenderness over the involved ligaments

127
Q

What is the treatment for a stable ankle fracture

A

Walking cast or splint for around 6 weeks

128
Q

What is the treatment for an unstable ankle fracture

A

ORIF - plates and screws

anatomical reduction

129
Q

How does a midfoot dislocation/fracture present

A

Grossly swollen and bruised foot
Unable to weight bear
X-ray may appear normal

130
Q

How do you treat a midfoot dislocation/fracture

A

Closed or open reduction with fixation (screws)

131
Q

Describe common metatarsal fractures

A

base of 5th common - inversion injury
2nd is common place for stress fracture
Lesser ones common to fracture but 1st is uncommon as so strong

132
Q

How do you treat metatarsal fractures

A

Walking cast or boot - 4-6 weeks

Stabilized with K wires

133
Q

How do you treat a toe fracture

A

Protection in stout boot

Open fractures need debridement and stabilisation with wires

MSK CORTEXT (13 decks)

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