Abdominal, Pelvis and Hip Trauma Flashcards
What are the most common forms of abdominal trauma?
- Blunt abdominal trauma
- Compression forces
- Deceleration forces
- Penetrating abdominal trauma
What effect do compression/concussive forces have on the abdomen as a form of blunt trauma?
Cause tears and subcapsular haematomas in solid organs (liver) and increase intraluminal pressure in hollow ones (stomach)
- Rupture or burst injury of a hollow organ by sudden rises in intra-abdominal pressures
- Crushing effect
What effect do deceleration forces have on the abdomen as a form of blunt trauma?
Cause stretching and linear shearing between relatively fixed and free objects
- “seat belt sign” - linked with intraperitoneal injury
- lap belts cause hyperflexion at the waist
How is abdominal trauma assessed?
- establish if a haemoperitoneum that is increasing in size exists - determines the need for a laparotomy
- plain film radiograph is not indicated unless there is a suspicion of a foreign body
What is projection imaging used for in cases of abdominal trauma?
- Fractures – nearby visceral damage
- Free intraperitoneal air
- Foreign bodies and missiles
How is CT used for imaging abdominal trauma?
- Accurate for solid visceral lesions and intraperitoneal hemorrhage
- Guide nonoperative management of solid organ damage
- IV not oral contrast
What are the disadvantages of CT when imaging abdominal trauma?
- insensitive for injury of the pancreas, diaphragm, small bowel, and mesentery
Why is angiography used for diagnosing/assessing abdominal trauma?
- To embolize bleeding vessels or solid visceral hemorrhage from blunt trauma in an unstable pt
- Rarely for diagnosing intraperitoneal and retroperitoneal hemorrhage after penetrating abdominal trauma
Why is ultrasound used for imaging abdominal trauma?
- To detect whether intra-abdominal free fluid is increasing rather than defining the exact site of injury
- To triage patients who might require surgery
- F A S T - Focused Assessment for the Sonographic examination of the Trauma patient
- kidney, spleen, liver, subcostal heart view
What is a Diagnostic Peritoneal Lavage (DPL) and how is it performed?
A surgical diagnostic procedure to determine if there is free-floating fluid in the peritoneal cavity
- Local anaesthesia
- Vertical incision at point 1/3 distance from umbilicus to pubic symphysis
- Linea alba divided
- Catheter inserted
- Aspiration attempted
- Washout with saline and analysis
What does the physiological evaluation of penetrating abdominal injuries focus on?
- Peritonitis - inflammation of peritoneum (from organ rupture or infection_
- Haemodynamic instability - unstable/abnormal blood pressure
What are the common intra-abdominal injuries from stab wounds?
31% stab wounds
- Liver - 40%
- Small bowel - 30%
- Diaphragm - 20%
- Colon - 15%
What are the common intra-abdominal injuries from gunshot wounds?
64% gunshot wounds
- Small bowel - 50%
- Colon - 40%
- Liver - 30%
- Abdominal vascular structures - 25%
How is penetrating abdominal trauma managed?
Thoracoabdomen
- Big concern is diaphragmatic injury
- 7% of thoracoabdominal wounds
- Diagnostic evaluation:
- CXR (haemothorax or pneumothorax)
- Diagnostic peritoneal lavage
- FAST
- Thoracoscopy
What types of pelvic fracture are there?
- Pelvic ring fractures
- Acetabular fractures
- Avulsion fractures
What are the signs of a major injury to the pelvis?
- Lots of force required to disrupt the ring
- Bruising, swelling, tenderness, pain and crepitus
- Hypovolaemic shock
- Ruptured urethra
- Other viscera
- Neurological signs
What do we look for to spot pelvic ring fractures?
- Main pelvic ring
- Two secondary rings (obturator foramen)
- Sacro-iliac joints - widths should be equal
- Symphysis pubis
- superior surfaces should be in alignment
- joint width of approximately 5mm
- Acetabulum
How do acetabular fractures occur?
- Young - high energy trauma
* Later life - post-traumatic arthritis
What is Judet classification?
A system for classifying types of acetabulular fractures.
A - posterior wall B - posterior column C - anterior wall D - anterior column E - transverse acetabular fractures
What avulsion fractures occur in the pelvis?
- From muscle contractions at the site of insertion
- Athletic injuries in adolescence
- ASIS (sartorius)
- contraction with hip extended and knee flexed (sprinting, swinging bat)
- Ischial tuberosity (hamstring)
- contraction while flexed (running, hurdling)
What is Garden’s classification?
System for classifying femoral neck fractures and displacements.
- Stage I - incomplete # (including impacted)
- Stage II - complete #, no displacement
- Stage III - complete #, partial displacement
- Stage IV - complete #, full displacement
How do we judge the displacement of femoral neck fractures on a radiograph?
Judged by the amount of mal-alignment between the trabecular lines in the femoral head and neck on either side of the fracture line on an AP hip radiograph.
How does hip dislocation occur?
- Many follow severe trauma
- 80% are posterior dislocations
- Associated fracture of acetabulum or femoral head are common
What is developmental dysplasia of the hip?
- Hip joint has not formed normally
- Head is loose in socket and may be easily disolocated
- Femoral heads may appear to rest by the iliac spine
