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Y2 MSK > Adult Regional Trauma > Flashcards

Adult Regional Trauma Flashcards

1
Q

When spinal shock occurs, loss of motor function and sensation occurs above the level of the injury. True/False?

A

False

BELOW the level of the injury

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2
Q

What normal body reflex is absent in spinal shock?

A

Bulbocavernous reflex

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3
Q

Describe complete spinal cord injury

A

No sensory or voluntary motor function below level of injury

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4
Q

Describe incomplete spinal cord injury

A

Some neurologic function present distal to level of injury

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5
Q

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

A

True

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6
Q

Pelvic fractures are more common in which age groups?

A 
Young patients (high energy)
Old patients (osteoporosis)
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7
Q

Name the bones that form the pelvic ring

A

Sacrum
Ilium
Ischium
Pubic bones

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8
Q

How is the pelvic ring like a polo mint?

A

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

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9
Q

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

A

One half of pelvis is displaced medially

e.g. RTA

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10
Q

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

A

One half of pelvis is displaced superiorly

e.g. fall from height

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11
Q

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

A

Disruption of pubic symphysis (open-book-pelvis)

e.g. motorcycle accident

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12
Q

What neurovascular structures are at risk in pelvic fractures?

A

Branches of internal iliac artery
Venous plexus
Lumbo-sacral plexus

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13
Q

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

A

True

Assess sacral nerve root function, check blood

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14
Q

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

A

Low energy osteoporotic injury due to FOOSH

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15
Q

Which part of the proximal humerus is most commonly fractured?

A

Surgical neck

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16
Q

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

A

Medially (due to pull of pectoralis major)

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17
Q

What is the mainstay treatment for proximal humerus fractures?

A

Sling immobilisation

Internal fixation if recurrent displacement

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18
Q

Which direction of shoulder dislocation is most common?

A

Anterior

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19
Q

What is a Bankart lesion?

A

Anterior shoulder dislocation causes detachment of glenoid labrum and capsule

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20
Q

What is a Hill-Sachs lesion?

A

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

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21
Q

Which nerve is at risk in shoulder dislocation?

A

Axillary nerve

Also other nerves of brachial plexus

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22
Q

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

A

Lightbulb sign

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23
Q

What is the principle sign of axillary nerve injury?

A

Loss of sensation in badge-patch area

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24
Q

What is the mainstay of treatment for anterior shoulder dislocation?

A

Closed reduction under sedation/anaesthetic
Sling 2-3wks
Physio

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25
Q

Describe the relationship between risk of recurrent shoulder dislocation and age of the patient

A

Patients under 20yrs have 80% risk of re-dislocation; patients over 30yrs have 20% risk

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26
Q

What is involved in Bankart repair?

A

Reattach torn labrum and capsule via arthroscopy/open repair

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27
Q

How do injuries of the ACJ usually occur?

A

Fall onto the point of the shoulder

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28
Q

In subluxation of the ACJ, what is usually ruptured?

A

Acromioclavicular ligaments

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29
Q

In dislocation of the ACJ, what is usually ruptured?

A

Coracoclavicular ligaments

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30
Q

Up to how many degrees of angulation are accepted in humeral shaft fractures? Why?

A

30’

Mobility of shoulder and elbow joint aid union

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31
Q

Which nerve is susceptible to injury in humeral shaft fractures? What pathology can damage to this nerve cause?

A

Radial nerve

Wrist drop + loss of sensation in first dorsal web space

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32
Q

How are intraarticular fractures generally treated?

A

ORIF (open reduction, internal fixation)

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33
Q

Describe the usual mechanism of injury in olecranon fractures

A

Fall onto the point of the elbow + contraction of triceps

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34
Q

Most elbow dislocations occur in which direction?

A

Posteriorly

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35
Q

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)

A

If one bone fractures, there is usually a fracture in the other bone as well

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36
Q

What is a nightstick fracture?

A

Fracture of the ulnar shaft

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37
Q

What is the name given to a fracture of the ulnar shaft?

A

Nightstick fracture

38
Q

How is a diaphyseal fracture of both forearm bones treated?

A

ORIF with plates and screws

Intramedullary nail if very unstable

39
Q

Describe a Monteggia fracture

A

Fracture of ulna + dislocation of radial head at the elbow

A is proximal

40
Q

What is the name given to a fracture of ulna with dislocation of radial head at the elbow?

A

Monteggia fracture

41
Q

Describe a Galeazzi fracture

A

Fracture of radius + dislocation of ulna at distal radioulnar joint
Z is distal

42
Q

What is the name given to a fracture of radius with dislocation of ulna at distal radioulnar joint?

A

Galeazzi fracture

43
Q

What is the usual mechanism of injury in distal radial fractures?

A

FOOSH

44
Q

Describe a Colles fracture

A

Extra-articular fracture of distal radius, within an inch of the articular surface, with dorsal displacement

45
Q

Which nerve can be damaged in Colles fracture?

A

Median nerve

46
Q

Describe a Smith’s fracture

A

Extra-articular fracture of distal radius with volar displacement

47
Q

All Smith’s fractures should undergo what treatment?

A

ORIF with plate and screws

48
Q

Describe a Barton’s fracture

A

Intra-articular fracture of distal radius, where carpal bones sublux

49
Q

What is another name for a dorsal Barton’s fracture?

A

Intra-articular Colles fracture

50
Q

What is another name for a volar Barton’s fracture?

A

Intra-articular Smith’s fracture

51
Q

List clinical signs of a scaphoid fracture

A

Tender anatomical snuffbox

Pain on compressing thumb metacarpal

52
Q

How many XRAY views of a suspected scaphoid fracture are taken?

A

4AP, lateral + 2 oblique views two weeks post injury

53
Q

How are undisplaced scaphoid fractures usually treated?

A

Plaster cast for 6-12 weeks

54
Q

Fractures of the 5th metacarpal usually occur how?

A

Punching injury (Boxer’s fractures)

55
Q

How many degrees of angulation can be tolerated in a Boxer’s fracture?

A

Up to 45’

56
Q

What is the most common cause of hip fractures in the elderly?

A

Osteoporosis

57
Q

The majority of hip fractures occur in males. True/False?

A

False

Females

58
Q

Nearly all patients with hip fracture undergo surgery. True/False?

A

True

Risk of non-op just as high as risk of op

59
Q

What are the 2 broad categories of hip fractures?

A

Intracapsular

Extracapsular

60
Q

What is the blood supply to the head of the femur?

A

Branch of obturator artery

61
Q

What is the blood supply to the neck of the femur?

A

Femoral circumflex artery (medial and lateral)

62
Q

The arterial supply of the femoral head is more at risk of disruption in extracapsular fractures. True/False?

A

FalseIntracapsular

63
Q

Describe the position of intracapsular fractures

A

Subcapital/above trochanteric line

64
Q

What is the mainstay of treatment for intracapsular hip fractures?

A

Hemiarthroplasty

Total hip replacement

65
Q

Extracapsular hip fractures can be repaired with internal fixation. True/False?

A

True
High union rate + low risk of AVN
Compression/dynamic hip screw

66
Q

Which type of embolism can occur with femoral shaft fractures?

A

Fat embolism

67
Q

Which type of splint is recommended for femoral shaft fractures?

A

Thomas splint

68
Q

A knee dislocation is a surgical emergency. True/False?

A

True

High risk of neurovascular injury - popliteal artery

69
Q

Virtually all patellar dislocations occur in which direction?

A

Lateral dislocation

70
Q

Patellar dislocation is more common in females. True/False?

A

True - most commonly teenage girls - likely to have hypermobility or ligament laxity which contributes

71
Q

Are proximal tibia (plateau) fractures intra- or extra- articular? What is another name for them?

A

Intra-articular

Bumper fracture

72
Q

Which nerve may be injured in proximal tibia fractures?

A

Common fibular nerve

can cause foot-drop

73
Q

Which fracture is the commonest cause of compartment syndrome after trauma?

A

Tibial shaft fracture

74
Q

What is the extent of displacement and angulation acceptable for conservative management of tibial shaft fractures?

A

Up to 50% displacement

5% angulation

75
Q

What is the commonest method of surgical stabilisation in tibial shaft fractures?

A

Intramedullary nail

76
Q

What is another name for a distal tibia fracture?

A 
Pilon fracture
(refers to intra-articular fracture)
77
Q

Pilon fractures are treated how?

A

ORIF generally

78
Q

What is the most common mechanism of injury in ankle fractures?

A

Inversion injury

Rotational force on planted foot

79
Q

What is the main clinical sign of an unstable ankle fracture on XR?

A

Talar shift

80
Q

What is another name for a midfoot fracture?

A

Lisfranc fracture

81
Q

Describe a Lisfranc fracture

A

Fracture of base of 2nd metatarsal with/without dislocation of other metatarsals at the TMJs

82
Q

Which tendon is involved in avulsion fracture of the 5th metatarsal?

A

Peroneus brevis

83
Q

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

A

Posterior fat pad sign (fat should be anterior to distal humerus)

84
Q

What nerve is at risk of damage in posterior hip dislocation?

A

Sciatic nerve

85
Q

How is a Lisfranc fracture typically managed?

A

Internal fixation

86
Q

List some clinical signs of hip fractures

A 
Shortening
External rotation positioning
Trochanteric bruising
Unable to SLR
Severe groin pain on rotational movement
87
Q

What is the characteristic sign on XRAY in intracapsular hip fracture?

A

Break in Shenton’s line (line along border of pubic ramii and neck of femur)

88
Q

How are subtrochanteric hip fractures managed?

A

Thomas splint for analgesia

IM nail if delayed union

89
Q

List 4 ways in which hip fractures are prevented?

A

Falls clinic
Anti-resorptive drugs for osteoporosis
Hip protectors
Excercise to maintain muscle strength and bone mineral density

90
Q

How are Monteggia and Galeazzi fracures managed?

A

Reduction and rigid fixation

Y2 MSK (30 decks)

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