Basics and general concepts of trauma Flashcards
Principal mineral of bone
Ca hydroxyapatite
Components of bone
Organic: osteoid
Water
Inorganic ca hydroxyapatite
Osteoid is composed of
cells and proteins
Bone proteins include
Type 1 collagen (main)
Osteocalcin
Osteonectin
Cells of bone include
Osteoblast
Osteocyte
Osteoclast
Osteoblast is rich in?
ALP
Osteoclast is rich in
TRAP and carbonic anhydrase
Most abundant cell in bone
Osteocyte
Longest life span among bone cells
Osteocyte
Type of collagen in
1. Knee meniscus
2. Articular hyaline cartilage
- Type 1
- Type 2
Formation markers of bone
Pro collagen
Osteonectin
Osteocalcin
ALP (imp)
Breakdown markers of bone
Hydroxyproline
Hydroxylysine
N and C telopeptide
TRAP (M. I)
What markers rise in osteoporosis?
TRAP
Layers of growth plate
Germinal layer (m.i)
Proliferative layer
Hypertrophic layer
Layer of calcification
Layer of ossification
Weakest layer of growth plate
Hypertrophic layer
MC layer involved in traumatic injury in growth plate
Hypertrophic layer
Revise salter and harris classification
f
MC type of Salter Harris fractures
Type 2
Metaphyseal fragment in Type 2 fracture is called
Thurston Holland fragment
Which # in Salter Harris classification has the worst prognosis?
Type V/ Rammed/ Crushed #
(bec late presentation)
Most Imp clinical indication of (#
Abnormal motility
WHat clinical feature separates pathological # from the other #?
Pain occurs before # d/t preexisting lesion
What is Mirel’s criteria used for?
Plan for prophylactic fixation of pathological #
AT what score is the need for prophylactic internal fixation decided in Mirel’s criteria?
> 8
Multiple stress # requires what investigation?
Bone scan
Bones with tendency for AVN
Head of femu\r
Prox pole of scaphoid
Prox pole of lunate
body of talus
Distal femoral condyle
Head of humerus
Capitulum
causing most amount of blood loss
Pelvis > femur
What are the causes of traumatic AVN?
waist of scaphoid
# neck of talus
# waist of scaphoid
MCC of non traumatic AVN
Other causes of non traumatic AVN
Idiopathic > Steroid use
Sickle cell d/s
Gaucher’s d/s
Alcohol abuse
Perthes’ d/s
Caisson d/s
Above what score in MESS is indication of amputation?
> /= 7
What are the components of MESS
Mangled Extremity Severity Score:
V: Velocity of injury/ soft tissue coverage
I: Ischemia time (MI)
S: Shock
A: Age
Other Trauma related scores
Ganga score
Limb salvage score
CHeck out the diagrams of amputation
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What prosthesis are available?
Jaipur foot and Solid Ankle Cushion Heel (SACH)
MC pathogen involved in open #
S/ aureus
Gustilo Anderson classification– check out
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WHen should wound closure be delayed in open #?
> 6 hr wound
New neurovasc injury
Edges cannot be approximated
Instruments used for external fixation
- Schantz pin with external rod
- Illizarov ring fixator
- Rail fixator/ limb reconstruction system
- Spanning external fixator
Check out the pics
Spanning external fixator is used in
Periarticular #
Which fixator uses distraction osteogenesis?
Illizarov external fixator
It is aka Callotaxis (1mm/d)
Primary healing of # is aka? Secondary healing is aka
Primary/ Direct/ intramembranous
Secondary/ Indirect/ Endochondral
Callus formation is seen in what type of healing?
Secondary
What achieves primary healing of #?
Compression plates
Lag screws
Check out stages of secondary healing
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Types of non union
Hypertrophic and atrophic non union
CHeck out hypertrophic vs atrophic non union diff
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Treatment of –
hypertrophic non union
Atrophic non union
Immobilisation
Autologous bone grafting
MC site of bone graft harvesting?
Iliac crest
MOA of bone graft incorporation
Creeping substitution
Malunion TOC
Osteotomy
Bones with increased risk of malunion
Clavicle (MC)
SCH #
Intertrochanteric extracapsular # femur
Colle’s
Bones with increased risk of nonunion
Lower 1/3 of tibia (mMC)
Scaphoid
Lat condyle of humerus
Neck of femur (intracapsular)
Neck of talus
Mx of Intraarticular #
ORIF with plates and screws
Mx of Extraarticular #
Conservative: POP, cast, slab..
Surgical (definitive):
UL– Plating with screws
LL– Intramedullary rods/ nails with interlocking screws
Mx of patella or oleacranon #
Bc they have fragment pulled by attached tendons
Tension band wiring with K wires and stainless steel wires
(distractive force becomes compressive force)
Fractures of necessity:
Intracondylar #
Neck of femur #
Monteggia/ Galleazi #
Lat condylar # humerus
