CORTEXT: Trauma Flashcards
what is remodelling of bone?
change shape with bone laid down along areas of stress
what is the main role of the periosteum?
increases width/circumference of growing long bones
do adults or children have a thicker periosteum?
children
what would you do if a child had a moderate displaced fracture?
just cast them, bone can remodel better than adults
when would a child’s fracture be treated as an adults fracture?
12-14
what causes an angular deformity?
one side of the physis affected by growth arrest
which salter harris fracture has the best prognosis?
salter harris 1 fracture
which salter harris type are most physeal fractures?
type 2
what salter harris type are unable to be seen on x ray?
type 5
why is there greater potential for growth arrest in type 3 and 4 salter harris fractures?
fracture splits the physis as they are intraarticular
how long should a splint be left on for a buckle fracture?
3-4 weeks
treatment for greenstick fractures?
manipulation and casting
name a common area for a salter haris type 2 fracture in older children?
distal radius
what would you do if a complete fracture is very unstable after reduction
do wire stabilisation or plate fixation
what are the only type of fractures to be improved by 1st line recuction and rigid fixation?
monteggia and galeazzi fractures
how should a displaced fracture of both forearm bones be managed?
flexible intramedullary nails
how should an angulated fracture of both forearm bones be managed?
manipulation then cast
what movement tends to cause a supracondylar elbow fracture?
heavy fall onto extended outstretched hand
how to treat undisplaced supracondylar fracture of the elbow?
splint
how to treat angulated, displaced or rotated fractures of the supracondylar elbow?
closed reduction and pinning with wires
why can some patients with an extension type supracondylar elbow fracture not make the OK sign?
median nerve and brachial artery are compressed by a fragment of bone
what nerve injuries make up the majority in a supracondylar fracture of the elbow?
neurapraxias
what symptoms would make you consider nerve entrapment from a fracture?
unpleasant shooting or burning pain radiating to the sensory distribution of the nerve
most common movement causing a femoral shaft fracture?
flexed knee
most common cause of femoral shaft fracture in kids under 2
NAI
treatment for femoral shaft fracture in kids aged 2-6?
thomas splint
hip spica cast
treatment for femoral shaft fractures in kids under 2?
hip spica
gallows traction
treatment for kids age 6-12 for femoral shaft fracture?
flexible intramedullary nails
treatment for femoral shaft fracture in kids over 12?
adult intramedullary nail
what is a toddlers fracture?
undisplaced spiral fractures of tibial shaft
mainstay treatment for tibial fractures for kids?
cast
why do you not treat adults in a cast for tibial fractures?
risk of compartment syndrome much higher
name the 4 ways in which the spinal cord can get damaged?
contusion
compression
laceration
stretch
what is spinal shock?
physiologic response to injury with loss of sensation, motor function and reflexes below the level of injury
how long does spinal shock take to recovr?
24hrs
what test would you use to see if spinal shock is present?
bulbocavernous reflex to see if anal spincter contracts
neurogenic shock occurs secondary to temporary shutdown of x outflow from what nerve roots?
x = sympathetic
T1-L2
injury in what area is most likely to cause neurgenic shock?
cervical or upper thoracic cord
how long does it take for neurogenic shock to resolve itself?
24-48hrs
treatment for neurogenic shock?
IV fluid therapy
difference between complete and incomplete spinal cord injury?
no sensory or voluntary motor function below level of injury in complete BUT in incomplete there is still some neurologic function distal to injury
how do you determine the level of the injury in complete spinal cord injury?
most distal spinal cord level with partial function
what vessels are at risk in a pelvic fracture?
internal iliac arterial system
pre sacral venous plexus
3 main patterns of injury to the pelvis?
lateral compression fracture
vertical shear fracture
anteroposterior compression injury
cause of a lateral compression fracture of pelvis?
side impact eg in RTA
cause of a vertical shear fracture?
axial force on one hemipelvis eg in fall from heigh, rapid deceleration
if a lateral compression fracture is in the pubic rami or ischium, what else are the going to have?
SI joint disruption or
sacral compression fracture
what of the 3 pelvis fractures will present with a shortened leg?
vertical shear
what pelvic fracture is described as an open book fracture due to the way the pelvis moves after injury?
anterioposterior compression injury
immediate management of a fractured pelvis?
fluids/transfusion if blood loss
apply tied sheet or pelvic binder around it
angiogram/embolisation if bleeding
PR exam
what would rectal bleeding after pelvic injury suggest?
open fracture causing rectal tear
most common pelvic fracture to occur in elderly?
minimally displaced lateral compression injuries
what other pathologies can be present in a posterior wall fracture?
hip dislocation
can acetabular fractures be treated conservatively?
yes, if small and undisplaced
are proximal humerus fractures usually high or low energy?
low, usually osteoporotic
is fracture of the surgical or anatomical neck of the humerus more common
surgical
does the humerus tend to displace medially or laterally
medially
treatment for displaced humeral neck fractures?
internal fixation
what do you could an impaction fractue of the posterior head of the humerus?
hill sachs lesion
principle sign of axilalry nerve injury?
loss of sensation in regimental badge area
what fractures can happen along with a shoulder dislocation?
surgical neck
greater tuberosity
treatment for shoulder dislocation?
closed reduction under anaesthetic
sling for 2-3 weeks
is age inversely proportional to likelihood of future dislocation?
yes
what causes posterior shoulder dislocations?
posterior force on an adducted, internally rotated arm
3 forms of injury that can happen to the AC joint?
sprain
subluxation
dislocation
treatment for AC joint injury?
sling
physio
what is the only fracture alignment that can increase bone length?
distraction
what would you call a fracture that has shortened the overall bone but hasnt affected the alignment?
impacted fracture
what is an avulsion fracture?
ligament or tendon pulling off a bone fragment
cause of a stress fracture?
permanent low impact trauma to normal bone
only visible x ray abnormality of a stress fracture?
subtle calcification of periosteum
what do you call a transverse and partially comminuted fracture of the radius?
colles fracture
what other fracture is common along with a colles fracture?
transverse fracture of ulnar styloid
how is the distal radius’ position changed as a result of a colles fracture?
dorsal displacement
angulation
what is diastasis?
separation of 2 normally adjacent parts
treatment for mild and severe colles fractures?
mild = splintage severe = manipulation then ORIF/percutaneous wires
what nerve injury can happen with a colles fracture and why?
median nerve compression via stretched nerve/carpal tunnel bleed
late local complication of colles fracture?
extensor pollicis longus rupture
what happens to the distal radius in a smith’s fracture?
it is volarly displaced/angulated
where is the volar surface of the wrist?
the side on the same as the palm
treatment for smiths fracture?
ORIF using plate and screws
which of these fractures is intraarticular?:
bartons
smiths
colles
bartons
what area of the body does a bartons fracture affect?
distal radius
another name for a volar bartons fracture?
intraarticular smiths fracture
clinical signs of a scaphoid fracture?
tenderness in anatomical snuffbox
pain on compression of thumb
the anatomic snuffbox is located between which tendons?
abductor pollicis brevis
extensor pollicis longus
how many views are taken of a scaphoid fracture? what are they?
4: AP, lateral, 2 obliques
what is a clinical scaphoid fracture?
suspected scaphoid fracture that doesn’t appear on x ray
treatment for undisplaced scaphoid fractures?
plaster cast for 6-12 weeks
treatment for displaced scaphoid fractures?
fixation with special compression screw
what structure(s) are at risk of injury in a volar fracture of the hand?
flexor tendons
digital nerves
digital arteries
what structure(s) are at risk of injury in a dorsal hand fracture?
extensor tendons
how do you manage a complete or significant partial tendon injury?
surgical repair always
clinical presentation of mallet finger?
pain
drooped DIPJ
inability to extend at DIPJ
most common cause of a 5th metacarpal fracture?
punching
what metacarpal fractures are treated conservatively?
3, 4, 5
what is a fight bite?
punchee’s teeth penetrating tendons in finger?
mortality from a hip fracture at 1 month?
10%
mortality from a hip fracture at four months?
20%
mortality from a hip fracture at one year?
30%
arterial supply to the femoral head?
anastomosis of the circumflex femoral arteries (branch of deep femoral artery)
what type of hip fracture poses a risk to the arterial supply of the femoral head?
intracapsular
what type of hip fracture poses a risk of avascular necrosis?
intracapsular
treatment for extracapsular hip fracture?
internal fixation
what medication can cause a femoral shaft fracture?
bisphosphonates long term
why are thomas’ splints good for emergencies?
stabilises a fracture to minimise blood loss and fat embolism
management of femoral shaft fracture?
closed reduction and stabilisation with intramedullary nail
treatment for unstable knee dislocation?
external fixation
what ligament injuries make the knee particularly unstable?
PCL
LCL
do you get a haemarthrosis in patellar dislocation?
yes
clinical presentation of patellar dislocation?
obviously displaced patella
tenderness over medial retinaculum
haemarthrosis
treatment for patellar dislocation?
splintage then physio
are tibial plateau fractures intra or extraarticular?
intra
most common management for intraarticular fractures?
surgical fixation to reduce articular surface
cause of a lateral plateau fracture?
valgus stress injury
what fracture is a blow from a car bumper most likely to cause?
proximal fibular
what tools are used in surgical fixation of a tibial plateau fracture?
plates and screws
what should be checked before starting ORIF?
check for soft tissue swelling or injury
what kind of force is the most likely cause of a transverse tibial shaft fracture?
bending
what kind of force is the most likely cause of a spiral tibial shaft fracture?
rotation
what kind of force is the most likely cause of a oblique tibial shaft fracture?
compressive eg by deceleration
can you get open tibial fractures?
yes, not uncommon as tibia is subcutaneous
commonest cause of compartment syndrome after trauma?
tibial fracture
how much displacement and angulation of the tibia is tolerated to be conservatively treated?
50% displacement
5 degree angulation
operative management of tibial fractures?
internal fixation
method of surgical stabilisation used for tibial shaft fractures?
intramedullary nailing
how can non unions be managed in tibial fractures?
bone grafting
special circular frames
clinical presentation of an ankle sprain?
pain
bruising
mild to moderate tenderness
what symptoms would make you give an x ray for an ankle fracture?
severe localised tenderness of the distal tibia/fibula
inability to weight bear for 4 steps
what ankle fractures are deemed to be unstable?
distal fibular fractures with rupture of deltoid ligament
what management is needed for any talar shift?
anatomic reduction
rigid internal fixation
management for bimalleolar fractures?
ORIF
major association with a base of 2nd metatarsal fracture?
2nd base of metatarsal dislocation
what does a metatarsal fracture look like on x ray?
normal usually
clinical presentation of metatarsal fracture?
swollen
bruised
unable to weight bear
most common site for a stress fracture in the foot?
2nd metatarsal
