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2 MSK > CORTEXT: Trauma > Flashcards

CORTEXT: Trauma Flashcards

1
Q

what is remodelling of bone?

A

change shape with bone laid down along areas of stress

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2
Q

what is the main role of the periosteum?

A

increases width/circumference of growing long bones

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3
Q

do adults or children have a thicker periosteum?

A

children

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4
Q

what would you do if a child had a moderate displaced fracture?

A

just cast them, bone can remodel better than adults

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5
Q

when would a child’s fracture be treated as an adults fracture?

A

12-14

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6
Q

what causes an angular deformity?

A

one side of the physis affected by growth arrest

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7
Q

which salter harris fracture has the best prognosis?

A

salter harris 1 fracture

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8
Q

which salter harris type are most physeal fractures?

A

type 2

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9
Q

what salter harris type are unable to be seen on x ray?

A

type 5

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10
Q

why is there greater potential for growth arrest in type 3 and 4 salter harris fractures?

A

fracture splits the physis as they are intraarticular

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11
Q

how long should a splint be left on for a buckle fracture?

A

3-4 weeks

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12
Q

treatment for greenstick fractures?

A

manipulation and casting

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13
Q

name a common area for a salter haris type 2 fracture in older children?

A

distal radius

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14
Q

what would you do if a complete fracture is very unstable after reduction

A

do wire stabilisation or plate fixation

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15
Q

what are the only type of fractures to be improved by 1st line recuction and rigid fixation?

A

monteggia and galeazzi fractures

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16
Q

how should a displaced fracture of both forearm bones be managed?

A

flexible intramedullary nails

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17
Q

how should an angulated fracture of both forearm bones be managed?

A

manipulation then cast

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18
Q

what movement tends to cause a supracondylar elbow fracture?

A

heavy fall onto extended outstretched hand

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19
Q

how to treat undisplaced supracondylar fracture of the elbow?

A

splint

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20
Q

how to treat angulated, displaced or rotated fractures of the supracondylar elbow?

A

closed reduction and pinning with wires

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21
Q

why can some patients with an extension type supracondylar elbow fracture not make the OK sign?

A

median nerve and brachial artery are compressed by a fragment of bone

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22
Q

what nerve injuries make up the majority in a supracondylar fracture of the elbow?

A

neurapraxias

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23
Q

what symptoms would make you consider nerve entrapment from a fracture?

A

unpleasant shooting or burning pain radiating to the sensory distribution of the nerve

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24
Q

most common movement causing a femoral shaft fracture?

A

flexed knee

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25
Q

most common cause of femoral shaft fracture in kids under 2

A

NAI

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26
Q

treatment for femoral shaft fracture in kids aged 2-6?

A

thomas splint

hip spica cast

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27
Q

treatment for femoral shaft fractures in kids under 2?

A

hip spica

gallows traction

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28
Q

treatment for kids age 6-12 for femoral shaft fracture?

A

flexible intramedullary nails

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29
Q

treatment for femoral shaft fracture in kids over 12?

A

adult intramedullary nail

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30
Q

what is a toddlers fracture?

A

undisplaced spiral fractures of tibial shaft

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31
Q

mainstay treatment for tibial fractures for kids?

A

cast

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32
Q

why do you not treat adults in a cast for tibial fractures?

A

risk of compartment syndrome much higher

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33
Q

name the 4 ways in which the spinal cord can get damaged?

A

contusion
compression
laceration
stretch

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34
Q

what is spinal shock?

A

physiologic response to injury with loss of sensation, motor function and reflexes below the level of injury

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35
Q

how long does spinal shock take to recovr?

A

24hrs

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36
Q

what test would you use to see if spinal shock is present?

A

bulbocavernous reflex to see if anal spincter contracts

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37
Q

neurogenic shock occurs secondary to temporary shutdown of x outflow from what nerve roots?

A

x = sympathetic

T1-L2

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38
Q

injury in what area is most likely to cause neurgenic shock?

A

cervical or upper thoracic cord

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39
Q

how long does it take for neurogenic shock to resolve itself?

A

24-48hrs

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40
Q

treatment for neurogenic shock?

A

IV fluid therapy

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41
Q

difference between complete and incomplete spinal cord injury?

A

no sensory or voluntary motor function below level of injury in complete BUT in incomplete there is still some neurologic function distal to injury

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42
Q

how do you determine the level of the injury in complete spinal cord injury?

A

most distal spinal cord level with partial function

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43
Q

what vessels are at risk in a pelvic fracture?

A

internal iliac arterial system

pre sacral venous plexus

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44
Q

3 main patterns of injury to the pelvis?

A

lateral compression fracture
vertical shear fracture
anteroposterior compression injury

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45
Q

cause of a lateral compression fracture of pelvis?

A

side impact eg in RTA

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46
Q

cause of a vertical shear fracture?

A

axial force on one hemipelvis eg in fall from heigh, rapid deceleration

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47
Q

if a lateral compression fracture is in the pubic rami or ischium, what else are the going to have?

A

SI joint disruption or

sacral compression fracture

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48
Q

what of the 3 pelvis fractures will present with a shortened leg?

A

vertical shear

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49
Q

what pelvic fracture is described as an open book fracture due to the way the pelvis moves after injury?

A

anterioposterior compression injury

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50
Q

immediate management of a fractured pelvis?

A

fluids/transfusion if blood loss
apply tied sheet or pelvic binder around it
angiogram/embolisation if bleeding
PR exam

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51
Q

what would rectal bleeding after pelvic injury suggest?

A

open fracture causing rectal tear

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52
Q

most common pelvic fracture to occur in elderly?

A

minimally displaced lateral compression injuries

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53
Q

what other pathologies can be present in a posterior wall fracture?

A

hip dislocation

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54
Q

can acetabular fractures be treated conservatively?

A

yes, if small and undisplaced

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55
Q

are proximal humerus fractures usually high or low energy?

A

low, usually osteoporotic

56
Q

is fracture of the surgical or anatomical neck of the humerus more common

A

surgical

57
Q

does the humerus tend to displace medially or laterally

A

medially

58
Q

treatment for displaced humeral neck fractures?

A

internal fixation

59
Q

what do you could an impaction fractue of the posterior head of the humerus?

A

hill sachs lesion

60
Q

principle sign of axilalry nerve injury?

A

loss of sensation in regimental badge area

61
Q

what fractures can happen along with a shoulder dislocation?

A

surgical neck

greater tuberosity

62
Q

treatment for shoulder dislocation?

A

closed reduction under anaesthetic

sling for 2-3 weeks

63
Q

is age inversely proportional to likelihood of future dislocation?

A

yes

64
Q

what causes posterior shoulder dislocations?

A

posterior force on an adducted, internally rotated arm

65
Q

3 forms of injury that can happen to the AC joint?

A

sprain
subluxation
dislocation

66
Q

treatment for AC joint injury?

A

sling

physio

67
Q

what is the only fracture alignment that can increase bone length?

A

distraction

68
Q

what would you call a fracture that has shortened the overall bone but hasnt affected the alignment?

A

impacted fracture

69
Q

what is an avulsion fracture?

A

ligament or tendon pulling off a bone fragment

70
Q

cause of a stress fracture?

A

permanent low impact trauma to normal bone

71
Q

only visible x ray abnormality of a stress fracture?

A

subtle calcification of periosteum

72
Q

what do you call a transverse and partially comminuted fracture of the radius?

A

colles fracture

73
Q

what other fracture is common along with a colles fracture?

A

transverse fracture of ulnar styloid

74
Q

how is the distal radius’ position changed as a result of a colles fracture?

A

dorsal displacement

angulation

75
Q

what is diastasis?

A

separation of 2 normally adjacent parts

76
Q

treatment for mild and severe colles fractures?

A 
mild = splintage
severe = manipulation then ORIF/percutaneous wires
77
Q

what nerve injury can happen with a colles fracture and why?

A

median nerve compression via stretched nerve/carpal tunnel bleed

78
Q

late local complication of colles fracture?

A

extensor pollicis longus rupture

79
Q

what happens to the distal radius in a smith’s fracture?

A

it is volarly displaced/angulated

80
Q

where is the volar surface of the wrist?

A

the side on the same as the palm

81
Q

treatment for smiths fracture?

A

ORIF using plate and screws

82
Q

which of these fractures is intraarticular?:
bartons
smiths
colles

A

bartons

83
Q

what area of the body does a bartons fracture affect?

A

distal radius

84
Q

another name for a volar bartons fracture?

A

intraarticular smiths fracture

85
Q

clinical signs of a scaphoid fracture?

A

tenderness in anatomical snuffbox

pain on compression of thumb

86
Q

the anatomic snuffbox is located between which tendons?

A

abductor pollicis brevis

extensor pollicis longus

87
Q

how many views are taken of a scaphoid fracture? what are they?

A

4: AP, lateral, 2 obliques

88
Q

what is a clinical scaphoid fracture?

A

suspected scaphoid fracture that doesn’t appear on x ray

89
Q

treatment for undisplaced scaphoid fractures?

A

plaster cast for 6-12 weeks

90
Q

treatment for displaced scaphoid fractures?

A

fixation with special compression screw

91
Q

what structure(s) are at risk of injury in a volar fracture of the hand?

A

flexor tendons
digital nerves
digital arteries

92
Q

what structure(s) are at risk of injury in a dorsal hand fracture?

A

extensor tendons

93
Q

how do you manage a complete or significant partial tendon injury?

A

surgical repair always

94
Q

clinical presentation of mallet finger?

A

pain
drooped DIPJ
inability to extend at DIPJ

95
Q

most common cause of a 5th metacarpal fracture?

A

punching

96
Q

what metacarpal fractures are treated conservatively?

A

3, 4, 5

97
Q

what is a fight bite?

A

punchee’s teeth penetrating tendons in finger?

98
Q

mortality from a hip fracture at 1 month?

A

10%

99
Q

mortality from a hip fracture at four months?

A

20%

100
Q

mortality from a hip fracture at one year?

A

30%

101
Q

arterial supply to the femoral head?

A

anastomosis of the circumflex femoral arteries (branch of deep femoral artery)

102
Q

what type of hip fracture poses a risk to the arterial supply of the femoral head?

A

intracapsular

103
Q

what type of hip fracture poses a risk of avascular necrosis?

A

intracapsular

104
Q

treatment for extracapsular hip fracture?

A

internal fixation

105
Q

what medication can cause a femoral shaft fracture?

A

bisphosphonates long term

106
Q

why are thomas’ splints good for emergencies?

A

stabilises a fracture to minimise blood loss and fat embolism

107
Q

management of femoral shaft fracture?

A

closed reduction and stabilisation with intramedullary nail

108
Q

treatment for unstable knee dislocation?

A

external fixation

109
Q

what ligament injuries make the knee particularly unstable?

A

PCL

LCL

110
Q

do you get a haemarthrosis in patellar dislocation?

A

yes

111
Q

clinical presentation of patellar dislocation?

A

obviously displaced patella
tenderness over medial retinaculum
haemarthrosis

112
Q

treatment for patellar dislocation?

A

splintage then physio

113
Q

are tibial plateau fractures intra or extraarticular?

A

intra

114
Q

most common management for intraarticular fractures?

A

surgical fixation to reduce articular surface

115
Q

cause of a lateral plateau fracture?

A

valgus stress injury

116
Q

what fracture is a blow from a car bumper most likely to cause?

A

proximal fibular

117
Q

what tools are used in surgical fixation of a tibial plateau fracture?

A

plates and screws

118
Q

what should be checked before starting ORIF?

A

check for soft tissue swelling or injury

119
Q

what kind of force is the most likely cause of a transverse tibial shaft fracture?

A

bending

120
Q

what kind of force is the most likely cause of a spiral tibial shaft fracture?

A

rotation

121
Q

what kind of force is the most likely cause of a oblique tibial shaft fracture?

A

compressive eg by deceleration

122
Q

can you get open tibial fractures?

A

yes, not uncommon as tibia is subcutaneous

123
Q

commonest cause of compartment syndrome after trauma?

A

tibial fracture

124
Q

how much displacement and angulation of the tibia is tolerated to be conservatively treated?

A

50% displacement

5 degree angulation

125
Q

operative management of tibial fractures?

A

internal fixation

126
Q

method of surgical stabilisation used for tibial shaft fractures?

A

intramedullary nailing

127
Q

how can non unions be managed in tibial fractures?

A

bone grafting

special circular frames

128
Q

clinical presentation of an ankle sprain?

A

pain
bruising
mild to moderate tenderness

129
Q

what symptoms would make you give an x ray for an ankle fracture?

A

severe localised tenderness of the distal tibia/fibula

inability to weight bear for 4 steps

130
Q

what ankle fractures are deemed to be unstable?

A

distal fibular fractures with rupture of deltoid ligament

131
Q

what management is needed for any talar shift?

A

anatomic reduction

rigid internal fixation

132
Q

management for bimalleolar fractures?

A

ORIF

133
Q

major association with a base of 2nd metatarsal fracture?

A

2nd base of metatarsal dislocation

134
Q

what does a metatarsal fracture look like on x ray?

A

normal usually

135
Q

clinical presentation of metatarsal fracture?

A

swollen
bruised
unable to weight bear

136
Q

most common site for a stress fracture in the foot?

A

2nd metatarsal

2 MSK (61 decks)

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