Dislocations

Question 1

what is the definition of dislocation and subluxation?

Answer 1

dislocation: 100% loss of congruency with articular surface. complete loss of joint articulation
subluxation: partial loss of joint articulation

Question 2

how is a dislocation diagnosed?

Answer 2

clinical & radiological (x-ray)

Question 3

what direction does an elbow dislocation occur?

Answer 3

posterior

Question 4

what direction is most common in shoulder dislocation?

Answer 4

anterior

Question 5

what is posterior shoulder dislocation usually a sign of?

Answer 5

electric shock

epilepsy

Question 6

what direction is the most common in hip dislocation?

Answer 6

posterior

Question 7

what is the presentation of a hip dislocation?

Answer 7

leg is shortened, hip flexed and internally rotated and adducted

Question 8

what direction is most common in ankle dislocation?

Answer 8

laterally

Question 9

what is the presentation of a laterally dislocated ankle?

Answer 9

externally rotated and prominent medial malleolus

Question 10

what is the presentation of a shoulder dislocation?

Answer 10

locked in internal rotation

squared off

Question 11

what is usually the cause of hip dislocations?

Answer 11

high energy injuries i.e. car accidents

Question 12

what is the definition of an open fracture?

Answer 12

direct communication between the external environment and the fracture

Question 13

why are open fractures emergencies?

Answer 13

higher energy injury
increased infection risk
soft tissue injury
long term morbidity

Question 14

what is the classification system of open fractures?

Answer 14

Gustilo classification

Question 15

what is the name of the guidelines for open fracture treatment?

Answer 15

BOAST

Question 16

what is the management of a open fracture?

Answer 16

full acute trauma life support (ATLS) assessment and treatment

antibiotic prophylaxis i.e. clindamycin

wounds only derided to remove gross contamination, then photographed, covered to stabilise limb (if out of hours)

surgical debridement and fixation

Question 17

what are the 4 C’s in the examination of an open fracture before surgery?

Answer 17

colour
contraction
consistency
capacity to bleed

Question 18

what are the indications for emergency surgery (within 6 hours)?

Answer 18

polytraumatised patient
marine or farmland environment
gross contamination
neurovascular compromise
compartment syndrome

(6 hour rule doesn’t apply to solitary open fractures)

Question 19

what is the most common type of surgical amputation ?

Answer 19

Guillotine