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X. MRCS: Pathophysiology > Fractures, Dislocations, Trauma > Flashcards

Fractures, Dislocations, Trauma Flashcards

1
Q

Borders/bones of the orbit

A

Roof: frontal bone, lesser wing of spenoid
Floor: maxilla, palatine, zygomatic bones
Medial wall: ethmoid, maxilla, lacrimal, sphenoid bones
Lateral wall: zygomatic bone, greater wing of spenoid
Apex: opening to optic canal
Base: opens to the face

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2
Q

Fractures of the orbit

A

Orbital rim fracture: fracture of bones forming outer rim

“Blowout” fracture: partial herniation of orbital contents through one of its walls (medial and lateral walls weakest)

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3
Q

Bones of the face

A

Zygomatic (2): cheekbones
Lacrimal (2): smallest. Medial wall of orbit
Nasal (2): slender bones located at bridge of nose
Inferior nasal conchae (2): located within nasal cavity
Palatine (2): rear of oral cavity and forms part of hard palate
Maxilla (2): upper jaw and hard palate
Vomer: forms posterior aspect of nasal septum
Mandible: articulates with cranium at TMJ

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4
Q

Fractures of the face

A

Nasal fracture: most common facial fracture
Maxillary fracture: classified by Le Fort
Mandibular fracture: often bilateral
Zygomatic arch fracture: associated with trauma to side of face

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5
Q

Le Fort I

A

Horizontal or “floating palate”
Fracture of maxillary alveolar ridge.
Spans the bony nasal septum. May involve pterygoid plates of sphenoid
Sx: swelling of upper lip, buccal surface bruising, malocclusion, loosening of teeth

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6
Q

Le Fort II

A

Pyramidal
Posterolateral maxillary sinuses, inferior orbital rim, lacrimal/ethmoid bones, nasofrontal suture
Sx: swelling/deformity to midface, widening of intercanthal space, mobility of upper jaw/nose, malocclusion, peri orbital oedema/ecchymosis, epistaxis, CSF rhinorrhea

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7
Q

Le Fort III

A

Horizontal: craniofacial dislocation
Superior orbital fissures, ethmoid and nasal bones, greater wings of sphenoid, frontozygomatic sutures
Sx: similar to type II, lengthening/flattening of face, orbital hooding, enophthalmis, ear drainage and haemotympanium.

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8
Q

Anatomy of C-spine

A

Cervical vertebrae: triangular foramen, bifid spinous process, transverse foramina (contain vertebral artery, vein, sympathetic nerves)
C1: atlas: no vertebral body, no spinous process. anterior arch contains facet for articulation with dens of axis, secured by transverse ligament of atlas
C2 (axis): odontoid process (dens), articulates with atlas.

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9
Q

Ligaments of spinal column

A 
Ant and post longitudinal ligaments
Ligamentum flavum
Interspinous ligament
Nuchal ligament (only C-spine)
Transverse ligament of atlas (only C1)
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10
Q

Common spinal fractures

A 
Compression
Burst
Jefferson
Chance
Hangmans
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11
Q

Burst fracture

A

Axial loading
Results in comminuted fracture of vertebral body
May be associated with retropulsion of bony fragments into spinal canal: unstable fracture with Neuro deficits

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12
Q

Chance fracture

A

“Seatbelt fracture”
Flexion distraction injury
Fracture through vertebral body, pedicles and spinous process
Can be associated with increased interspinous distance and facet joint separation
Unstable, neurological deficit.

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13
Q

Jefferson fracture

A

Axial loading injury
Fracture of anterior and posterior arch of C1
Imaging: Offset of lateral masses of C1
Usually not associated with neuro injury

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14
Q

Hangman’s fracture

A

Hyperextension compression injury
Fracture of pedicles of C2
Not usually associated with neuro deficit

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15
Q

Odontoid fractures

A

Type I: avulsion fracture of the tip
Type II: fracture of base of odontoid
Type III: through body of C2

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16
Q

Facet dislocation

A

Associated with disc herniation
Can be unilateral or bilateral
Unilateral: may affect nerve root
Bilateral: >50% of spinal cord injury

17
Q

Humeral head fractures

A

Neer classification

Complications: axillary nerve avascular necrosis of humeral head

18
Q

Scapular fractures

A

Rare. High energy.

Floating shoulder: scapula neck + clavicle fracture

19
Q

Humeral shaft fracture

A

Bimodal: trauma + osteoporotic
Complications: radial nerve injury
Holstein-Lewis fracture: distal 1/3 of humerus + entrapment of radial nerve
Rx: ORIF with plate/conservative

20
Q

Clavicle fracture

A 
Allman classification:
Type I: middle 1/3 (75%)
Type II: lateral 1/3 (20%)
Type III: medial 1/3 (5%): associated with mediastinal injury, pneumothorax, haemothorax
Rx: most conservative. ORIF
21
Q

Shoulder dislocation

A

Anterior: force applied when shoulder extended, abducted, externally rotated
Posterior: seizure/electrocution, anterior blow in flexion and adduction
Nerve: Axillary/suprascapular injuries
Bone: Bony Bankart, Hill-Sachs
Soft tissue: soft Bankart, rotator cuff injury, glenohumeral ligament avulsion
XR: “lightbulb” = posterior.

22
Q

Supracondylar fracture

A

Common pads elbow injury: 5-7yrs
FOOSH in elbow extension
Gartland classification
Type I: undisplayed
Type II: displaced with intact posterior cortex
Type III: displaced in 2 or 3 parts
Type. IV: complete periosteal disruption
Complications: anterior interosseous nerve, ulnar nerve, malunion, cubitus varus deformity “gunstock”, Volkmann’s contracture
Rx: I & II: above elbow cast. II, III, IV: closed reduction and K-wire

23
Q

Radial head fractures

A

FOOSH
XR: sail sign (elevation of anterior fat pad)
Mason classification:
Type I: <2mm displacement
Type II: partial articular fracture with >2mm displacement
Type III: comminuted fracture and displacement
Rx: I: non-operative. II: non-operative (if no block)/ORIF. III: ORIF/radial head excision.

24
Q

Olecranon fractures

A

FOOSH. Inability to extend elbow
Classifications: Mayo or Schatzker
Rx: non-operative if <2mm displacement. Operative if >2mm displacement. olecranon plating/tension band wiring

25
Q

Elbow dislocation

A 
Usually occur in young adults
Simple or complex
Complications: ulnar nerve injury
Rx: closed reduction
Terrible triad: lateral collateral ligament injury, radial head fracture, coronoid fracture: results in very unstable elbow
26
Q

Forearm Fractures

A

Galeazzi

Monteggia

27
Q

Galeazzi fracture

A

Fracture of distal third of radius and dislocation of distal radioulnar joint
Complications: compartment syndrome, anterior interosseous nerve palsy

28
Q

Monteggia fracture

A

Fracture of proximal third of ulnar and dislocation of proximal head of radius

29
Q

Distal radius fractures

A

Colles’ (90%)
Smith’s
Barton’s

30
Q

Colles’ fracture

A

Extra-articular fracture of distal radius.
Dorsal angulation and dorsal displacement
(Avulsion fracture of ulnar styloid)

31
Q

Smith’s fracture

A

Extra-articular

Volar angulation of distal fragment

32
Q

Barton’s fracture

A

Intra-articular fracture with associated dislocation of radio-carpal joint

33
Q

Scaphoid fracture

A

X. MRCS: Pathophysiology (13 decks)

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