General Trauma Flashcards
what is polytrauma
more than one major long bone is injured
major complications of poly trauma are
SIRS
ARDS
Multi organ dysfunction syndrome
death
what do intramedullary nails increase the risk of
fat embolism
what cells build new bone
osteoblasts
difference between healing by primary and secondary intention
primary - gap is small and new bone can form spontaneously
secondary - large gaps so this need to be filled to allow healing eg ORIF
describe the types of fractures
transverse oblique spiral comminuted segmental
cardinal features of compartment syndrome
increased pain on PASSIVE stretch of muscle
severe pain not explained by clinical context
swollen limb
tender to touch
pulses usually present - absent pulses is a LATE sign
treatment of compartement syndrome
fasciotomy
complication of compartment syndrome
ischaemic muscle will necrose resulting in a fibrotic contracture known as Volkmann’s ischaemic contracture
describe what neurapraxia means
occurs when the nerve has a temporary conduction defect from compression or stretch and resolve over time with full recovery (can take up to 28 days)
describe what axonotmesis means
sustained compression or stretch of nerve with subsequent distal axonal death - recovery more variable and may take longer or not recover fully
what is neurotmesis
complete transection of nerve - needs surgical repair
usually occurs only in a penetrating injury
nerve injury in colles fracture
median nerve
nerve injury in anterior dislocation of the shoulder
axillary nerve
nerve injury in humeral shaft fracture
radial - wrist drop
nerve injry in supracondylar fracute of elbow
median nerve
posterior dislocation of hip can injury which nerve
sciatic
bumper injury to lateral knee can injure what nerve
common peroneal
knee dislocation risks injury to what vessel
popliteal artery
paediatric supracondylar factrure risks injury to what vessel
brachial artery
should trauma risk injury to what vessle
axillary artery
how would you asses the vascular status of a limb
temperature
colour
pulses
cap refill
if compromised - vascular surgery review
signs of excessive skin pressure which could lead to necrosis
tenting of the skin
blanching
management excessive pressure on the skin
reduce fraction as an emergency under analgesia and sedation
important complication to the skin in crush or shearing injuries
‘degloving’ skin is avulsed from blood supplu
signs of fracture non union
ongoing pain
ongoing oedema
movement at fracture sign
what is the slowest healing bones in body
tibia - takes 16 weeks to a year :O
femoral shaft - takes 2-4 months
what is a delayed union
A delayed union is a fracture that has not healed within the expected time
commonest cause of delayed union
infection
what causes hypertrophic non union
excessive motion at fracture site results in large defective callus
infection can also cause
causes fo atrophic non union
lack of blood supply
chronic disease
infection
fractures prone to poor healing are
scaophoid
distal clavivle
subtrochanteric femur fracture
jones frature of 5th metatarsal
fractures prone to AVN
scaphoid
talus
femoral neck
management of open fracture
IV broad specturm Abx - flucox and gent and met
sterile or antiseptic soaked dressing
surgical managemetn to debride and stabilised either internally or externally
what complete tendon tears need surgically repaire
quadrices
patellar
as essential for function
some others eg achilles or biceps can be managed conservatively
management of septic arthritis
joint aspiration
IV antibiotics
surgical washout
