General Trauma

Question 1

are all dislocations reduced?

Answer 1

yes

as soon as possible

Question 2

how are dislocations reduced?

Answer 2

closed manipulation under sedation and analgesia or sometimes general/regional anaesthetic
open reduction if delayed presentation (e.g alcoholics etc)

Question 3

what can cause dislocation/increase the risk?

Answer 3

significant trauma

low energy injury can cause dislocation in hypermobile people (marfans, ehlers danlos etc)

Question 4

what other injuries are dislocations associated with?

Answer 4

tendon tears
nerve injury
vascular injury
compartment syndrome
fractures (fracture-dislocation)

Question 5

how are dislocations managed?

Answer 5

may need soft tissue repair/reconstruction or bony surgery if recurrent
ORIF may be required for fracture-dislocation if un-reducable, bony fragment in joint or unstable joint

Question 6

give 4 possible soft tissue injuries which can occur with fractures

Answer 6

ligaments/tendon sprain, partial tear or rupture

muscle tear

Question 7

how are ligament ruptures graded?

Answer 7

grade 1 = sprain
grade 2 = partial tear
grade 3 = complete tear

Question 8

mainstay of treatment for soft tissue injury?

Answer 8

RICE
rest
ice
compression
elevation
followed by early movement

Question 9

when is surgical repair used for tendon rupture?

Answer 9

if complete tear of tendons essential for function (patellar, quadriceps etc)
others can be treated conservatively

Question 10

what can cause division of a tendon and where is this common? how is this managed?

Answer 10

penetrating incised wounds
flexor and extensor tendons in hands/wrists
usually need surgical repair

Question 11

what can cause septic arthritis?

Answer 11

spread via blood
spread from infection in adjacent tissues
direct penetration of a joint (e.g fight bite)
intra-articular surgery

Question 12

what are the effects of septic arthritis?

Answer 12

causes irreversible damage to hyaline cartilage within 2 days
associated with endocarditis

Question 13

what are the risk factors for septic arthritis?

Answer 13

young
elderly
IV drug use
immunocompromised
neonates/infants with metaphyseal osteomyelitis (metaphyses are intra-articular in neonates/infants)

Question 14

most common causative bacteria in septic arthritis?

Answer 14

staph aureus = most common
strep = 2nd most common
haemophilus
gonorrhoea - young adults
E coli = elderly, IVDU, seriously ill people

Question 15

management of suspected septic joint?

Answer 15

aspirate the joint to get sample
antibiotics - general then specific once pathogen known
surgical washout (open or arthroscopic)
serial CRP throughout treatment

Question 16

what is the gustilo classification system?

Answer 16

describes degree of contamination, size of wound, whether wound will be able to be closed or require plastic surgery cover and presence of associated vascular injury

Question 17

initial A&E management of an open fracture?

Answer 17

IV antibiotics
- flucloxacillin
- gentamicin
- metronidazole
application of sterile/antiseptic soaked dressing

Question 18

general management of open fractures?

Answer 18

prompt surgery
- removal of all contamination and debridement
stabilisation with internal or external fixation providing an early and thorough debridement

Question 19

when can an open fracture wound be closed primarily?

Answer 19

if skin is viable and uncontaminated and can be closed without skin tension - wound can be closed primarily

Question 20

what is used if open fracture wound cant be closed primarily?

Answer 20

skin graft
local flap coverage
free flap coverage

Question 21

which tissues readily accept a skin graft?

Answer 21

muscle
fascia
granulation tissue
paratendon
periosteum

Question 22

what is done if doubt over viability of soft tissue or wound is contaminated?

Answer 22

leave wound open for 48 hrs to allow infection to drain out

surgical debridement of necrotic tissue after 48 hrs and secondary closure of wound