General Trauma Flashcards

1
Q

are all dislocations reduced?

A

yes

as soon as possible

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2
Q

how are dislocations reduced?

A

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

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3
Q

what can cause dislocation/increase the risk?

A

significant trauma

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

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4
Q

what other injuries are dislocations associated with?

A
tendon tears
nerve injury
vascular injury
compartment syndrome
fractures (fracture-dislocation)
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5
Q

how are dislocations managed?

A

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

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6
Q

give 4 possible soft tissue injuries which can occur with fractures

A

ligaments/tendon sprain, partial tear or rupture

muscle tear

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7
Q

how are ligament ruptures graded?

A

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

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8
Q

mainstay of treatment for soft tissue injury?

A
RICE
rest
ice
compression
elevation
followed by early movement
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9
Q

when is surgical repair used for tendon rupture?

A

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

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10
Q

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

A

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

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11
Q

what can cause septic arthritis?

A

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

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12
Q

what are the effects of septic arthritis?

A

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

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13
Q

what are the risk factors for septic arthritis?

A
young
elderly
IV drug use
immunocompromised
neonates/infants with metaphyseal osteomyelitis (metaphyses are intra-articular in neonates/infants)
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14
Q

most common causative bacteria in septic arthritis?

A
staph aureus = most common
strep = 2nd most common
haemophilus
gonorrhoea - young adults
E coli = elderly, IVDU, seriously ill people
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15
Q

management of suspected septic joint?

A

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

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16
Q

what is the gustilo classification system?

A

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

17
Q

initial A&E management of an open fracture?

A
IV antibiotics
- flucloxacillin
- gentamicin
- metronidazole
application of sterile/antiseptic soaked dressing
18
Q

general management of open fractures?

A

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

19
Q

when can an open fracture wound be closed primarily?

A

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

20
Q

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

A

skin graft
local flap coverage
free flap coverage

21
Q

which tissues readily accept a skin graft?

A
muscle
fascia
granulation tissue
paratendon
periosteum
22
Q

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

A

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