General trauma

Question 1

What is the “golden hour” in trauma?

Answer 1

Survival is better if resuscitation etc is delivered within the first hour of arriving in hospital e.g. stabilised, imaging done, management plan made

Question 2

What is the difference between the initial primary survey and secondary surgvey in ATLS?

Answer 2

initial primary survey = ABCDE

Secondary survey = survey to look for other injuries than ones that require immediate treatment (CT helpful)

Question 3

What are the 2 types of bone healing and what are the differences between them?

Answer 3

Primary and secondary bone healing
Primary = where there is a minimal gap (hairline fractures or fractures united by screws and plates) - bridge the gap with new bone from osteoblasts
Secondary = gap at the fracture site, callus forms and remodelling occurs due to an inflammatory response

Question 4

What are the 4 steps in secondary bone healing?

Answer 4

Step 1: inflammation - macrophages and osteoclasts remove debris and resorb the bone ends
Step 2: soft callus formation (2-3 weeks)
Step 3: Hard callus formation (6-12 weeks)
Step 4: remodelling

Question 5

What is a transverse fracture and explain mechanism of injury?

Answer 5

break right through a bone due to a bending force

Question 6

What is an oblique fracture and explain mechanism of injury?

Answer 6

break right through a bone due to a shearing force (deceleration/fall from height)

Question 7

What is a spiral fracture and mechanism of injury?

Answer 7

spiral fracture through the bone, due to rotational forces

Question 8

What is a segmental fracture?

Answer 8

When a bone is fractured in 2 separate places

Question 9

What is a comminuted fracture?

Answer 9

Bone fractured into 3+ segments - usually a high energy injury

Question 10

What is the difference between translation, angulation and rotation in terms of describing a displaced fracture?

Answer 10

translation = distal fracture can be DISPLACED anteriorly or posteriorly or TRANSLATED medially or laterally 
Angulation = describes the direction that the distal fragment points towards
Rotation = rotation of the distal fragment relative to the proximal fragment

Question 11

Give 4 early local complications of fractures?

Answer 11

Compartment syndrome
Vascular injury/ischaemia
Nerve injury/compression
Skin necrosis

Question 12

Give 4 early systemic complications of fractures?

Answer 12

Hypovoleamia
Shock
Fat embolism
Death

Question 13

Give 4 late local complications of fractures?

Answer 13

Infection
Non-union
Mal-union
Volkmann’s isachaemic contracture

Question 14

What is the main late systemic complication of fractures?

Answer 14

Pulmonary embolism

Question 15

What is compartment syndrome?

Answer 15

Serious complication of fractures and surgical emergency - raised pressure within a compartment in a limb due to bleeding or muscle swelling after trauma which leads to compression of vasculature and nerves

Question 16

Why is there severe pain in compartment syndrome?

Answer 16

Rising pressure causes congestion in the muscle which leads to secondary ischaemia and arterial blood cant reach the muscle - combination leads to severe pain

Question 17

What are the key clinical signs of compartment syndrome?

Answer 17

Increased pain on passive stretching of the muscles involved
Severe pain that wouldn’t be expected in the clinical context

Question 18

Management of compartment syndrome?

Answer 18

Immediately remove all casts and bandages

Fasciotomy (slipping of the fascia)

Question 19

What would happen if compartment syndrome was left untreated?

Answer 19

Ischaemic muscle would would necrose, resulting in Volkmann’s contracture

Question 20

Which artery is at risk in knee dislocations?

Answer 20

Popliteal artery

Question 21

Which artery is at risk in supracondylar fractures (especially in children)?

Answer 21

Brachial artery

Question 22

Which artery is at risk in an anterior shoulder dislocation?

Answer 22

Axillary artery

Question 23

What is given initially in open fractures to help prevent infection?

Answer 23

IV broad spectrum antibiotics (usually flucloxacillin)

Question 24

What surgical procedure must be done in open fractures?

Answer 24

Debridement