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Year 2 MSK > General Trauma > Flashcards

General Trauma Flashcards

1
Q

What is usually the cause of death in the golden hour?

A

Airway compromise
Severe head or chest injury
Internal organ rupture
Fractures with substantial blood loss

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2
Q

What fractures are generally associated with substantial blood loss?

A

Pelvis and Femur

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3
Q

What is the primary survey?

A

Quick assessment of vital functions and appropriate management in response to the findings.

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4
Q

What makes up the primary survey?

A 
ABCDE approach
Airway with cervical spine control.
Breathing and ventilation
Circulation and bleeding control
Disability (neurological evaluation)
Exposure and environmental control
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5
Q

What does a Glasgow coma score of less than 8 indicate?

A

Loss of airway control

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6
Q

Whats the minimum Glasgow coma scale score?

A

3

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7
Q

Whats the maximum Glasgow coma scale score?

A

15

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8
Q

What are the two types of bone healing?

A

Primary

Secondary

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9
Q

What conditions denote primary bone healing?

A

Minimal fracture gap less than 1m

Hairline fractures and when fractures fixed with compression plates and screws.

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10
Q

How does primary bone healing occur?

A

Osteoblasts simply bridge the gap and form new bone.

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11
Q

What conditions denote secondary bone healing?

A

A large gap

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12
Q

What is process of secondary bone healing?

A

Fracture
Haematoma forms with inflammation
Marcophages and osteoclasts remove debris and resorb bone ends
Granulation tissue forms
Chondroblasts form cartilage (soft callus)
Osteoblast lay down bone matrix (enchondral ossification)
Calcium mineralisation produces immature woven bone ( hard callus)
Remodelling an reorganisation along lines of stress into lamellar bone.

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13
Q

When is the soft callus usually formed by?

A

2nd to 3rd week

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14
Q

When is the hard callus usually formed by?

A

6-12 weeks

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15
Q

What does secondary bone healing require?

A

Good blood supply for oxygen nutrients and stem cells.

A little movement and stress to help rearrangement into lamella bone.

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16
Q

What can result in atrophic non union?

A

Lack of blood supply
No movement
To large a gap
Tissue trapped in fracture

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17
Q

What can impair fracture healing?

A

Smoking due to vascular disease.
Chronic ill health
Malnutrition

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18
Q

What can result in hypertrophic non union?

A

Excessive movement

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19
Q

What are the five types of fracture ?

A 
Transverse
Oblique
Spiral
Comminuted
Segmental
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20
Q

Transverse fracture

A

Pure bending force
Cortex on one side fails due to compression and the other sides cortex due to tension
Will not shorten but can rotate the bone

21
Q

Oblique fractures

A

Shearing force e.g. fall from height

Shorten and rotate the bone

22
Q

Spiral fractures

A

Torsional forces
Unstable if presented with torsional forces
Can rotate the bone

23
Q

Comminuted fractures

A 
Three or more segments
Higher energy or poor bone quality
Substantial soft tissue injury
Reduced blood supply
Poor healing
Very unstable
24
Q

Segmental fractures

A

Fractured into two places

Unstable

25
Q

How are oblique fracture often fixed?

A

Inter-fragmentary screw

26
Q

How are spiral fractures fixed?

A

Potentially inter-fragmentary screws

27
Q

How are Comminuted fractures fixed?

A

Have to be surgically stabilised

28
Q

How are segmented fractures fixed?

A

Long rods or plates

29
Q

What risks do intra-articular fractures carry?

A

Stiffness
Pain
Post traumatic osteoarthritis

30
Q

What is a fracture called if it has 100% translation?

no articular surfaces

A

Off-ended

31
Q

Clinical signs of a fracture

A

Localised bony tenderness
Swelling
Deformity
Crepitus bone ends grating

32
Q

What should be covered in the assessment of an injured limb?

A

Is the injury open or closed?
Distal neurvascular function
Compartement syndrome
Status if skin and soft tissue envelope.

33
Q

What should be checked in the distal neuromuscular status?

A 
Pulses
Capillary refil
Temperature
Colour
Sensation
Motor power
34
Q

When is a technetium bone scan used?

A

For stress fracture
e.g. Hip femur tibia fibula 2nd metatarsal
As they don’t show up on x ray until hard callus forms

35
Q

Clinical signs of compartment syndrome?

A

Increased pain on passive stretching
Severe pain outith anticipated severity of injury
Tensely swollen and sore to touch

36
Q

In compartment syndrome what are the clinical signs its too late?

A

Loss of pulse and perishingly cold.

37
Q

Upon diagnosis what is treatment?

A

Removal off tight bandages

Emergency fasciotomies

38
Q

Pathophysiology behind compartment syndrome?

A

Bleeding and inflammatory exudates increase pressure.
Compression of venous system leads to congestion
Secondary ischaemia as arterial blood can’t reach area
Necrosis of ischaemic tissue

39
Q

What is a sign that the skin may have been devolved?

A

Skin is unblanching

Skin may be insensate

40
Q

Initial management of open fracture

A

IV broa spectrum Abx

 - Flucloxacillin gram +ve
 - Gentamicin gram -ve
 - Metronidazole anaerobes (if soil contamination)
41
Q

Causes of septic arthritis

A 
Staph Aureus - commonest in adults
Streptococci - second commonest
H.Influenzae - was most common in kids
N.gonorrhoea - young adults 
E.coli - elderly, IV drug users, seriously ill
42
Q

What nerve ganglion controls abduction of the arm?

A

C5

43
Q

What nerve ganglion controls flexion of digits?

A

C8

44
Q

What nerve controls the adduction and abduction of digits?

A

T1

45
Q

What nerve controls flexion of the elbow?

A

C(5)6

46
Q

What nerve controls adduction of the toes?

A

S2,S3

47
Q

What nerve controls great toe dorsiflexion?

A

L5

48
Q

What controls flexion of the knee?

A

L5 S2

49
Q

What controls flexion of the hip?

A

L1 L2

Year 2 MSK (19 decks)

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