General Trauma Flashcards
What is usually the cause of death in the golden hour?
Airway compromise
Severe head or chest injury
Internal organ rupture
Fractures with substantial blood loss
What fractures are generally associated with substantial blood loss?
Pelvis and Femur
What is the primary survey?
Quick assessment of vital functions and appropriate management in response to the findings.
What makes up the primary survey?
ABCDE approach Airway with cervical spine control. Breathing and ventilation Circulation and bleeding control Disability (neurological evaluation) Exposure and environmental control
What does a Glasgow coma score of less than 8 indicate?
Loss of airway control
Whats the minimum Glasgow coma scale score?
3
Whats the maximum Glasgow coma scale score?
15
What are the two types of bone healing?
Primary
Secondary
What conditions denote primary bone healing?
Minimal fracture gap less than 1m
Hairline fractures and when fractures fixed with compression plates and screws.
How does primary bone healing occur?
Osteoblasts simply bridge the gap and form new bone.
What conditions denote secondary bone healing?
A large gap
What is process of secondary bone healing?
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.
When is the soft callus usually formed by?
2nd to 3rd week
When is the hard callus usually formed by?
6-12 weeks
What does secondary bone healing require?
Good blood supply for oxygen nutrients and stem cells.
A little movement and stress to help rearrangement into lamella bone.
What can result in atrophic non union?
Lack of blood supply
No movement
To large a gap
Tissue trapped in fracture
What can impair fracture healing?
Smoking due to vascular disease.
Chronic ill health
Malnutrition
What can result in hypertrophic non union?
Excessive movement
What are the five types of fracture ?
Transverse Oblique Spiral Comminuted Segmental
Transverse fracture
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
Oblique fractures
Shearing force e.g. fall from height
Shorten and rotate the bone
Spiral fractures
Torsional forces
Unstable if presented with torsional forces
Can rotate the bone
Comminuted fractures
Three or more segments Higher energy or poor bone quality Substantial soft tissue injury Reduced blood supply Poor healing Very unstable
Segmental fractures
Fractured into two places
Unstable
How are oblique fracture often fixed?
Inter-fragmentary screw
How are spiral fractures fixed?
Potentially inter-fragmentary screws
How are Comminuted fractures fixed?
Have to be surgically stabilised
How are segmented fractures fixed?
Long rods or plates
What risks do intra-articular fractures carry?
Stiffness
Pain
Post traumatic osteoarthritis
What is a fracture called if it has 100% translation?
no articular surfaces
Off-ended
Clinical signs of a fracture
Localised bony tenderness
Swelling
Deformity
Crepitus bone ends grating
What should be covered in the assessment of an injured limb?
Is the injury open or closed?
Distal neurvascular function
Compartement syndrome
Status if skin and soft tissue envelope.
What should be checked in the distal neuromuscular status?
Pulses Capillary refil Temperature Colour Sensation Motor power
When is a technetium bone scan used?
For stress fracture
e.g. Hip femur tibia fibula 2nd metatarsal
As they don’t show up on x ray until hard callus forms
Clinical signs of compartment syndrome?
Increased pain on passive stretching
Severe pain outith anticipated severity of injury
Tensely swollen and sore to touch
In compartment syndrome what are the clinical signs its too late?
Loss of pulse and perishingly cold.
Upon diagnosis what is treatment?
Removal off tight bandages
Emergency fasciotomies
Pathophysiology behind compartment syndrome?
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
What is a sign that the skin may have been devolved?
Skin is unblanching
Skin may be insensate
Initial management of open fracture
IV broa spectrum Abx
- Flucloxacillin gram +ve - Gentamicin gram -ve - Metronidazole anaerobes (if soil contamination)
Causes of septic arthritis
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
What nerve ganglion controls abduction of the arm?
C5
What nerve ganglion controls flexion of digits?
C8
What nerve controls the adduction and abduction of digits?
T1
What nerve controls flexion of the elbow?
C(5)6
What nerve controls adduction of the toes?
S2,S3
What nerve controls great toe dorsiflexion?
L5
What controls flexion of the knee?
L5 S2
What controls flexion of the hip?
L1 L2
