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PHM BSc - Applied Science > Limbs > Flashcards

Limbs Flashcards

1
Q

Describe when vasculature of the upper limb is likely to be damaged

A

Subclavian - clavicle fractures
Anterior humeral circumflex - proximal humerus fracture
Brachial - posterior elbow dislocation
Profunda brachii - humeral shaft fracture
Radial - PCI

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2
Q

Describe any important anatomical features and therefore common injury points of the musculocutaneous nerve

A

Travels beneath biceps therefore is well protected

Stab wounds

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3
Q

Describe any important anatomical features and therefore common injury points of the Axillary nerve

A

Through the quadrangular space with posterior circumflex humeral artery then wraps around the surgical neck

  • surgical neck of humerus fractures
  • anterior shoulder dislocation
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4
Q

Describe any important anatomical features and therefore common injury points of the radial nerve

A

Enters the posterior compartment and winds around the spiral groove before passing infront of the lateral epicondyle

  • humeral shaft fracture
  • proximal radius fracture
  • stabs wounds to anticubital fossa or wrist
  • Saturday night palsy
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5
Q

Describe any important anatomical features and therefore common injury points of the median nerve

A

Travels lateral to the brachial artery then crosses over to sit medially to it in the antecubital fossa

  • supracondylar humerus fractures
  • stab wounds
  • carpal tunnel syndrome
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6
Q

Describe any important anatomical features and therefore common injury points of the ulnar nerve

A 
Behind the medial epicondyl
Through guyon’s canal
- supracondylar humerus fractures 
- medial epicondyl fracture
- elbow dislocation
- stab wounds
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7
Q

What happens in a “pulled elbow”

A

There is subluxation of the radial head out of the annular ligament due to a direct pull on an extended pronated arm

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8
Q

How is a pulled elbow reduced

A

Flex and fully supinate
OR
Pronate and fully extend

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9
Q

What is a green stick fracture

A

One cortical surface of the bone breaks whilst the other bends

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10
Q

What is a torus/buckle fracture

A

The cortex of the bone buckles

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11
Q

Describe the MOI and signs on imaging of a supracondylar humeral fracture

A

FOOSH

Joint effusion causing fat pad sign

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12
Q

What are the complications of a supracondylar fracture

A

Brachial artery, median nerve, radial nerve damage
Malunion
Compartment syndrome

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13
Q

What are the elbow ossification centres (CRITOL)

A 
Capitulum - 1
Radial head - 3
Internal (medial) epicondyle - 5
Trochlea - 7
Olecranon - 9
Lateral epicondyle - 11
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14
Q

What is the salter Harris classification

A

Classification of fractures across growth plates in children
1 - straight through (epiphysis separates from metaphysis)
2 - above (piece of metaphysis separates with the epiphysis)
3 - lower than
4 - through everything (articular surface, epiphysis, plate, metaphysis)
5 - rammed (epiphyseal plate is crushed)

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15
Q

When using interosseous devices where is the fluid/drugs going

A

Into medullary cavity venous sinusoids or long bones

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16
Q

What are the locations for interosseous device insertion

A 
Proximal tibia (below and medial to tuberosity)
Distal tibia (above medial malleolus)
Distal femur
Proximal humerus (greater tubercle)
Sternum
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17
Q

What are the contraindications for interosseous device use

A

Infection or fracture proximal to insertion sight
Ipsilateral vascular injury
Unsuccessful first attempt
Osteoporosis

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18
Q

What are the complications of interosseous devices

A

Osteomyelitis
Iatrogenic fracture
Fat or bone microemboli
Fluid extravasation = compartment syndrome

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19
Q

Femoral nerve - what are the important anatomical pathway relations and common injury sites

A 
Under psoas major appearing laterally
Under inguinal ligament 
Femoral triangle 
Adductor canal
- anterior hip dislocation and IVDU
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20
Q

Obturator nerve - what are the important anatomical pathway relations and common injury sites

A

Under psoas major and appears medially
Sits along pelvic wall
Through obturator canal
- anterior hip dislocations, pelvic surgery

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21
Q

Sciatic nerve - what are the important anatomical pathway relations and common injury sites

A

Greater sciatic foramen below piriformis
Descends inferolaterally deep to biceps femoris
- posterior hip dislocations (especially tibial part!), IM injections, disc prolapse

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22
Q

Tibial nerve - what are the important anatomical pathway relations and common injury sites

A

Arises in popliteal fossa travelling in posterior compartment
Posterior to medial malleolus
- very rare, tarsal tunnel syndrome

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23
Q

Common fibular nerve - what are the important anatomical pathway relations and common injury sites

A

Wraps around the neck of fibula and gives off superficial and deep

  • fibular neck fractures, tight casts
  • superficial fibular can get stretched in ankle sprains
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24
Q

Which way does the femur most commonly dislocate an how does this present

A

Posteriorly

Shortened and interiorly rotated

25
What are the complications of hip dislocations
Posterior - sciatic nerve damage, AVN | Anterior - femoral and obturator nerve, artery and vein damage
26
What is the appearance of a posterior hip dislocation on x-ray
Loss of Shentons line Femoral head appears smaller Loss of lesser trochanter Head superimposes roof of acetabulum
27
How does a NOF fracture present and what is the major complication
Shortened and externally rotated lower limb (unopposed iliopsoas) Groin, medial thigh and knee pain Compication: AVN due to medial circumflex damage
28
Describe the MOI and structures than can be damaged in a posterior knee dislocation
Posteriorly directed forces against proximal tibia (dashboard injuries) Popliteal artery!! Common fibular nerve Cruciates and collaterals
29
What investigations need doing following a knee dislocation
Vascular assessment feeling for dorsalis pedis and posterior tibial ABI and CTA Assess common fibular nerve
30
MOI for patellar dislocation
Fixed foot and flexed knee with the femur rotating internally leading to lateral dislocation
31
What is the patella apprehension test and what is it used for
Diagnose patella dislocations | With the leg extended press the medial side of the patella pushing it laterally and observe the patients face
32
What is a LisFranc injury
Disruption of the medial cuneiform and 2nd metatarsal | This can range from a sprain to a fracture-dislocation
33
How do LisFranc injuries occur and what is the resulting deformity
Axial load on a hyperplantarflexed forefoot (RTC or fall from height) Metatarsal moves dorsally on the tarsal
34
How do LisFranc injuries present
Tenderness along LisFranc joint Medial plantar bruising Diminished dorsalis pedis Imaging: widened space between 1/2 metatarsal with dorsal displacement of proximal base of 2nd metatarsal
35
When do you get calcaneous fractures
Axial loading eg fall from height
36
What are the palpable leg/foot pulses
Posterior tibial- behind medial malleolus | Dorsalis pedis - lateral to extensor hallucis longus
37
What are the prehospital indications for amputation
Limb is trapping patient at an unsafe scene Limb is trapping a patient who will die in the time taken to extract them Mutilated non survivable limb Dead patient whos limb is delaying access to potentially live patients
38
What is compartment syndrome
Rise in osseofacial compartment to the point at which perfusion decreases
39
Describe the pathophysiology of compartment syndrome
Fracture, crush injury, tight dressing or extravasation leads to bleeding and oedema = increased interstitial pressure = reduced venous outflow relative to arterial inflow = compartment pressure rises further. When compartment pressure > arterial pressure there is reduced arterial inflow = ischaemia to muscle and nerve
40
How does compartment syndrome present and what needs to be done
Pain out of proportion, parasthesia, pal, pulseless, perishingly cold, paralysis Fasciotomy
41
Where does compartment syndrome commonly occur and why
Anterior leg and anterior/volar forearm | Interosseous membrane is tight, small compartment, vessels located here
42
What are the 2 factors that leads to tissue damage in reperfusion injury
ROS leading to oxidative cell damage | Inflammatory response with cytokine activation
43
What is the relation of stabbings to Langers lines
Perpendicular to = gape | Parallel to = slit like
44
List the methods available for haemorrhage control
``` Direct pressure Packing with sterile gauze and bandages Haemostatic agents Tourniquet REBOA TXA ```
45
What are the types of haemostatic agents
Mucoadhesive agents eg Celox - adheres to tissue physically blocking bleeding + promotes clot formation and RBC bonding by absorption and dehydration Factor concentrators eg QuickClot - absorbs water content of blood leavin concentrated protein and cellular components
46
How should a torniquet be applied
Directly to the skin and as distal as possible | A second tourniquet may be applied proximally
47
Where is the clavicle most likely to fracture and what is the resulting position of the medial and lateral segments of clavicle
Within the middle 3rd as it’s the thinnest with no support from muscles or ligaments Medial - pulled superiorly by SCM Lateral - drops by weight of arm and pectoralis pull
48
What structures can be damaged in a clavicle fracture
Subclavian artery and vein Brachial plexus Apex of lung
49
What can be damaged in a proximal humerus fracture
Axillary nerve | Anterior humeral circumflex artery = AVN
50
What is a complication of humeral shaft fractures
Radial nerve and profunda brachii damage as they sit in radial groove of the humerus
51
Which way does the shoulder most commonly dislocate and why
Anteriorly - rotator cuff provides posterior support + anteriorly there is a weak point of the joint capsule
52
What are the forces involved in a anterior shoulder dislocation
Excessive extension and external rotation of the humerus
53
How does a anterior shoulder dislocation present (signs and imaging)
Step off deformity at acromion | Imaging shows the humeral head displaced medially, inferiorly and overlying the glenoid
54
What structures can be damaged in a shoulder dislocation
Axillary nerve Rotator cuff Biceps tendon
55
Which way is the humerus rotated in a posterior shoulder dislocation and what is seen on imaging
Internally rotated humerus giving the “lightbulb” sign on x-ray
56
Which way does the elbow most commonly dislocate
Posterolateral (the humerus is driven through the anterior joint capsule)
57
What structures can be damaged with an elbow dislocation
Ulnar nerve Brachial artery and radial nerve can be damaged but this is rare Ulnar collateral ligament
58
What structure can be damaged in a distal radial fracture
Median nerve
59
Compare a Colles and Smiths distal radial fracture
Colles - land on extended wrist. Dorsal angulation and displacement of the distal fragment Smiths - land on flexed wrist. Volar angulation ad displacement of the distal fragment

PHM BSc - Applied Science (12 decks)

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