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PHM BSc - Applied Science > Limbs > Flashcards

Limbs Flashcards

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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
Q

What are the complications of hip dislocations

A

Posterior - sciatic nerve damage, AVN

Anterior - femoral and obturator nerve, artery and vein damage

26
Q

What is the appearance of a posterior hip dislocation on x-ray

A

Loss of Shentons line
Femoral head appears smaller
Loss of lesser trochanter
Head superimposes roof of acetabulum

27
Q

How does a NOF fracture present and what is the major complication

A

Shortened and externally rotated lower limb (unopposed iliopsoas)
Groin, medial thigh and knee pain
Compication: AVN due to medial circumflex damage

28
Q

Describe the MOI and structures than can be damaged in a posterior knee dislocation

A

Posteriorly directed forces against proximal tibia (dashboard injuries)
Popliteal artery!!
Common fibular nerve
Cruciates and collaterals

29
Q

What investigations need doing following a knee dislocation

A

Vascular assessment feeling for dorsalis pedis and posterior tibial
ABI and CTA
Assess common fibular nerve

30
Q

MOI for patellar dislocation

A

Fixed foot and flexed knee with the femur rotating internally leading to lateral dislocation

31
Q

What is the patella apprehension test and what is it used for

A

Diagnose patella dislocations

With the leg extended press the medial side of the patella pushing it laterally and observe the patients face

32
Q

What is a LisFranc injury

A

Disruption of the medial cuneiform and 2nd metatarsal

This can range from a sprain to a fracture-dislocation

33
Q

How do LisFranc injuries occur and what is the resulting deformity

A

Axial load on a hyperplantarflexed forefoot (RTC or fall from height)
Metatarsal moves dorsally on the tarsal

34
Q

How do LisFranc injuries present

A

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
Q

When do you get calcaneous fractures

A

Axial loading eg fall from height

36
Q

What are the palpable leg/foot pulses

A

Posterior tibial- behind medial malleolus

Dorsalis pedis - lateral to extensor hallucis longus

37
Q

What are the prehospital indications for amputation

A

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
Q

What is compartment syndrome

A

Rise in osseofacial compartment to the point at which perfusion decreases

39
Q

Describe the pathophysiology of compartment syndrome

A

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
Q

How does compartment syndrome present and what needs to be done

A

Pain out of proportion, parasthesia, pal, pulseless, perishingly cold, paralysis
Fasciotomy

41
Q

Where does compartment syndrome commonly occur and why

A

Anterior leg and anterior/volar forearm

Interosseous membrane is tight, small compartment, vessels located here

42
Q

What are the 2 factors that leads to tissue damage in reperfusion injury

A

ROS leading to oxidative cell damage

Inflammatory response with cytokine activation

43
Q

What is the relation of stabbings to Langers lines

A

Perpendicular to = gape

Parallel to = slit like

44
Q

List the methods available for haemorrhage control

A 
Direct pressure
Packing with sterile gauze and bandages
Haemostatic agents 
Tourniquet 
REBOA
TXA
45
Q

What are the types of haemostatic agents

A

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
Q

How should a torniquet be applied

A

Directly to the skin and as distal as possible

A second tourniquet may be applied proximally

47
Q

Where is the clavicle most likely to fracture and what is the resulting position of the medial and lateral segments of clavicle

A

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
Q

What structures can be damaged in a clavicle fracture

A

Subclavian artery and vein
Brachial plexus
Apex of lung

49
Q

What can be damaged in a proximal humerus fracture

A

Axillary nerve

Anterior humeral circumflex artery = AVN

50
Q

What is a complication of humeral shaft fractures

A

Radial nerve and profunda brachii damage as they sit in radial groove of the humerus

51
Q

Which way does the shoulder most commonly dislocate and why

A

Anteriorly - rotator cuff provides posterior support + anteriorly there is a weak point of the joint capsule

52
Q

What are the forces involved in a anterior shoulder dislocation

A

Excessive extension and external rotation of the humerus

53
Q

How does a anterior shoulder dislocation present (signs and imaging)

A

Step off deformity at acromion

Imaging shows the humeral head displaced medially, inferiorly and overlying the glenoid

54
Q

What structures can be damaged in a shoulder dislocation

A

Axillary nerve
Rotator cuff
Biceps tendon

55
Q

Which way is the humerus rotated in a posterior shoulder dislocation and what is seen on imaging

A

Internally rotated humerus giving the “lightbulb” sign on x-ray

56
Q

Which way does the elbow most commonly dislocate

A

Posterolateral (the humerus is driven through the anterior joint capsule)

57
Q

What structures can be damaged with an elbow dislocation

A

Ulnar nerve
Brachial artery and radial nerve can be damaged but this is rare
Ulnar collateral ligament

58
Q

What structure can be damaged in a distal radial fracture

A

Median nerve

59
Q

Compare a Colles and Smiths distal radial fracture

A

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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