MSK trauma

Question 1

Control of arterial bleed

Answer 1

Move down this ladder:

1. Apply direct pressure to the vessel
2. Apply pressure dressing using a stack of gauze
3. Apply manual pressure to the proximal vessel
4. Consider tourniquet

Question 2

Tourniquet application technique

Answer 2

Tighten enough to stop bleeding: needs to stop arterial pressure as occluding only venous can cause haemorrhage and result in swollen, cyanotic extremity

Question 3

Pressures up to what level may required to stop bleeding in upper and lower limbs

Answer 3

Upper limb could be as high as 250mmHg

Lower limb could be as high as 400mmHg

Question 4

Timing of tourniquet

Answer 4

if time to operative management is longer than 1 hr, a single attempt at deflating the tourniquet may be considered to reduce ischaemic time

Question 5

Indication for arteriography in a bleeding patient

Answer 5

Only if resuscitated and stable haemodynamically

Question 6

Use of vascular clamps in control of bleeding

Answer 6

Not advised unless it is a clear superficial vessel

Question 7

Treatment of an open fracture associated with haemorrhaging wound

Answer 7

One person to apply pressure to wound whilst you reduce it under traction

Question 8

Candidates for replantation

Answer 8

Patients with isolated upper limb extremity in traumatic amputations

Question 9

How to transport a traumatically amputated extremity

Answer 9

Wash with hartmans

Wrap in moist sterile gauze

Wrap in moist towel

place in plastic bag in insulated cooling box, with crushed ice

Question 10

Ix for rhabodmyolysis

Answer 10

Myoglobin in urine

Raised CK

Question 11

Role of splinting in control of haemorrhage

Answer 11

Helps as keeps structures stable, allowing haematoma formation which would stop bleeding

Question 12

Anterior shoulder dislocation appearance

Answer 12

Squared off shoulder

Question 13

Posterior shoulder dislocation

Answer 13

Locked in internal rotation

Question 14

Posterior elbow dislocation appearance

Answer 14

Olecranon prominent posteriorly

Question 15

Anterior hip dislocation appearance

Answer 15

Extended

Abducted

Externally rotated

Question 16

Posterior hip dislocation appearance

Answer 16

Flexed

Adducted

Internally rotated

Question 17

Anteroposterior knee dislocation

Answer 17

Loss of normal contour

Extended

Question 18

Subtalar dislocation appearance

Answer 18

laterally displaced calcaneus

Question 19

Lateral ankle dislocation appearance

Answer 19

Externally rotated prominent medial maelleolus

Question 20

In what scenario would you not get an x-ray before treating a dislocation

Answer 20

vascular compromise

or

impending skin breakage

Question 21

Management of open wounds

Answer 21

Remove gross contamination

Cover with a moist sterile dressing

Apply immobilisation

Abx + tetanus

Question 22

Management of a dislocated joint in presence of an associated arterial injury

Answer 22

Gentle attempts at reducing may be done

Otherwise must splint the dislocation and obtain emergency consultation

Question 23

Compartment syndrome definition

Answer 23

Increased pressure within musculofascial compartments causes ischaemia

Question 24

Compartment syndrome latest sign

Answer 24

Absence of palpable pulse

Question 25

What intracompartmental pressure could be harmful

Answer 25

Tissue pressure of greater than 30 mmHg suggests reduced capillary blood flow

Question 26

Treatment of compartment syndrome

Answer 26

fasciotomy

Question 27

Treatment of lacerations

Answer 27

Debridement and closure If extends below fascial level, may require operative intervention

Question 28

Management of contusions

Answer 28

If seen early: limit function apply cold packs

Question 29

Morel-Lavallee lesion injury mechanism

Answer 29

Soft-tissue avulsion, shearing the skin from the deep fascia, allowing for significant accumulation of blood in the resulting cavity

Question 30

Risk factors for tetanus

Answer 30

Wounds \>6hrs old Contused or abraded \>1cm deep Burns/cold contaminated Denervated or ischaemic

Question 31

Site of injury to ulnar nerve

Answer 31

Elbow

Question 32

Site of injury to median nerve

Answer 32

Wrist fracture

Question 33

Site of injury to anterior interosseous nerve

Answer 33

Supracondylar fracture of humerus (children)

Question 34

Site of injury to the musculocutaneous nerve

Answer 34

Anterior shoulder dislocation

Question 35

Site of injury to radial nerve

Answer 35

Distal humeral shaft Anterior shoulder dislocation

Question 36

Site of injury to axillary nerve

Answer 36

Anterior shoulder dislocation Proximal humerus fracture

Question 37

Site of injury to femoral nerve

Answer 37

Pubic ramus fracture

Question 38

Site of injury to obturator nerve

Answer 38

Obturator ring fracture

Question 39

Site of injury to posterior tibial nerve

Answer 39

Knee dislocation

Question 40

Site of injury to suprficial peroneal nerve

Answer 40

Fibular neck fracture Knee dislocation

Question 41

Site of injury to deep peroneal nerve

Answer 41

Fibular neck fracture Compartment syndrome

Question 42

Site of injury to sciatic nerve

Answer 42

Posterior hip dislocation

Question 43

Site of injury to superior gluteal nerve

Answer 43

acetabular fracture

Question 44

Site of injury to inferior gluteal nerve

Answer 44

acetabular fracture