Musculo-skeletal trauma and Emergency orthopaedics Flashcards
What are two core principles of treating severe trauma? [2]
Treat life threatening injuries 1st
* e.g. apply pressure to haemorrhage from an open wound / reduce a pelvic fracture if haemodynamically unstable, etc
Prevent long term complications:
* systematic examination of everything and planned treatment of non-life threatening injuries when patient stable
How do you assess level of consciousness in a trauma incident? [4]
Which state is only normal state? [1]
Level of consciousness AVPU = Alert, verbal stimuli, painful stimuli, unresponsive
Alert = normal
Where should you assess when investigating an impacted joint?
Investigate the joint above and the joint below the area impacted
What is a polytrauma?
polytrauma= trauma to several body areas or organ systems. One or more of these may be life threatening
State out of lower and upper limb which is more life threatening [1] and more disabling [1]
Upper limb:
* More disabling
* Less life threatening
Lower limb:
* Less disabling
* Can be lifethreatening
How much blood loss is possible from the first 2hrs from
Tibia / fibula region [1]
Femur region [1]
Pelvic region [1]
Possible blood loss within the first 2 hours
tibia/fibia= 500ml
femur= 500ml
pelvic= 2000ml
Which type of fracture is called ‘the killing fracture’ [1]
Open pelvic fractures
Explain why open pelvic fractures are so problematic? [1]
- Due to the number of blood vessels: both internal and external iliac arteries and veins.
- pelvis is usually the protective structure for these vessels
- fractured and fracture dislocations involving the sacroiliac joint can rupture any of these vessels.
Open pelvic fracture bleeds are commonly caused by damage to which structures? [3]
- Posterior pelvic venous plexus (85%)
- Bleeding from trabecular bone
- < 10 % is arterial source
Explain specifically why the venous plexus undergoes such bad haemorrhage in an open pelvic fracture [2]
Pre-sacral venous plexus overlies sacro-iliac joint, fracture disrupts SI joint and tears veins causing bleeding
What is the mortality of open pelvice fracture? [1]
10-20%
Describe methods used to stabilise a pelvic fracture
External fixation = left for 8 weeks if possible
Define the damage the occurs in each of the following:
neuropraxia
axonotemsis
Neurotmesis
- Neurapraxia: no axonal discontinuity
- Axonotmesis: axoplasmic disruption endoneural sheath intact
- Neurotmesis: axon disrupted loss of tubules, support cells destroyed
Define what is meant by a degloving injury [1]
avulsions or detachment of the skin and subcutaneous tissue from the underlying muscle and fascia secondary to a sudden shearing force applied to the skin surface
Define crush injury [1] and crush syndrome [1]
Crush injury:
* Injury caused as a result of direct physical crushing of the muscles due to something heavy.
Crush syndrome:
* Also termed rhabdomyolysis, involves a series of metabolic changes produced due to an injury of the skeletal muscles of such a severity as to cause a disruption of cellular integrity and release of its contents into the circulation.
Describe overview of treating severe soft tissue injuries [2]
All severe soft tissue injuries require urgent treatment because of potential complications
After treatment of the soft tissue injury the fracture requires fixation
A severe soft-tissue injury will delay fracture healing
PRICE:
* Protect
* Rest
* Ice
* Compression
* Elevate
Which organ may speficcally be damaged in soft tissue injury [1]
Kidney damage
What is an open reduction internal fixation (ORIF) used? [1]
Why is an ORIF useful? [1]
Name a risk of an ORIF [1]
ORIF:
* Used when internal fixation needed
* Allows v accurate reduction
* RIsk of an infection
What type of internal fixation is this? [1]
K wires
What type of internal fixation is this?
Intramedullary nail
State some different types of external stabilisations
All protect bone fracture when healing
What are absoulte indications for operative treatment? [5]
- Displaced intra-articular fractures
- Open fractures
- Fractures with vascular injury or compartment syndrome
- Pathological fractures
- Non-unions
State the healing time for
:)
What is a fat embolism? [1]
Fat embolism syndrome occurs when embolic fat macroglobules pass into the small vessels of the lung and other sites, roducing endothelial damage and resulting respiratory fapilure (acute respiratory distress syndrome (ARDS-like) picture), cerebral dysfunction
Define volkman contracture [1]
Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.
The condition is also called Volkmann ischemic contracture.
What triad of things are you looking for with a fat embolism? [3]
Lung involement: causes hypoxaemia
Brain involvement: fat droplets get lodged in white matter in brain
Petachie: droplets get stuck in vessels and cause haemorrhage
