Musculoskeletal trauma and emergency orthopaedics

Question 1

Define polytrauma

Answer 1

Trauma to several body areas/ organ systems

Question 2

Are upper or lower limb fractures or dislocations associated with more severe injuries

Answer 2

Lower limb

Question 3

Are injuries to upper or lower limb more likely to be disabling

Answer 3

Upper

Question 4

Are lower or upper limb transplants better

Answer 4

Lower

Question 5

Where is blood most lost from

Answer 5

Pelvis (a litre an hour)

Question 6

How much blood can be lost in two hours from

a) tib/ fib
b) femur

Answer 6

Both 500ml in 2 hours

Question 7

What blood vessel structure is most affected by pelvic fracture

Answer 7

Posterior pelvic venous plexus (85%)

Question 8

How much of pelvic bleeding following a fracture is arterial

Answer 8

<10%

Question 9

What is the mortality rate of a pelvic fracture

Answer 9

10%

Question 10

Complications post pelvic fracture

Answer 10

Chronic pain (25-30%)

Question 11

What is immediate treatment of pelvic fracture

Answer 11

Immobilise and stabilise

Tape the feet to stop them from moving

Question 12

How long should external fixation frame be left on for

Answer 12

8 weeks

Question 13

What soft tissue injuries can affect the skin

Answer 13

Open fractures
De-gloving
Ischaemic necrosis

Question 14

What type of injuries are more likely to ischaemic necrosis

Answer 14

Crushing injuries

Question 15

What soft tissue injuries can affect vessels

Answer 15

Vasospasms

Question 16

What is neurapraxias

Answer 16

No axonal damage, but axon compressed for short while before pressure is released

Question 17

What is axontmesis

Answer 17

Axon damaged, but endoneuronal CT is intact

Question 18

What is neurotmesis

Answer 18

Laceration where axon and everything is broken

Question 19

What is usually done with open reduction

Answer 19

Internal fixation

Question 20

What does ORIF stand for

Answer 20

Open reduction internal fixation

Question 21

What are the risks of ORIF

Answer 21

Infection

Can slow healing if too rigid

Question 22

When is traction used

Answer 22

Fractures or dislocations requiring slow reduction

Question 23

What 2 ways can a reduction be held

Answer 23

Plaster- semi rigid

Rigid- internal fixation

Question 24

What are the disadvantages of treating fracture non-operatively

Answer 24

Slow rehab
Joint stiffness
Higher risk of malunion
Higher risk of non-union

Question 25

Has there been a move towards or away from internal fixation

Answer 25

Towards

Question 26

What affects healing time

Answer 26

Age of individual

Ischaemia

Question 27

Whats clinical union

Answer 27

Bone moves as one- 2 pieces of fracture are together and there is a calcified callous

Question 28

What is radiological union

Answer 28

3 of 4 cortices healed on 2 view

Callus is remodelling intself

Question 29

What can fat embolisms come from

Answer 29

Fractures or hip replacements

Question 30

First symptom of fat embolism

Answer 30

Low blood oxygen because it is blocking the lungs

Question 31

Second symptom of fat embolism

Answer 31

Neurological symptoms

Fatty deposits move to the brain

Question 32

What is the third symptom of fat embolism

Answer 32

Petechiael haemorrhaging into chest and upper arm

Question 33

6 ps of musculoskeletal assessment

Answer 33

Pallor
polar
paralysis
paresthesias
pain
pulseless

Question 34

How is compartment syndrome treated

Answer 34

Fasciotomy