O: Trauma Flashcards
signs of fractures?
bruising, swelling, bony tenderness
what’s important to check when a fracture presents?
peripheral nerves to check neural status, and vascular integrity
when should you use an ex-fix?
in soft tissue injuries + fracture
investigation for trauma?
x-ray
what to look for in a trauma x-ray…
- type of #: complete, transverse, oblique, spiral, bowing, buckle, greenstick, growth plate
- location of bone #: diaphysis, metaphysis, epiphysis
- displacement?
4: jt integrity?
5: other fractures
mx for acute trauma #?
restore alignment, reduce/ stabilise
analgesia, splintage, check for open fractures/ compartment syndrome, surgery?
what are some upper limb fractures?
proximal humeral fracture humeral shaft fracture olecranon fracture forearm fracture distal radial fracture hand fractures
epi of proximal humeral fracture?
very common low energy, osteoporotic bone, FOOSH
which humeral neck is usually affected by proximal humeral fracture?
surgical as opposed to anatomical neck
which nerve is commonly injured in proximal humeral fracture?
axillary nerve
mx of proximal humeral fracture?
collar and cuff or operative (ORIF, hemiarthroplasty)
aetiology of humeral shaft fracture?
falling on arm (oblique/ spiral), direct trauma (transverse or comminuted)
which nerves are commonly injured in humeral shaft fractures?
radial nerve injury
mx of humeral shaft fracture?
conservative- humeral brace, U-slab cast
op- ORIF, IM nail
aetiology of olecranon fracture?
falling on point of elbow
mx of olecranon fracture?
cast or operatives wires
anatomy of forearm fracture?
radius and ulna connected with radioulnar jt forming a ring
types of forearm fractures?
nightstick injury: ulnar break
monteggia: kids- fall type injury
gallezzi: dislocation of distal ulnar jt with radial fracture
T/F: mx of nightstick injury is operative
F: nightstick= cast. Monteggia/Gallezzi is ORIF
what is aetiology of distal radial fracture?
FOOSH
types of distal radial fracture?
Colles: dorsally angulated broken bone
Smith’s: volar angulated (palmar) broken bone
Barton’s
which injury is at risk with distal radial fracture?
median nerve
mx of colles?
conservative- cast/split
mx of Smith’s?
operative: ORIF, MUA+ K-wires, ex-fix
what are types of hand fractures?
mallet finger and Bennett’s fracture
what is mallet finger?
deformity caused by disruption of the terminal extensor tendon distal to DIP jt
s/s of mallet finger?
can’t extend finger, pain
mx of mallet finger?
mallet splint for 6/52, wire fix if displaced avulsion fracture
what is Bennett’s fracture?
fracture at base of thumb metacarpal
mx of Bennett’s fracture?
wires or screws to fixate
what are some lower limb fractures?
pelvic fracture, hip fracture, femoral shaft fracture, tibial plateau fracture, tibial shaft fracture, ankle fracture, metatarsal break, lis franc injury, calcaeneus fracture
epi of pelvic fractures?
elderly- associated with pubic rami fractures
s/s of pelvic fracture?
pelvis is ring bone so often multiple fractures
ix for pelvic fracture
CT
what is the classification used for pelvic ring fractures?
Young-Burgess (A (1-3), B (1-3), C)
mx of pelvic fracture
acute: pelvic binder*
conservative: mobilise and analgesia
operative: ORIF, external fixation, internal fixation
why is a pelvic binder necessary in an emergent pelvic fracture?
to reduce the volume into which bleeding can go
epi of hip fractures?
very common, F>M, 30% mortality
risks of hip fractures?
> 50
osteoporosis
smoking & alcohol, malnutrition
neuro/ impaired visual conditions
types of hip fracture?
intra-capsular: proximal to intra-trochanteric line
extra-capsular: distal to intra trochanteric line
can also be displaced v undisplayed
types of extra-capsular hip fracture?
intertrochanteric, subtrochanteric, basicervical, reverse-oblique
what are the 3 main arteries of the hip?
- intramedullary artery of shaft of femur
- medial and lateral circumflex
- favel artery
ligamentum teres receives blood flow from which artery?
favel artery
ix of hip fracture?
imaging: x-ray, MRI (bone oedema)
which line is important to look for on x-ray for a broken hip?
Shenton’s Line
mx of hip fracture?
operate (screws/ fixation/ arthroplasty), and early mobilisation
T/F: extra capsular hip fractures are at greater risk of AVN?
F: intra-capsular hip fractures are at greater risk
how many types of femoral shaft fractures can there be?
7
name 3 types of femoral shaft fractures?
3 out of... transverse linear non-displaced displaced/ compound spiral greestick comminuted
mx of femoral shaft fracture?
acute: thomas splint
operative: nial/ORIF, may take 12 weeks to heal
what is a tibial plateau fracture?
fracture of tibial head/ tibial plateau
what is the classification used for plateau fracture?
Schatzer Classification (1-6)
mx of tibial plateau fracture?
conservative- above knee cast then hinge cast
operative: nails, ORIF, ex-fix
what are the 2 main complications/risks of tibial plateau fracture?
NV injury of popliteal structures, peroneal nerve injury
how do ankle fractures occur?
inversion and rotational force applied to planted foot
types of ankle fractures?
stable: no medial malleolus fracture or deltoid ligament rupture
unstable: medial malleolus fracture and deltoid ligament rupture
a pilon fracture is a fracture of…
the tibia near the ankle
classification for ankle fractures?
Webber A,B,C
- level of fracture in relation to syndesmosis of ankle
what should you look for on x-ray of broken ankle?
talar shift
mx for ankle fractures (weber A & B/C)
A= stable. cast/moonboot B/C= ORIF surgery
which metatarsal is most common to break?
5th
types of metatarsal break?
avulsion by peroneus brevis= tearing away of bone from main bony mass
Jones fracture= break between base and middle of MT
proximal shaft= stress fracture
aetiology of metatarsal break?
unaccustomed walking, new shoes, osteoporosis, soldiers, runners, dancers
which ix is indicated for metatarsal break and why?
MRI/ isotope bone scan as not well picked up by x-ray
mx of metatarsal break?
no wt bearing and rigid soled boot
what is a Lis Franc injury
tarsometatarsal break/ dislocation
which fracture is most common if you fall from height and land on feet?
calcaneus fracture
what are some early local fracture complications?
compartment syndrome, vascular injury, nerve injury, soft tissue injury
what are some early systemic fracture complications?
hypovolaemia, fat embolism, ARDS, systemic inflammatory response syndrome
what are the 3 nerve injuries one can sustain…
Neurapraxia= temporary conduction block, resolves within a month Axontemesis= nerve cell axon dies distally from point of injury but regenerates Neurotemesis= nerve transected- nerve grafting needed
how to assess an open fracture?
mechanism, energy, wound, contamination
mx of open fracture?
ABCDE (pressure, reduce, remove debris, cover, stabilise) + Abx + tetanus?
which broad spec abx are given in an open fracture scenario?
co-amoxi/ metronidazole
what is compartment syndrome?
muscle compartment pressure exceeds perfusion pressure > muscle swells > loss of blood supply to muscle
pathophysiology of compartment pressure?
tissue pressure rises > capillary collapses > inc blood flow > oedema & pressure rise again > venous occlusion > ischameia & muscle necrosis
compartment syndrome is most common with which fractures?
anterior & deep leg compartments: tibia, foot, calf, buttock
forearm
risk factors for compartment syndrome?
open fractures, PWIDs, anticoags, burns
s/s of compartment syndrome?
4 Ps: pain, pallor, paraesthesia, pulselessness
which of the 4Ps of compartment syndrome is a late sign?
pulselessness
mx of compartment syndrome?
fasciotomy to release compartment
late local complications of fractures?
loss of function, post-traumatic arthritis, non-union, malunion, Volkmann’s ischaemic contracture of forearm, osteomyelitis, AVN
systemic late complications of fractures?
DVT, PE
what are 2 types of non-union?
atrophic: nothing happens at fracture site due to poor blood supply/ fracture gap too big/ smoking
hypertrophic: too much movement + callous growth resulting in soft tissue
what is Volkmann’s ischaemic contracture?
late complication of compartment syndrome- muscles die and atrophy of muscle occurs
what is a tell-tale sign of volkmann’s ischaemic contracture?
swan like deformity of hand
what are dislocations?
complete loss of contact between 2 joint surfaces (sublaxity is partial loss)
epi of joint hyper mobility syndrome?
F, 3rd decade
s/s of joint hypermobility syndrome?
arthralgia, premature osteoarthritis
classification for joint hypermobility syndrome?
modified Brighton score
3 upper limb dislocations are…
shoulder, elbow, phalanx
aetiology of shoulder dislocation?
contact sports, fall from height, traction injuries
direction of shoulder dislocation?
anterior, posterior, inferior
anterior shoulder dislocation:
fall with shoulder in external rotation, humeral head anterior to glenoid
T/F: posterior shoulder dislocation has humeral head anterior to glenoid
F: it is posterior to glenoid
which of the 3 types of shoulder dislocations requires prompt NV check?
inferior
ix for shoulder dislocation and how to differentiate between anterior and posterior dislocations?
x-ray
- posterior= lightbulb sign
axillary nerve damage is most common with which type of shoulder dislocations?
anterior
mx of shoulder dislocations?
reduce (Hippocratic, in-line traction), sling, physio
aetiology of elbow dislocation?
FOOSH, parent yanking child’s arm, divergent- force from above pushing down
direction of elbow dislocation
posterior, anterior, medial/lateral, divergent
mx of elbow dislocation?
reduce (open reduction/ closed under sedation), sling, physio
what is a phalanx dislocation?
PIP/ DIP dislocation
aetiology of phalanx dislocation?
hyperextension injury, direct axial blow
T/F: PIP dislocations tend to also have fractures
True
ix for phalanx fracture?
clinical, stress test (lateral, hyperextension, elson tests), V-sign on x-ray
mx of phalanx fracture?
reduce, sling (buddy strapping/ solar slab if unstable), physio
what are the 3 lower limb dislocations?
hip, knee, patella
aetiology of hip dislocations?
flexed, internal rotation and adducted knee- high energy RTA dashboard injury, fall form height
direction of hip dislocation?
posterior
important nerve assessment with hip dislocation?
sciatic nerve assessment
mx for hip dislocation?
urgent reduction and stabilisation in traction, follow up imaging
mechanisms of injury for knee dislocations?
high energy= high complications
elderly from low velocity injuries
dislocation following a twisting injury with planted foot commonly results in a ______ dislocation
posterior
for a knee to dislocate, what must usually happen and is a common complication?
soft tissue injuries e.g. ligamental tears
mx for knee dislocation
reduce in theatre, may need ex-fix/splint, follow up surgery to repair ligaments
which nerve damage (often caused by knee injury) may result in a foot drop?
peroneal nerve
epi of patellar dislocation?
F>M, teens, not high risk
aetiology of patellar dislocation
sudden quad contraction with flexed knee, rapid turn or direct blow
what are some risk factors for patellar dislocation
hyper mobility, under developed later femoral condyle, inc Q angle (Genu Valgum)
direction of patellar dislocation?
lateral
mx for patellar dislocation
tend to self-resolve and fall back into place
physio, brace, follow up x-rays, repeat dislocations consider surgery
what is a diagnostic test for patellar dislocation
patella apprehension test +ev
why do ankles sprain?
elastic limit of ligaments
common ligaments affected by ankle sprains?
AFTL, CFL
mx for ankle sprains?
RCE, physio- conservative
brostrum ghould/ chrisman snook- operative
what are the principles of tx for severe mutilating injuries?
. preserve all amputated parts on ice in a moist gauze . debride early . establish stable bony support . establish vascularity . repair all tissues- nerves, tendons etc . establish skin cover via grafts . prevent infection . aggressive mobilisation
in burns, what is the thick leathery skin that forms called?
eschar
mx of burns?
escharotomy & skin grafts, early mobility
