O: Trauma Flashcards
1
Q
signs of fractures?
A
bruising, swelling, bony tenderness
2
Q
what’s important to check when a fracture presents?
A
peripheral nerves to check neural status, and vascular integrity
3
Q
when should you use an ex-fix?
A
in soft tissue injuries + fracture
4
Q
investigation for trauma?
A
x-ray
5
Q
what to look for in a trauma x-ray…
A
- type of #: complete, transverse, oblique, spiral, bowing, buckle, greenstick, growth plate
- location of bone #: diaphysis, metaphysis, epiphysis
- displacement?
4: jt integrity?
5: other fractures
6
Q
mx for acute trauma #?
A
restore alignment, reduce/ stabilise
analgesia, splintage, check for open fractures/ compartment syndrome, surgery?
7
Q
what are some upper limb fractures?
A
proximal humeral fracture humeral shaft fracture olecranon fracture forearm fracture distal radial fracture hand fractures
8
Q
epi of proximal humeral fracture?
A
very common low energy, osteoporotic bone, FOOSH
9
Q
which humeral neck is usually affected by proximal humeral fracture?
A
surgical as opposed to anatomical neck
10
Q
which nerve is commonly injured in proximal humeral fracture?
A
axillary nerve
11
Q
mx of proximal humeral fracture?
A
collar and cuff or operative (ORIF, hemiarthroplasty)
12
Q
aetiology of humeral shaft fracture?
A
falling on arm (oblique/ spiral), direct trauma (transverse or comminuted)
13
Q
which nerves are commonly injured in humeral shaft fractures?
A
radial nerve injury
14
Q
mx of humeral shaft fracture?
A
conservative- humeral brace, U-slab cast
op- ORIF, IM nail
15
Q
aetiology of olecranon fracture?
A
falling on point of elbow
16
Q
mx of olecranon fracture?
A
cast or operatives wires
17
Q
anatomy of forearm fracture?
A
radius and ulna connected with radioulnar jt forming a ring
18
Q
types of forearm fractures?
A
nightstick injury: ulnar break
monteggia: kids- fall type injury
gallezzi: dislocation of distal ulnar jt with radial fracture
19
Q
T/F: mx of nightstick injury is operative
A
F: nightstick= cast. Monteggia/Gallezzi is ORIF
20
Q
what is aetiology of distal radial fracture?
A
FOOSH
21
Q
types of distal radial fracture?
A
Colles: dorsally angulated broken bone
Smith’s: volar angulated (palmar) broken bone
Barton’s
22
Q
which injury is at risk with distal radial fracture?
A
median nerve
23
Q
mx of colles?
A
conservative- cast/split
24
Q
mx of Smith’s?
A
operative: ORIF, MUA+ K-wires, ex-fix
25
what are types of hand fractures?
mallet finger and Bennett's fracture
26
what is mallet finger?
deformity caused by disruption of the terminal extensor tendon distal to DIP jt
27
s/s of mallet finger?
can't extend finger, pain
28
mx of mallet finger?
mallet splint for 6/52, wire fix if displaced avulsion fracture
29
what is Bennett's fracture?
fracture at base of thumb metacarpal
30
mx of Bennett's fracture?
wires or screws to fixate
31
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
32
epi of pelvic fractures?
elderly- associated with pubic rami fractures
33
s/s of pelvic fracture?
pelvis is ring bone so often multiple fractures
34
ix for pelvic fracture
CT
35
what is the classification used for pelvic ring fractures?
Young-Burgess (A (1-3), B (1-3), C)
36
mx of pelvic fracture
acute: pelvic binder*
conservative: mobilise and analgesia
operative: ORIF, external fixation, internal fixation
37
why is a pelvic binder necessary in an emergent pelvic fracture?
to reduce the volume into which bleeding can go
38
epi of hip fractures?
very common, F>M, 30% mortality
39
risks of hip fractures?
>50
osteoporosis
smoking & alcohol, malnutrition
neuro/ impaired visual conditions
40
types of hip fracture?
intra-capsular: proximal to intra-trochanteric line
extra-capsular: distal to intra trochanteric line
can also be displaced v undisplayed
41
types of extra-capsular hip fracture?
intertrochanteric, subtrochanteric, basicervical, reverse-oblique
42
what are the 3 main arteries of the hip?
1. intramedullary artery of shaft of femur
2. medial and lateral circumflex
3. favel artery
43
ligamentum teres receives blood flow from which artery?
favel artery
44
ix of hip fracture?
imaging: x-ray, MRI (bone oedema)
45
which line is important to look for on x-ray for a broken hip?
Shenton's Line
46
mx of hip fracture?
operate (screws/ fixation/ arthroplasty), and early mobilisation
47
T/F: extra capsular hip fractures are at greater risk of AVN?
F: intra-capsular hip fractures are at greater risk
48
how many types of femoral shaft fractures can there be?
7
49
name 3 types of femoral shaft fractures?
```
3 out of...
transverse
linear
non-displaced
displaced/ compound
spiral
greestick
comminuted
```
50
mx of femoral shaft fracture?
acute: thomas splint
operative: nial/ORIF, may take 12 weeks to heal
51
what is a tibial plateau fracture?
fracture of tibial head/ tibial plateau
52
what is the classification used for plateau fracture?
Schatzer Classification (1-6)
53
mx of tibial plateau fracture?
conservative- above knee cast then hinge cast
| operative: nails, ORIF, ex-fix
54
what are the 2 main complications/risks of tibial plateau fracture?
NV injury of popliteal structures, peroneal nerve injury
55
how do ankle fractures occur?
inversion and rotational force applied to planted foot
56
types of ankle fractures?
stable: no medial malleolus fracture or deltoid ligament rupture
unstable: medial malleolus fracture and deltoid ligament rupture
57
a pilon fracture is a fracture of...
the tibia near the ankle
58
classification for ankle fractures?
Webber A,B,C
| - level of fracture in relation to syndesmosis of ankle
59
what should you look for on x-ray of broken ankle?
talar shift
60
mx for ankle fractures (weber A & B/C)
```
A= stable. cast/moonboot
B/C= ORIF surgery
```
61
which metatarsal is most common to break?
5th
62
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
63
aetiology of metatarsal break?
unaccustomed walking, new shoes, osteoporosis, soldiers, runners, dancers
64
which ix is indicated for metatarsal break and why?
MRI/ isotope bone scan as not well picked up by x-ray
65
mx of metatarsal break?
no wt bearing and rigid soled boot
66
what is a Lis Franc injury
tarsometatarsal break/ dislocation
67
which fracture is most common if you fall from height and land on feet?
calcaneus fracture
68
what are some early local fracture complications?
compartment syndrome, vascular injury, nerve injury, soft tissue injury
69
what are some early systemic fracture complications?
hypovolaemia, fat embolism, ARDS, systemic inflammatory response syndrome
70
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
```
71
how to assess an open fracture?
mechanism, energy, wound, contamination
72
mx of open fracture?
ABCDE (pressure, reduce, remove debris, cover, stabilise) + Abx + tetanus?
73
which broad spec abx are given in an open fracture scenario?
co-amoxi/ metronidazole
74
what is compartment syndrome?
muscle compartment pressure exceeds perfusion pressure > muscle swells > loss of blood supply to muscle
75
pathophysiology of compartment pressure?
tissue pressure rises > capillary collapses > inc blood flow > oedema & pressure rise again > venous occlusion > ischameia & muscle necrosis
76
compartment syndrome is most common with which fractures?
anterior & deep leg compartments: tibia, foot, calf, buttock
forearm
77
risk factors for compartment syndrome?
open fractures, PWIDs, anticoags, burns
78
s/s of compartment syndrome?
4 Ps: pain, pallor, paraesthesia, pulselessness
79
which of the 4Ps of compartment syndrome is a late sign?
pulselessness
80
mx of compartment syndrome?
fasciotomy to release compartment
81
late local complications of fractures?
loss of function, post-traumatic arthritis, non-union, malunion, Volkmann's ischaemic contracture of forearm, osteomyelitis, AVN
82
systemic late complications of fractures?
DVT, PE
83
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
84
what is Volkmann's ischaemic contracture?
late complication of compartment syndrome- muscles die and atrophy of muscle occurs
85
what is a tell-tale sign of volkmann's ischaemic contracture?
swan like deformity of hand
86
what are dislocations?
complete loss of contact between 2 joint surfaces (sublaxity is partial loss)
87
epi of joint hyper mobility syndrome?
F, 3rd decade
88
s/s of joint hypermobility syndrome?
arthralgia, premature osteoarthritis
89
classification for joint hypermobility syndrome?
modified Brighton score
90
3 upper limb dislocations are...
shoulder, elbow, phalanx
91
aetiology of shoulder dislocation?
contact sports, fall from height, traction injuries
92
direction of shoulder dislocation?
anterior, posterior, inferior
93
anterior shoulder dislocation:
fall with shoulder in external rotation, humeral head anterior to glenoid
94
T/F: posterior shoulder dislocation has humeral head anterior to glenoid
F: it is posterior to glenoid
95
which of the 3 types of shoulder dislocations requires prompt NV check?
inferior
96
ix for shoulder dislocation and how to differentiate between anterior and posterior dislocations?
x-ray
| - posterior= lightbulb sign
97
axillary nerve damage is most common with which type of shoulder dislocations?
anterior
98
mx of shoulder dislocations?
reduce (Hippocratic, in-line traction), sling, physio
99
aetiology of elbow dislocation?
FOOSH, parent yanking child's arm, divergent- force from above pushing down
100
direction of elbow dislocation
posterior, anterior, medial/lateral, divergent
101
mx of elbow dislocation?
reduce (open reduction/ closed under sedation), sling, physio
102
what is a phalanx dislocation?
PIP/ DIP dislocation
103
aetiology of phalanx dislocation?
hyperextension injury, direct axial blow
104
T/F: PIP dislocations tend to also have fractures
True
105
ix for phalanx fracture?
clinical, stress test (lateral, hyperextension, elson tests), V-sign on x-ray
106
mx of phalanx fracture?
reduce, sling (buddy strapping/ solar slab if unstable), physio
107
what are the 3 lower limb dislocations?
hip, knee, patella
108
aetiology of hip dislocations?
flexed, internal rotation and adducted knee- high energy RTA dashboard injury, fall form height
109
direction of hip dislocation?
posterior
110
important nerve assessment with hip dislocation?
sciatic nerve assessment
111
mx for hip dislocation?
urgent reduction and stabilisation in traction, follow up imaging
112
mechanisms of injury for knee dislocations?
high energy= high complications
| elderly from low velocity injuries
113
dislocation following a twisting injury with planted foot commonly results in a ______ dislocation
posterior
114
for a knee to dislocate, what must usually happen and is a common complication?
soft tissue injuries e.g. ligamental tears
115
mx for knee dislocation
reduce in theatre, may need ex-fix/splint, follow up surgery to repair ligaments
116
which nerve damage (often caused by knee injury) may result in a foot drop?
peroneal nerve
117
epi of patellar dislocation?
F>M, teens, not high risk
118
aetiology of patellar dislocation
sudden quad contraction with flexed knee, rapid turn or direct blow
119
what are some risk factors for patellar dislocation
hyper mobility, under developed later femoral condyle, inc Q angle (Genu Valgum)
120
direction of patellar dislocation?
lateral
121
mx for patellar dislocation
tend to self-resolve and fall back into place
| physio, brace, follow up x-rays, repeat dislocations consider surgery
122
what is a diagnostic test for patellar dislocation
patella apprehension test +ev
123
why do ankles sprain?
elastic limit of ligaments
124
common ligaments affected by ankle sprains?
AFTL, CFL
125
mx for ankle sprains?
RCE, physio- conservative
| brostrum ghould/ chrisman snook- operative
126
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
```
127
in burns, what is the thick leathery skin that forms called?
eschar
128
mx of burns?
escharotomy & skin grafts, early mobility
