orthopaedic emergencies

Question 1

what is the difference between primary, secondary and tertiary survey ?

Answer 1

1ry - treat the greatest threats to life first , then ABCDE
2ry - physical examination , obtain imaging
3ry - repeat physical examination when mental status has stabilized

Question 2

which vertebrae must be visualized in lateral c spine imaging ?

Answer 2

c7 to T1

Question 3

what is the initial management for open fractures ?

Answer 3

wound irrigation
removal of gross contamination
take a photo
saline soaked dressing
back slab
broad spectrum antibiotics
tetanus prophylaxis

Question 4

what is the gustilo classification ?

Answer 4

G1- wound less than 1 cm
G2 - 1-10 cm , moderate soft tissue injury
G3a - more than 10 , high energy, extensive soft tissue damage
G3b - periosteal stripping - needs soft tissue coverage
G3c - vascular injury and requires repair

Question 5

what is thee definitive management of open fractures ?

Answer 5

must all be assumed to be contaminated :
antibiotic prophylaxis
urgent wound debridement
temporary stabilization
definitive fixation and wound cover

Question 6

what are the complications associated with fractures with vascular injury ?

Answer 6

organ hypoperfusion and hypovolemic shock
coagulopathy
fluid administration to replace the lost blood

Question 7

what vessel is affected in 1st rib fracture ?

Answer 7

sbclavian arteery/ vein

Question 8

what vessel is affected in shoulder dislocation ?

Answer 8

axillary artery

Question 9

what artery is affected in humeral supracondylar fracture ?

Answer 9

brachial artery

Question 10

what artery is affected by elbow dislocation ?

Answer 10

brachial artery

Question 11

what artery is affected by pelvic fractures ?

Answer 11

presacral and internal iliac

Question 12

what artery iis affectedd with femoral suprachondylar fracture ?

Answer 12

femoral artery

Question 13

what artery is affected in knee dislocation ?

Answer 13

popliteal arterry/vein

Question 14

what artery is affected in fracture of the proximal tibial ?

Answer 14

popliteal artery

Question 15

what is considered a priority when managing fractures with vascular injury ?

Answer 15

control external haemorrhage

Question 16

what is the most sensitive finding associated with compartment syndrome ?

Answer 16

pain with passive motion

Question 17

what is the treatment for compartment syndrome ?

Answer 17

fasciotomy

Question 18

how is a diagnosis of septic arthritis made ?

Answer 18

joint aspirate with a WBC of more than 50000

Question 19

what is the most affected joint by septic arthritis ?

Answer 19

knee

Question 20

what is the treatment for septic arthritis ?

Answer 20

joint washout in theatre
IV antibiotics followed by oral for 4-6 weeks
analgesia
splintage

Question 21

what is the most common cause of cauda equina ?

Answer 21

acute lumbar disc herniation

Question 22

what is the presentation of cauda equina ?

Answer 22

acute back pain
alternating or bilateral radiculopathy
saddle like paraesthesia
bowel or bladder dysfunction

Question 23

how is cauda equina confirmed ?

Answer 23

urgent MRI

Question 24

what is the treatment of cauda equina ?

Answer 24

prompt surgical decompression

Question 25

what is the usual cause of death in traumatic amputations ?

Answer 25

haemorrhage or lung injury

Question 26

before reducing a dislocated fracture what should be done ?

Answer 26

obtain an Xray

Question 27

what are the causes of anterior vs posterior dislocation of the shoulder ?

Answer 27

anterior - fall on outstretched hand
posterior - electrocution or epilepsy

Question 28

how does inferior dislocation of the shoulder happen ?

Answer 28

hyperabduction
risk of brachial plexus injury

Question 29

what is the safest and most effective method to treat shoulder dislocations ?

Answer 29

traction- countertraction

Question 30

what is the presentation of hip dislocations in each of the following :
posterior -
anterior -
central -

Answer 30

posterior - leg in internal rotation
anterior - leg in external rotation
central - acetabular fracture

Question 31

what are the complications associated with hip dislocation ?

Answer 31

sciatic nerve palsy
avascular necrosis

Question 32

what is the reduction technique used in hip dislocation ?

Answer 32

allis reduction technique

Question 33

what is the management for a knee dislocation ?

Answer 33

reduction
followed by CT angio