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UCPEX > Plastics > Flashcards

Plastics Flashcards

1
Q

Most common site of hand high pressure soft tissue injuries

A

Non-dominant index finger, middle finger, palm

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2
Q

Symptoms and signs of high pressure soft tissue injury

A

Development over 4-6 hours
Pain
Pallor
Swelling
Tenderness
Restricted ROM
Neuromuscular compromise

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3
Q

Complications of high pressure soft tissue injury

A

Amputation (50% if injected with organic solvents)
Compartment syndrome
Infection

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4
Q

Structure and function of volar plate

A

Fibrocartilage tissue volar surface of finger PIPJ
Provides anteroposterior joint stability and prevents hyperextension at PIPJ

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5
Q

Complications of unmanaged volar plate injury

A

PIPJ stiffness
Flexion contracture
Swan neck deformity
Persistent hyper extensibility

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6
Q

At risk group for tendon injury of hand

A

Male
Working age
Sports - rugby, rock climbing
Food preparation/manual labour - risks of cuts/crush
Rheumatoid arthritis - degenerative rupture

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7
Q

Criteria for conservative management of tendon injuries

A

Flexor tendons <60% laceration - dorsal blocking splint
Extensor tendons <50% laceration - splint in extension
Hand therapy follow up

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8
Q

Mechanism of injury for UCL thumb

A

Acute - hyperabduction or hyperextension of thumb
Skier’s thumb

Chronic - repetitive stress, gamekeeper’s thumb

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9
Q

Examination of UCL thumb injury

A

Xray prior
Valgus stress to MCPJ at full extension and 30 deg flexion
Complete rupture: >30 deg gapping or >15 deg compared to contralateral

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10
Q

Mallet finger mechanism

A

Forced DIPJ flexion at extended finger

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11
Q

Mallet finger examination

A

Extensor lag at DIPJ 45 deg
Inability to actively extend
Can be corrected with passive extension
Swelling and tenderness at dorsum DIPJ

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12
Q

Management of mallet finger and complications

A

Splint in extension for 6-8 weeks full time, then gradually wean over 8 weeks. Don’t allow DIPJ to flex at all, otherwise restart.
Regular hand therapy follow up

Complications - extensor lag, swan neck deformity

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13
Q

Criteria for referral for intraarticular finger fractures

A

Involvement >30% joint space
Subluxation of joint
Failed reduction
Failed conservative management

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14
Q

Boutonniere deformity cause

A

Central slip injury, base of middle phalanx button holes between extensor tendons

Trauma
Rheumatoid arthritis/connective tissue disorder

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15
Q

Stages of Boutonniere’s deformity

A

Stage 1 - PIPJ synovitis and flexion, can be passively corrected, hyperextension DIPJ, normal MCPJ

Stage 2 - 30-40 deg flexion contracture PIPJ, limited passive correction, MCPJ and DIPJ hyperextension

Stage 3 - PIPJ in fixed flexion, radiological changes

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16
Q

Jersey finger mechanism

A

FDP avulsion from base of distal phalanx:
Forced extension of DIPJ in maximal contraction in flexion
Finger caught in jersey
Contact sports

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17
Q

Jersey finger examination

A

Swelling and tenderness at volar DIPJ
Loss of active DIPJ flexion
DIPJ rests in extension

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18
Q

Common finger dislocations and mechanisms

A

PIPJ dorsal dislocation - hyperextension
DIPJ dorsal dislocation - hyperextension
MCPJ thumb - forced hyperextension and abduction

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19
Q

Finger dislocation criteria for referral

A

Failed reduction
Fracture dislocation
Compound dislocation
Volar dislocation
MCPJ dislocation
Unable to get full ROM after reduction
Collateral instability
Neurovascular compromise

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20
Q

Finger fracture aetiology for age group:
10-29
40-69
70+

A

10-29 - sports
40-69 - machinery/workplace
70+ - falls

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21
Q

Referral criteria for extraarticular finger fractures

A

Shortening >2mm
Rotational deformity
Angulated >10 deg + unable to reduce
Displaced fracture
Compound fracture
Multiple fractures
Unstable fracture

22
Q

How to transfer amputated digit

A

Wrap in wet gauze in water tight bag
Put bag in container with ice

23
Q

Referral criteria for base of 1st metacarpal fractures

A
  • Extraarticular with angulation >30 deg
  • Bennett’s fracture <1mm displacement (partial intra-articular)
  • All Rolando fractures (complete intra-articular)
  • Severely comminuted fractures
24
Q

Most common metacarpal fracture

A

5th metacarpal
Neck (thinnest bone)

25
Q

Referral criteria for metacarpal fractures

A

Head - all intra-articular and displaced
Neck - volar angulation:
Index and middle >10-15 deg
Ring >30-40 deg
Little >50-60 deg
Shaft - volar angulation:
Index and middle >10 deg
Ring and little >20 deg

> 5mm shortening (spiral fractures)
Any shortening for other fractures
Intraarticular
Rotational deformity
Neurovascular compromise
Tendon injury
Compound fracture
Subluxation

26
Q

Carpal bone fracture mechanisms:
- Capitate
- Hamate
- Trapezium
- Pisiform

A

Capitate - FOOSH, extension + radial deviation
Hamate - body: punch, hook: direct blow (pain with tight grip)
Trapezium - axial load/hyperextension on adducted thumb, usually intra-articular
Pisiform - FOOSH wrist extension, direct blow

27
Q

Associated injuries with carpal bone fractures:
- Capitate
- Hamate
- Trapezium
- Pisiform

A

Capitate - Scaphoid fracture, metacarpal fracture, perilunate dislocation, median nerve injury
Hamate - ulnar nerve injury
Trapezium - radial nerve injury
Pisiform - FCU rupture, ulnar nerve injury at Guyon’s canal

28
Q

Retrobulbar haemorrhage
- Signs
- Complications

A

Intraconal haemorrhage:
Proptosis, chemosis, ophthalmoplegia, reduced VA, globe firm to palpate

Compartment syndrome
Irreversible ischaemia in 2 hours

29
Q

Traumatic optic neuropathy signs

A

Decreased visual acuity and pupillary reflex
10% have delayed reduced VA

30
Q

White eye blow out fracture
- Signs
- Complications

A

Painful restriction eye movement/diplopia
No subconjunctival haematoma
Nausea +/- vomiting
Raised vagal tone

Entrapment of infraorbital nerve
Permanent restriction of ocular movement if not treated within 48 hours

31
Q

LeFort fracture mechanism

A

High speed deceleration, midface/maxilla vs stationary object

LeFort I - Straight on/downwards force on upper teeth
LeFort II - Straight on blow lower/mid maxilla
LeFort III - Slight downward force nasal bridge + upper maxilla

32
Q

LeFort fracture complications

A

Life threatening haemorrhage
- Epistaxis (II and III)
Upper airway obstruction
Ocular injury
Cribiform plate disruption - CSF leak (II and III)

33
Q

LeFort fracture pattern

A

LeFort I - Transverse fracture through maxilla above root of teeth - 3 walls of maxillary sinus, pterygoid process
Unilateral or bilateral

LeFort II - Pyramidal fracture through
bridge of nose, medial + inferior orbit, hard palate and pterygomaxillary buttress.
Usually bilateral

LeFort III - Bridge of nose, medial + inferior + lateral orbit, zygomatic arch ie. craniofacial dissociation

34
Q

Features of mammalian bite with high infection risk

A

Dog infection rate 1-20%
High risk: Cats, rodents, bats, humans, monkeys
Hands, feet, genitalia
Delayed presentation >8 hours
Sutured dog bite wounds
Immunocompromised/diabetes/lymphoedema/poor blood supply
Large/dirty wound
Muscle/tendon/joint/bone involvement

35
Q

Common organisms in bites:
- Dog
- Cat
- Human

+ antibiotic treatment

A

Dog: Pasteurella multocida, Pasteurella canis, Staphylococcus, Streptococcus, Corynebacterium, Capnocytophaga canimorsus
Tetanus, rabies, mycobacterium - rare

Cat: Pasteurella multocida, Capnocytophaga canimorsus, Staph, Strep

Human: Staph aureus, Strep viridans, Bacteroides, coagulase neg Staph, Fusobacterium, Corynebacterium, Peptostreptococcus
Eikenella corrodens (fist bite)

Augmentin 15-30mg/kg, 625mg tds 7 days
OR
Metronidazole 7.5mg/kg, 400mg tds +
- adults: doxycycline 200mg day 1, 100mg OD day 2-7
- children: co-trimoxazole 24mg/kg BD 7 days
Update tetanus

36
Q

Venomous bites/stings

A

Spider - Lactodectus (black widow), antivenom in severe pain + systemic symptoms (<20%)

Toxic fish - Stingray, catfish, lionfish, scorpionfish, weaverfish, stonefish, toadfish, ratfish, rabbitfish, leatherback, some sharks
- Neuro-cardiac toxicity
- Soak in warm water for 30-60mins, surgical removal of barb, antivenoms for some

Blue-ringed octopus, Octopus joubini - releases tetrodotoxin, histamine, serotonin
- Numbness paralysis, hypotension, resp failure
- No anti-venom

Venomous sea snake
- rhabdomyolysis, hyperkalaemia
- Anti-venom

Cone shell - neurotoxicity, 15-20% mortality
- Neostigmine, supportive therapy

Jellyfish (Portugese man of war, box jellyfish, bluebottle) - nematocysts with neurotoxicity
Box jellyfish mortality 15-20%
Bathe in seawater, then vinegar. Avoid water, ETOH (causes nematocyst to discharge). Anti-venom. Supportive care.

========
Seal, sea lion bite - Micrococcus infection, tetracycline 2g QID 1/12

Corals - cellulitis + secondary infection (Vibrio, Alteromonas)
Clean with antiseptic, soap + water, hydrogen peroxide

Sponges - irritant dermatitis. Florida fire sponges give toxic rash, erythema multiforme.
- Remove spicule, bathe in vinegar, topical steroid

Sea urchins - secondary infection, some toxic (glycosides, acetylcholine, serotonin)
- Remove spines, treat infection

Starfish (Acanthaster planci) - chronic painful local lesions

Marine bristleworm - irritation, some venemous. Remove spines with tape. Soak in dilute ammonia

37
Q

Characteristics of burns:
Epidermal
Superficial dermal
Mid dermal
Deep dermal
Full thickness

A

Epidermal
Red, no blister, normal cap refill, normal sensation, good healing

Superficial dermal
Pale pink, small blisters, normal cap refill, painful, good healing

Mid dermal
Dark pink, large blisters, reduced cap refill, +/- sensation, intermediate healing

Deep dermal
Blotchy red, +/- blisters, no cap refill, no sensation, poor healing

Full thickness
White, no blisters, no cap refill, no sensation, poor healing

38
Q

Burns at risk of hypovolaemic shock
Fluid resus amount

A

> 15% TBSA

Normal saline, 1mL x % TBSA /10kg over 1 hour

39
Q

Burns requiring emergency assessment

A

Temp >38.9
Hypotension - systolic <90 or <5th percentile for age for children
Diffuse macular erythroderma
Dysfunction of 3+ organ systems

40
Q

Signs of upper + lower airway burn

A

Upper:
Perioral burns
Soot in nostrils/sputum
Singed nasal hairs
Pharyngeal oedema
Laryngeal oedema (hoarseness, stridor)

Lower:
Above plus:
Wheeze
Bronchorrhoea
Reduced peak flow
Reduced sats (be wary of carbon monoxide poisoning)
Altered LOC

41
Q

Management of upper/lower airway burns

A

Upper:
- Nebulised humidified air/O2 +/- beclomethasone
- Non-patent - tracheal intubation (using smaller ET tube), cricothyrotomy if significant facial trauma

Lower:
- Nebulised salbutamol
- IV fluids: 1mL per %TBSA per 10kg
- Consider abx

42
Q

Referral criteria for Regional Burns Unit

A

> 10% TBSA adult, >5% TBSA child
Airway injury
Circumferential burn
Full thickness burn >5%
Burn to hands, feet, face, genitalia, joints
Chemical burns
Electrical burns
Extremes of age
Comorbidities that can affect recovery
Concerns for abuse

43
Q

Referral criteria for National Burns Unit

A

> 30% adult, >15% child
Prolonged ventilation requirement
High voltage injuries with underlying tissue damage
Significant chemical burns
Full thickness burns to hands, feet, face, genitalia, joints

44
Q

Risk factors for poor wound healing

A

Large, deep wounds
Contaminated wounds/infection
Irregular wound edges, crush, burst wounds
Devitalised tissue, foreign body
Delayed presentation/wound closure
Dependent location (lower limb)
Sutures - too many/too tight
Trauma during suturing
Movement during healing
Elderly
Immunocompromised, peripheral vascular disease, oedema, chronic steroids, diabetes, renal disease, IHD, heart failure
Poor nutrition
Smoking
Obesity

45
Q

Local anaesthetic toxic dose

A

Lignocaine 1-2% - 3-5mg/kg
Lignocaine 1% + adrenaline - 6mg/kg
Prilocaine 0.5% - 5mg/kg
Prilocaine 1% + adrenaline - 8mg/kg
Bupivacaine 0.25-0.5% 2mg/kg

Topicaine (lignocaine 4%, adrenaline 0.18%, tetracaine 0.5%) - 0.1mL/kg
More cardiotoxic

46
Q

Cautions with adrenaline use in LA

A

End arteries - ears, nose, genitalia, ?fingers
Crush/contaminated wounds
On beta blockers with unopposed alpha receptor stimulation - hypertensive crisis
Peripheral vascular disease

47
Q

Techniques to reduce pain in LA

A

Lower concentration
No adrenaline
Warmed
Buffered with NaHCO3 1:10
Small gauge needle - 26-30G
Inject through wound margins
Inject slowly
Inject subdermal
Small volumes (reduce tissue distortion)

48
Q

Alternatives for local anaesthetic allergy

A

Diphenhydramine 1%
Benzyl alcohol
Tetracaine (ester)
?SC tramadol

49
Q

Wound irrigation method

A

0.9% saline, tap water, 1% povidine iodine
Aiming 1L irrigation
30-60mL syringe
18G needle
Aiming 5-8 PSI

Stingray injuries - use hot saline (<40 deg)

50
Q

Appropriate wounds for glue

A

Short (<4cm)
Low tension (<5mm gaping)
Clean

UCPEX (13 decks)

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