R2 LOCO2 Flashcards
How much blood loss is possible from the first 2hrs from
Tibia / fibula region [1]
Femur region [1]
Pelvic region [1]
Possible blood loss within the first 2 hours
tibia/fibia= 500ml
femur= 500ml
pelvic= 2000ml
Open pelvic fracture bleeds are commonly caused by damage to which structures? [3]
- Posterior pelvic venous plexus (85%)
- Bleeding from trabecular bone
- < 10 % is arterial source
Define the damage the occurs in each of the following:
neuropraxia
axonotemsis
Neurotmesis
- Neurapraxia: no axonal discontinuity
- Axonotmesis: axoplasmic disruption endoneural sheath intact
- Neurotmesis: axon disrupted loss of tubules, support cells destroyed
Define what is meant by a degloving injury [1]
avulsions or detachment of the skin and subcutaneous tissue from the underlying muscle and fascia secondary to a sudden shearing force applied to the skin surface
Define crush injury [1] and crush syndrome [1]
Crush injury:
* Injury caused as a result of direct physical crushing of the muscles due to something heavy.
Crush syndrome:
* Also termed rhabdomyolysis, involves a series of metabolic changes produced due to an injury of the skeletal muscles of such a severity as to cause a disruption of cellular integrity and release of its contents into the circulation.
Which organ may speficcally be damaged in soft tissue injury [1]
Kidney damage
What type of reduction would you use for a Colles fracture? [1]
Closed reduction (alignment without angulation) with a splint
What are absoulte indications for operative treatment? [5]
- Displaced intra-articular fractures
- Open fractures
- Fractures with vascular injury or compartment syndrome
- Pathological fractures
- Non-unions
What are current relative indications for operative treatment? [4]
- Loss of position with closed method
- Poor functional result with non-anatomical reduction
- Displaced fractures with poor blood supply
- Economic and medical indications
Healing time
Define what clinical union is [1]
Define what radiological union [1]
Clinical union:
* the bones move as one and can be tender when stressed
Radiological union:
* Bridging callus formation
* Fracture line is often still present
* Remodelling
State the healing time for
:)
What is an early [1] and late [3] complication to bone from trauma?
Early:
* infection: osteomyelitis
Late:
* Non-union
* Mal-union
* AVN
What is are early [4] and late [3] complication to soft tissue from trauma?
Early:
* Plaster sores
* Infection
* Neurovascular injury
* Compartment syndrome
Late:
* Tendon rupture
* Nerve compression
* Volkmann contracture
Define volkman contracture [1]
Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.
The condition is also called Volkmann ischemic contracture.
What triad of things are you looking for with a fat embolism? [3]
Lung involement: causes hypoxaemia
Brain involvement: fat droplets get lodged in white matter in brain
Petachie: droplets get stuck in vessels and cause haemorrhage
Tx for fat embolism? [3]
Fluids
O2
Albumin
What are the 6Ps of compartment syndrome? [6]
Which one is early? [1] and which is late? [1]
Pale
Pulseless
Parenthesis: first stage
Pain
Paralysis: late stage
Polar
What pressures are normal in compartment? [1]
What are elevated [1] and emergency [1] pressures in a compartment?
Why are these clinically significant? [2]
Normal 0-10mmHg
Elevated 20-30mmHg: venous flow compromised
Emergency 30+ mmHg: arterial flow compromised
What delta pressures would be a definite indication [1] and relative indication for a fasciotomy? [2]
< 20mmHg = definite indication for a fasciotomy
< 30mmHg = relative indication for a fasciotomy
Apart from increases in delta pressures, name two indications for a fasciotomy [2]
- Interruption of arterial perfusion for 4 or more hours
- Clinical signs of acute compartment syndrome
Biggest cause of mortality in septic arthritis is
Staphylococcus aureus
Streptococci spp.
Clostridium sp
Neisseria gonorrhoea
Escherichia coli
Biggest cause of mortality in septic arthritis is
Staphylococcus aureus
How would a S. aureus infection appear in culture? [1]
Appears as grape like clusters, on trypticase soy agar plate produces yellow pigment: staphlyoxanthin
Describe radiological changes seen in septic athritis patients? [4]
May see soft tissue swelling
Joint capsule distension
Destructive changes seen after at least 2 weeks
* Erosion of articular surface
* Associated soft tissue swelling
Which antibiotics would you give for chronic osteomyelitis [1]
Vancomycin cement beads
What is sequestrum in chronic osteomyelitis? [1]
What is Involucrum in chronic osteomyelitis? [1]
Sequestrum: fragment of necrosed bone that has become separated from surrounding tissue
Involucrum: covering or sheath that contains a sequestrum of bone
Which of the following is a fibrous ligament
achilles ligament
deltoid ligament
spring ligament
patella ligament
spring ligament
Name the condition for pain at the tendon at the arrow [1]
De Quervain’s tenosynovitis
Name the condition for this tendon condition [1]
Trigger finger
Discoid lesions are assoicated with
Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma
SLE
A characterisitic of [] arthritis is that it can be moved back into the correct position. What is this arthritis called? [1]
Jaccoud arthritis
What pathology is depicted here? [1]
Trigger finger
Superficial and deep flexor tendons with local tenosynovitis at the metacarpal head subsequently develop localised nodal formation on the tendon, distal to the pulley (Fig. 1). The A1 pulley is the most frequently involved ligament in trigger finger.
Which of the following is most commonly involved ligament in trigger finger?
A1 pulley
A2 pulley
A3 pulley
A4 pulley
A5 pulley
A1 pulley
