Regional Adult Trauma Flashcards
C -spine fractures are common after what type of injury?
high energy e.g RTA, fall from height
when should you go C spine control
during A (airways ) of ABCDE
what criteria must be satisfied before clearing the C spine?
no history of loss of consciousness
GSC 15 with no alcohol intoxication
no significant distracting injury e.g head injury
no neuro symptoms in limbs
no midline tenderness on palpation of C spine
no pain on gentle active neck movement
a full neuro exam might include?
peripheral motor function coarse touch sensation upper and lower limb reflexes cranial nerve evaluation rectal exam assessment of bulbocavernous reflex
more stable c spine injuries can be treated with what?
cervical collar
more unstable c spine injuries may require immobilization with what?
halo vest
what tends to cause thoracolumbar spinal fractures?
RTA or fall from height
can get wedge fractures in elderly if osetoporosis
what is spinal shock?
physiologic response to injury with complete loss of sensation and motor functions and loss of reflex below the level of injury
how long does spinal shock last
can resolve in 24 hours
what is the bulbocavernous reflex?
a reflex contraction of anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urinary catheter
is the bulbocavernous reflex present in spinal shock?
no
what is neurogenic shock and when does it occur?
occurs secondary to temporary shut down of sympathetic outflow from the cord from T1 to L2
how do you treat neurogenic shock?
Iv fluid
what is a complete spinal cord injury?
when there is no sensory or motor function below level of injury
prognosis is very poor
what is an incomplete spinal injury
when there is some neurologic (sensory and or motor) present distal to site of injury
what does sacral sparing indicate?
an incomplete spinal cord injury and a much better prognosis
what is the most common incomplete spinal cord injury?
central cord syndrome
what type of injury tends to cause central cord syndrome?
hyper extension injury in cervical spine
in central cord syndrome what gets paralysed more-arms or legs?
arms
because the corticospinal motor tracts of the upper limbs are more central than those of lower limbs
sacral sparing is usually present
what does anterior cord syndrome result in?
loss of motor function as well as loss of coarse touch, pain, and temperature sensation
what does posterior cord syndrome result in?
loss of dorsal column function-vibration sense, light touch, proprioception
loss of dorsal column function-vibration sense, light touch, proprioception
posterior cord syndrome
loss of motor function as well as loss of coarse touch, pain, and temperature sensation
anterior cord syndrome
what causes Brown-sequard syndrome?
hemisection of cord
usually from penetrating injury e.g stab wound
hemisection of cord
usually from penetrating injury e.g stab wound
Brown -sequard syndrome
what does brown -sequard syndrome cause?
ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation
ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation
brown -sequard syndrome
if the pelvic ring is broken in one place is there likely to be another fracture?
yes
what is a lateral compression fracture of the pelvis?
occurs with side impact e.g RTA where one half of pelvis is displaced medially.
fractures through pubic rami or ischium are accompanied by sacral compression fracture or SI joint disruption
occurs with side impact e.g RTA where one half of pelvis is displaced medially.
fractures through pubic rami or ischium are accompanied by sacral compression fracture or SI joint disruption
lateral compression fracture of the pelvis
what is a vertical shear fracture of the pelvis?
occurs due to axial force on pelvis e.g fall from height
affected hemipelvis is displaced superiorly
sacral nerve roots and lumbosacral plexues are at high risk of injury
leg on affected side may appear shorter
occurs due to axial force on pelvis e.g fall from height
affected hemipelvis is displaced superiorly
sacral nerve roots and lumbosacral plexues are at high risk of injury
leg on affected side may appear shorter
vertical shear pelvis fracture
what is an anteroposterior compression fracture of the pelvis?
may result in wide distribution of pubic symphysis
open book pelvis fracture
anteroposterior compression fracture of the pelvis
may result in wide distribution of pubic symphysis
anteroposterior compression fracture of the pelvis
what do you need to do to assess sacral nerve root function?
PR exam
what are humeral neck fractures causes by usually?
falling onto an outstretched hand
how do you treat a humeral neck fracture?
sling and gradual return to mobilization
persistently displaced ones can be surgically treated with internal fixation
if the humeral head splits, what is usually done?
shoulder replacement
what type of shoulder dislocation is more common?
anterior shoulder dislocation
what causes anterior shoulder dislocation?
excessive external rotation force or a fall onto back of shoulder
can occur due to a seizure
how do you confirm anterior shoulder dislocation?
x ray
how do you treat anterior shoulder dislocation?
closed reduction under sedation or anaesthetic then placed in sling for 2-3 weeks
physio
can ligamentous laxity cause shoulder dislocations?
yes
what causes a posterior shoulder dislocation?
a posterior force on the adducted and internally rotated arm
light bulb sign on x ray
posterior shoulder dislocation
when do injuries of the acromioclavicular joint occur?
after a fall onto the point of the shoulder
how do you treat acromioclavicular joint injuries?
mainly conservatively - sling then physio
surgery for those with chronic pain
what can cause humeral shaft fractures?
direct trauma e.g RTA causing transverse or comminuted fractures
a fall (with or without twisting injury) resulting in oblique or spiral fracture
what nerve is susceptible to injury in a humeral shaft fracture?
radial nerve
how do you treat a humeral shaft fracture?
most with a functional humeral brace
internal fixation with intramedullary nail
what causes a Olecranon fracture?
falling onto point of elbow with a contracted tricep
usually in the elderly
how are olecranon fractures treated?
simple ones- tension band wiring
complicated- ORIF with plates and screws
what usually causes radial head and neck fractures?
fall onto outstretched arm
in what direction do most elbows dislocate?
posterior
what is a nigthstick fracture?
ulnar shaft fracture
what causes an isolated fracture of ulna?
direct blow
if there is a fracture of both bones in forearm , what is the treatment?
ORIF with plates and screws
what causes Monteggia Fracture dislocation?
dislocation of radial head at elbow and fracture of ulna
it requires ORIF
dislocation of radial head at elbow and fracture of ulna
Monteggia Fracture dislocation
what is a Galeazzi fracture dislocation?
fracture of radius and dislocation of ulna at distal radioulnar joint
fracture of radius and dislocation of ulna at distal radioulnar joint
Galeazzi
what is a colles fracture?
extra articular fracture of distal radius
caused by a fall onto outstretched hand
what nerve could be damaged in a colles fracture?
median nerve
what is a smiths fracture?
volarly displaced displaced or angulated extra-articular fracture of distal radius
usually occurs after falling onto back of flexed wrist
volarly displaced displaced or angulated extra-articular fracture of distal radius
usually occurs after falling onto back of flexed wrist
smiths fracture
what is a bartons fracture?
intra articular fractures of distal radius involving dorsal or volar rim, where the carpal bones sublux with the displaced rim fragment…can be classified as dorsal or volar
what do scaphoid fractures usually occur after?
FOOSH
pain and tenderness an anatomical snuff box?
scaphoid fracture
how many x ray views are needed to confirm a scaphoid fracture and why?
4
because it has a funny kidney bean shapeit can be difficult to visualize
how are undisplaced scaphoid fractures treated?
plaster cast for 6-12 weeks
what are the complications of scaphoid fractures?
non union
AVN
what is peri-lunate dislocation?
dislocation of one of the carpal bones around the lunate
what causes a scapho-lunate dissociation?
rupture of scapho-lunate ligaments
penetrating volar hand injuries risk damaging what?
flexor tendons, digital nerve and digital arteries
penetrating dorsal hand injuries risk damaging what?
extensor tendons
what is mallet finger?
an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ
an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ
mallet finger
treatment for mallet finger?
mallet splint holding DIPJ extended which should be worn continuously for 4 weeks
how are fractures of 3rd, 4th and 5th metacarpals treated?
conservatively
how do fractures of 5th metatarsal occur?
punching injury
boxers fracture?
5th metatarsal inury
how do you treat fracture of the 5th metatarsal?
strap it to 4th finger
how do you treat phalangeal fractures?
neighbour strapping/splintage
what are the 2 types of hip fracture?
intracapsular
extracapsular
which type of hip fracture can lead to AVN of femoral head?
intracapsular
how should intracapsular hip fracture be treated?
replacement
how can extracapsular hip fractures be treated?
internal fixation
can patients with pagets disease get femoral shaft fractures?
yes
how much blood loss can occur with a displaced femoral shaft fracture?
up to 1.5L of blood
initial management of femoral shaft fracture?
resuscitation
analgesia with femoral nerve block
application of thomas splint
what does a thomas splint minimise?
more blood loss
and
fat embolism
what is the definitive management of femoral shaft fracture?
closed reduction and stabalization with intramedullary nail
or plate fixation can be used
why is a knee dislocation so bad?
vascular injury
nerve injury
compartment syndrome
what tends to cause knee dislocation?
high energy injury
severe hyperextension and/ or rotational forces with a sporting injury
management of dislocated knee?
urgent reduction with thorough neurovascular assessment and vascular surgery referral
if knee is unstable an external fixator may be applied
in which direction does the patella usually dislocate?
laterally
what can cause patella dislocation?
direct blow
contraction of quads with a rotational force with patella not engaged in trochlea
what predisposes patella dislocations?
ligamentous laxity
valgus alignment of the knee
rotational malalignment
shallow trochlear groove
who most commonly gets dislocated patella?
adolescents (esp females)
are proximal tibia fractures intra or extra articular?
intraarticular
high energy injuries causing proximal tibia fractures are associated with what>
compartment syndrome
neurovascular injury
what causes a tibial shaft fracture?
indirect force and either a bending or rotational energy, compressive force from deceleration, a combination of the above or
high energy injury
most common cause of compartment syndrome
tibial shaft fracture
how do you treat a tibial shaft fracture?(non operative)
above knee cast
how do you treat a tibial shaft fracture?(operative)
internal fixation
intramedullary nail=most common way of stabilization
what is a pilon fracture?
distal tibia
how do you treat a stable ankle fracture?
walking cast or splint for approx 6 weeks
is a bimalleolar fracture stable or unstable?
unstable and needs ORIF
what causes calcaneal fracture?
fall from height onto heel
what is a lisfranc fracture/dislocation
fracture of base of 2nd metatarsal associated with dislocation of base 2nd metatarsal
can there be a normal looking x ray with a lisfranch fracture?
yes
how do you treat a lisfranc fracture?
open or closed reduction with fixation using screws is recommended
what metatarsal is a common site for a stress fracture?
2nd
what treatment is needed for toe fractures?
stout boot
if intra articular it may benefit from fixation and reduction
