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MSK > Regional Adult Trauma > Flashcards

Regional Adult Trauma Flashcards

1
Q

C -spine fractures are common after what type of injury?

A

high energy e.g RTA, fall from height

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2
Q

when should you go C spine control

A

during A (airways ) of ABCDE

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3
Q

what criteria must be satisfied before clearing the C spine?

A

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

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4
Q

a full neuro exam might include?

A 
peripheral motor function
coarse touch sensation
upper and lower limb reflexes
cranial nerve evaluation
rectal exam
assessment of bulbocavernous reflex
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5
Q

more stable c spine injuries can be treated with what?

A

cervical collar

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6
Q

more unstable c spine injuries may require immobilization with what?

A

halo vest

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7
Q

what tends to cause thoracolumbar spinal fractures?

A

RTA or fall from height

can get wedge fractures in elderly if osetoporosis

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8
Q

what is spinal shock?

A

physiologic response to injury with complete loss of sensation and motor functions and loss of reflex below the level of injury

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9
Q

how long does spinal shock last

A

can resolve in 24 hours

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10
Q

what is the bulbocavernous reflex?

A

a reflex contraction of anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urinary catheter

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11
Q

is the bulbocavernous reflex present in spinal shock?

A

no

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12
Q

what is neurogenic shock and when does it occur?

A

occurs secondary to temporary shut down of sympathetic outflow from the cord from T1 to L2

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13
Q

how do you treat neurogenic shock?

A

Iv fluid

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14
Q

what is a complete spinal cord injury?

A

when there is no sensory or motor function below level of injury

prognosis is very poor

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15
Q

what is an incomplete spinal injury

A

when there is some neurologic (sensory and or motor) present distal to site of injury

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16
Q

what does sacral sparing indicate?

A

an incomplete spinal cord injury and a much better prognosis

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17
Q

what is the most common incomplete spinal cord injury?

A

central cord syndrome

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18
Q

what type of injury tends to cause central cord syndrome?

A

hyper extension injury in cervical spine

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19
Q

in central cord syndrome what gets paralysed more-arms or legs?

A

arms

because the corticospinal motor tracts of the upper limbs are more central than those of lower limbs

sacral sparing is usually present

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20
Q

what does anterior cord syndrome result in?

A

loss of motor function as well as loss of coarse touch, pain, and temperature sensation

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21
Q

what does posterior cord syndrome result in?

A

loss of dorsal column function-vibration sense, light touch, proprioception

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22
Q

loss of dorsal column function-vibration sense, light touch, proprioception

A

posterior cord syndrome

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23
Q

loss of motor function as well as loss of coarse touch, pain, and temperature sensation

A

anterior cord syndrome

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24
Q

what causes Brown-sequard syndrome?

A

hemisection of cord

usually from penetrating injury e.g stab wound

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25
Q

hemisection of cord

usually from penetrating injury e.g stab wound

A

Brown -sequard syndrome

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26
Q

what does brown -sequard syndrome cause?

A

ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation

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27
Q

ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation

A

brown -sequard syndrome

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28
Q

if the pelvic ring is broken in one place is there likely to be another fracture?

A

yes

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29
Q

what is a lateral compression fracture of the pelvis?

A

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

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30
Q

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

A

lateral compression fracture of the pelvis

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31
Q

what is a vertical shear fracture of the pelvis?

A

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

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32
Q

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

A

vertical shear pelvis fracture

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33
Q

what is an anteroposterior compression fracture of the pelvis?

A

may result in wide distribution of pubic symphysis

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34
Q

open book pelvis fracture

A

anteroposterior compression fracture of the pelvis

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35
Q

may result in wide distribution of pubic symphysis

A

anteroposterior compression fracture of the pelvis

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36
Q

what do you need to do to assess sacral nerve root function?

A

PR exam

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37
Q

what are humeral neck fractures causes by usually?

A

falling onto an outstretched hand

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38
Q

how do you treat a humeral neck fracture?

A

sling and gradual return to mobilization

persistently displaced ones can be surgically treated with internal fixation

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39
Q

if the humeral head splits, what is usually done?

A

shoulder replacement

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40
Q

what type of shoulder dislocation is more common?

A

anterior shoulder dislocation

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41
Q

what causes anterior shoulder dislocation?

A

excessive external rotation force or a fall onto back of shoulder

can occur due to a seizure

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42
Q

how do you confirm anterior shoulder dislocation?

A

x ray

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43
Q

how do you treat anterior shoulder dislocation?

A

closed reduction under sedation or anaesthetic then placed in sling for 2-3 weeks
physio

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44
Q

can ligamentous laxity cause shoulder dislocations?

A

yes

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45
Q

what causes a posterior shoulder dislocation?

A

a posterior force on the adducted and internally rotated arm

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46
Q

light bulb sign on x ray

A

posterior shoulder dislocation

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47
Q

when do injuries of the acromioclavicular joint occur?

A

after a fall onto the point of the shoulder

48
Q

how do you treat acromioclavicular joint injuries?

A

mainly conservatively - sling then physio

surgery for those with chronic pain

49
Q

what can cause humeral shaft fractures?

A

direct trauma e.g RTA causing transverse or comminuted fractures

a fall (with or without twisting injury) resulting in oblique or spiral fracture

50
Q

what nerve is susceptible to injury in a humeral shaft fracture?

A

radial nerve

51
Q

how do you treat a humeral shaft fracture?

A

most with a functional humeral brace

internal fixation with intramedullary nail

52
Q

what causes a Olecranon fracture?

A

falling onto point of elbow with a contracted tricep

usually in the elderly

53
Q

how are olecranon fractures treated?

A

simple ones- tension band wiring

complicated- ORIF with plates and screws

54
Q

what usually causes radial head and neck fractures?

A

fall onto outstretched arm

55
Q

in what direction do most elbows dislocate?

A

posterior

56
Q

what is a nigthstick fracture?

A

ulnar shaft fracture

57
Q

what causes an isolated fracture of ulna?

A

direct blow

58
Q

if there is a fracture of both bones in forearm , what is the treatment?

A

ORIF with plates and screws

59
Q

what causes Monteggia Fracture dislocation?

A

dislocation of radial head at elbow and fracture of ulna

it requires ORIF

60
Q

dislocation of radial head at elbow and fracture of ulna

A

Monteggia Fracture dislocation

61
Q

what is a Galeazzi fracture dislocation?

A

fracture of radius and dislocation of ulna at distal radioulnar joint

62
Q

fracture of radius and dislocation of ulna at distal radioulnar joint

A

Galeazzi

63
Q

what is a colles fracture?

A

extra articular fracture of distal radius

caused by a fall onto outstretched hand

64
Q

what nerve could be damaged in a colles fracture?

A

median nerve

65
Q

what is a smiths fracture?

A

volarly displaced displaced or angulated extra-articular fracture of distal radius

usually occurs after falling onto back of flexed wrist

66
Q

volarly displaced displaced or angulated extra-articular fracture of distal radius

usually occurs after falling onto back of flexed wrist

A

smiths fracture

67
Q

what is a bartons fracture?

A

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

68
Q

what do scaphoid fractures usually occur after?

A

FOOSH

69
Q

pain and tenderness an anatomical snuff box?

A

scaphoid fracture

70
Q

how many x ray views are needed to confirm a scaphoid fracture and why?

A

4

because it has a funny kidney bean shapeit can be difficult to visualize

71
Q

how are undisplaced scaphoid fractures treated?

A

plaster cast for 6-12 weeks

72
Q

what are the complications of scaphoid fractures?

A

non union

AVN

73
Q

what is peri-lunate dislocation?

A

dislocation of one of the carpal bones around the lunate

74
Q

what causes a scapho-lunate dissociation?

A

rupture of scapho-lunate ligaments

75
Q

penetrating volar hand injuries risk damaging what?

A

flexor tendons, digital nerve and digital arteries

76
Q

penetrating dorsal hand injuries risk damaging what?

A

extensor tendons

77
Q

what is mallet finger?

A

an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ

78
Q

an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ

A

mallet finger

79
Q

treatment for mallet finger?

A

mallet splint holding DIPJ extended which should be worn continuously for 4 weeks

80
Q

how are fractures of 3rd, 4th and 5th metacarpals treated?

A

conservatively

81
Q

how do fractures of 5th metatarsal occur?

A

punching injury

82
Q

boxers fracture?

A

5th metatarsal inury

83
Q

how do you treat fracture of the 5th metatarsal?

A

strap it to 4th finger

84
Q

how do you treat phalangeal fractures?

A

neighbour strapping/splintage

85
Q

what are the 2 types of hip fracture?

A

intracapsular

extracapsular

86
Q

which type of hip fracture can lead to AVN of femoral head?

A

intracapsular

87
Q

how should intracapsular hip fracture be treated?

A

replacement

88
Q

how can extracapsular hip fractures be treated?

A

internal fixation

89
Q

can patients with pagets disease get femoral shaft fractures?

A

yes

90
Q

how much blood loss can occur with a displaced femoral shaft fracture?

A

up to 1.5L of blood

91
Q

initial management of femoral shaft fracture?

A

resuscitation
analgesia with femoral nerve block
application of thomas splint

92
Q

what does a thomas splint minimise?

A

more blood loss

and

fat embolism

93
Q

what is the definitive management of femoral shaft fracture?

A

closed reduction and stabalization with intramedullary nail

or plate fixation can be used

94
Q

why is a knee dislocation so bad?

A

vascular injury
nerve injury
compartment syndrome

95
Q

what tends to cause knee dislocation?

A

high energy injury

severe hyperextension and/ or rotational forces with a sporting injury

96
Q

management of dislocated knee?

A

urgent reduction with thorough neurovascular assessment and vascular surgery referral
if knee is unstable an external fixator may be applied

97
Q

in which direction does the patella usually dislocate?

A

laterally

98
Q

what can cause patella dislocation?

A

direct blow

contraction of quads with a rotational force with patella not engaged in trochlea

99
Q

what predisposes patella dislocations?

A

ligamentous laxity
valgus alignment of the knee
rotational malalignment
shallow trochlear groove

100
Q

who most commonly gets dislocated patella?

A

adolescents (esp females)

101
Q

are proximal tibia fractures intra or extra articular?

A

intraarticular

102
Q

high energy injuries causing proximal tibia fractures are associated with what>

A

compartment syndrome

neurovascular injury

103
Q

what causes a tibial shaft fracture?

A

indirect force and either a bending or rotational energy, compressive force from deceleration, a combination of the above or

high energy injury

104
Q

most common cause of compartment syndrome

A

tibial shaft fracture

105
Q

how do you treat a tibial shaft fracture?(non operative)

A

above knee cast

106
Q

how do you treat a tibial shaft fracture?(operative)

A

internal fixation

intramedullary nail=most common way of stabilization

107
Q

what is a pilon fracture?

A

distal tibia

108
Q

how do you treat a stable ankle fracture?

A

walking cast or splint for approx 6 weeks

109
Q

is a bimalleolar fracture stable or unstable?

A

unstable and needs ORIF

110
Q

what causes calcaneal fracture?

A

fall from height onto heel

111
Q

what is a lisfranc fracture/dislocation

A

fracture of base of 2nd metatarsal associated with dislocation of base 2nd metatarsal

112
Q

can there be a normal looking x ray with a lisfranch fracture?

A

yes

113
Q

how do you treat a lisfranc fracture?

A

open or closed reduction with fixation using screws is recommended

114
Q

what metatarsal is a common site for a stress fracture?

A

2nd

115
Q

what treatment is needed for toe fractures?

A

stout boot

if intra articular it may benefit from fixation and reduction

MSK (15 decks)

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