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Musculoskeletal > Regional Trauma > Flashcards

Regional Trauma Flashcards

1
Q

Describe the mechanism of injury in cervical spine fracture?

A

High Energy

  • Fall from height
  • RTA
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2
Q

High C-spine fractures or dislocations can be fatal, especially if above …?

(What vertebral level)

A

High c-spine fractures or dislocations can be fatal, especially if above C3

(Above phrenic nerve, C3, C4, C5 which supplies the diaphragm)

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3
Q

Describe the mechanism of injury of thoraco/lumbar spine fractures?

A

High energy

  • RTA
  • Fall from high

May be osteoporotic wedge insufficiency fractures in the elderly

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4
Q

Describe the type of thoraco/lumbar fracture seen in:

  • Elderly osteoporotic low impact
  • Young high impact
A

Elderly osteoporotic = Wedge Insufficiency

Young, High Impact = Burst Fractures

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5
Q

What is spinal shock?

A

Acute response to spinal injury

Complete loss of sensation, motor function and reflexes both the level of injury

Resolves after 24 hours

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6
Q

What is neurogenic shock?

Treatment of neurogenic shock?

A

Occurs secondary to temporary shutdown of sympathetic outflow from T1 to T2 (usually due to cervical or upper thoracic cord injury)

Causes hypotension and bradycardia

Treatment is IV Fluids

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7
Q

Describe complete spinal cord injury?

Prognosis?

How do you determine the level of the injury? (vertebral level)

A

No sensation, no voluntary motor function below level of injury

Reflexes should return

Prognosis is poor

The level of the injury is the lowest vertebral level which is has partial function

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8
Q

Describe partial spinal cord injury?

What sign suggests partial and not complete spinal cord injury?

Prognosis?

A

Some neurological function (sensory or motor) is still present distal to the injury

Sacral sparing suggests partial spinal cord injury

Better prognosis than complete

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9
Q

Describe central cord syndrome?

A

Partial cord injury

Most common partial cord injury

Hyperextension injury in a spinal cord with osteoarthritis

  • Paralysis of arms (more common)
  • Paralysis of legs
  • Sacral Sparing
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10
Q

Describe Brown-Sequard syndrome?

A

Often caused by penetrating trauma

Form of partial spinal cord injury

Ipisilateral paralysis, loss of vibration and deep touch

Contralateral loss of pain, temperature and light touch

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11
Q

What is the rule for pelvic fractures (Look for what on X-Ray?)

A

If someone has a pelvic ring fracture, it is very likely to fracture somewhere else as well

Like a polo mint

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12
Q

What pattern of injury has caused this pelvic fracture?

A

B

C

A

A = Lateral compression

B = Anterior Compression

C = Vertical Shear

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13
Q

What examination MUST be done in someone with a pelvic fracture?

A

PR

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14
Q

Describe Acetabulum fractures?

Treatment?

A

High energy in young

Low energy in old

Can be seen in RTA (dashboard injury)

Undisplaced/small = Conservative

Large and displaced = Reduction

Rigid Fixation

THR (elderly patients)

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15
Q

Proximal humeral fractures are commonly seen when?

What part of the humerus fractures?

Displacement?

A
  • Low energy injury in osteoporotic bone
  • Fall onto shoulder or outstretched hand

The surgical neck of the humerus

Most common presentation is surgical neck of humerus with medial deviation

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16
Q

What is the most commonly appearance of humeral neck fractures?

A

Fracture of surgical neck of humerus with medial displacement

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17
Q

Treatment of humeral shoulder fractures?

A

Minor/Small Displacement: Sling, gradual mobilization

Persistently displaced: Internal fixation (Can have chronic stiffness, pain, etc)

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18
Q

Treatment of head splitting humeral fractures?

A

Normally need replacement until patient is younger with very good bone quality

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19
Q

Which type of shoulder dislocation is more common - anterior or posterior?

A

Anterior shoulder dislocation is much more common

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20
Q

Detachment of the anterior glenoid labrum (Eg: Due to shoulder dislocation) is know as a …?

A

Bankart Lesion

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21
Q

The posterior humeral head can impact on the anterior glenoid producing an impaction fracture of the posterior head. This is called a..?

A

Hill Sachs Lesion

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22
Q

Signs and symptoms of shoulder dislocation?

A

Loss of symmetry

Loss of sensation in badge area (suggests axillary nerve injury)

Pain

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23
Q

Treatment of shoulder dislocation?

A

Closed Reduction

Sling

If there is delayed presentation (Eg: Alcoholics) then open reduction may be needed

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24
Q

Describe risk of dislocation recurrence after shoulder dislocation?

A

80% if under 20

20% if over 30

Young first time dislocations should be stabilized using a Bankart Repair

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25
Q

An X-Ray finding of lightbulb sign suggests?

Treatment?

A

Posterior Shoulder Dislocation

Closed reduction

Immobilization (sling)

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26
Q

Describe the injury that causes acromioclavicular joint injury?

A

Normally seen after a fall onto the point of the shoulder

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27
Q

Describe the ligaments involved in acromioclavicular joint

  • Subluxation?
  • Dislocation?
A

Subluxation = Acromioclavicular ligaments ruptured

Dislocation = Coracoclavicular ligaments rupture

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28
Q

Treatment of acromioclavicular injury?

A

Conservative treatment

Sling

Physiotherapy

Coracoclavicular ligament surgery if chronic pain

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29
Q

Describe the cause of humeral shaft fractures?

A

Direct trauma (RTA) or due to fall with or without twisting

Heals very well

Treatment is functional humeral brace. Internal fixation may be considered

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30
Q
  • Person in an RTA
  • Arm pain (suspected humeral fracture)
  • Wrist Drop
  • Loss of sensation in 1st dorsal web space
A

Suspect radial nerve injury

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31
Q

Describe Olecranon Fractures?

Treatment?

A

Usually occur due a trip with a fall onto the point of the elbow

Most undergo open reduction with interal fixation

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32
Q

Describe radial head and neck fractures?

Radiology?

Treatment?

A

Often occur due to a fall onto an outstretched hand

May show up on X-ray or may not

May have Posterior Fat Pad Sign

Conservative

  • Sling
  • Injection
  • Haemoarthrosis aspiration

Surgery

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33
Q

Describe elbow dislocations?

A

Most commonly occurs after a fall onto an outstretched hand

Treatment:

Closed Reduction

Sling Stabilization

Surgery if entrapped bony fragments block extension

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34
Q

Describe a fracture of the ulnar shaft?

Treatment?

A

This is called a NightStick Fracture

Caused by isolated blow to ulna

(Eg: Truncheon - used to be called a nightstick)

Treament - Conservative

Open Reduction Internal Fixation

35
Q

Describe fracture of both forearm bones?

A

Highly unstable

Requires open reduction with internal fixation

36
Q

Describe Monteggia fracture dislocation?

A

Fracture of ulna alongside dislocation of radial head at the elbow

Requires open reduction, internal fixation

37
Q

Describe Galezzi fracture dislocation?

A

Fracture of the radius with dislocation of the ulnar head

Treatment is open reduction, internal fixation

38
Q

Describe a colle’s fracture?

Treatment?

Common complication?

A

Caused by fall onto outstretched hand (FOOSH)

Extra-articular fracture of radial head with dorsal displacement

  • Splint
  • Cast
  • Open Reduction, Internal Fixation

Median Nerve Compression/Carpal Tunnel

39
Q

What does a colle’s fracture look like on radiology?

A

Dinner Fork Deformity

40
Q

Describe a Smith’s fracture?

Cause?

Treatment?

A

Distal radius fracture, extra-articular, volar displaced

Caused by falling onto the back of a flexed wrist

Open Reduction, Internal Fixation (highly unstable)

41
Q

What kind of fracture is this?

A

Smith’s Fracture

42
Q

What is D?

What is E?

A

D = Colle’s Fracture

E = Smith’s Fracture

43
Q

Describe Barton’s fracture?

A

Distal radius fracture, intra-articular, can be dorsal or volar

Treatment: Open Reduction, Internal Fixation

44
Q

What part of your hand is volar?

What part is dorsal?

A

Palm = Volar

Back = Dorsal

45
Q

Describe how scaphoid fractures normally occur?

Clinical signs of scaphoid fracture?

A

After fall onto outstretched hand

Tenderness in the anatomical snuffbox

Pain on compressing thumb metacarpal

46
Q

How do you image suspected scaphoid fracture?

A

4 Imaging

  • Lateral
  • AP
  • Two Obliques
47
Q

Treatment of non-displaced scaphoid fracture?

A

Plaster casts for 6-12 weeks

48
Q

Complications of scaphoid fracture?

A
  • Non-union
  • Avascular Necrosis
49
Q

Describe mallet finger?

Symptoms/Signs?

Treatment?

A

Avulsion of extensor tendon from its attachment

Caused by forced flexion - usually from a ball at sport

  • Pain
  • Drooped DIPJ
  • Inability to extend at DIPJ

Treatment: Splint for 4 weeks

50
Q

How do you treat 3rd, 4th and 5th metacarpal injuries?

A

Conservatively

51
Q

How do you get 5th Metacarpal fractures?

How do you treat them?

A

Punching

Neck of 5th metacarpal fracture is known as boxers fracture

Treatment invovles strapping to the next digit

52
Q

What is a fight bite?

What can this lead to?

Treatment?

A

Laceration to a hand caused by punching someones tooth

Can rupture extensor tendons and can cause septic arthritis

Washout

DO NOT SUTURE CLOSE DUE TO INFECTION

53
Q

How do you treat phalangeal fractures?

A

Most are treated by strapping to neighbour

May require manipulation under anaesthesia

54
Q

Hip fractures are generally seen in.. (Which demographic)?

What is the treatment?

A

Elderly

Osteoporosis

Surgery for nearly all patients

55
Q

What is the blood supply to the femoral head?

A

Comes from the anamastoses of circumflex femoral arteries (from profunda femoral artery)

56
Q

Describe intracapsular hip fractures?

A

The arterial supply can be disrupted leading to avascular necrosis

Treatment is therefore hemiarthroplasty or total hip replacement

  • Total in high function
  • Hemiarthroplasty in limited function
57
Q

Describe extracapsular hip fractures?

Treatment?

A

These should not cause avascular necrosis

Have a high union rate

Treatment invovles internal fixation, keeping the patients own hip joint

58
Q

Name the type of fracture if it was in area:

  • A?
  • B?
  • C?
A

A = Intracapsular

B = Extracapsular, Trochanteric

C = Extracapsular, Subtrochanteric

59
Q

Who gets subtrochanteric fractures?

Treatment? Explain why?

A

Usually elderly patients with osteoporosis

Fall onto side

Poor blood supply and non-union is common

Indirect fixation using an intramedullary nail is recommended - try not to disturb blood supply further

60
Q

What causes femoral shaft fractures?

Complications?
Treatment?

A

Often occurs in very high energy injuries. Can also be a stress fracture in osteoporosis/metastasis/Paget’s/Long term biphosphonate use

Complications = Hypovolaemia

Treatment = Closed Reduction, Stabilization

61
Q

When do distal femoral fractures occur?

How are they fixed?

A

Fall onto a flexed knee

Usually fixed using plate and screws

62
Q

Knee dislocations:

  • Common or rare?
  • Mode of injury?
  • Treatment?
A

Rare

Occur in high energy injuries eg: RTA or sporting injuries

Treatment: Surgical Emergency

Reduce, vascular assessment, neuro assessment

63
Q

Describe patellar dislocations:
- Common or rare?

  • Mode of injury?
  • Treatment?
A

Patellar dislocations are common

Often caused by a blow during sports that causes LATERAL DISLOCATIONS

Treatment invovles physiotherapy to strengthen muscles. Adolescents will often stabilize as they grow up

Very occasionally surgical stabilization can be done

64
Q

Does the patellar dislocate medially or laterally?

A

LATERALLY

65
Q

Describe proximal tibial (plateau) fractures:

  • Mode of injury?
  • Treatment?
A

High energy injuries in young

Low energy injuries in elderly (osteoporosis)

Treatment: Fixation with plates and screws

66
Q

What causes tibial shaft fractures?

Treatmentm?

A

Indirect force - Eg: Bending

Direct force - Eg: Dashboard injuries

Open fractures are not uncommon

Treatment:

Casts

Surgery for internal fixation

Intramedullary nails commonest method

67
Q

What causes calcaneal fractures?

A

Usually high energy Eg: Fall from height onto heel

68
Q

What causes Talar Fractures?

Complications?

Treatment?

A

Forced dorsiflexion from rapid deceleration (RTA, Aircraft crash)

High risk of avascular necrosis

Treatment: Open or closed reduction, fixation

69
Q

Describe midfoot (Lisfranc) fracture?

A

Fracture of the base of 2nd metatarsal

Associated with dislocation of the 2nd metatarsal

May also include dislocation of the other metatarsal joints

70
Q

Describe presentation of midfoot/Lisfranc fracture?

Treatment?

A
  • Grossly swollen foot
  • Painful
  • Bruised
  • Can’t wait bear

Closed or open reduction

Stabilize using screws

71
Q

Describe Metatarsal fractures?

Treatment?

A

1st = Uncommon

2-5 = Common

2nd = Stress Fracture

5th = Due to inversion injury

Treatment:

  • Casts
72
Q

Treatment of toe injuries?

A

Rarely require anything other that protection in a stout boot

Dislocations are reduced then can be strapped to neighbours

73
Q

What is greenstick fracture?

Treatment?

A

Partial fracture of bone

Seen in children

Treated with cast or splint

74
Q

Why are children’s bones:

  • Less likely to break?
  • Faster to heal?
A

Less likely to break due to thick periosteum

Faster healing due to periosteum which is a rich source of osteoblasts

75
Q

Describe the Salter Harris classification of physeal fractures?

A
  1. Pure physeal separation - best prognosis
  2. Like 1 but with small metaphyseal invovlement - good prognosis

3 and 4 - Intrarticular, fracture splits the physis, potential for growth arrest

  1. Compression to physis, causes growth arrest
76
Q

Describe treatment of each type of Harris Salter Physeal fracture?

A

1 and 2 = Closed reduction, cast or splint

3 and 4 = Closed reduction, stabilization

5 = Can’t be seen on X-ray, only detected once angular deformity has developed

77
Q

Name three common distal radius fractures in children?

Treatment?

A

Salter Harris 2 (Cast, may need manipulation)

Greenstick (May need cast)

Buckle (3-4splints)

78
Q

How do you treat Monteggia and Galeazzi fractures in children?

A

Fixation with plates and screws

(Not normally done in children but it is in this case)

79
Q

Supracondylar elbow fractures in children?

Treatment?

A

Common

Due to fall onto outstretched hand

Treatment involves

  • Splint (for undisplaced)
  • Closed reduction and wires (if displaced)
80
Q

If a child under two years presented with femoral shaft fracture, what would you suspect?

A

NAI

81
Q

Describe femoral shaft fracture in children?

  • Cause?
  • Treatment?
A

Caused by a fall onto flexed knee or by indirect bending

Treatment:

Aged 2-6: Thomas Splint

6-12: Intramedullary Nails

Over 12: Adult type intramedullary nail

82
Q

What should you always consider in femoral shaft fracture of children?

A

NAI in young

Bone tumours

83
Q

Undisplaced spiral fractures of the tibia are common in…?

(Which age group?)

Treatment?

A

Toddlers

Treatment is cast

Musculoskeletal (23 decks)

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