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regional trauma Flashcards

1
Q

what is spinal shock

A

physiologic response to injury woth complete loss of sensatin and motor function and loss of reflexes below the level of the injury

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2
Q

spinal shock usually resolves in ____ hours

A

24

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3
Q

the return of which reflex signals the end of spinal shock

A

bulbocavernous reflex

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4
Q

what is neurogenic shock

A

hypotension and bradycardia secondary to temporary shutdown of sympathetic outflow from T1-L2

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5
Q

neurogenic shock normally resolves in ____ hours

A

24-48

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6
Q

how is neurogenic shock treated

A

IV fluid therapy

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7
Q

what is a complete spinal cord injury

A

no sensory or voluntary motor function below the level of the injury

reflexes should return

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8
Q

what is an incomplete spinal cord injury

A

some neurologic function (sensory and/or motor) is present distal to the level of injury

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9
Q

sacral sparing indicates which type of spinal cord injury

A

an incomplete spinal cord injury

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10
Q

neurogenic shock is more common than hypovolaemic shock in spinal cord injuries

true/false

A

false

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11
Q

treatment of spinal cord injury is aimed at…

A

preventing further damage

preventing complications of paralysis

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12
Q

loss of intercostal muscle function results from injury to which spinal levels

A

T1-T12

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13
Q

most common causes of pelvic fracture in young patients

A

high energy injury

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14
Q

what is the pelvic ring formed by

A

sacrum

ilium

ischium

pubic bones

supporting ligaments

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15
Q

injury at a single point of the pelvic ring is common

true/false

A

false

if there is a fracture at one point in the ring, there is likely to be furhter disruption at another point

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16
Q

which vascular structures are prone to injury in a plevic fracture

A

branches of the internal iliac artery

pre-sacral venous plexus

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17
Q

when would a lateral compression fracture of the pelvis occur

A

side impact (eg RTC)

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18
Q

a lateral compression fracture results in one half of the pelvis to be displaced laterally/medially

A

medially

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19
Q

fractures through the pubic rami or ischium are accompanied by

A

a sacral compression fracture of SI joint disruption

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20
Q

a vertical shear fracture of the pelvis occurs due to

A

axial force on one hemipelvis (eg fall from height, rapid deceleration)

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21
Q

in a vertical shear fracture, the affected hemipelvis is displaced superiorly/inferiorly

A

superiorly

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22
Q

in a vertical shear fracture the leg on the affected side will appear

A

shorter

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23
Q

an anterioposterior compresson injury of the pelvis may result in what sort of injury

A

the pelvis opening up like a book due to disruption of the pubic symphysis

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24
Q

why is there such a big risk of hypovolaemia with an anteroposterior compression injury

A

the pelvic volume increases exponentially with the degree of displacement do the pelvis can contain several litres of blood before tamponade and clotting occur

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25
Q

an anteroposterior compression injury is also known as

A

an open book pelvic fracture

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26
Q

how does presence of blood in a PR exam change the management of a plevic fracture

A

it would be considered an open fracture

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27
Q

what sort of pelvic fracture is most common in elderly patients

A

minimally displaced lateral compression injury

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28
Q

what is the acetabulum

A

intra-articular part of the pelvis and forms the ‘cup’ of the hip joint

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29
Q

posterior wall acetabular fractures may be associated with which further injury

A

dislocation

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30
Q

which imaging techniques are most useful when assessing an acetabular fracture

A

CT scans help determine the pattern of the fracture

oblique X-rays may help

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31
Q

most common mechanism of injury for a proximal humeral fracture

A

FOOSH

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32
Q

the most common pattern of proximal humeral fracture

A

fracture of the surgical neck with medial displacement of the humeral shaft due to pull of the pectoralis major muscle

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33
Q

treatment of humeral neck fractures

A

minimally displaced: conservative treatment with a sling

displaced: internal fixation

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34
Q

anterior shoulder dislocation is less common than posterior

true/false

A

false

anterior is more common

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35
Q

traumatic anterior shoulder dislocation occurs due to…

A

an excessive external rotation force or fall onto the back of the shoulder

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36
Q

what is a bankart lesion

A

anterior shoulder dislocation that results in detachment of the naterior glenoid labrum and capsule

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37
Q

how can the axillary nerve be damaged in shoulder dislocation

A

it can be stretched as it passes through the quadrilateral space

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38
Q

clinical signs of shoulder dislocation

A

loss of symmetry

loss of roundness of the shoulder

arm held in adducted position supported by patient’s other arm

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39
Q

what is the prinicple sign of axillary nerve injury

A

loss of sensation on the regimental badge area

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40
Q

which humeral fractures can occur with a shoulder dislocation

A

surgical neck

greater tuberosity

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41
Q

managment of shoulder dislocation

A

closed reduction under sedation or anaesthetic

neurovascular assessment before and after reduction

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42
Q

why is it important to do a full neurovascular assessment beofre and after reduction of dislocation

A

because it is important to identify any nerve injury before reduction so that you can prove that you didnt cause an injury while reducing the dislocation

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43
Q

patients less than 20 have an ___% chance of re-dislocation

A

80%

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44
Q

patients over 30 have a ___% chance of redislocation

A

20%

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45
Q

recurrent dislocations can be stabilised with a _______ repair

A

bankart repair

reattachmnet of the torn labrum and capsule by arthroscopic or open means

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46
Q

mainstay of management of recurrent dislocation in a patient eith ligamentous laxity/hypermobility

A

physiotherapy to strengthen the rotator cuff muscles

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47
Q

posterior shoulder dislocation is caused by

A

a posterior force on the adducted and internally rotated arm

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48
Q

main xray finding of a posterior shoulder dislocation

A

‘light bulb’ sign

excessively internally rotated humeral head look symmetrical on AP view

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49
Q

treatment of shoulder dislocation

A

perior of immobilisation (sling) and physiotherapy

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50
Q

injuries of the acromioclavicular joint usually occur

A

after a fall onto the point of the shoulder

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51
Q

in an acromioclavicular joint subluxation what happens to the acromioclavicular ligaments

A

they are ruptured

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52
Q

which ligaments are ruptured in an acromioclavicular dislocation

A

acromioclavicular ligaments

coracoclavicular ligaments (conoid and trapezoid ligaments)

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53
Q

most acromioclavicular injuries are treated with

A

conservative management

sling and physiotherapy

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54
Q

reconstruction of the coracoclavicular ligaments is reserved for patients with…

A

chronic pain

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55
Q

why can a high degree of angulation (30 degrees) be accepted in a humeral shaft fracture

A

because of the mobility of the shoulder joint and elbow joint

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56
Q

why is the radial nerve susceptible to injury in a humeral shaft fracture

A

the radial nerve sits in the spiral groove which is a common site of fracture

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57
Q

what are the signs of a radial nerve palsy

A

wrist drop and loss of sensation in the first dorsal web space

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58
Q
A
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59
Q

humeral shaft fractures can normally be treated with

A

a functional humeral brace

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60
Q

olecranon fractures are normally caused by

A

a fall onto the point of the elbow with contraction of the triceps muscle

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61
Q

what is the fat pad sign

A

a sign of radial head fracture

a triangle like a sail anterior to the distal humerus

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62
Q

radial head and neck fractures often result in a ______ degree loss of terminal extension

A

10-15 degree

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63
Q

why might a displaced radial headfracture require surgery

A

there is a displaced fragment causing a mechanical block to full extension

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64
Q

how to differentiate between loss of elbow movement due to mechanical block and loss of elbow movement due to pain

A

aspiration of haemarthrosis is present

injection of local steroir to reduce swelling

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65
Q

most elbow dislocations occur in the posterior direction after…

A

a FOOSH

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66
Q

which fractures are associated with an elbow dislocation

A

radial head

humeral epicondyle

coronoid process of the ulna

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67
Q

isolated forearm fractures are common

true/false

A

false

due to the strong ligaments at the proximal and distal radioulnar joints, a fracture of one bone normally results in fracture/dislocation of the other

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68
Q

what is a nightstick fracture

A

isolated fracture of the ulna

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69
Q

how does an isolated fracture of the ulna occur

A

a direct blow to the ulna

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70
Q

what is a monteggia fracture dislocation

A

fracture of the ulna with dislocation of the radial head at the elbow

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71
Q

monteggia fracture management

A

ORIF (even in children)

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72
Q

why does a montegia fracture require ORIF and not just manipulation

A

manipulation alone risk re-dislocation due to the unstable nature of the injury

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73
Q

what is a galeazzi fracture

A

a fracture of the radius with dislocation of the ulna ath te distal radioulnar joint

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74
Q

which xrays should be requested if a galeazzia fracture is suspected

A

forearm xray

lateral xray of the risk

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75
Q

what types of xray are needed to visualise a monteggia fracture

A

forearm xray

elbow xray

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76
Q

distal radial fractures are common following a…

A

FOOSH

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77
Q

what is a colles fracture

A

an extra-artciular fracture of the distal radius within a inch of the articular surface with dorsal displacement or angulation

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78
Q

treatment of a colles fracture (minimally displaced or angulated)

A

splintage

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79
Q

treatment of colles fracture (angulated)

A

manipulation

plaster cast/percutaneous wires/ORIF

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80
Q

which nerve injury is associated with a colles fracture

A

median nerve compression

(due to stretch of the nerve or a bleed into the carpal tunnel)

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81
Q

a late complication of a colles fracture

A

rupture of the extensr pollicis longus tendon

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82
Q

what is smiths fracture

A

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

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83
Q

treatment of smith’s fractures

A

ORIF using a plate and screws

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84
Q

malunion of a smiths fracture may result in

A

reduced grip strength and wrist extension

85
Q

what is barton’s fracture

A

intra-articular fracture of the distal radius involving the dorsal or volar rim, where the carpal bone of the wrist joint sublux with the displaced rim fragment

86
Q

treatment of cominuted intra-articular distal radius fractures

A

external fixation

87
Q

clinical signs of scaphoid fracture

A

tenderness in the anatomic snuff box

pain on compressing the thumb metacarpal

88
Q

how many xray views are needed if a scaphoid fracture is suspected

A

4 views

AP, lateral and 2 oblique

89
Q

what is a ‘clinical scaphoid fracture’

A

scaphoid fracture is suspected but there is no xray evidence

90
Q

managment of clinical scaphoid fracture

A

splintage of wrist

clinical assessment +/- further xray 2 weeks later

91
Q

treatment of definite scaphoid fracture

A

plaster cast for 6-12 weeks

92
Q

scaphoid fracture complications

A

non-union (synovial fluid inhibits fracture healing)

AVN of the proximal pole

93
Q

risk of penetrating injuries to the volar aspect of the hand

A

damage to flexor tendons, digital nerves and digital arteries

94
Q

risk of dorsal penetrating injury to hand

A

damage to extensor tendons

95
Q

digital nerve injuries proximal to the DIPJ require surgical repair

true/false

A

true

96
Q

what is mallet finger

A

avulsion of the extensor tendon from its insertion into the terminal phalanx

97
Q

what causes mallet finger

A

forced flexion of the extended DIPJ

98
Q

mallet finger presentation

A

pain

drooped DIPJ

inability to extend at the DIPJ

99
Q

treatment of mallet finger

A

mallet splint holding the DIPJ extended worn continuously for at least 4 weeks

100
Q

fractures ofthe 3rd, 4th and 5th metacarpals are usually treated conservatively

true/false

A

true

101
Q

fractures of the 5th metacarpal often occur with what type of injury

A

punching injury

102
Q

treatment of metacarpal fractures

A

neighbour strapping of the affected digit to the adjacent finger

early motion to regain function

103
Q

complications of ‘fight bite’ injury in the hand

A

damage to MCP joint

disruption of the extensor tendon

intra-oral organsims may cause infection and septic arthritis

104
Q

what is a ring block

A

a digital nerve block

105
Q

why is mortality so high for hip fractures in the elderly

A

comorbidities (cardiorespiratory disease, renal failure etc)

reduced physiological reserves

106
Q

management of hip fracture in elderly

A

surgery within 24 hours

107
Q

complications of non-surgical treatment of hip fracture in elderly patients

A

prolonged bed rest is required and can result in;

pain while toileting/bathing

pressure sores

chest infections

potential non-/mal-union

muscular atrophy making rehabilitation more difficult

108
Q

what is the relevance of the intra-/extra-capsular classification

A

determines the likelihood of disruption to the femoral head blood supply

109
Q

arterial supply to the femoral head arises from which arteries

A

circumflex femoral arteries

(medial and lateral circumflex arteries are branches of profunda femoris)

110
Q

intracapsular hip fractures are less likely to disrupt blood supply to the femoral head

true/false

A

false

they are more likely than extra-capsular fractures

111
Q

management of intracapsular hip fracture

A

replacement of the femoral head (total or hemi-arthroplasty)

112
Q

THR vs hemi-arthroplasty in intra-capsular hip fractures

A

THR has higher rates of dislocation but better function

hemi-arthroplasty more secure but poorer functional outcome

113
Q

AVN is a complication of extracapsular hip fractures

true/false

A

false

extacapsular hip fractures should not cause AVN as it shouldn’t disrupt the blood supply to the femoral head

114
Q

management of extracapsular hip fractures

A

internal fixation

115
Q

subtrachanteric proximal femoral fractures heal well

true/false

A

false

the blood supply is quite poor and the area is under considerable bending stress

116
Q

high energy fractures have a higher risk of concomitant fracture elsewhere

true/false

A

true

117
Q

femoral shaft fractures are associated with substantial blood loss

true/false

A

true

118
Q

how does a femoral shaft fracture result in fat embolism

A

fat from the medullary canal can enter the damaged venous system

119
Q

initial management of femoral shaft fracture

A

ABCDE

optimising analgesia (femoral nerve block)

thomas splint

120
Q

definitive management of femoral shaft fracture

A

close reduction and stabilsation with an IM nail

121
Q
A
122
Q

distal femoral fracture management

A

fixed with plate and screws

123
Q

management of knee dislocation

A

reduction of obvious dislocations

neurovascular assessment (doppler, duplex scan, angiogram)

revascularisation

external fixator

multi-ligament reconstruction normally required

124
Q

virtually all patellar dislocations are medial

true/false

A

false

they are mostly lateral

125
Q

risk factors for patellar dislocation

A

generalised ligamentous laxity

valgus alignment of the knee

rotational malalignement (eg femoral neck anteversion)

shallow trochlear groove

126
Q

are tibial plateau fractures extra-articular or intra-articular

A

intra-articular

127
Q

management of tibial plateau fracture

A

reduction of articular surface and rigid fixation

128
Q

foot drop is a sign of damage to which nerve

A

common peroneal

129
Q

a valgus stress injury to the knee may cause what sort of fracture and injury to which ligaments

A

lateral plateau fracture

injury to MCL and possibly ACL

130
Q

a varus stress injury to the knee may result in what type of fracture and injury to which structures

A

medial plateau fracture

LCL injury

stretch injury to common peroneal nerve

131
Q

management of proximal tibia (plateau) fracture

A

plates and screws for fixation

may require bone graft to provide support

132
Q

tibial fractures are the most common cause of compartment syndrome

true/false

A

true

particularly the anterior compartment of the leg

133
Q

why are open fractures common in tibial fractures

A

the tibial shaft is subcutaneous

134
Q

average time for a tibial shaft to heal

A

16 weeks

135
Q

what is commonest surgical method of stabilisation of tibial shaft fracture

A

IM nail

136
Q

benefits of IM nail in tibial shaft fracture

A

promotes secondary bone healing

less disruption of the periosteal blood supply

137
Q

what are the most common causes of ankle injury

A

inversion and rotational force on a planted foot

138
Q

which ankle ligaments are most commonly sprained

A

anterior and posteior talofibular ligaments

calcaneofibular ligament

139
Q

signs of ankle sprain

A

pain, bruising and mild to moderate tenderness over the involved ligaments

140
Q

what criteria is used to indentify suspected ankle fractures

A

ottawa criteria

141
Q

indication for xray in investigation of ankle fracture

A

severe localised bony tenderness of distal tibia or fibula

inability to weight bear for four steps

142
Q

treatment of stable ankle fracture

A

walking cast or splint

143
Q

isolated distal fibular fractures with no medial fracture or rupture of delotoid ligament

stable/unstable

A

stable

144
Q

distal fibular fractures with rupture of the deltoid ligament

stable/unstable

A

unstable

145
Q

treatment of unstable ankle fracture

A

ORIF

(plates and screws)

146
Q

xray signs of deltoid ligament rupture (ankle)

A

talar shift

talar tilt

147
Q

talar shift increases the risk of post-traumatic OA

true/false

A

true

ankle joint contact pressures increase greatly which increases the risk of OA

148
Q

bimalleolar fractures are stable/unstable

A

unstable

149
Q

why might ORIF be delayed when treated an ankle fracture

A

ankle fractures can be associated with substantial soft tissue swelling and fracture blisters

1-2 weeks may be necessary to allow swelling to reduce and lower the risk of wound healing problems and infection

150
Q

what are the tarsal bones

A

talus

calcaneus

cuboid

medial, lateral and middle cuneiforms

navicular

151
Q

why do calcaneal fractures occur

A

fall from height

152
Q

which joint may be involved in a calcaneal fracture

A

subtalar joint

153
Q

what facotrs increase the risk of wound healing problems and infection

A

heavy smoking

vascular disease

diabetes

poor surgical technique

increasing age

154
Q

with displacement of the fracture or subluxation/dislocation of the talus, there is a high risk of ____

A

AVN affecting the talar body

155
Q

what is a midfoot fracture/dislocation

A

fracture of the base of the 2nd metatarsal is associated with dislocation of the base of the 2nd metatarsal with or without dislocation of the other metatarsals at the tarso-metatarsal joints

156
Q

presentation of midfoot fracture

A

grossly swollen, bruised foot

unable to weight bear

poosibly a normaly xray

157
Q

treatment of midfoot fracture

A

open or closed reduction

fixation using screws

158
Q

what is a midfoot fracture/dislocation also known as

A

lisfranc fracture/dislocation

159
Q

treatment of 5th metatarsal fractures

A

walking cast/supportive bandage/stout boot for 4-6 weeks

160
Q

fractures of the first metatarsal are normally treated with

A

fixation

161
Q

why can it take several weeks for a stress fracture to the 2nd metatarsal to appear on xray

A

it may not be visible until healing (callus response)

162
Q

what does a ‘greenstick’ fracture refer to

A

paediatric fracture where the bone hasn’t completely fractured, with some continuity of ‘fibres’ within the bone

(like breaking a green stick from a tree)

children’s bones are more elastic and pliable than adult bones

163
Q

what role does the periosteum play in the healing of paediatric fractures

A

can help stabilty and assist reduction as it is thicker than in adults

it also helps fractures heal faster as the periosteum is a rich source of osteoblasts

164
Q

how does the periosteum differ between children and adults

A

children have thicker periosteum which serve to increase the circumference of growing long bones

165
Q

why do children’s fractures heal faster than adults

A

the thicker periosteum is a rish source of osteoblasts

166
Q

how does the management of paediatric fractures differ from adult fractures

A

paediatric fractures are less commonly surgically stabilised and a greater degree of angulation can be accepted

167
Q

at what point do children’s fractures tend to be treated as adult’s fractures and why

A

at puberty (12-14)

because they have a lesser potential for remodelling

168
Q

complications of fractures to the physis (in children)

A

potential to disturb growth

may result in shortened limb or an angular deformity if only one side if physis is affected

169
Q

what is the salter-harris classification

A

classification of physeal fractures in children

170
Q

what is a salter-harris I fracture and what is its prognosis

A

pure physeal separation

best prognosis, least likely to affect growth

171
Q

what is a salter-harris II fracture and its prognosis

A

separation of the physis, but with a small metaphyseal fragment attached to the physis and epiphysis

low risk of growth disturbance

172
Q

what is a salter-harris III fracture and its prognosis

A

intra-articular fracture where only part of the physis separates from the diaphysis

increased risk of grwoth disturbance

173
Q

what is a slater-harris IV fracture and its prognosis

A

intra-articular fracture where only part of the physis separates, but part of the diaphysis is attached

increased risk of growth disturbance

174
Q

what is salter-harris V fracture and its prognosis

A

compression injury to the physis

definite growth arrest

175
Q

multiple fractures of varying ages (varying amounts of callus or helaing) or multiple trips to A&E with different injuries raises the suspicion of

A

NAI/child abuse

176
Q

which type of salter-harris fracture often occurs in the distal radial physis of older children

A

salter-harris II

177
Q

dorsal angulation is more common than volar in distal radial fractures

true/false

A

true

178
Q

management of paediatric monteggia and galeazzi fracture/dislocations

A

reduction and rigid fixation with plates and screws

(reduces rate of redislocation)

179
Q

what are the two types of supracondylar fractures and how are they caused

A

extension type - heavy FOOSH

flexion type - fall onto point of flexed elbow

180
Q

treatment of supracondylar fractures

A

undisplaced - splint

angulated/rotated/displaced - closed reduction and pinning with wires

181
Q

which neurovascular structures may be damaged in an off-ended extension type supracondylar fracture

what is a sign of damage to the nerve

A

brachial artery and median nerve

patient is unable to make OK sign

182
Q

femoral shaft fractures occur in children due to

A

fall onto flexed knee

indirect bending

rotational forces

183
Q

why can a small degree of shortening be accepted in a paediatric femoral shaft fracture

A

because there tends to be a degree of overgrowth after fracture healing

184
Q

main cause of femoral shaft fracture in under 2 years olds

A

NAI/child abuse

185
Q

treatment of femoral shaft fractue in child less than 2

A

gallows traction and early hip spica cast

186
Q

treatment of femoral fracture in child 2-6

A

thomas splint or hip spica cast

187
Q

treatment of femoral shaft fracture in child 6-12

A

flexible IM nail

188
Q

treatment of femoral shaft fracture in child 12 or over

A

adult type IM nail

189
Q

what type of tibial fracture is common in toddlers

A

undisplaced spiral fracture of tibial shaft

‘toddler’s fracture’

190
Q

how are intra-capsular hip fractures often treated

A

hemiarthroplasty or THR

191
Q

what nerve is most at risk secondary to a displaced Colles fracture

A

median

192
Q
A

A - lateral femoral condyle

B - medial tibial plateau

C - fibula head

D - medial femoral condyle

E - lateral tibial plateau

193
Q

what is the most common type of shoulder dislocation

A

anterior

194
Q

it is common for srugery for hip fractures to be avoided due to the significant comorbidities often present in this population

true/false

A

false

non-operative risks are just as high

195
Q

the most common anatomical site for proxima lhumeral fracture is the…

A

surgical neck of the humerus

196
Q

a colles fracture describes a dorsally angulated or displaced fracture at what site

A

distal radius

197
Q
A

A - greater tuberosity

B - lesser tuberosity

C - pubic symphysis

D - superior pubic rami

E - left sacro-iliac joint

198
Q

what is the most common management of a minimally displaced, 2 part proximal humeral fracture

operatively with an IM nail

operatively with external fixation

non-operatively in collar and cuff

A

non-operatively in collar and cuff

199
Q

what type of splint may be used for the temporary splintage of femoral shaft fractures

A

thomas splint

200
Q

finger flexor tendon injuries may occur secondary to a penetrating wound to the volar aspect of the forearm

true/false

A

true

201
Q

lateral circumflex artery

profunda femoris

obturator artery

A

A - obturator artery

B - lateral circumflex artery

202
Q

which 3 are true in relation to scaphoid fractures

scaphoid fractures may cause AVN of the distal pole

may not be visible on xrays immediately post injury

undisplaced fractures are usually treated in a cast for 6-12 weeks

scaphoid xrays involve obtaining 4 different views of the bone

patient with signs/symptoms of scaphoid but no xray evidence are reviewed again at 6 weeks

A

may not be visible on xrays immediately post injury

undisplaced fractures are usually treated in a cast for 6-12 weeks

scaphoid xrays involve obtaining 4 different views of the bone

203
Q

which nerve is particularly at risk of injury in humeral shaft fracture

A

radial nerve

(radial groove)

204
Q

radiographic sign associated with posterior dislocation of the humeral head

A

lightbulb sign

205
Q
A

A - medial malleolus

B - talus

C - calcaneus

D - cuboid

E - tibia

F - navicular

G - lateral malleolus

206
Q

what is the approximate mortality rate post hip fracture at 1 year

A

30%

207
Q

which nerve is most at risk of injury during traumatic anterior shoulder dislocation

A

axillary nerve

208
Q

the risk of recurrent shoulder dislocation is inversely proportional to the age of first time dislocation

true/false

A

true

cortext (6 decks)

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