Sports Injuries

Question 1

Where do clavicular fractures normally occur

Answer 1

middle 1/3 of the clavicle

Question 2

How does the arm of someone with a clavicle fracture look and why

Answer 2

proximal to fracture: lifts due to SCM attachment

distal to fracture: drops due to weight

Question 3

What are the complications associated with a clavicle fracture

Answer 3

subclavian artery and vein
brachial plexus damage
pneumothorax
skin tenting can break down and it can become an open fracture

Question 4

how is a clavicle fracture managed

Answer 4

broad arm sling

Question 5

How does an acromio-clavicular dislocation present

Answer 5

shoulder is squared off

the squaring occurs more proximal than would occur with a shoulder dislocation

Question 6

Which way does the shoulder most commonly dislocate and why

Answer 6

anteriorly because this is where the rotator cuff is at it’s weakest

Question 7

how does an anterior shoulder dislocation appear on x-ray

Answer 7

inferior, medial and overlying glenoid

Question 8

What is a complication of shoulder dislocations

Answer 8

axillary nerve damage

Question 9

How is a shoulder dislocation managed

Answer 9

relocate with the cunningham technique - massage trapezius and deltoid to relax them and the humeral head should fall back into place.
Entonox
traction and counter traction
broad arm sling

Question 10

What is luxation erecta and how is it managed prehospitally

Answer 10

bilateral inferior dislocation of the shoulders

package them with their arms above their heads as impossible to reduce prehospitally

Question 11

what can complicate a proximal humerus fracture

Answer 11

AVN due to damage to anterior humeral circumflex

axillary nerve

Question 12

where does the proximal humerus most commonly fracture

Answer 12

surgical neck

Question 13

how is a proximal humerus fracture managed

Answer 13

cuff and collar

Question 14

what nerve can be damaged in humeral shaft fractures

Answer 14

radial nerve

Question 15

what structures can be damaged in distal humerus fractures

Answer 15

brachial artery

median and radial nerve

Question 16

why is ketamine not ideal in dislocations

Answer 16

it is a sympathomimetic so tightens everything up preventing relocation

Question 17

which way does the elbow most often dislocate

Answer 17

postero-lateral (humerus sits anterior to the olecranon)

Question 18

what structures can be damaged in an elbow dislocation

Answer 18

Ulnar nerve is stretched

brachial artery and radial nerve are rarely damaged too

Question 19

how should an elbow dislocation be managed

Answer 19

relocate by pushing your thumbs against the olecranon

benecast

Question 20

what nerve can be damaged in distal forearm fractuers

Answer 20

Median

Question 21

compare a colles and smiths fracture

Answer 21

colles - dorsal displacement of the distal fragment

smiths - volar displacement of the distal fragment

Question 22

What can cause musculocutaneous nerve damage and what does this result in

Answer 22

stab wound to axilla
loss of sensation to lateral forearm
weak elbow flexion
loss of biceps reflex

Question 23

What can cause axillary nerve damage and what does this result in

Answer 23

anterior shoulder dislocation
proximal humerus fractures (surgical neck)
loss of sensation in regimental badge area
weakened abduction from 15-90 degrees

Question 24

What can cause radial nerve damage and what does this result in

Answer 24

humeral shaft fracture
loss of sensation to posterior arm, forearm, hand and digits laterally (i.e. thumb)
weak elbow, wrist and MCPJ extension
loss of triceps reflex

Question 25

What can cause median nerve damage and what does this result in

Answer 25

``` distal humerus fracture loss of sensation to palm and digits laterally (i.e. thumb) weak wrist and digit flexion weak wrist abduction weak thumb opposition ```

Question 26

What can cause ulnar nerve damage and what does this result in

Answer 26

elbow dislocation it is commonly stretched distal humerus fractures loss of sensation to ventral and dorsal palm and digits medially (i.e. little finger) weak wrist adduction weak finger ab/adduction and other intrinsic hand movements

Question 27

how does traction and countertraction work in relocating bones?

Answer 27

fatigues the muscles so that they relax and the bones can fall back into place

Question 28

common injury mechanism causing hip dislocations

Answer 28

dashboard injury | direct blow to femoral head

Question 29

which way does the hip commonly dislocate

Answer 29

posterior

Question 30

how does a dislocated hip present and why

Answer 30

shortened and internally rotated | because the anterior muscles become taught

Question 31

how does a dislocated hip appear on x-ray

Answer 31

``` loss of shentons line loss of lesser trochanter (because it's internally rotated) appears smaller (moved posteriorly) ```

Question 32

what can often be damaged in hip dislocations

Answer 32

sciatic nerve

Question 33

how is a dislocated hip reduced

Answer 33

Allis manoeuvre

Question 34

what causes an anterior hip dislocation and what structures are at risk of damage

Answer 34

direct blow to the femoral head | femoral nerve, artery and vein can be damaged

Question 35

how does a hip fracture present and why

Answer 35

shortened and externally rotated | because of unopposed iliopsoas

Question 36

what structure is at risk of damage in a fractured NOF

Answer 36

medial circumflex artery leading to AVN

Question 37

describe how hip fractures are categorised anatomically

Answer 37

intracapsular: subcapital or basicervical extracapsular: intertrochanteric or subtrochanteric

Question 38

how is a midshaft femur fracture managed prehospitally

Answer 38

KTD

Question 39

what complications can occur as a result of a distal femur fracture

Answer 39

fat emboli can lead to ARDS especially in young people damage to popliteal vessels major haemorrhage

Question 40

which way does the knee commonly dislocate

Answer 40

posterior

Question 41

what can cause an anterior knee dislocation

Answer 41

hyperflexion of the knee

Question 42

what structures are at risk when a knee dislocates

Answer 42

popliteal vessels - you need to CTA them common fibular nerve PCL (especially in anterior dislocation)

Question 43

which way does the patella commonly dislocate

Answer 43

laterally

Question 44

how should a patella dislocation be managed

Answer 44

place thumbs on the lateral patella and push medially whilst hyperextending the knee

Question 45

what is a lisfranc injury

Answer 45

disruption of the medial cuneiform and 2nd metatarsal which is dorsally displaced

Question 46

what causes a lisfranc injury

Answer 46

axial load on a hyper-plantarflexed forefoot

Question 47

what causes a calcaneous fracture

Answer 47

jump/fall from height onto the feet - axial load

Question 48

how does a person with a pelvic fracture present

Answer 48

groin pain considerable bruising externally rotated legs

Question 49

where does the bleeding in a pelvic fracture come from and where does it pool

Answer 49

90% of the time it comes from the venous plexus (located near sacroiliac joint so at risk of damage) This bleeding is retroperitoneal Bleeding can also come from the cancellous bone

Question 50

why is the venous plexus at risk in pelvic fractures

Answer 50

it is thin walled | located near the sacroiliac joint which is often disrupted in pelvic fractures

Question 51

Describe which structures are damaged in a AP pelvic fracture

Answer 51

pubic bones separate sacroiliac joint separates sacrospinous and sacrotuberous ligaments

Question 52

what vessel is at risk in an AP pelvic fracture

Answer 52

superior gluteal artery

Question 53

why are AP pelvic fractures more dangerous than lateral

Answer 53

because of the external rotation they cause the pelvic volume to increase therefore there is more space for blood to be lost into

Question 54

describe the structures damaged in a LC pelvic fracture

Answer 54

pubic rami sacral alar iliac wing

Question 55

what vessels are at risk in an LC pelvic fracture

Answer 55

internal pudendal artery | obturator artery

Question 56

describe a VS pelvic fracture

Answer 56

vertical shift of the hemipelvis

Question 57

when is the femoral nerve commonly damaged and what deficit results

Answer 57

anterior hip dislocations weak hip flexion and knee extension loss of sensation to anterior thigh and medial leg

Question 58

when is the sciatic nerve commonly damaged and what deficit results

Answer 58

posterior hip dislocation, pelvic fractures, IM injection into gluteal region, disc prolapse weak hip extension loss of sensation to lateral leg

Question 59

when is the common fibular nerve commonly damaged and what deficit results

Answer 59

tight cast neck of fibular fracture weak ankle dorsiflexion

Question 60

when is the obturator nerve commonly damaged

Answer 60

anterior hip dislocation

Question 61

How is a suspected pelvic fracture managed

Answer 61

pelvic binder centred over the greater trochanters