T&O

Question 0

Beck’s triad

Answer 0

Hypotension
Distended neck veins
Muffled heart sounds

Cardiac tamponade

Question 1

Upper brachial plexus injury

1. Causes
2. Symptoms and signs

Answer 1

1. Neonates: traction injury during forceps delivery. Erb-Duchenne palsy

Adults: RTAs - head forcibly moved from shoulder, or fall on shoulder

2. Adducted, internally rotated, extended at elbow. Loss of sensation over lateral aspect of arm and forearm. (Porter’s tip position)

Question 2

Indications for internal fixation

Answer 2

Fractures that require open reduction
Unstable fractures
Intra-articular fractures
Multiple injuries

Question 3

Advantages of internal fixation

Answer 3

Anatomical reduction, therefore absolute stability
Primary bone healing
Early mobilisation of joints
Early discharge from hospital

Question 4

Complications of internal fixation

Answer 4

Infection
Anaesthetic risks
Failure of fixation
Malposition of metalwork

Question 5

External fixation advantages

Answer 5

Rapid application
Can be useful in multiple injuries
Stabilises comminuted fractures that are unsuitable for internal fixation
Fixate outside the zone of injury too for open fractures, and allows access to the wound

Question 6

Gustilo and Anderson’s classification of open fractures

Type 1

Type 2

Type 3

Answer 6

1. Wound 1cm long, no extensive soft tissue doge, moderate contamination and fracture comminution

Type 3: see separate card

Question 7

Gustilo and anderson classification of open fractures type 3

Type A

Type B

Type C

Answer 7

Type A: adequate soft tissue coverage over the fracture. Comminuted and segmental high energy fractures are included regardless of the wound size

Type B: extensive soft tissue injuries, MASSIVE CONTAMINATION, severe fracture comminution. Requires LOCAL/FREE FLAP to cover

Type C: arterial injury. Requires repair

Question 8

What is MESS score?

Answer 8

MESS = Mangled Extremity Severity Score
Considers: 
1-4 energy of the injury
1-3 limb ischaemia
0-2 shock
0-2 age

> 7 is indication for amputation

Question 9

Conditions that may be associated with pseudo gout

Answer 9

Hyperparathyroidism
Hypothyroidism
Acromegaly
Haemochromatosis

Question 10

Proximal tibio-fibular dislocation

1. Activities it is associated with
2. People who are susceptible
3. Examination findings

Answer 10

1. Parachute jumping, “horseback rider’s knee”
2. Hypermobile patients, eg. Ehlos-Danlos
3. Ankle movement can cause knee pain
   Common peroneal nerve damage

Question 11

Kocher criteria

1. Use
2. What are the four criteria?

Answer 11

1. Diagnosing septic arthritis in children. 4 means 99% chance of septic arthritis
2. Unable to weight bear on joint affected
   ESR >40
   WCC >12
   History of fever

Question 12

Transient synovitis

1. What is it?
2. Investigations and findings
3. Treatment

Answer 12

1. Effusion, usually following URTI. Pain and limp
   M>F, 3-8y/o
2. Investigate for Perthes, SUFE, septic arthritis etc. all would be normal. No joint destruction, ultrasound may show effusion
3. Bed rest and analgesia

Question 13

Developmental dysplasia of hip RISK FACTORS

Answer 13

Breech
Female
First born
FH
White kids
Races who swaddle kids with legs adducted and extended

Question 14

Conditions associated with DDH

Answer 14

1. Congenital talipes equinovarus
2. Torticollis
3. Metatarsus adductus
4. Neuromuscular disorders and syndromes

Question 15

Aortic disruption: Radiographic findings

Answer 15

Widened mediastinum
Obliterated aortic knob
Trachea deviated to right
Obscuration of AP (aortopulmonary) window
LMB depression