Trauma Flashcards
Pneumonic for Pathological fractures?
Osteoporosis
Metabolic - hyperPTH, HyperT, rickets, osteogenesis imperfecta
Infection/Iatrogenic - radiation, surgical defect
Tumour
Rule of 2s for imaging?
2 sides
2 views
2 joints
2 times before and after reduction
Garden classification of Hip NOF?
Undisplaced, incomplete fracture
Undisplaced, complete fracture
Incompletely displaced, complete fracture
Completely displaced, complete fracture
Weber’s classification for ankle fracture?
A = Fracture below level of syndesmosis
B = Fracture at level of syndesmosis
C = Fracture above level of syndesmosis
Early local complications of fractures?
Neurovascular injury
Compartment syndrome
Soft tissue blister -> infection
Late local complications of fractures?
Malunion, Nonunion, delayed union
AVN, post-traumatic arthritis and stiffness
OM
Heterotrophic ossification
Joint instability
Nerve compression/entrapment
Reflex sympathetic dystrophy
Early systemic complications of fractures?
Fat embolism, DVT/PE
ARDS
Haemorrhagic shock
Operative treatment of indirect fracture healing?
Intramedullary nailing
Bridge plating
Operative treatment for direct fracture healing?
Lag screw, compression plates
External stabilization for fracture?
Slings in UL, Splint, cast, traction in femur, external fixator
Internal stabilization for fracture?
Perc pinning
Extramedullary or intramedullary fixation
Examples of fragility fractures? They are often low-mechanism fractures
Vertebral compression
Hip fractures
Proximal humerus
Distal radius
Sacral fractures
Rule of 11s for distal radius fracture?
Radial height 11mm
Volar tilt 11 degrees
Radial inclination 22 degrees
More means will recommend surgery
Internal vs external fixation?
External fixation means outside skin e.g. rods/pins
5 ligaments for syndesmotic injury?
AITFL
PITFL
Interosseous membrane
Interosseous ligament
Inferior transverse ligament
What is stable vertebral fracture and its features?
Structural ability of spine is compromised
1. Spine can move as multiple independent units, which can cause spinal cord injury
2. Mid-column and posterior column features
What sling for humerus fracture?
Collar and cuff sling
What sling for clavicle fracture?
Arm sling
What fixture to put right and a while after fracture?
Back slab to give space to swell and prevent compartment syndrome
what fixture is put a while after fracture?
Cast - circumferental tc.
Where to use splint/brace or other fixtures?
Splint for smaller joint fractures
For bigger joints use brace e.g. knee
Can use aircast boot for feet
During long-term healing of clavicle fracture there can be a _________
Can have slight bony bump over clavicle. But its normal.
Some pts can feel shoulder is sagging or narrower, but its fine.
When u walk with a healing ankle fracture it will 100% ____.
It will definitely swell. But its fine
Humerus or femur fracture can have _____ fractures within the head. Seen in trauma clinic
3 segmental fracture
Always look for ______ deformity as they predispose to functional problems. For hand!
Always look for ROTATIONAL deformity as they predispose to functional problems. Mild deformities are generally tolerated
Borders of the 3 Gilula lines in AP view of hand?
Arc 1: proximal surface of proximal carpal row
Arc 2: Distal surface of proximal carpal row
3: Proximal surface of capitate and hamate
What is position of “safety’ in hand fractures? For conservative Mx in unsure situations
Wrist extended 20°, MCP flexed 90°, DIPJ and PIPJ fully extended
Differentials of radial wrist pain?
Scaphoid fracture
Distal radius fracture
1st CMCJ fracture/dislocation
Sprain/contusion
Clinical presentation of scaphoid fracture
Snuffbox tenderness
Tuberosity tenderness - volar forearm
Resisted pronation
Axial grind
_____% of scaphoid bone fractures are initially undetectable on XR
25%!!!
Best initial test for scaphoid fracture
Wrist XR in PA, Lateral, oblique, and possibly scaphoid view.
Where do eschars occur?
On full thickness injuries - wounds that extend below epidermis and dermis
Complications of scaphoid fracture
Carpal tunnel syndrome
Avascular necrosis - Scaphoid Nonunion Advanced Collapse
What sign for Lunate dislocation?
Spilled tea-cup sign. Lunate does not articulate with radius
What is seen for perilunate dislocation?
Capitate does not articulate with lunate and radius
Mechanism of mallet fracture of finger?
Stubbed finger! Volleyball, Basketball, falls
Seddon’s classification of nerve injury?
Neuropraxia -> Axonotmesis -> Neurotmesis
Neuropraxia = minor injury
Axonotmesis = Nerves stretch + damaged
Neurotmesis = severed
What is Maisonneuve fracture?
Spiral fracture of upper third of fibula
likely Weber C
Criteria for stable / unstable acute spine fractures?
Number of affected columns!
1 = stable
2 or more = unstable
Disruption of post ligamentous complex = chronic unstable
Why is scaphoid prone to AVN?
Scaphoid is under a lot of stress from motion of carpal bones
Scaphoid is unattached to any muscle -> poorer blood supply
Scaphoid supplied by dorsal carpal branch of Radial artery
What bones are prone to AVN? Why?
Talus
NOF
Scaphoid
Talus and Scaphoid are watershed zones.
Why is NOF prone to AVN? Compare to intertrochanteric #
What supplies NOF?
NOF is site of anastomoses of medial and lateral circumflex arteries that branch from Profunda femoris.
IT # does not disrupt any blood supply.
What does lunate/perilunate dislocation show on XR?
AP view = Assess Gilula lines - carpal alignment shows more overlap btw lunate and capitate
Lat view = line of radius-lunate-capitate [apple on cup shape]
Scaphoid view if want to TRO scaphoid #
What is Volkmann’s ischemic contracture?
Fibrotic contracture of skeletal muscle weeks of months after severe ischemic insult of compartment syndrome
How good is healing potential of NOF frac? Why?
- Femoral neck is intracapsular, bathed in synovial fluid.
- Lacks periosteal layer
- Callus formation limited, which affects healing
In which part of NOF frac is risk of complications particularly high?
Subcapital and Transcervical. They’re intra-capsular.
Basicervical is extra-capsular
Risks include AVN, malunion
Gustilo-Anderson classification for open fracs?
Mechanism energy
Soft tissue damage
Wound size
Contamination
Frac comminution
Periosteal stripping
Skin coverage
Lol go google its too long
What is greenstick fracture?
Fracture in immature bone.
Cortex bends rather than breaks
