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Orthopaedics > Trauma > Flashcards

Trauma Flashcards

1
Q

Name three things you need to mention when describing a fracture

A
  1. site of bone (proximal, middle, distal) or type of bone involeved (eg epiphysial)
  2. Intra or extra articular
  3. Displacement
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2
Q

How is displacement of a bone described?

A

The translation of the distal fragment using anatomical tersms

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3
Q

Give four clinical signs of a fracture

A

Localised bony (marked) tenderness – not diffuse mild tenderness
Swelling
Deformity
Crepitus – from bone ends grating with an unstable fracture

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4
Q

How would you assess the neurovascular supply distal to the fracture?

A

Pulse, cap refill, temperature, colour, sensation, motor power.

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5
Q

When would you use an MRI scanner if you suspected a fracture?

A

To detect occult fractures where there is clinical suspicion but a normal X Ray

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6
Q

When would a technetium bone scan be useful to diagnose fracture?

A

Stress fractures, as these may fail to show up on x ray until hard calluses occur

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7
Q

Describe the initial management of a long bone fracture

A

Clinical assesment
Analgesia (usually IV morphine)
Splintage and immobilization
Investigation (X ray usually)

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8
Q

What is the definitive management for stable fractures that are not displaced?

A

Non operatively with a period of splintage and immobilisation and then rehabilitation.

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9
Q

What is the definitive treatment for a displaced or angulated fracture?

A

Reduction under general aneasthetic

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10
Q

What is the definitive fracture management for unstable injuries?

A

Surgical stabilisation eg using plates and screws

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11
Q

Name some early local complications of fractures

A

Compartment syndrome
Vascular injury with ischaemia
Nerve compression/injury
Skin necrosis

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12
Q

Name some early systemic complications of fractures

A

Hypovolaemia, fat embolism, shock, acute respiratory distress syndrome, renal failure, SIRS

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13
Q

Name some late local complication of fractures

A

Stiffness, loss of function, Chronic pain syndrome, post traumatic osteoarthritis, DVT

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14
Q

Name some late systemic complications of fractures

A

Pulmonary embolism (can occur several days/weeks after injury)

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15
Q

Describe the pathogeneisis of compartment syndrome

A
  1. In the case of an injury there is bleeding and inflammatory exudate.
  2. This causes the pressure within a compartment to rise.
  3. This rising pressure can compress the venous system which results in congestion within the muscle.
  4. This congestion stops arterial blood to the muscle and so secondary ischaemia will occur
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16
Q

Describe what is meant by a muscle compartment

A

Groups of muscles are bound together tightly by fascia, making a tough connective tissue septa. These compartments are distinct and usually have separate nerve and blood supplies from their neighbours. All the muscles within a compartment will generally be supplied by the same nerve. They fascia is tight and has limited capacity for swelling.

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17
Q

What are the cardinal clinical signs of compartment syndrome?

A
  1. Increased pain on passive stretching of the involved muscle
  2. Severe pain outwith the anticipated severity in a clinical context.
    Limb will be tensely swollen and very tender to touch.
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18
Q

What does it mean if there is loss of pulses in compartment syndrome?

A

End stage ischaemia - diagnosis has been made too late

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19
Q

What should you do if you suspect compartment syndrome?

A
  1. Remove tight bandages
  2. Emergency fasciotomy through skin and fascia to reliev pressure. Open wound then left for a few days before secondry closure.
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20
Q

What artery is at risk of being compromised in a knee dislocation?

A

Polpiteal artery

21
Q

What artery is at risk of being compromised in shoulder trauma?

A

Axillary artery

22
Q

Give some clinical signs you may see if there is non union in fracture healing

A

Ongoing pain, ongoing oedema, movement at fracture site, bridging callus may be seen on x ray/CT

23
Q

If the tibia slow or fast to heal?

A

Very slow. Fractures on average take about 16 weeks to unit

24
Q

What is a delayed union of a fracture?

A

A fracture that has not healed within the expected time

25
Q

Give examples of some drugs you could use in complex regional pain syndrome

A

Analgesics, atidepressents (amitryptiline) anticonvulsants (gabapentin) and sterois

26
Q

What fracture is most likely to cause a pulmonary embolism?

A

Pelvic or lower limb

27
Q

What is an “inside out’ open fracture?

A

An open fracture in which the spike of fractured bone from within has punctured the skin.

28
Q

What is an “outside in” open fracture?

A

Laceration of the skin due to a penetrating injury

29
Q

What is the initial A & E management of an open fracture?

A 
IV broad spectrum antibiotics:
- Flucloxacillin (gram positive)
- Gentamicin (gram negatives)
- Metronidazole (anerobes)
Sterile/antiseptic soaked dressing
30
Q

What dies the surgical management of open fractures involve?

A

Debridement
Stabilization with internal or external fixation
Wound often needs to be closed with skin gratfs

31
Q

What are the three grades of ligament tears?

A

Grade 1 = Sprain
Grade 2 = Partial tear
Grade 3 = Complete tear

32
Q

What is the mainstay of treatment for most soft tissue injuries?

A

RICE

Rest, Ice, Compression, Elevation

33
Q

What is a pseudo tumour?

A

It is an inflammatory granuloma produced in response to metal wear particles in the context of a joint replacement, which may be locally invasive but cannot metastasise

34
Q

What nerve is at risk of compression in the carpal tunnel?

A

Median nerve

35
Q

What nerve is at risk of compression in the cubital tunnel?

A

Ulnar nerve

36
Q

What two places can the ulnar nerve become compressed at?

A

Cubital tunnel

Guyon’s canal on ulnar aspect of the wrist

37
Q

What artery is at risk when there is a paediatric supracondylar fracture?

A

Brachial artery

38
Q

Is grip strength associated with flexion or extension of the wrist?

A

Extension

39
Q

What nerve is at risk in a blow to the lateral aspect of the knee?

A

Common peroneal nerve

40
Q

What nerve is at risk in a supracondylar fracture of the distal humerus?

A

Median nerve

41
Q

What nerve is at risk if there is a posterior dislocation of the hip?

A

Sciatic nerve

42
Q

What procedure involves the surgical stiffening or fusion of a joint in a position of function

A

Arthrodesis. This procedure is good for relieving pain but function may be limited

43
Q

What kind of fracture occurs due to torsional forces acting on the bone. These fractures are most unstable to rotational forces but can also angulate.

A

Spiral fracture

44
Q

What kind of fracture occurs when bone is exposed to a shearing force (eg fall from height, deceleration). There is a risk shortening and angulation with these fractures as they’re inheritently unstable.

A

Oblique fracture

45
Q

What kind of fracture occurs when a pure bending force is applied to a bone. The cortex on one side fails in compression and the cortex on the other side fails in tension

A

Transverse fracture

46
Q

What is the main indication for total joint arthoplasty?

A

Pain in a joint

47
Q

What is total joint arthoplasty?

A

Arthroplasty (literally “surgical repair of joint”) is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure

48
Q

What suffix do all bone tumours end in?

A

Sarcoma

49
Q

What is spinal shock?

A

Physiological response to injury with complete loss of sensation and motor function and loss of reflexes below the level of the injury

Orthopaedics (8 decks)

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