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MSK Pathology > Trauma > Flashcards

Trauma Flashcards

1
Q

Are the majority of fractures due to direct or indirect trauma?

A

indirect e.g. twisting/bending forces

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2
Q

What is primary bone healing?

A

There is a minimal fracture gap, and bone simply bridges gap with new bone from osteoblasts

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3
Q

When does primary bone healing occur?

A

healing of hairline fractures

when fractures are fixed with compression screws and plates

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4
Q

What is secondary bone healing?

A

there is a gap at the fracture site, needs to be filled temporarily to act as scaffold for new bone

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5
Q

What does secondary bone healing involve?

A

inflammatory response with recruitment of pluropotential stem cells, which differentiate into different cells during healing process

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6
Q

Describe the process of secondary bone healing.

A
  1. fracture occurs
  2. haematoma with inflammation
  3. macrophages and osteoclasts remove debris and resorb bone ends
  4. granulation tissue forms from fibroblasts and new vessels
  5. chrondroblasts form cartilage
  6. osteoblasts lay down bone matrix (collagen type 1 - endorchondral ossification)
  7. calcium mineralization produces immature woven bone (hard callus)
  8. remodeling occurs with organization along lines of stress into lamellar bone
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7
Q

Give the 4 main steps of secondary bone healing.

A

inflammation
soft callus
hard callus
remodelling

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8
Q

When is the soft callus usually formed?

A

by 2nd to 3rd week

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9
Q

When is hard callus usually formed??

A

6-12 weeks

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10
Q

What may result in atrophic non union?

A

lack of blood supply, no movement e.g. internal fixation with fracture gap, too big a fracture gap or tissue trapped in gap

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11
Q

What can smoking do to fracture healing?

A

severely impair it due to vasospasm

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12
Q

Why do hypertrophis non unions occur?

A

too much movement

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13
Q

List the 5 basic fracture patterns.

A

transverse, oblique, spiral, comminuted, segmental

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14
Q

Describe transverse fractures.

A

pure bending force causes one side to fail in compression and the other to fail in tension

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15
Q

Describe oblique fractures.

A

shearing force e.g. fall from height causes oblique fracture pattern

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16
Q

What are oblique fractures able to be fixed with?

A

interfragmentary screw

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17
Q

Do oblique fractures tend to shorten~??

A

yes

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18
Q

Describe spiral fractures.

A

occur due to torsional forces (twisting)

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19
Q

What are communuted fractures?

A

fractures with 3 or more fragments

suggests higher energy injury, very unstable

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20
Q

What is a segmental fracture?

A

bone is fracture in two different places. very unstable - need rods or plates

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21
Q

What is displacement?

A

direction of translation of distal fragment (e.g. can be anteriorly or posteriorly displaced and medially or laterally displaced)

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22
Q

What does angulation describe?

A

direction which the distal fragment points towards

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23
Q

What is different about children’s fractures?

A

periosteum in children is much thicker, tends to remain intact
Fractures heal more quickly
Can remodel more easily
Tend to buckle/partially fracture or splinter

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24
Q

At what age does a child’s fractures tend to be treated as an adult’s?

A

12-14 start of puberty

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25
Q

Fractures where have the ability to disturb growth?

A

fractures around physis (growth plate)

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26
Q

What is the Salter Harris classification of physeal fractures?

A

Salter Harris 1 = pure physeal separation
Salter Harris 2 = small metaphyseal fragment attached to physis and epiphysis
Salter Harris 3 and 4 = intra articular and with the fracture splitting the physis, more potential for growth arrest
Salter Harris 5 = compression injury to the physis with subsequent growth arrest - CANNOT BE DETECTED ON X RAY, only once angular deformity is present

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27
Q

Which Salter Harris type is most common type of physeal fractures?

A

2

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28
Q

Which features should raise suspicious of Non accidental injury?

A 
inconsistent history
discrepancy between parents
history not consistent with injury
multiple bruises
atypical injuries eg cigarette burns
rib fractures
metaphyseal fractures in infants
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29
Q

Give 4 clinical signs of a fracture.

A

localized bony tenderness
swelling
deformity
crepitus (from bone ends grating)

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30
Q

Do all MSK injuries require X ray to exclude a fracture?

A

no

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31
Q

What is a useful rule for doing an X ray?

A

if patient cannot weight bear on lower limb, x ray should be requested

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32
Q

What should be used to investigate a fracture?

A 
X ray (lateral and AP - always both)
Oblique views for complex shaped bones eg scaphoid, acetabulum, tibial plateau
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33
Q

What is a tomogram?

A

moving X ray to take images of complex bones

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34
Q

What may be needed to assess fractures of complex bone and determine degree of articular damage?

A

CT

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35
Q

What may MRI be used to detect?

A

occult fractures

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36
Q

What are technetium bone scans used for?

A

stress fractures, as these may fail to show up on x ray

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37
Q

What is the main late systemic complication of a fracture?

A

PE

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38
Q

What happens in compartment syndrome?

A

groups of muscles are bound in tigh fascial compartments with limited capacity for swelling
pressure rises, ischaemia occurs
SEVERE PAIN, PARAESTHESIAE, SWELLING

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39
Q

What is the cardinal clinical sign of compartment syndrome?

A

increased pain on passive stretching of muscle

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40
Q

If left untreated, what can compartment syndrome lead to?

A

necrosis of muscle resulting in fibrotic contracture known as Volkmann’s ischaemic contracture and poor function

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41
Q

Are vascular injuries common in trauma?

A

no, but consequences can be significant

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42
Q

Which fracture risks brachial artery injury?

A

paediatric supracondylar fracture of elbow

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43
Q

What can result in axillary artery compromise?

A

shoulder trauma

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44
Q

What may help localize the site of arterial occlusion urgently in theatre?

A

angiography

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45
Q

How can ongoing haemorrhage from arterial injury in the pelvis be controlled?

A

angiographic embolization

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46
Q

What are two types of open fractures?

A

due to fractured bone puncturing skin (inside out) or laceration of skin from penetrating injury (outside in)

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47
Q

Which classification system exists for open wounds to describe the degree of contamination, size of wound and whether t he wound will be able to be closed or require plastic surgery?

A

Gustilo

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48
Q

What is initial management for open fractures in A and E?

A

IV anti bs, normally flucloxicillin, gentamicin and metronidazole

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49
Q

How are open fractures usually stabilized?

A

internal or external fixation providing an early and thorough debridement

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50
Q

In a situation where a fracture is causing a lot of pressure on the skin, as shown by blanching what should happen?

A

fracture should be reduced as emergency to avoid necrosis

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51
Q

What can a shearing force on the skin result in?

A

avulsion of skin from underlying blood vessels, known as DEGLOVING

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52
Q

If excessive soft tissue swellings and contusions are present, what are more appropriate treatment, external or internal fixators?

A

external

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53
Q

What is one of the slowest healing bones in the body?

A

tibia

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54
Q

What is fracture disease?

A

stiffness and weakness due to fracture

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55
Q

What type of fractures, metaphyseal or cortical, tend to heal more quickly?

A

metaphyseal

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56
Q

Give a cause of delayed union.

A

infection

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57
Q

What causes hypertrophic non union, and what causes atrophic non union?

A

hypertrophic non union: instability and excess motion

atrophic non union: rigid fixation with fracture gap/lack of blood supply

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58
Q

What can mal-union cause?

A

cosmetic deformity, risks OA

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59
Q

What can malunited colles fracture result in?

A

weakness, stiffness and chronic pain

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60
Q

Which fractures are prone to developing AVN?

A

femoral neck, scaphoid and talus

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61
Q

What are characteristics of CRPS?

A

constant burning, throbbing, sensitivity to stimuli, painful movement and skin colour change

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62
Q

For what should you use a Thomas splint?

A

femoral shaft fractures

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63
Q

What type of fractures are treated non surgically with splintage or immobilization?

A

undisplaced, minimally displaced and minimally angulated

considered stable

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64
Q

When is reduction under anaesthetic performed?

A

in displaced or angulated fractures

position deemed unacceptable

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65
Q

How can unstable injuries be treated?

A

surgical stabilization, which involves pins, cerclage wires, screws, plates, intramedullary nails, external fixation etc

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66
Q

How should unstable extra articular diaphyseal fractures be fixed?

A

open reduction and internal fixation (ORIF) using plates and screws

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67
Q

In which cases of extra articular diaphyseal fractures should ORIF be avoided?

A

soft tissue swelling too large
blood supply in tenuous
femoral shaft
tibia

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68
Q

What should be done if extra articular diaphyseal fractures cannot be treated by ORIF?

A

external fixation

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69
Q

What does ORIF aim for, primary or secondary bone healing?

A

secondary

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70
Q

Fractures involving a joint with predictable poor outcome should be treated how?

A

arthrodesis or joint replacement

71
Q

Who are more likely to be treated non operatively?

A

elderly

72
Q

Give 4 signs of fracture healing.

A

resolution of pain and function
absence of point tenderness
no local oedema
resolution of movement at fracture site

73
Q

Give 3 signs of non union.

A

ongoing pain
ongoing oedema
movement at fracture site

74
Q

What may be seen on X ray in non union?

A

bridging callus

75
Q

How are dislocations treated?

A

reduction by closed manipulation

76
Q

With regard to dislocations, what increases the risk of needing an open reduction and recurrent instability?

A

delayed presentation

77
Q

In whom may dislocations occur with seemingly innocuous trauma?

A

Ehlers Danlos

Marfans

78
Q

Describe the grading of ligament tears.

A

Grade I (sprain), Grade 2 (partial tear), Grade 3 (complete tear)

79
Q

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

A

RICE - but some complete ligament ruptures may need repair, tightening or graft reconstruction

80
Q

What tendon injuries are particularly common, usually requiring surgical repair?

A

flexor and extensor tendon injuries in hand

81
Q

Why do pelvic fractures occur in young patients?

A

due to high energy

82
Q

Why are older patients likely to get pelvic fractures from low energy injuries?

A

osteoporosis

83
Q

What forms the pelvic ring?

A

sacrum, ilium, ischium and pubic bones

84
Q

If pelvic ring is disrupted in one place, is it likely there will be any further disruption?

A

yes - either fracture or ligament injury at SI joint

85
Q

Which arteries and veins in pelvis are prone to injury, with risk of serious hypovolaemia?

A

internal iliac arterial system

pre-sacral venous plexus

86
Q

What is mandatory to asses sacral nerve root function and to look for presence of blood in bladder and urethral injuries?

A

PR exam

87
Q

What type of injuries do low energy pubic rami fractures in eldery tend to be?

A

minimally displaced lateral compression injuries

88
Q

What are the more common fractures at the shoulder?

A

proximal humerus fracture

89
Q

Why do most proximal humerus fractures occur?

A

low energy injuries in osteoporotic bone due to fall on outstretched hand or directly onto shoulder

90
Q

What is the most common pattern in proximal humerus fracture, fracture of surgical or anatomic neck? Displacement of what occurs?

A

surgical neck

medial displacement of humeral shaft (due to pull of pectoralis muscle)

91
Q

What is the most common type of shoulder dislocation?

A

anterior

92
Q

Why does anterior shoulder dislocation occur?

A

due to excessive external rotation, for fall onto back of shoulder

93
Q

What can also cause a shoulder dislocation?

A

seizure

94
Q

What is seen in a shoulder dislocation(anterior)?

A

loss of symmetry
loss of roundness
arm held in adducted position supported by patients other arm

95
Q

What type of fractures are caused in the humeral shaft by:

a) direct trauma
b) fall with or without twist

A

direct trauma - transverse or comminuted

fall - oblique or spiral

96
Q

Why are union rates in humeral shaft fracture high?

A

mobility of ball and socket shoulder joint and of elbow joint

97
Q

How are most cases of humeral shaft fracture treated?

A

non operatively with humeral brace

98
Q

Who get supracondylar fractures?

A

mostly children

99
Q

Are olecranon fractures common?

A

yes, with fall onto elbow

100
Q

What is a fracture of ulnar shaft also known as?

A

nightstick fracture

101
Q

What is a monteggia fracture dislocation?

A

fracture of ulna occurs with dislocation of radial head at elbow

102
Q

What is a galeazzi fracture dislocation?

A

fracture of radius with dislocation of ulna

103
Q

Is colles fracture intra or extra articular?

A

extra articular fracture

104
Q

Why does a colles fracture occur?

A

FOOSH (fall on outstretched hand) with the wrist extended

105
Q

What can accompany a colles fracture?

A

median nerve compression

bleed into carpal tunnel

106
Q

What is a specific late local complication of a colles fracture?

A

rupture of extensor pollicis longus tendon

107
Q

When does a smith’s fracture occur?

A

falling onto back of flexed wrist

108
Q

Which fracture is of the distal radius involving the dorsal or volar rim where carpal bones of the wrist joint sublux with the displaced rim fragment?

A

Barton’s fracture - ORIF

109
Q

What should be done to treat comminuted intra articular distal radius fracture?

A

external fixation across wrist joint

110
Q

When do scaphoid fractures usually occur?

A

after a FOOSH

111
Q

What is the shape of the scaphoid?

A

kidney bean shaped

112
Q

How should undisplaced scaphoid fractures be treated?

A

plaster cast

113
Q

Are penetrating hand injuries common?

A

Yes

114
Q

Injuries to both digital arteries in a digit require what?

A

microsurgical repair to restore circulation

115
Q

What is the condition where avulsion of the extensor tendon from its insertion into the terminal phalanx occurs, caused by forced flexion of the extended DIPJ, and what can cause this?

A

mallet finger

a ball at sport

116
Q

Why do flexor tendon injuries pose a particular problem?

A

tendons need to run smoothly within the tendon sheath and under the pulleys

117
Q

The tendon sheath requires careful repair with preservation of the pulleys to avoid what of the tendon?

A

bowstringing

118
Q

In whom are hip fractures common?

A

elderly

119
Q

How can hip fractures be broadly classified?

A

intracapsular

extracapsular

120
Q

Which type of hip fractures can interfere with the arterial supply of the femoral head, risking AVN and non union?

A

intracapsular

121
Q

How should intracapsular hip fractures be treated?

A

replacement of femoral head

122
Q

Which type of hip replacement, total or hemi, has a higher risk of dislocation?

A

total

123
Q

How should extracapsular hip fractures be fixed?

A

dynamic hip screw

124
Q

How do femoral shaft fractures normally occur?

A

high energy injuries

125
Q

Long term use of which drug can have risk of femoral shaft fracture?

A

bisphonates

126
Q

What can occur with displaced femoral shaft fractures?

A

substantial blood loss, fat embolism, hypoxia, risk of ARDS

127
Q

Treatment of Femoral shaft fracture?

A

Thomas splint

128
Q

Are knee dislocations common?

A

no

129
Q

What is there a risk of with knee dislocations?

A

vascular injury, nerve injury, compartment syndrome

130
Q

What may be applied in knee dislocation if the knee is very unstable?

A

external fixation

131
Q

What are more common, knee dislocations or patellar dislocations?

A

patellar (relatively common)

132
Q

In whom is patellar dislocation or subluxation more common?

A

teens, particularly females

133
Q

What do patients have tenderness over in patellar dislocation?

A

medial retinaculum

134
Q

In dislocation of what is there likely to be a haemoarthrosis from impact?

A

patella

135
Q

What type of injury to the knee may cause a lateral plateau with failure of MCL (and potentially ACL)?

A

valgus stress injury

136
Q

What kind of blow could cause proximal fibular fracture?

A

direct blow from car bumper

137
Q

What injury occurs with proximal fibular fracture?

A

injury to common peroneal nerve with footdrop

138
Q

What may result in medial plateau fracture?

A

varus injury

139
Q

What type of fractures can a tibial shaft fracture be?

A

all but segmental

140
Q

Are open tibial shaft fractures common?

A

no - due to tibial shaft being subcutaneous

141
Q

What are the commonest cause of compartment syndrome after trauma?

A

tibial fractures

142
Q

What compartment of the leg do tibial fractures affect?

A

anterior

143
Q

What is the commonest method of surgical stabilization of tibial fracture?

A

intramedullary nails

144
Q

What are most ankle injuries due to?

A

inversion injury/rotation on planted foot

145
Q

What characterize sprains of lateral ankle ligaments?

A

pain, bruising, tenderness

146
Q

What merits an X ray of an ankle injury?

A

inability to weight bear

bony tenderness of distal tibia/fibula

147
Q

What distinction needs to be made in ankle injuries?

A

stable or unstable

148
Q

Treatment of ankle injury?

A

walking cast or splint

149
Q

What does a talar shift or a talar tilt mean?

A

deltoid ligament must be ruptured if there is not medial malleolar fracture

150
Q

Are bimalleolar fractures stable?

A

no unstable

151
Q

Are fractures of the base of the 5th metatarsal common?

A

Yes

152
Q

What is it called when the bone fractures in the proximal diaphysis in the foot? Is this good or bad?

A

Jones fracture - can be bad, as poor blood supply here

153
Q

Is the first metatarsal commonly fractures?

A

no

154
Q

Are the less metatarsals commonly fractured?

A

yes, often with multiple fractures

155
Q

What do toe fractures normally just need?

A

protection in stout boot

156
Q

Treatment of Buckle fractures?

A

3-4 weeks of splintage

157
Q

Where are buckle and greenstick fractures?

A

distal radius

158
Q

What type of fractures may be angulated and may require manipulation?

A

greenstick

159
Q

Where do Salter-Harris II fractures commonly occur?

A

around distal radial physis in older children

160
Q

In ehom can moteggia and galaezzi fractures occur?

A

children and adults

161
Q

Name a relatively weak point the growing upper limb.

A

supracondylar region of distal humerus

162
Q

Are extensor or flexor injuries of supracondylar region of elbow more common?

A

extensor

163
Q

When do extension type fractures of supracondylar region of elbow occur?

A

heavy FOOSH

164
Q

When do flexion type fractures of supracondylar region of elbow occur?

A

fall onto point of flexed elbow

165
Q

When is a patient unable to make the OK sign?

A

extension type fractures of supracondylar region of elbow

pressure may occur on brachial artery and median nerve

166
Q

Why do femoral shaft fractures occur?

A

fall onto flexed knee

indirect bending/rotational forces

167
Q

Can shortening be accepted in femoral shaft fractures?

A

yes

168
Q

Treatment of femoral shaft fracture in patients aged 2-6?

A

Thomas splint

169
Q

Treatment of femoral shaft fracture in patients aged 6-12?

A

intramedullary nails

170
Q

Treatment of femoral shaft fracture in patients aged 12+?

A

intramedullary nail

171
Q

What is the femur a common site for?

A

tumors

172
Q

What type of tibial shaft fractures are common in toddlers?

A

undisplaced spiral

173
Q

What is the mainstay of management for children’s tibial fractures?

A

cast

MSK Pathology (17 decks)

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