Trauma Flashcards
T bone fracture, signs and symptoms
FN injury
hearing loss vertigo CSF otorrhea TM perforation hemotympanum canal laceration
T bone fracture patterns
- Longitudinal vs transverse
- Otic capsule sparing vs involving
MC = oblique / mixed
What is more common, transverse or longitudinal t bone fracture?
Long = 70-90%
Tran = 10-30%
More likely to involve FN, transverse or longitudinal t bone fracture?
Transverse
But overall, MC in long since long is more common
Longitudinal t bone fracture pattern anatomy
pars squamosa --> posterosuperior bony EAC --> roof of middle ear anterior --> labyrinth --> close proximity to foramen lacerum or foramen ovale
Longitudinal t bone fracture signs
FN injury (20%)
EAC lac
Hemotympanum
Ossicular chain discontinuity
MCC of CHL in t bone fracture
incudostapedial joint dislocation
Trasverse t bone fracture pattern anatomy
foramen lacerum across petrous pyramid –>
foramen magnum
Transverse t bone fracture signs
FN injury (frequent)
severe SNHL +/- vertigo if capsule destroyed
MCC of post-traumatic vertigo
concussive injury to the membranous labyrinth
Rate of CSF leak from t bone fracture
20%
Usually temporary
Indication for surgical repair of orbital floor blowout fractures (4)
1 - Rapid onset of intraorbital bleeding and decreased visual acuity
2 - Diplopia lasting more than 7 days
3 - Entrapment
4 - Enophthalmos greater than 2 mm or involvement of one-third to one-half of the orbital floor
MC error in orbital floor reconstruction
failure to repair the posterior orbital floor
Ideal time for surgical repair of orbital floor fracture
is 10 to 14 days
*only urgent is entrapment with oculocardiac reflex activation
Always perform this after repairing an orbital floor fracture
Forced duction test
Signs of NOE fracture (2)
Telecanthus
Orbital swelling
*Assoc with skull base fracture and CSF leak
NOE fracture types (3)
Type I—single, noncomminuted fragment of bone without medial canthal tendon disruption
Type II—comminution of bone, but medial canthal tendon is still attached to segment of bone
Type III—comminution of bone with disruption of medial canthal tendon
Normal intercanthal distance
3 to 3.5 cm
Main goal of NOE fracture repair
Rreconstruct the nasal root, into which the medial canthal tendon inserts
*May need to reapproximate medial canthal tendon with wire
LeFort fracture types (3)
Type I—palate separated from midface. Involves the pterygoid plates
Type II—involves pterygoid plates, frontonasal maxillary buttress, and skull base. Often results in CSF leak
Type III—involves pterygoid plates, frontonasal maxillary buttress, and frontozygomatic buttress. Results in craniofacial separation
Occlusion (Angle classification) classes (3)
Class I—normal. First maxillary molar has four cusps (mesiobuccal, mesio-lingual, distobuccal, and distolingual). Mesiobuccal cusp of the first maxillary molar fits in mesiobuccal groove of first mandibular molar
Class II—retrognathic (mesiobuccal cusp of first maxillary molar is in between first mandibular molar and the second premolar)
Class III—prognathic.
MC locations of mandible fractures
Condyle, angle, and body
C-A-B
Forces acting on the inferior rim vs superior rim of the mandible
Compressive - inferior
Areas of tension (distract) - superior
*Unfavorable vs favorable fractures - acted on by the pterygoid and masseter
Closed reduction with MMF, contraindications (7)
Multiple comminuted fractures
Pregnant
Children
Elderly
Severe pulmonary disease
Mentally handicapped/seizures
Alcoholic
Cervical injury zones (3)
Zone 1—sternal notch to cricoid cartilage
Zone 2—cricoid cartilage to angle of mandible
Zone 3—angle of mandible to skull base
Angiography vs surgery as first step based on zone of neck
Zone 1 & 3 - Angiography
Zone 2 - surgery*
*esp if Subcutaneous emphysema Hemoptysis Hematemesis Hematoma / Significant bleeding Dysphagia Dysphonia Neurologic injury
Contrast study after cardiomediastinal injury indications (5)
Widened mediastinum
Pulse rate deficit
Supraclavicular hematoma
Brachial plexus injury
Cervical bruit
Cardiac tamponade symptoms / signs (5)
Low cardiac output manifests as low blood pressure and increased heart rate
Muffled cardiac sounds
Increased central venous pressure
Decreased amplitude on electrocardiography (ECG)
Diagnosis/treatment by pericardiocentesis
Air emobolism signs (2)
“To-and-fro” murmur
decreased cardiac output
*can be seen with ultrasound (echocardiogram)
Air embolism treatment
Place patient in Trendelenburg (head down) and left lateral decubitus position — this traps air in the ventricle and prevents ejection into pulmonary system
Cardiac puncture may be required for aspiration of air (also possible with a Swan-Ganz catheter)
