Trauma

Question 1

What is a colles fracture?

Answer 1

This is a fracture of the distal radius with dorsal displacement of fragments.

Question 2

If a reduction of the fracture is needed, which method of pain relief is most effective? (reduction is needed if there is neurovascular compromise).

Answer 2

Regional block (ultra sound guided nerve block around brachial plexus).
Also available, is GA, proximal periosteal block.
If you can’t achieve reduction- operation needed.

Question 3

Mgmt for fractures generally?

Answer 3

X-ray, analgesia, immobilise joint above and below.
As trauma to this joint usually causes swelling a cast is avoided initially- usually apply a back slab held in place by crepe bandages. Then patient is seen a few days later in fracture clinic- has another x-ray then a full cast is applied.

Question 4

How will you know if someone has a scaphoid fracture?

Answer 4

Pain in the anatomical snuff box

Question 5

What should you do if you suspect scaphoid fracture?

Answer 5

Make this clear on requesting the X-ray as they can take 4 views of the scaphoid with the wrist in ulnar deviation.

Question 6

Mgmt of a scaphoid fracture?

Answer 6

Immediate cast immobilisation followed by repeat examination and further imaging. This is the exception to the rule as usually there is no swelling with a scaphoid fracture and so you can skip the back-slab part.

Question 7

Complications of a scaphoid fracture?

Answer 7

Avascular necrosis: the blood supply enters the scaphoid near its waist. Fractures in this area can potentially interrupt the blood supply to the proximal part of the scaphoid, leading to avascular necrosis, non-union and arthritis.
Scaphoid non-union/delayed union; non-union occurs in approximately 5-10% of undisplaced scaphoid fractures.
Reduced grip strength and reduced range of motion.
Osteoarthritis of the radiocarpal joint.

Question 8

Who are colles fractures common in?

Answer 8

Older people and people who have osteoporosis- any patient who has a colles fracture should be investigated for osteoporosis.

Question 9

What deformity is characteristic of a colles fracture?

Answer 9

Dinner fork deformity

Question 10

Mgmt of a colles fracture?

Answer 10

MUST be reduced. The manoeuvre involves disimpaction of the fracture and a movement forwards and medially (the opposite of the deformity).
A back slab is applied and a repeat X-ray taken to assess the adequacy of reduction. If the position is unsatisfactory the procedure needs to be repeated. If the fracture appears unstable then orthopaedic help is required. Percutaneous pinning is sometimes necessary

Question 11

When is surgical reduction of a colles fracture needed?

Answer 11

Surgical reduction is recommended for intra-articular fractures if there is any articular incongruity.

Question 12

How long will a colles fracture take to heal?

Answer 12

6 weeks

Question 13

Complications of colles fracture?

Answer 13

Median and/or ulnar nerve damage can occur acutely. There can be an acute carpal tunnel syndrome.
Compartment syndrome can occur with excessive swelling.
Deformity can occur on healing and result in long-term loss of mobility and in functional problems.
Chronic pain can occur.
Malunion/non-union are possible, as with all fractures.
Arthritis is a late complication.
Complex regional pain syndrome.

Question 14

What is a smiths fracture?

Answer 14

This is the same as a colles except with volar/anterior displacement of fragments at the distal radius.

Question 15

What is the usually appearance of someone with a hip fracture?

Answer 15

Their leg is shortened, adducted and externally rotated.

Question 16

What is shentons line?

Answer 16

Shentons line is an imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur. This line should be continuous and smooth. This line is disrupted in hip fractures.

Question 17

When should you preform an MRI regarding hip factures?

Answer 17

If the fracture can’t be visualised on plain radiograph and the patient doesn’t have a pacemaker (if they do request a CT).

Question 18

What classification is used for intra-capsular hip fractures?

Answer 18

Garden classification

Question 19

Assessment of someone with a hip fracture?

Answer 19

General workup including FBC and cross match, renal function, glucose, ECG and, if indicated, CXR, intravenous access with intravenous infusion if indicated.
Analgesia should be adequate for the patient and should enable the movements necessary for investigations and for nursing care and rehabilitation.
Non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended.
Early assessment for cognitive impairment and treatable comorbidities - eg, anaemia, volume depletion, electrolyte imbalance, acute confusional states, uncontrolled diabetes, uncontrolled heart failure, cardiac ischaemia, arrhythmia, chest infection.

Question 20

Mgmt of hip fractures

Answer 20

So intra or extra?
If intra- displaced or not displaced?
If intra displaced- arthroplasty/if patient is well Total hip arthroplasty

If intra non-displaced- internal fixation with screws or hemi if not fit.
So basically intra= hemiarthroplasty (unless fit then get total)

Extra= NICE recommends extramedullary implants such as a sliding hip screw in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter. (ie lower down the femur- screw)dy

Question 21

Where is a supra-condylar fracture?

Answer 21

Fracture of the distal humerus

Question 22

When requesting X-rays for MSK

Answer 22

Request AP and lateral views

Question 23

What is meralgia parasthesia?

Answer 23

caused by compression of lateral cutaneous nerve of thigh

typically burning sensation over antero-lateral aspect of thigh

Question 24

What is the difference between facet joint pain and a prolapsed disc?

Answer 24

They both can come on suddenly, however a straight leg test would cause a lot of pain in a prolapsed disc as opposed to facet joint pain.