Trauma

Question 1

When do you need to X Ray ankle injuries?

Answer 1

1. Inability to weight bear for 4 steps
2. Tenderness/bone tenderness over the distal fubula
3. Pain in the malleolar zobne

Question 2

What is the initial managment of suspected ankle fractures?

Answer 2

Prompt reduction

Young patients often require surgical repair

Question 3

What are the classical signs of a hip fracture?

Answer 3

A leg that is shortened and externally rotated

Question 4

What two X Ray views do you need if you suspect a hip fracture?

Answer 4

AP

Lateral

Question 5

What is shentons line? What does it mean if this is disrupted?

Answer 5

A line formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus. Loss of contour of this line is a sign of a fractured neck of femur.

Question 6

What is meant by intracapsular and extracapsular hip fractures?

Answer 6

Intracapsular - bone that is enveloped by the ligamentous hip joint
Extracapsular - bone below the capsule. Classed as either trochanteric or subtrochanteric

Question 7

What is the garden system of classifying intracapsular hip fractures?

Answer 7

Type 1: Stable fracture with impaction in valgus
Type 2: Complete fracture but undisplaced
Type 3: Dispaced, rotated and angulated but still has boney contact
Type 4: Complete boney disruption

Question 8

How do you treat an undisplaced intracapsular hip fracture

Answer 8

Internal fixation or hemiarthrop;asy

Question 9

How do you treat a displaced intracapsular hip fracture?

Answer 9

Hemiarthroplasty or total hip replacement

Question 10

How do you treat an extracapsular hip fracture?

Answer 10

Dynamic hip screw

Question 11

What are the 4 stages of bone remodelling?

Answer 11

1: Inflammation
- WBC’s clear debris and create inflammation and cause new red blood cells to grow.
2. Soft callus (2 - 3 weeks)
- Fibrous tissue begins to form
3. Hard callus (6 - 12 weeks)
- Created a bilge at the fracture site which can be seen on X Rays a few weeks following the injury
4. Remodelling
- Body replaces old bone with new bone in a continuous proces

Question 12

What are the five basic fracture patterns that occur?

Answer 12

1. Transverse fracture
   - Bending force
2. Oblique fracture
   - Shearing force
3. Spiral fracture
   - Torsional forces
4. Comminuted fracture
   - Fractures with 3 or more fragments
5. Segmental fracture
   - Bone is fractures in two separate places (very unstable and require stabilisation with rods of plates)

Question 13

What are the four key things you look for if you suspect there is a fracture in a limb?

Answer 13

1. Assess whether injury is open or closed
2. Distal neurovascular status (pulse, cap refil, temperature, colour, sensation, motor power)
3. Look for compartment syndrome ( Pain on passive stretching)
4. Status of skin and soft tissue

Question 14

What is the immediate treatment for compartment syndrome?

Answer 14

Emergency fasciotomy

Question 15

What is a neuropraxia after a fracture?

Answer 15

The nerve has a temporary conduction defect from compression or stretch and will resolve with time (may be around 28 days)

Question 16

What is a axonotmesis after a fracture?

Answer 16

results from sustaines compression or stretch and the axons distal to the unjury die. They can regenerate but this takes time.

Question 17

What nerve injury is associated with a colles fracture?

Answer 17

Acute median nerve compression (carpal tunnel)

Question 18

What nerve injury is associated with anterior dislocation of the shoulder?

Answer 18

Axillary nerve palsy

Question 19

What nerve injury is associated with a humeral shaft fracture?

Answer 19

Radial nerve palsy (in spiral groove)

Question 20

What nerve injury is associated with a supracondylar fracture of the elbow?

Answer 20

Median nerve injury (usually anterior interosseous branch)

Question 21

What nerve injury is associated with a posterior dislocation of the hip?

Answer 21

Sciatic nerve injury

Question 22

What nerve injury is associated with an injury to the lateral knee?

Answer 22

Common peroneal nerve palsy

Question 23

What are the three grades of ligament ruptures?

Answer 23

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

Question 24

how is response to treatment for septic arthritis measured?

Answer 24

Serial CRP measurement

Question 25

What are the criteria for clearing the C spine following trauma?

Answer 25

• No loss of consciousness
• GCS 15 with no alcohol intoxication
• No significant distracting injury
• No neurological symptoms in the upper or lower limb
• No midline tenderness of the C spine
• No pain on gentle neck movement

If these are not all fulfilled then the collar must stay on until there is further imaging

Question 26

What is the first line imaging for adults if you can not clear the C spine clinically?

Answer 26

CT. If there is a neurological abnormality which could be explained by spinal cord injury then MRI

Question 27

What is the first line imaging for children if you can not clear the C spine clinically?

Answer 27

MRI

Question 28

What is the first line imaging for adults if you suspect a thoracic or lumbosacral column injury?

Answer 28

X Ray

if this is abnormal then CT

Question 29

What is spinal shock?

Answer 29

Physiological response to injury with complete loss of sensation and motor function and loss of reflexes below the level of the injury. Usually resolves within 24 hours. Bulbocavernous reflex is absent

Question 30

What is neurogenic shock?

Answer 30

Occurs secondary to temporary shutdown of sympathetic outflow from the cord from T1 - L2 usually due to injury in the cervical or upper thoracic cord. This leads to hypotension and bradycardia which resolves within 24 - 24 hours. Priapism may be present due to unopposed parasympathetic stimulation. Treated with IV fluids.

Question 31

What is the commonest fracture of the distal radius?

Answer 31

Colles fracture - dorsally translated and dorsally and radially angulated