Trauma Flashcards
When do you need to X Ray ankle injuries?
- Inability to weight bear for 4 steps
- Tenderness/bone tenderness over the distal fubula
- Pain in the malleolar zobne
What is the initial managment of suspected ankle fractures?
Prompt reduction
Young patients often require surgical repair
What are the classical signs of a hip fracture?
A leg that is shortened and externally rotated
What two X Ray views do you need if you suspect a hip fracture?
AP
Lateral
What is shentons line? What does it mean if this is disrupted?
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.
What is meant by intracapsular and extracapsular hip fractures?
Intracapsular - bone that is enveloped by the ligamentous hip joint
Extracapsular - bone below the capsule. Classed as either trochanteric or subtrochanteric
What is the garden system of classifying intracapsular hip fractures?
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
How do you treat an undisplaced intracapsular hip fracture
Internal fixation or hemiarthrop;asy
How do you treat a displaced intracapsular hip fracture?
Hemiarthroplasty or total hip replacement
How do you treat an extracapsular hip fracture?
Dynamic hip screw
What are the 4 stages of bone remodelling?
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
What are the five basic fracture patterns that occur?
- Transverse fracture
- Bending force - Oblique fracture
- Shearing force - Spiral fracture
- Torsional forces - Comminuted fracture
- Fractures with 3 or more fragments - Segmental fracture
- Bone is fractures in two separate places (very unstable and require stabilisation with rods of plates)
What are the four key things you look for if you suspect there is a fracture in a limb?
- Assess whether injury is open or closed
- Distal neurovascular status (pulse, cap refil, temperature, colour, sensation, motor power)
- Look for compartment syndrome ( Pain on passive stretching)
- Status of skin and soft tissue
What is the immediate treatment for compartment syndrome?
Emergency fasciotomy
What is a neuropraxia after a fracture?
The nerve has a temporary conduction defect from compression or stretch and will resolve with time (may be around 28 days)
What is a axonotmesis after a fracture?
results from sustaines compression or stretch and the axons distal to the unjury die. They can regenerate but this takes time.
What nerve injury is associated with a colles fracture?
Acute median nerve compression (carpal tunnel)
What nerve injury is associated with anterior dislocation of the shoulder?
Axillary nerve palsy
What nerve injury is associated with a humeral shaft fracture?
Radial nerve palsy (in spiral groove)
What nerve injury is associated with a supracondylar fracture of the elbow?
Median nerve injury (usually anterior interosseous branch)
What nerve injury is associated with a posterior dislocation of the hip?
Sciatic nerve injury
What nerve injury is associated with an injury to the lateral knee?
Common peroneal nerve palsy
What are the three grades of ligament ruptures?
Grade 1 - Sprain
Grade 2 - Partial tear
Grade 3 - Complete tear
how is response to treatment for septic arthritis measured?
Serial CRP measurement
What are the criteria for clearing the C spine following trauma?
- 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
What is the first line imaging for adults if you can not clear the C spine clinically?
CT. If there is a neurological abnormality which could be explained by spinal cord injury then MRI
What is the first line imaging for children if you can not clear the C spine clinically?
MRI
What is the first line imaging for adults if you suspect a thoracic or lumbosacral column injury?
X Ray
if this is abnormal then CT
What is spinal shock?
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
What is neurogenic shock?
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.
What is the commonest fracture of the distal radius?
Colles fracture - dorsally translated and dorsally and radially angulated
