Trauma

Question 1

What is the medical term for a broken bone?

Answer 1

Fracture

Question 2

Give examples of situations that would cause high-energy fractures

Answer 2

RTA
Gunshot
Fall from heightbomb blast

Question 3

What is meant by a pathological fracture?

Answer 3

Underlying bone disease/weakness causes the fracture

Question 4

What is meant by primary/first-intention bone healing?

Answer 4

Minimal fracture gap (hairline) is bridged by new bone formation by osteoblasts

Question 5

What is meant by secondary bone healing?

Answer 5

Gap needs to be filled to act as a scaffold for new bone formation

Question 6

Ourline the fracture process of secondary bone healing

Answer 6

Fracture
Haematoma + inflammation
Macrophages + osteoclasts remove debris
Granulation tissue forms + angiogenesis
Chondroblasts form soft cartilage callus
Osteoblasts lay down type 1 collagen
Calcium mineralisation produces hard callus
Remodelling with organisation

Question 7

When does soft callus usually form by?

Answer 7

2-3weeks

Question 8

When does hard callus usually form by?

Answer 8

6-12weeks

Question 9

What lifestyle habit may severely impair fracture healing?

Answer 9

Smoking

Question 10

List the 5 basic fracture patterns

Answer 10

Transverse
Oblique
Spiral
Comminuted
Segmental

Question 11

Describe a transverse fracture

Answer 11

Bending force causing horizontal break

Question 12

Describe an oblique fracture

Answer 12

Shearing force causing diagonal break

Question 13

Describe a spiral fracture

Answer 13

Tortional force causing diagonal + circular break

Question 14

Describe a comminuted fracture

Answer 14

Has 3 or more fragments, usually due to high-energy injury

Question 15

Describe a segmental fracture

Answer 15

Bone fractures in two separate places

Question 16

What is meant by an intraarticular fracture?

Answer 16

Fracture at the end of a long bone extending into a joint

Question 17

When describing a fracture, displacement is described by the tranlation of the proximal fragment. True/False?

Answer 17

False

Displacement describes direction of translation of the distal fragment

Question 18

How is anterior/posterior and medial/lateral displacement in the forearm/hand described?

Answer 18

Volar/dorsal

Ulnar/radial

Question 19

What does angulation of a fracture describe?

Answer 19

Which way the distal fragment points

Question 20

List clinical signs of a fracture

Answer 20

Localised tenderness
Swelling
Deformity
Crepitus

Question 21

List the factors that should be considered when assessing an injured limb

Answer 21

Open/closed
Neurovascular status
Compartment syndrome
Skin/soft tissue status

Question 22

List ways of checking neurovascular status

Answer 22

Capillary refill
Pulses
Temperature
Colour
Sensation
Motor power

Question 23

Which XRAY views are usually used to assess the personality of a fracture?

Answer 23

AP

Lateral

Question 24

When is CT useful for assessing fractures?

Answer 24

Complex bones (vertebrae, pelvis, feet)

Question 25

Outline initial management of a long bone fracture

Answer 25

Clinical assessment Analgesia (IV morphine) Splint/immobilise Imaging

Question 26

Describe a fracture that would be considered "stable" and be treated with a period of splintage + rehab

Answer 26

Undisplaced Minimally displaced Minimally angulated

Question 27

How can unstable/acceptable fractures be treated?

Answer 27

Reduction Cast application Surgical stabilisation

Question 28

List materials that can be used in surgical stabilisation/open reduction and internal fixation

Answer 28

Plates and screws Intramedullary nails Cerclage wires

Question 29

List early local complications of fractures

Answer 29

Compartment syndrome Vascular injury/ischaemia Nerve damage Skin necrosis

Question 30

What is compartment syndrome?

Answer 30

Increased pressure (inflammatory exudate, bleeding) compresses the venous system, causing congestion within muscle compartments and ischaemia since arterial blood cannot get through

Question 31

List the cardinal clinical signs of compartment syndrome

Answer 31

Increased pain on passive stretching of muscle Severe pain outwith severity of context Swollen/tender limb

Question 32

What is the urgent surgery for compartment syndrome?

Answer 32

Fasciotomy

Question 33

What is the name of the fibrotic contracture that can develop from necrotised muscle in compartment syndrome?

Answer 33

Volkmann's ischaemic contracture

Question 34

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

Answer 34

``` RICE Rest Ice Compression Elevation ```

Question 35

List late local complications of fractures

Answer 35

``` Stiffness/LOF PT arthiritis CRPS Osteomyelitis AVN DVT ```

Question 36

List early systemic complications of fractures

Answer 36

``` Hypovolaemia Fat embolism ARDS SIRS MODS ```

Question 37

List a late systemic complication of fractures

Answer 37

Pulmonary embolism

Question 38

What is an escharotomy?

Answer 38

Surgical release of eschar, thick leathery skin which forms after burns, to relieve underlying pressure and allow movement