Trauma

Question 1

What are the two fractures most at risk of leading to compartment syndrome?

Answer 1

Supracondylar fractures and Tibial shaft injuries.

Question 2

What investigation is used to diagnose compartment syndrome?

Answer 2

Measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic

Question 3

What is the emergency treatment for compartment syndrome?

Answer 3

Prompt and excessive fasciotomies to relieve the pressure.

Aggressive fluid therapy may be needed as a result of myoglobinuria following fasciotomy.

Question 4

What is the most common mechanism of lateral ankle sprain?

Answer 4

Inversion of the plantar flexed foot

Question 5

What is the most common mechanism of syndesmotic (high ankle) sprain (syndesmotic ligaments are the combination of the interosseous ligament and lower tibiofibular ligaments)?

Answer 5

Dorsiflexion and eversion of the ankle with internal rotation of the tibia - eg, during skiing or football.

Question 6

When is an ankle or foot X-ray to check for fracture indicated according to the Ottawa ankle rules?

Answer 6

If there is pain in malleolar region and 1+ of:
Bony tenderness at posterior edge or tip of lateral or medial malleous
Bony tenderness at base of 5th metatarsal or navicular
Inability to weight bear for 4 steps either immediately after the injury or in the ED

Question 7

What is the Weber classification of fibular fractures?

Answer 7

Type A: fibular fracture below the syndesmosis, which is intact.
Type B: fibular fracture at the level of the syndesmosis.
Type C: fibular fracture above the syndesmosis, indicating rupture of the syndesmosis.

Question 8

What is the typical mechanism that leads to a Colles’ fracture?

Answer 8

A fall on to an outstretched hand that results in forced dorsiflexion of the wrist - giving a characteristic dinner fork deformity

Question 9

What is the typical mechanism that leads to a Smith’s fracture?

Answer 9

Usually caused by falling backwards - a fall on to the palm of the outstretched hand with the arm above it pronating as the body falls - leads to ‘garden spade deformity’

Question 10

What is a Barton’s fracture?

Answer 10

A distal radius fracture but with an additional dislocation of the radiocarpal joint
(basically it is a Colles’ or Smith’s fracture with dislocation)

Question 11

How might the leg of a patient with a hip fracture appear?

Answer 11

Shortened and externally rotated

Question 12

What classification system is used to describe intracapsular hip fractures?

Answer 12

Garden system

Type 1 to 4

Question 13

What is the recommended surgical management of intratrochanteric extracapsular hip fractures?

Answer 13

Dynamic hip screw

Question 14

What is the recommended surgical management of subtrochanteric extracapsular hip fractures?

Answer 14

Use intramedullary device

Question 15

What are the surgical management options for a displaced intracapsular hip fracture?

Answer 15

Under 70: internal fixation if poss, hip arthroplasty if not
Over 70: total hip arthoplasty
Major co-morbidities (any age): hemiarthroplasty

Question 16

What is the recommended surgical management of an undisplaced intracapsular hip fracture?

Answer 16

Internal fixation

Question 17

What is a comminuted fracture?

Answer 17

When there are three or more resulting bone pieces

Question 18

Where is the most common site of proximal humerus fracture?

Answer 18

Surgical neck of the humerus

Question 19

An externally rotated and abducted arm is likely to correlate to which type of shoulder dislocation?

Answer 19

Anterior dislocation

Question 20

What sign may be seen on X-ray in posterior shoulder dislocation?

Answer 20

‘Light bulb sign’

Question 21

What are the criteria for immobilising a patient’s C-spine pre-hospital if they have a head injury?

Answer 21

GCS is <15 at any time since the injury.
Neck pain or tenderness.
Focal neurological deficit.
Paraesthesia in the extremities.
Any other clinical suspicion of cervical spine injury exists.

Question 22

What are the NICE criteria for a CT scan of the brain within 1 hour of assessment?

Answer 22

Glasgow Coma Scale (GCS) <13 when first assessed or GCS <15 two hours after injury
Suspected open or depressed skull fracture
Signs of base of skull fracture*
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting

Question 23

All patients with a head injury on oral anticoagulant therapy or a coagulopathy should have a CT head within how long after assessment (providing they haven’t met the criteria for urgent (1 hr) CT)?

Answer 23

8 hours