TRAUMA Flashcards
Acute Compartment syndrome
- swelling of tissue in anatomical compartment → ↑compartment pressure → occludes vascular supply → hypoxia → acute ischaemia + oedema → necrosis
- Commonly lower and upper limb, also abdomen, gluteal region
Causes: Trauma, burns, infection, vascular, muscular hypertrophy. Regional anaesthetic, IV opiates can mask symptoms.
Signs: initial within 48 hrs injury
- increasing pain despite immobilisation of injury
- worse on passive stretch
- muscle tenderness and swelling
- sensory deficit
- peripheral pulses present
late signs: tissue ischaemia, paralysis of muscle groups
Ivx: bloods = increase CK & U+ES –> cause renal failure
Do Intra-compartmental pressure monitoring = WICK CATHETER - needle manometry
TX: If >30mmHg with surgical decompression and fasciotomy.
- release cast, dressing and elevate limb
- monitor BP
- complications = tissue necrosis and muscle necrosis
- renal failure from rhabdomyolysis increasing CK.
Sprained Ankle
Are majority inversion or eversion?
CF:
severity scale?
X-ray rule?
● Majority of ankle trauma is INVERSION injuries (sole of foot turns to face medially → damage to lateral malleolus
● Eversion injury (less common) → damage medial malleolus structures
CF: Tenderness + swelling
Bruising around joint
Functional loss e.g. pain on weight bearing
Mechanical instability if sprain is severe!
Extensive swelling or bruising indicates ligament tear or fracture
Peroneal nerve injury (common) → ↓sensation over dorsum
IVX: anterior talofibular ligament often affected
1. Examination – knee down for tenderness over proximal fibula, lateral + medial malleolus and ligaments, Navicular, calcaneus, Achilles tendon, 5th metatarsal base
● Classified by severity of damage to ligaments
⇒ 1st deg = damage to a few ligament fibres
⇒ 2nd deg = significant damage to lig, but still intact
⇒ 3rd deg = rupture of lig
x-ray for ottawa ankle rule
Management: RICE
4 weeks full recovery
Crutches if cant weight bare and below knee cast 10 days
Complication: peroneal tendon sublixation
Colles fracture = FOOSH
smiths is fall on flexed wrist - opposite
Distal fragment angulates to point DORSALLY
● Due to fall on outstretched hand i.e. EXTENDED wrist – typically elderly, frail, osteoporosis
CF: Pain, dinner fork, tender and swollen.
IVX: WRIST x ray (radius fracture and sometimes ulnar too)
- dorsal angulation, radial angulation, shortened appearance of radius
Management: analgesia, immobilise, elevate with sling, manipulate under anaesthetic, bier block
Complication: carpal tunnel syndrome
Hand sepsis
- FLEXOR TENOSYNOSOVITIS
FLEXOR TENOSYNOSOVITIS
- Infection of finger flexor tendor sheath following penetrating injury
- -> Presents with Kanavels 4 classic signs
- Fixed flexion
- symmetrical fulsiform swelling
- tenderness over flexor sheath EXCRUCIATING
- extreme pain on passive extension
IVX: exam, explore under LA,
bufalo (Blood and aspirate cultures before abx)
Management:
- urgent incision + drainage of flexor tendon sheath
- tendon sheath release
urgent broad ABX
Hip fracture
A fracture of the PROXIMAL FEMUR (proximal to 5cm below lesser trochanter)
● 3 key types: Intracapsular NOFF, Extracapsular inter-trochanteric, Extracapsular sub-trochanteric
● Common in Elderly due to osteoporosis, osteomalacia, ↑falls
Hand Sepsis: PARONYCHIA
Infection of nail fold adjacent to nail
● Acute = inoculation of bacteria (s.aureues common) into paronychia tissue from nail trauma or manipulation
● Bacteria = sudden-onset and painful
● Candida = slow and chronic
● RF: cleaners, bartenders, fisherman, injury
- Infection causes cellulitis around finger nail
Swollen with tight skin – may have abscess
Tender + Red
- Feverish if systemic – be wary of sepsis
Treatment:
1. Abx
⇒ Flucloxacillin if cellulitis, curative in early stages
⇒ Topical antifungal if fungal
- If abscess/pus develops urgent incision, drainage and irrigation under LA digital block
Hand Sepsis: PARONYCHIA
Infection of nail fold adjacent to nail
● Acute = inoculation of bacteria (s.aureues common) into paronychia tissue from nail trauma or manipulation
● Bacteria = sudden-onset and painful
● Candida = slow and chronic
● RF: cleaners, bartenders, fisherman, injury
- Infection causes cellulitis around finger nail
Swollen with tight skin – may have abscess
Tender
- Red
- Feverish if systemic – be wary of sepsis
Treatment:
1. Abx
⇒ Flucloxacillin if cellulitis, curative in early stages
⇒ Sss if fungal
- If abscess/pus develops urgent incision, drainage and irrigation under LA digital block
Hip Fracture Intracapsualr NOF
how does injured leg appear?
where does pain refer to?
- Involves femoral neck between edge of femur head + inter-trochanteric line of hip joint
- Typically follows a fall onto hip or bum
CF: I/L leg appears SHORTENED + EXTERNALLY rotated
TENDERNESS over hip ± greater trochanter particularly on rotation
May have referred knee pain instead
Check for dehydration, hypothermia, AKI (pt. may have been lying for hours)
High risk of Haemarthrosis
- AVASCULAR NERCROSIS likely
IVX: x-ray look at shentons line if distrupted
- garden classification
MANAGEMENT:
- IV access, fluids, ecg, analgesia + admit to ortho for surg
- high mortality
Extracapsular inter-trochanteric fracture –
fracture distal to insertion of capsule involving or between two trochanters
CF:
Pain in groin
⇒ Radiates to thigh
⇒ Worse on external rotation and flexion
Bruising around joint (haematomas are not contained within the joint capsule)
Inability to weight bear
↓RoM
Shortened limb (less likely externally rotated)
Extracapsular sub-trochanteric fracture
fracture < 5cm below the lesser trochanter involving proximal femoral shaft at or distal to trochanters
● Low risk of avascular necrosis (outside capsule)
CF:
Pain in groin
⇒ Radiates to thigh
⇒ Worse on external rotation and flexion
Bruising around joint (haematomas are not contained within the joint capsule)
Inability to weight bear
↓RoM
Shortened limb (less likely externally rotated)
Long bone fracture
e.g. humerus, radius, ulna, femur, tibia, and fibula.
Hx- mechanism and risk factors, altered nerve sensation + impaired motor function
IVX: x-ray limb, FBC, blood typing, and cross-matching (major trauma)
Management: check distal pulses and senstion
- provide analgesia + support fracture
(2) Facial injury
Cleaning is crucial
- Refer for exploration in theatre if ? parotic duct / facial nerve damage
(2) Shoulder fractures
- Humeral neck/head fracture
- falls onto outstreched hand/ trauma to upper arm
- shoulder movement limited by pain
- 2/3/4 part fractures depending on no. fragments reusulting
Treat: collar and cuff support, analgesia and follow up
(2) ilizarov frame
- external frame used to lengthen or reshape bones
Shoulder dislocaton
Anterior shoulder = forced external rotation / abduction
Posterior = fall onto internally rotated arm (light bulb sign)
