Trauma Flashcards
What are the 2 types of femoral fractures?
Shaft and distal (supracondylar)
How are femoral shaft fractures caused?
What are the types of femoral shaft fractures?
-Femoral shaft fractures are caused by HIGH-ENERGY injury e.g. Falls, crushing injury or high speed RTC
Types:
- transverse (horizontal)
- linear (vertical)
- oblique (diagonal)
- spiral (due to twisting force)
- comminuted (>2 bone pieces)
- greenstick (bends and cracks)
- compound or open (penetrates through skin)
Clinical presentation of femoral shaft fracture?
Clinical presentation of femoral shaft fracture
- Severe pain
- Unable to WB
- tense and swollen upper thigh
- Hip EXTERNALLY ROTATED and SHORTENED (but abducted unlike NOFF)
- Often very clear deformity
Investigations of femoral shaft fracture?
Investigations of femoral shaft fracture Bedside -Examination -(look feel move) of hip and knee joint -assess sensation and pulses -Thomas splint – prevent deformity and ↓haemarthrosis
Bloods
-FBC and crossmatch
Xray of femur (AP and lateral views of)
- femur (determine type and severity)
- knee and hip to exclue NOFF
Management of femoral shaft fracture?
Management of femoral shaft fracture
- Femoral-nerve block (Analgesia) – useful
- Open (surgery) or Closed reduction to put back in place
- Fixation –internal (most common is intramedullary nail) or external (big metal cage outside skin)
- Immobilise – Plaster (back slab) or Thomas splint
- X-Ray femur – verify alignment of femur + monitor healing
How long does a femoral shaft fracture take to heal?
femoral shaft fracture takes 4-6 months completely healed – open fracture takes longer
Complications of femoral shaft fracture? (8)
Complications of femoral shaft fracture
- Neurovascular damage – from sharp bone ends
- Acute compartment syndrome – high risk
- Large haematoma (subtle in closed fractures, as it involves large volumes of blood loss before swelling is obvious)
- Infection –high risk in open fractures
- Delayed union (keep cast on for longer)
- Non union (surgery)
- Fat embolism, DVT (PE)
- Shortening, angular, misalignment
Differentials for femoral shaft fracture?
Differentials for femoral shaft fracture
- Hip fracture (NOFF)
- Supracondylar fracture
What is a supracondylar fracture?
What TYPE of fracture are common with supracondylar fracture?
-supracondyl fracture is fracture to the distal 1/3 of femur
(typically weaker metaphyseal bone)
-Commonly COMMINUTED and intra-articular → damage to knee joint
How do supracondylar fractures most commonly occur?
What can supracondyl fractures cause damage to?
Supracondylar fractures common causes:
- Direct violent trauma in adolescent and young adults
- Osteoporosis with low energy trauma in elderly
-Supracondyl fractures can cause damage to the popliteal artery (because the distal fragment of femur pulls backward)
How do supracondylar fractures present?
Supracondylar fractures
- Pain
- Deformity
- Weakness
- History of falls (elderly)
- High impact injury (young adults)
Investigations for supracondylar fracture?
Bedside
- Examination
- (look feel move) of hip and knee joint
- assess sensation and pulses
- Thomas splint – prevent deformity and ↓haemarthrosis
Bloods
-FBC and crossmatch
Xray of femur (AP and lateral views of)
- femur (Categorise as extra-articular, partial articular or complete articular)
- knee Xray is essential
What is Flexor Tenosynovitis? What is the most common cause?
What are the four signs of flexor tenosynovitis?
Flexor Tenosynovitis is an infection of finger flexor tendon sheath (surrounds tendon) following PENETRATING INJURY (common)
Kanaval’s 4 signs
- Fixed flexion of digit – “trigger finger”
- Symmetrical fusiform swelling of digit (sausage finger)
- Excruciating tenderness over flexor sheath
- EXTREME pain on passive extension
What is the treatment of flexor tenosynovitis?
What is a complication of flexor tenosynovitis?
Treatment of flexor tenosynovitis
1. Urgent incision, drainage and irrigation of flexor tendon sheath
2. Tendon sheath release
3. URGENT broad IV Abx (commonly staph infection) –
Co-amox (animal bite), narrow Abx following cultures
Complication: significant sheath scaring → compromise finger function
What is a felon? What is the most common cause?
- Felon is a subcutaneous abscess over the pulp of distal phalanx or thumb
- Due to penetrating injury
What is the treatment of felon?
Treatment of felon
- Urgent incision, drainage and irrigation of absess
- Warm antiseptic soaks
- Oral Abx (IV if septic)
What is Paronychia?
What 2 pathogens can cause this and whats the difference in presentations between them?
Paronychia
-Infection of nail fold adjacent to nail
Pathogens
- Bacteria (S aureas most common): sudden onset and painful
- Candida: slow and chronic
Treatment of paronychia?
Treatment of paronychia with absess?
Treatment of paronychia
- Flucoxacillin if cellulitis (curative in early stages)
- Fungal/chronic: topical antifungals
-If abscess/pus develops> urgent incision, drainage and irrigation under LA digital block with oral AB
What are the 3 types of humerus fractures?
Where does the radial nerve run?
Humeral fractures: proximal (5%), shaft, distal
Radial nerve runs posterior at middle 1/3rd of shaft in spiral groove
What features may indicated PATHOLOGICAL FRACTURE?
PATHOLOGICAL FRACTURE
- Bone pain preceeding fracture
- Limb swelling preceeding fracture or large post fracture swelling
- Cystic abnormality on Xray
- History of malignancy
- Pagets disease of the bone
What is the most common site of proximal humorous fracture?
Surgical neck (below tuberosities) is most common place for proximal humorous fracture
What is a common mechanism of injury for proximal humerus fracture? (what other signs may they have)
- Proximal humorous fracture often caused by FOOSH
- May also have posterior shoulder dislocation
Presentation of proximal humorous fracture?
Presentation of proximal humorous fracture
- Tenderness or swelling of proximal humerus
- ↓RoM at shoulder (due to pain)
Investigations for proximal humeral fracture?
BEDSIDE
MSK and neuro exam
-shoulder and elbow
Axillary nerve – sensation of regimental badge over deltoid + assess UL power
Brachial plexus – distal PNS exam of UL
Peripheral pulses
IMAGING
-AP and lateral of scapular and axillary
Special tests (NEER CLASSIFICATION) -based on 4 usual cleavage lines (head, LT, GT, surgical neck/shaft), therefore either 2, 3 or 4-part fractures