Trauma and Emergency Orthopaedics

Question 1

What are the six elements to advanced trauma life support?

Answer 1

• Airway & C-spine Control
• Breathing & Ventilation
• Circulation & Haemorrhage Control
• Disability & AVPU (alert, voice, pain, unresponsive)
• Exposure & Environment Control

Question 2

What are the 6 P’s of a musculoskeletal assessment?

Answer 2

Pain, pulse, pallor, polar, paralysis, paraesthesia

Question 3

What is the possible quantity of blood loss from a pelvic fracture in the first two hours?

Answer 3

2 litres

Question 4

Where does bleeding from a pelvic fracture come from?

Answer 4

o Bleeding is mostly from the posterior pelvic venous plexus and bleeding from the cancellous bone surfaces and less than 10% of the bleed is arterial. This is because the pre-sacral venous plexus overlies the sacroiliac joint, and therefore a fracture disrupts the SI joint and leads to the tearing of veins and therefore bleeding.

Question 5

What quantity of blood may be lost from a femur, tibia or fibular fracture in the first two hours?

Answer 5

~500ml

Question 6

Define neurapraxia

Answer 6

Temporary, non-severe damage to a nerve that will heal

Question 7

Define axonotmesis

Answer 7

Where axons and their myelin sheath are damaged, but Schwann cells, the endoneurium, perineurium and epineurium remain intact

Question 8

Define neurotmesis

Answer 8

This is the most serious nerve injury in the scheme. In this type of injury, both the nerve and the nerve sheath are disrupted.

Question 9

What are the absolute indications for fracture operations?

Answer 9

o	Displaced intra-articular fractures
o	Open fractures
o	Fractures with vascular injury or compartment syndrome
o	Pathological fractures 
o	Non-union fractures

Question 10

Define ‘clinical union’ with regard to fracture healing

Answer 10

Where the bone moves as one but can be tender when stressed

Question 11

Define ‘radiological union’ with regard to fracture healing

Answer 11

At least 3 out of 4 cortices are healed on two views, with bridging callus formation and the facture line often still present but evidence of bone remodelling

Question 12

What is the approximate fracture healing time for adults?

Answer 12

Upper limb = 6-8 weeks

Lower limb = 12-16 weeks

Question 13

What is the approximate fracture healing time for children?

Answer 13

Upper limb = 3-4 weeks

Lower limb = 6-8 weeks

Question 14

What are the potential early complications from fracture surgery?

Answer 14

Other injuries, PE, infection, plaster sores, infection, neurovascular injury, compartment syndrome

Question 15

What are the potential late complications from fracture surgery?

Answer 15

Chest infection, UTI, bed sores, non-union, mal-union, AVN, tendon rupture, nerve compression, Volkmann contracture

Question 16

What are the signs of a fat embolism?

Answer 16

ABG shows mild hypoxemia, and the chest X-ray is normal, with multiple hyperintense punctuate lesions throughout the cerebral white matter. With widespread petechiae over the chest and arms developing later

Question 17

What is the treatment for a fat embolism?

Answer 17

Wait until the body dissolves it by providing supportive management, but the clot itself cannot be externally broken down