Trauma and musculoskeletal

Question 1

What is are the 3 components of a ‘left sided injury package’ from blunt abdominal trauma?

Answer 1

splenic injury, lower L sided rib fractures with associated haemothorax/ pneumothorax, and left renal injury. (The left hemidaphragm may also be ruptured)

Question 2

What is the patient at risk of if in an MVA wearing a lap seat belt? (2)

Answer 2

1. Shearing injury to bowel/ mesentery.

2. Thoracolumbar spie injury

Question 3

What can cause a wide mediastinum?

Answer 3

Aortic rupture: at the root (aortic valve), ligamentum arteriosum or the diaphragm, thoracic aortic aneurism, mediastinal mass.

Question 4

Which structures are most at risk of injury in the setting of pelvic fractures?

Answer 4

Urinary bladder (particularly if it is distended) and urethra.

Question 5

What imaging modality can you use to see a ruptured bladder? How is it performed?

Answer 5

CT cystogram

It is performed by instillation of radio-opaque contrast into the bladder retrogradely via an indwelling catheter before the CT.

Question 6

What are the different causes of extraperitoneal and intraperitoneal bladder rupture?

Answer 6

Extraperitoneal bladder rupture into the perivesical tissues usually results from laceration of the bladder by the bony fragments of a pelvic fracture. Intraperitoneal rupture occurs following sudden increase of intraperitoneal pressure with a distended bladder rupturing through the bladder dome.

Question 7

Which carpal bones articulate with the radius at the wrist (underneath articular disc)?

Answer 7

scaphoid, lunate and triquetrium.

Question 8

How do you describe a displaced fracture/ bone?

Answer 8

Describe the direct that the distal portion has been displaced

Question 9

What does the fat pad sign look like and what does it mean?

Answer 9

X-ray: lucent (dark) triangles adjacent to the elbow joint. Indicates effusion into the joint space- the fat pads are normally collapsed against the bone and therefore not visible.

In a trauma patient this is suspicious for blood (and therefore a fracture), but without trauma could be an infection.

From radiopedia: The sail sign on an elbow radiograph describes the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat. It indicates the presence of an elbow joint effusion.

Question 10

What is the most likely bone fractured at the elbow in an adult?

Answer 10

Radius (radial head)

Question 11

What is the most common direction for shoulder dislocation?

Answer 11

Anteroir- inferior

Question 12

What does the humeral head being inferior to the coracoid process on X-ray imply about a shoulder dislocation?

Answer 12

Anterior dislocation

Question 13

What is a Galeazzi fracture-dislocation?

Answer 13

Galeazzi fracture-dislocations consist of fracture of the distal part of the radius with dislocation of distal ulnar (radioulnar joint) and an intact ulna. A Galeazzi equivalent fracture is a distal radial fracture with a distal ulnar physeal fracture 2.

Question 14

What is the typical mechanism of injury for a Galeazzi fracture?

Answer 14

FOOSH

Question 15

What is a Monteggia fracture-dislocation?

Answer 15

Monteggia fracture-dislocations comprise of a fracture of the proximal ulna shaft and dislocation of the radial head (at the elbow)

Question 16

What is the typical mechanism of injury for a Monteggia fracture?

Answer 16

FOOSH

Question 17

What does tenderness over the anatomical snuffbox imply?

Answer 17

Scaphoid fracture

Question 18

What is the order of the carpal bones?

Answer 18

Distal 4, starting from radial side: scaphoid lunate triquetrium pisiform
Proximal 4, starting from radial side: trapezium, trapezoid, capitate, hamate

Question 19

How can you radiologically assess a scaphoid fracture? How can you assess a suspected but radiologically occult fracture? (4)

Answer 19

scaphoid x-ray views

wrist immobilization and repeat X-rays in 7-10 days’ time to assess for secondary signs of a healing fracture such as presence of periosteal new bone formation or sclerosis of the fracture line.

Cross sectional imaging with CT (more readily available) or MRI (more sensitive) at the time of presentation

Nuclear medicine bone scan

Question 20

Why is there a risk of avascular necrosis with a fracture of the waist of the scaphoid?

Answer 20

Avascular necrosis of the proximal pole of scaphoid may occur in up to 15-30% of fractures through the waist of scaphoid as the majority of blood supply to the proximal pole is derived from branches of the radial artery which enter the scaphoid at the waist and course retrogradely to the proximal pole of the scaphoid.

Question 21

Which kind of MRI is best for seeing oedema/ fluid?

Answer 21

Fat suppressed T2 (fluid will be hyperintense)

Question 22

On which kind of MRI will fat and fluid be dark?

Answer 22

T1

Question 23

What does bone that has undergone avascular necrosis look like radiologically?

Answer 23

Increased density due to sclerosis

Question 24

What is a Boxer fracture?

Answer 24

Boxer fractures are minimally comminuted, transverse fractures of the 5th metacarpal and are the most common type of metacarpal fracture. They typically occur (as the name suggests) when punching and are a common sight in all emergency departments on Friday nights.

Question 25

What is a Colle’s fracture?

Answer 25

Extra-articular fractures of the distal radius with dorsal angulation that occur as the result of a fall onto an outstretched hand.

They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction

Question 26

How can you classify NOFs?

Answer 26

Subcapital: femoral head/ neck junction= intracapsular
Pertrochanteric (including intertrochanteric): between trochanters
Subtrachanteric

Question 27

What is the significance of NOF classification re risk of avascular necrosis?

Answer 27

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Question 28

What is the significance of NOF classification re how to fix it?

Answer 28

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