Trauma call Flashcards
What is the management of an open fracture?
- Examine neurovascular status
- Gross contamination removed
- Wound covered in saline soaked gauze and the limb should be splinted
- IV Abs within 1hr injury and every 8hrs until wound debridement
- Taken to theatre for wound washout and debridement
- VTE risk assessment and prophylaxis
- Stabilisation of fracture within 24hrs
Which fractures can lead to avascular necrosis?
- Scaphoid
- Femoral head
- Humeral head
- Talus
- Navicular
- 5th metatarsal of foot
Colle’s fracture:
- Site
- Cause
- Clinical signs
Site
- Distal radius
Cause
- FOOSH
Clinical signs
- Dinner fork deformity
Scaphoid fracture:
- Site
- Cause
- Clinical signs
Site
- Scaphoid bone
Cause
- FOOSH
Clinical signs
- Tenderness in anatomical snuffbox
- Loss of grip/pinch strength
What is the Weber classification of ankle fractures?
- A – below joint
- B – at level of joint
- C – above the joint
C causes ankle joint to be disrupted
What can a pelvic ring fracture lead to?
Intra-abdominal bleeding
- When one part fractures, another part will
What are the features of a hip fracture?
- Pain in groin or hip, which may radiate to knee
- Shortened and externally rotated leg
- Not able to weight bear
What are the types and subtypes of a hip fracture?
Intracapsular - Non displaced (Garden I-II) Intact blood supply - Displaced (Garden III-IV) Disruption of blood supply
Extracapsular
- Trochanteric
- Subtrochanteric
What is a possible hallmark xray sign of a hip fracture?
Disruption of Shenton’s line
What causes pathological fractures?
- Osteoporosis
- Paget’s disease
- Tumour
PoRTaBLe
- Po – Prostate
- R – Renal
- Ta – Thyroid
- B – Breast
- Le – Lung
What is osteoporosis?
BMD that lies 2.5 ≥ SDs below the average value for a young healthy person of the same race and sex as the patient
What are the risk factors for osteoporosis?
SHATTERED • Steroid use >5mg/d of prednisolone • Hyperthyroidism, Hyperparathyroidism or Hypercalciuria • Alcohol and tobacco • Thin (BMI <18.5) • Testosterone decreased • Early menopause • Renal/liver failure • Erosive/inflammatory bone disease (myeloma or RA) • Dietary Ca low/ malabsorption/ T1DM
When would you start bone protection in a steroid user?
Use of steroids >3 months
What are the clinical features of a vertebral fracture?
- Loss of height
- Kyphosis
- Dyspnoea
- Localised tenderness on palpation of spinous process at fracture site
What is the FRAX tool?
Rx of fragility fracture over next 10 years
What do the results of the DEXA scan indicate?
- -1.0 to -2.5 = osteopaenia
* < -2.5 = treatment for osteoporosis
How do you treat osteoporososis?
- Calcium adequate: 10 micrograms vitamin D o.d.
- Calcium inadequate: 10 micrograms vitamin D + 1000mg calcium o.d.
• Bisphosphonates (e.g. alendronic acid 10mg o.d. or 70mg weekly)
What can a long bone fracture increase the risk of and what are the clinical features?
Fat embolism
Gurd’s criteria:
- Respiratory distress (tachycardia, tachypnoea, hypoxia, pyrexia)
- Petechial rash
- Cerebral involvement (confusion and agitation)
How do you comment on a fracture?
- Site of fracture (which bone and part)
- Type of fracture
- Simple or comminated
- Displaced or not
- Angulated or not
- Is the bone normal consistency or not?
What are the symptoms of compartment syndrome?
5 P’s
o Pain (Despite analgesia) o Paraesthesia o Pale o Pressure (high) o Paralysis
Pulses may remain intact
What are the signs of compartment syndrome?
- Pain exacerbated by passive stretch
- Tense limb
- Pallor
- Poor blood flow
How do you manage compartment syndrome?
- Check neurovascular status of the limb
- Needle manometry (>40mmHg)
- Review analgesia
- Release any dressings/casts which may be causing external compression
- Position limb level with the heart
- Fasciotomy
Which muscle compartment is the most affected by compartment syndrome?
Anterior compartment of the lower limb
