Trauma - CORTEXT Flashcards
true or false: when spinal shock occurs, loss of motor function and sensation occurs above the level of the injury
false
occurs below the level of the injury
what normal body reflex is absent in spinal shock?
bulbocavernosus reflex
describe complete spinal cord injury
no sensory or voluntary motor function below the level of injury
describe incomplete spinal cord injury
some neurologic function present distal to the level of injury
true or false: the presence of sacral spinal cord sparing in spinal cord injury suggests a better prognosis
true
in which age groups are pelvic fractures more common?
young patients (high energy trauma)
old patients (osteoporosis)
name the bones that form the pelvic ring
sacrum
ilium
ischium
pubic bones
how is the pelvic ring like a polo mint?
if it breaks in one place, it will also break in another
what happens in a lateral compression fracture of the pelvis?
one half of the pelvis is displaced medially
what happens in a vertical shear fracture of the pelvis?
one half of the pelvis is displaced superiorly
what happens in an anteroposterior compression injury of the pelvis?
disruption of the pubic symphysis
what neurovascular structures are at risk in pelvic fractures?
branches of the internal iliac artery
venous plexus
lumbosacral plexus
true or false: a PR exam is mandatory in pelvic fractures
true
to assess sacral nerve root function and to check for blood
what is the most common mechanism of injury in proximal humerus fractures?
low energy osteoporotic injury due to FOOSH
what does FOOSH stand for?
fall onto out stretched hand
which part of the proximal humerus is most commonly fractured?
the surgical neck
in which direction does the humeral shaft usually displace in proximal humerus fractures and why?
medially
due to the pull of pectoralis major
what is the mainstay of treatment for proximal humerus fractures?
sling immobilisation
internal fixation if there is recurrent displacement
which direction of shoulder dislocation is most common?
anterior
what is a Bankart lesion?
anterior shoulder dislocation that causes detachment of the glenoid labrum and capsule
what is a hill-sachs lesion?
posterior humeral head impacts the anterior glenoid
causes an impaction fracture of the posterior humeral head
which nerve is at risk in shoulder dislocation?
axillary nerve
nerves of the brachial plexus
what is the characteristic sign on an x-ray of a posterior shoulder dislocation?
lightbulb sign
what is the principle sign of axillary nerve injury?
loss of sensation in a badge-patch area
what is the mainstay of treatment for anterior shoulder dislocation?
closed reduction under sedation
sling for two to three weeks
describe the relationship between risk of recurrent shoulder dislocation and the age of the patient
under 20 = 80%
over 30 = 20%
what is involved in Bankart repair?
reattach the torn labrum and the capsule via arthroscopy or open repair
how do injuries of the ACJ usually occur?
fall onto the point of the shoulder
in subluxation of the ACJ, what is usually ruptured?
the acromioclavicular ligaments
in dislocation of the ACJ, what is usually ruptured?
the coracoclavicular ligaments
up to how many degrees of angulation is accepted in a humeral shaft fracture and why?
30
the mobility of the shoulder and elbow joint aid union
which nerve is susceptible to injury in humeral shaft fractures?
radial nerve
what pathology can be caused by damage to the radial nerve?
wrist drop
loss of sensation in the first dorsal web space
how are intra articular fractures usually treated?
open reduction, internal fixation (ORIF)
describe the usual mechanism of injury in olecranon fractures
fall onto point of the elbow
contraction of the triceps
which direction of elbow dislocation is most common?
posterior
the forearm acts as a ring due to the ligaments around the radio-ulnar joints, what does this mean for fractures?
if one bone fractures, there is usually a fracture in the other bone too
what is a nightstick fracture?
fracture of the ulnar shaft
how is a diaphyseal fracture of both forearm bones treated?
ORIF with plates and screws
IM nail if very unstable
what is ORIF?
open reduction and internal fixation
describe a monteggia fracture
fracture of the ulna
dislocation of the radial head at the elbow
describe a galeazzi fracture
fracture of the radius
dislocation of the ulnar at the distal radioulnar joint
what is the usual mechanism of injury in distal radial fractures?
FOOSH
describe a colles fracture
extra articular fracture of the distal radius (within an inch of the articular surface), with dorsal displacement
which nerve can be damaged in colles fractures?
median nerve
describe a smith’s fracture
extra-articular fracture of the distal radius with volar displacement
what treatment should be done for all smith’s fractures?
ORIF with plate and screws
describe a barton’s fracture
intra articular fracture of the distal radius where carpal bones sublux
what is another name for a dorsal barton’s fratcure?
intra articular colles fracture
what is another name for a volar barton’s fracture?
intra articular smith’s fracture
name two clinical signs of a scaphoid fracture
tender anatomical snuffbox
pain on compressing the thumb metacarpal
how many x-ray views are taken of a suspected scaphoid fracture?
four
AP, lateral and two oblique views
how are undisplaced scaphoid fractures usually treated?
plaster cast for six to twelve weeks
how do fractures of the fifth metacarpal usually occur?
punching injury
hence why they are called boxer’s fractures
how many degrees of angulation can be tolerated in a boxer’s fracture?
up to 45
what is the most common cause of hip fractures in the elderly?
osteoporosis
true or false: the majority of hip fractures occur in males
false
true or false: nearly all patients with hip fractures have surgery
true
what are the two broad categories of hip fractures?
intracapsular
extracapsular
what is the blood supply to the head of the femur?
branch of the obturator artery
what is the blood supply to the neck of the femur?
femoral circumflex artery
true or false: the arterial supply of the femoral head is more at risk of disruption in extracapsular fractures
false
describe the position of an intracapsular hip fracture
above the trochanteric line
what is the mainstay of treatment for intracapsular hip fractures?
hemiarthroplasty
THR
true or false: extracapsular hip fractures can be repaired with internal fixation
true
if there is a high union rate and low risk of AVN
which type of embolism can occur with femoral shaft fractures?
fat embolism
which type of splint is recommended for femoral shaft fractures?
Thomas splint
true or false: a knee injury is a surgical emergency
true
due to high risk of neurovascular injury
which direction do the vast majority of patellar dislocations occur in?
lateral
true or false: patellar dislocation is more common in females
true
are proximal tibia fractures intra or extra articular?
intra
which nerve could be damaged in proximal tibia fractures?
common fibular nerve
which fracture is the most common cause of compartment syndrome after trauma?
tibial shaft fracture
what is the extent of displacement and angulation acceptable for conservative management of tibial shaft fractures?
up to 50% displacement and 5% angulation
what is the most common method for surgical stabilisation of tibial shaft fractures?
IM nail
what is another name for a distal tibia fracture?
pilon fracture
how are pilon fractures generally treated?
ORIF
what is the most common mechanism of injury in ankle fractures?
inversion injury
name the lateral ankle ligaments
anterior talofibular
posterior talofibular
calcaneofibular
what is another name for a midfoot fracture?
lisfranc fracture
describe a lisfranc fracture
fracture of the base of the 2nd metatarsal with/without dislocation of other metatarsals at the TMJ’s
which tendon is involved in an avulsion fracture of the 5th metatarsal?
peroneus brevis
