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Year 5 Core Conditions > Trauma - Level 3 > Flashcards

Trauma - Level 3 Flashcards

1
Q

Regions of maxillofacial area?

A

o Upper face – Frontal bone and frontal sinus
o Midface – nasal, ethmoid, zygomatic and maxillary bones
o Lower face – mandible

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2
Q

Regions of orbit?

A

o Superior – frontal bone
o Lateral – frontal process of zygomatic bone, zygomatic process of frontal bone and greater wing of sphenoid
o Inferior – maxilla and zygoma
o Floor – roof of maxillary sinus

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3
Q

Blood supply of maxillofacial area?

A

o Branches of external carotid supply face

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4
Q

Nerve supple of maxillofacial area?

A

o Facial nerve supply muscles of facial expression

o Trigeminal nerve (ophthalmic, maxillary and mandibular) supply skin innervation

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5
Q

Aetiology of facial injuries?

A
  • Assault
  • RTAs
  • Falls
  • Sporting Injuries
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6
Q

Imaging in facial injuries?

A
  • X-ray

- CT

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7
Q

Symptoms and management of frontal bone fracture?

A
  • Usually due to severe blow to forehead
  • Tenderness, crepitus or disruption of supraorbital rim
  • Surgery or observation if non-displaced
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8
Q

Classification of Maxillary fractures?

A

o Le Fort 1
 Horizontal fracture across inferior maxilla, alveolar process and hard palate become separated from rest of maxilla and extends through lower nasal septum, lateral maxillary sinus and palatine bones
 Present with Facial oedema, loose teeth and mobile hard palate
o Le Fort 2
 Pyrimidal-shaped fracture, extends from nasal bridge through frontal process, lacrimal bones and inferior orbit
 Presents with facial oedema, epistaxis, subconjunctival haemorrhage, CSF rhinorrhoea, mobile maxilla
o Le Fort 3
 Transverse fracture, separation of facial bones from cranial base

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9
Q

Management of maxillary fractures?

A

o Surgery – Open Reduction and fixation

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10
Q

Symptoms of orbital floor fracture?

A

o Follows blow from object >5cm
o Periorbital bruising, oedema, surgical emphysema
o Vertical diplopia
o Eye sunken

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11
Q

Management of orbital floor fracture?

A

 Do not blow nose for 10 days
 Liase with ophthalmologists and maxillofacial surgeons
 Conservative – prophylactic antibiotics and outpatient monitoring
 Surgery – if blow-out as child, symptomatic sunken eye, >50% floor involed

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12
Q

Symptoms and management of medial orbital wall fracture?

A

o Symptoms – subcutaneous emphysema, medial rectus dysfunction
o Management – surgical repair if pain or diplopia

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13
Q

Symptoms and management of orbital roof fracture?

A

o Common in young children, following blow to brow or forehead
o Symptoms – haematoma of upper lid, periocular ecchymoses, globe inferior displaced
o Management – Close monitoring for CSF leak, large fractures need surgery

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14
Q

Symptoms of mandibular fracture?

A

abnormal facial contour, tenderness, swelling, redness or haematoma

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15
Q

Management of mandibular fracture?

A
  • Investigations – XR, CT scan, If teeth unaccounted for – CXR in case of inhalation
  • Surgery
    o Antibiotics given
    o Closed/Open reduction
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16
Q

Management of facial lacerations - clean wound?

A

antiseptic, irrigate with saline

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17
Q

Management of facial lacerations - close wound?

A

suturing if >5cm or <5cm and excessive flexion/extension, deep, glue or steri-strips if easily opposed edges

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18
Q

Management of facial lacerations - stitch advice?

A

o Dress wound
o Check need for tetanus prophylaxis
o Remove stitches – 3-5 days on head, 10-14 days over joints, 7-10 days at other sites
o Remove steri-strips – 3-5 days on head, 7-10 days at other sites
o If high risk of infection – dress but don’t close wound and give 5-7 days of flucloaxacillin (co-amoxiclav if contaminated)

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19
Q

Anatomy of shoulder?

A

o Shoulder = scapula, humerus, clavicle
o Shoulder made up of glenohumeral joint, acromioclavicular joint and sternoclavicular joint
o Glenohumeral joint is ball and socket joint
o Fractures of shoulder usually involve clavicle, proximal humerus and scapula

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20
Q

Symptoms of shoulder fractures?

A 
o	Pain
o	Swelling and bruising
o	Inability to move shoulder
o	Crepitus
o	Deformity
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21
Q

Investigations in shoulder fracture?

A

o XR of shoulder

o CT

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22
Q

Anatomy of clavicle?

A
  • Articulates with acromion process of scapula laterally and manubrium of sternum medially
  • More common in children
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23
Q

Mechanism of clavicle fracture?

A

o Pain, swelling and tenderness around clavicle

o Deformity

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24
Q

Symptoms of clavicle fracture?

A

o Pain, swelling and tenderness around clavicle

o Deformity

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25
Q

Investigations of clavicle fracture?

A

o Neurovascular exam of upper limbs
o AP XR of clavicles
o CXR if pneumothorax suspected
o CT/MRI if joints involved

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26
Q

Allman classification of clavicle fracture?

A

o Group 1 – middle 1/3 of clavicle (shaft), most common, medial fragment tends to be displaced upwards
o Group 2 – Lateral 1/3 of clavicle (acromial end)
 Type 1 – non-displaced, intact ligaments hold fragment together
 Type 2 – displaced, coracoclavicular ligaments ruptured and medial segment displaces upwards
 Type 3 – Articular surface involving AC joint
o Group 3 – Medial 1/3 (sternal end)

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27
Q

Management of clavicle fracture - group 1?

A

o Sling arm
o Analgesia – paracetamol, opiates
 Immobilisation using sling, figure-of-eight bandage and straps
 Displaced fractures may need surgery

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28
Q

Management of clavicle fracture - group 2?

A

o Sling arm
o Analgesia – paracetamol, opiates
 Type 1 & 3 – immbolisation
 Type 2 – surgery (intramedullary screws or nails and plate fixation of clavicle)

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29
Q

Management of clavicle fracture - group 3?

A

o Sling arm
o Analgesia – paracetamol, opiates
 Displaced need surgery

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30
Q

Anatomy of humerus - articulation, neck, bicipital groove, nerve?

A

o Humeral head articulates with glenoid fossa of scapula
o Anatomical neck separates greater and lesser tuberosities
o Long head of biceps runs in bicipital groove
o Radial nerve runs posteriorly around middle 1/3 of humeral shaft in spiral groove

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31
Q

Mechanism of humeral fractures?

A

o Falls or direct trauma

o Classed into proximal, humeral shaft and distal humeral fracture

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32
Q

Cause of proximal humeral fractures?

A

o Usually due to FOOSH from standing, seizures, electric shock, direct trauma
o Middle age/Elderly women most common

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33
Q

Symptoms of proximal humeral fractures?

A

 Pain, swelling and tenderness around humerus

 Deformity

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34
Q

Assessment of proximal humeral fractures?

A

 Neurovascular assessment

 Peripheral pulses

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35
Q

Investigations of proximal humeral fractures?

A

 X-rays

 CT

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36
Q

Management of proximal humeral fractures?

A

 Immobilisation
 Analgesia – paracetamol, opioids
 Non-operative – sling or shoulder immoboliser & physiotherapy
 If displaced – surgery (closed reduction with percutaneous fixation, open reduction and internal fixation or proximal head replacement)

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37
Q

Management of humeral shaft fracture?

A

 Immobilisation
 Analgesia – paracetamol, opioids
 Non-operative – sling or shoulder immobiliser & physiotherapy
 If vascular compromise – open reduction and plates/screws or intramedullary fixation/nailing

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38
Q

Definition of anterior shoulder dislocation?

A
  • Results from forced external rotation/abduction of shoulder
  • Humeral head lies anteriorly and slightly inferior to glenoid
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39
Q

Definition of posterior shoulder dislocation?

A

o Results from blow onto anterior shoulder or a fall onto internally rotated arm
o May occur during seizure or electric shock

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40
Q

Definition of luxatio erecta dislocation?

A

o Rare inferior dislocation of humeral head

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41
Q

Most common shoulder dislocation?

A
  • Anterior most common dislocation
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42
Q

Symptoms of anterior shoulder dislocation?

A

o Step-off deformity at acromion with palpable gap below acromion
o Humeral head palpable antero-inferiorly to glenoid
o Complications: distal pulses reduced and decreased sensation over lateral aspect of shoulder (badge sign) supplied by axillary nerve

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43
Q

Symptoms of posterior shoulder dislocation?

A

o Shoulder internally rotated, pain, reduced ROM

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44
Q

Symptoms of luxatio erecta shoulder dislocation?

A

o Arm held above head

o May be neurovascular problems

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45
Q

XR findings in anterior shoulder dislocation?

A

o X-ray before reduction to exclude associated fractures (document before and after)
o X-ray
o Loss of congruity between humeral head and glenoid
o Humeral head displaced medially and inferiorly on an AP shoulder X-ray

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46
Q

XR findings in posterior shoulder dislocation?

A

o AP shoulder X-ray
 May be normal
 Abnormally symmetrical appearance of humeral head (‘light bulb sign’)
 Loss of congruity between humeral head and glenoid
o Modified axial view
 Confirm posterior dislocation of humeral head

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47
Q

Management of anterior shoulder dislocation - reduction?

A

o Analgesia and support in temporary sling
o Reduce under sedation/analgesia with full monitoring
 External rotated method
 Kocher’s Method
 Modified Milch Method

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48
Q

Management of anterior shoulder dislocation - post reduction?

A

 Recheck pulses and sensation
 Obtain CXR to check
 Immobilise in collar and cuff and body bandage
 Analgesia and arrange follow-up

49
Q

Management of posterior shoulder dislocation - reduction?

A

o Reduce
 Manipulate under sedation by applying traction and external rotation to upper limb at 90o to body
o If difficult, refer for reduction under GA

50
Q

Management of posterior shoulder dislocation - post reduction?

A

 Recheck pulses and sensation
 Obtain CXR to check
 Immobilise in collar and cuff and body bandage
 Analgesia and arrange follow-up

51
Q

Definition of trigger finger?

A

o Stenosing flexor tenosynovitis
o Finger or thumb click/lock when in flexion, preventing return to extension
o Preceded by repetitive movements leading to inflammation of tendon and sheath

52
Q

Associated conditions of trigger finger?

A

o Rheumatoid Arthritis
o Amyloidosis
o Diabetes Mellitus
o Increasing age

53
Q

Symptoms of trigger finger?

A

o Painless clicking/snapping/catching when trying to extend finger (most commonly middle/ring finger)
o May become painful and lock in flexion

54
Q

Management of trigger finger?

A

o Mild – splinting
o If not responding or severe – steroid injections
o Surgical management – percutaneous trigger finger release via needle under LA
 Severe – Surgical decompression of tendon tunnel

55
Q

Definition of Dupuytren’s Contracture?

A

o Contraction of longitudinal palmar fascia caused by fibroblastic hyperplasia and thickening
o Leading to fibrous cords and flexion contractures at MCP and IP joints
o Reduce digital movements

56
Q

Epidemiology of Dupuytren’s Contracture?

A

o Men 6x

o Ulnar digits most common (ring and little finger)

57
Q

Risk factors of Dupuytren’s Contracture?

A

o Smoking
o Alcoholic liver cirrhosis
o Diabetes
o Vibration tools or heavy manual labour

58
Q

Symptoms of Dupuytren’s Contracture?

A

o Reduced range of movement and nodular deformity

o Complete loss of movement

59
Q

Signs of Dupuytren’s Contracture?

A

o Thickened band of firm nodule adherent to skin
o Skin blanching on extension
o Digits in contracture
o Hueston’s Test – flexion at MCP joint, patient unable to place palm and fingers flat on hard surface

60
Q

Investigation sof Dupuytren’s Contracture?

A

o Clinical diagnosis

o Bloods – LFTs, HbA1c

61
Q

Management of Dupuytren’s Contracture?

A

o Conservative Management
 Hand exercises, multiple stretching exercises
 Injectable Clostridium Histiolyticum (Xiapex)

o Surgical Management (function impaired)
 Refer to hand surgeon or orthopaedic surgery
 Fasciectomy under LA/GA
 Techniques – regional fasciectomy (entire cord removed), segmental fasciectomy (short segment of cord removed), dermofasciectomy (cord and overlying skin removed then skin graft), closed fasciotomy, finger amputation

62
Q

Definition of scaphoid fracture?

A

o Most common carpus fracture
o Scaphoid has three parts: proximal pole, waist, distal pole
o Blood Supply – dorsal branch of radial artery enters via distal pole and travels in retrograde fashion towards proximal pole
o Fractures can compromise blood supply

63
Q

Epidemiology of scaphoid fracture?

A

o Men aged 20-30

64
Q

Symptoms of scaphoid fracture?

A

o Trauma prior, often high energy

o Sudden onset wrist pain and bruising

65
Q

Signs of scaphoid fracture?

A

o Tender anatomical snuffbox
o Pain on palpation of scaphoid tubercle
o Pain on abduction of thumb

66
Q

Investigations of scaphoid fracture?

A

o XR of wrist – Scaphoid series (AP, lateral and oblique views)
o If suspicion despite negative imaging – wrist immobilised in thumb splint and repeat in 10-14 days
o MRI scan used if still doubt

67
Q

Management of scaphoid fracture?

A

o Undisplaced fracture – strict immbolisation in plaster with thumb spica splint
o Displaced fracture – surgical fixation using percutaneous variable-pitched screw

68
Q

Complications of scaphoid fracture?

A

o Avascular necrosis (30% of cases), risk increased the more proximal fracture is
o Non-union failing to heal properly

69
Q

Definition and grading of knee sprain?

A

Sprain is stretch and/or tear of ligament

o Grade 1 – mild stretching of ligament without joint instability
o Grade 2 – partial rupture of ligament without joint instability
o Grade 3 – complete rupture of ligament with instability of joint

70
Q

Definition of strain and grading?

A

Strain is stretch and/or tear of muscle fibres and/or tendon

o 1st -degree (mild) – few muscle fibres stretched or torn, normal strength but power may be limited
o 2nd-degree (moderate) – several injured fibres and more severe muscle pain, mild swelling, loss of strength and bruise
o 3rd-degree (severe) – muscle tears all way through, may have ‘pop’ sensation, loss of motor function, swelling and visible bruise

71
Q

Risk factors of knee sprains and strains?

A 
o	Sports (contact, sprinting)
o	Poor exercise technique
o	Inappropriate footwear
o	Inadequate warm up
o	Muscle fatigue
o	Sudden trauma
o	Overweight or obese
o	Previous sprain or strain
72
Q

Symptoms of knee sprain?

A
  • Pain around joint
  • Tenderness
  • Swelling
  • Bruising
  • Loss of function
  • Instability
73
Q

Symptoms of knee strain?

A
  • Muscle pain
  • Weakness
  • Inflammation
  • Haematoma
74
Q

What are the Ottawa XR rule for Knee?

A 
o	One or more of following:
	Inability to bear weight (walk 4 steps) at time of injury and when examined
	Age >55
	Tender head of fibula
	Isolated patella tenderness
	Inability to flex knee to 90o
75
Q

When to refer knee problem to ED?

A

o Fracture, dislocation, damage to nerves, tendon rupture, known bleeding disorder, septic arthritis, complete muscle tear

76
Q

Management of knee strains and sprains - analgesia?

A

 Paracetamol or NSAIDs (ibuprofen gel)

 Codeine

77
Q

Management of knee strains and sprains - advice?

A

 Sprains – severe sprains

 Strains – 1st few days, crutches in severe injuries

78
Q

Management of knee strains and sprains - immobilisation?

A

 Sprains – severe sprains

 Strains – 1st few days, crutches in severe injuries

79
Q

Management of knee strains and sprains - referral to orthopaedic surgeon?

A

 Recovery slower than expected, worsening symptoms or out of proportion to degree of trauma

80
Q

Management of knee strains and sprains - prevention?

A

 Warm up properly
 Cool down
 Use proper equipment, technique, footwear
 Schedule regular days off from exercise
 Healthy weight

81
Q

Prognosis of knee strains and sprains?

A
  • Mild – few weeks with conservative treatment
  • Moderate – few weeks, high risk of further injury in first 4-6 weeks
  • Severe – month to heal, may require surgery
82
Q

Red flags for knee pain?

A

o Infection – red, swollen, heat, rapid onset, one joint, fever
o Tumour – persistent, bone pain, pain at night/at rest, unexplained weight loss, previous cancer, hard mass

83
Q

Ligaments of knee and their function?

A
  • MCL – prevents lateral movement of tibia on femur, runs between medial epicondyle of femur to anteromedial tibia
  • LCL – prevents medial movement of tibia on femur, runs between lateral epicondyle of femur to head of fibula
  • ACL – prevents forward movement of tibia in relation to femur, runs from anterior tibial plateau and posterolateral intercondylar notch of femur
  • PCL – prevents forward sliding of femur, runs from posterior part of tibial plateau to medial intercondylar notch of femur
84
Q

Mechanism of injury to ACL?

A

o Hyperextension, marked internal rotation of tibia, pure deceleration

85
Q

Mechanism of injury to PCL?

A

o Hyperflexion of knee

86
Q

Grading of ligament injury?

A

o Grade 1 – mild stretching of ligament without joint instability
o Grade 2 – partial rupture of ligament without joint instability
o Grade 3 – complete rupture of ligament with instability of joint

87
Q

Imaging in knee injury?

A
  • XR

- MRI

88
Q

Management of knee ligament injury - analgesia?

A

 Paracetamol or NSAIDs (ibuprofen gel)

 Codeine

89
Q

Management of knee ligament injury - advice ?

A 
	Protect from further injury
	Rest (avoid activity for 48-72h)
	Ice (ice wrapped in damp towel for 15-20 minutes, every 2-3 hours during 1st 48-72h)
	Compression (elastic bandage)
	Elevation
	Avoid heat, alcohol, running, massages
90
Q

Management of knee ligament injury - immobilisation?

A

 Non-weight-bearing crutches

91
Q

Management of knee ligament injury - referral to orthopaedic surgeon?

A

 Recovery slower than expected, worsening symptoms or out of proportion to degree of trauma

92
Q

Management of knee ligament injury - prevention?

A

 Warm up properly
 Cool down
 Use proper equipment, technique, footwear
 Schedule regular days off from exercise
 Healthy weight

93
Q

Management of ACL tear - conservative?

A

hinged brace

94
Q

Management of ACL tear - surgical?

A

 Usual method of treatment with reconstruction or grafting

95
Q

Management of PCL tear ?

A

o Crutches and long leg brace if conservative

o Surgery if fracture, or other ligaments affects too, or failed conservative measures

96
Q

What are the meniscus?

A
  • Two menisci in each knee, crescent shaped pads of cartilage tissue
  • Function – tibiofemoral load transmission, shock absorption, lubrication of knee joint and improve stability
97
Q

Mechanism of injuring menisci?

A

o Twisting or pivoting

98
Q

Symptoms of meniscal injury?

A
  • Acute pain
  • Popping/Catching/Locking of knee
  • Swelling and effusion
99
Q

Management of meniscal injury - analgesia?

A

 Paracetamol or NSAIDs (ibuprofen gel)

 Codeine

100
Q

Management of meniscal injury - advice?

A 
	Protect from further injury
	Rest (avoid activity for 48-72h)
	Ice (ice wrapped in damp towel for 15-20 minutes, every 2-3 hours during 1st 48-72h)
	Compression (elastic bandage)
	Elevation
	Avoid heat, alcohol, running, massages
101
Q

Management of meniscal injury - refer to orthopaedic surgeon?

A

 Urgently if locking of knee and meniscal injury suspected
 Routine if meniscal injury suspected and symptoms persist or interfere with ADLs
 Techniques – repair or partial meniscectomy (total possible)
• Functional activities within 7-8 days, running from 2 weeks

102
Q

Definition of pelvic fracture?

A
  • Fracture of any part of bony pelvis
103
Q

Definition of acetabular fracture?

A

Pelvic fractures, which involve ilium, ischium and/or pubis

104
Q

Types of pelvic fracture?

A

o High-energy trauma – significant fractures
o Stable fractures – less severe
o Avulsion fracture from sporting events where muscle detaches from insertion point

105
Q

Symptoms of pelvic fracture?

A
  • Tenderness, bruising, swelling of pubis, iliac bones, hips and sacrum
  • Haematuria
  • Rectal bleeding
  • Haematoma
  • Loin bruising
  • Unstable hip adduction and pain on hip motion
106
Q

Imaging of pelvic fracture?

A
  • X-Ray of hip
    o Destruction of Shenton’s Lines, asymmetry, widening of pubic symphysis or SI joints
  • CT pelvic
    o Whole-body if blunt major trauma or suspected multiple injuries
107
Q

Tile classification of pelvic fractures - type A?

A 
	Stable injuries
	Avulsion fractures occurring at points of muscle attachments
•	AIIS – rectus femoris
•	ASIS – sartorius
•	Ischial tuberosity – hamstrings
108
Q

Tile classification of pelvic fractures - type B?

A

 Rotationally unstable but vertically stable

 Openbook fractures

109
Q

Tile classification of pelvic fractures - type C?

A

 Rotationally and vertically unstable
 Pelvic ring disrupted in two or more places
 Associated with blood loss

110
Q

Management of pelvic fracture - if haemodynamically unstable?

A

o Immediate transfer to major trauma centre for definitive treatment
o Pelvic Binding
 Remove if no fracture, mechanically stable, no further bleeding
o Avoid rolling patient

111
Q

Management of pelvic fracture -if active arterial pelvic bleeding?

A

o Interventional radiology

o Pelvic packing if emergency laparotomy needed for abdominal injuries

112
Q

Management of pelvic fracture - pain relief?

A

o IV morphine

o 2nd line –ketamine

113
Q

Management of pelvic fracture - stable fractures?

A

o Surgery not usually needed
o Refer to orthopaedics for analgesia, bed rest then mobilisation
o Crutches or walker used
o Venous thromboprophylaxis

114
Q

Management of pelvic fracture - surgery?

A

o Surgery on day of, or day after admission
 Internal/External fixation
 Aim to fully weight bear immediately post-operative
 If displaced intracapsular hip fracture – replacement arthroplasty
o Physio and mobilisation on day of surgery and then at least once a day

115
Q

Definition of Ilizarov-Frame surgery?

A
  • External fixation apparatus used in orthopaedic surgery
116
Q

USes of Ilizarov-Frame surgery?

A

Lengthen or reshape limb bones
 Distraction osteogenesis
• Bone is cut during surgery or fractured bone, device pulls 2 pieces of bone apart slowly and lengthens bone
• Used in unequal leg length

Fracture non/mal-union

Limb-sparing technique in complex/open bone fractures

Infected non-unions of bones

117
Q

What is an Ilizarov-Frame?

A

o Stainless steel rings are fixed to bone via stainless steel wire pins (Kirschner wires)
o Rings are connected to each other with threaded rods attached through adjustable nuts
o Allows early weight bearing

118
Q

Theory behind Ilizarov-Frame?

A

o Theory of tension
o The top rings of Ilizarov (fixed to healthy bone) allow force to be transferred through external frame (vertical metal rods), bypassing fracture site
o Force is transferred back to healthy bone through bottom ring and tensioned wires
o Both immobilises fracture site and relieves stress

119
Q

Procedure of Ilizarov-Frame surgery?

A 
o	Under GA
o	Need to wear for at least 3 months – usually 6-12 months
o	Complications
	Pain
	Infection

Year 5 Core Conditions (55 decks)

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