Trauma main, poignet et autres membres Flashcards by Marie-Ève Boisvert

Types de fx? (conditions causales)

fx trauma
de stress
patho
fragilité
pédiatrique

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grade Salter-harris?

(fx ped, plaque de croissance)

I: physe
II: métaphyse
III: épiphyse
IV metaphyse + épiphyse
V crush/compression de la plaque de croissance

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critères Ottawa cheville?

dlr post sur 6 cm malléole med
6 cm mall lat
incapable de mettre du poids sur MI

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critères Ottawa pied?

dlr palpation 5e meta
dlr palpation naviculaire
incapable de MEC

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critères Ottawa genou?

>50 ans
incapable de flexion ad 90°
MEC impossible  ou <4 pas
dlr palpation tête fibula
dlr palpation patella

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os du carpe?

people try love sex that they can’t handle

pisiform
triquetrum
lunatum
scaphoide
trapeze
trapezoid
capitatum
hamtum

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ddx atteinte des tendons de la main?

de Quervain
lacérations
tendinites
trigger finger
infectious tenosynovite

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[…] is stron evidence of an LCA tear.

Test Lachman +

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Vrai ou faux

Les entrainements de forces musculaires aide à réduire les déchirures du LCA.

Vrai

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test dx pour déchirure LCA?

IRM

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conduite entorse grade I-II cheville?

glace, compression, élévation
application ‘‘air or gel splints’’
dans les 48h: mobilisation (physiotx)

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étape principal en trauma en préH?

immobiliser la colonne cervicale dès qu’on a un doute pour fx

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trauma, Pt relativement stable en arrivant à l’urgence. suspicion de fx cerviale.
examen #1?

RX cerviale 3 vues (AP, lat, odontoïdes)

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indication de RX cervical en trauma?

déficit neuro
altération sensitive ou intox
dlr cou
ceux qui ont des blessures ‘‘distracting’’ même s’ils sont asx de la colonne

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tx initial (dans les 3h premières heures post trauma) lors de fx de la colonne?

methylprednisolone iv

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une fois methylpred reçu dans un contexte de fx cervicale, conduite?

réduction fermée (par traction)
*patient who cannot be examined when closed reduction is planned should first undergo an IRM prior to attend reduction. The presence of a significant disc herniation in this setting is considered an indication for a ventral decompression prior to reduction.

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parametre radiologique pour déterminer la présence d’une dislocation atlanto-occipital après une blessure par trauma?

'’basion-axial interval-basion-dental interval’’

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[…] also known as ‘‘internal decapitation’’ is an uncommon injury that results in cranial-cervical disjunction, can be difficult to identify and yet is associated with high mortality. Death often results from respiratory paralysis and can be prevented with rapid mechanical ventilation. Treatment consists of immediate halo vest application with reduction of the subluxation and an occiputo-C2 fusion is required in most cases to provide longterm stability. Pt with complex dislocations are often quadriplegic because of damage to the descending motor axons of the corticospinal tract.

Atlanto-occipital dislocation

fonction de quel nerf?

ability to toch the tip of the thumb to the tip of the little finger indicates normal function of…

nerf médian

quel nerf?

extension du pouce et des doigts

radial

une atteinte de ce nerf entraine un poignet tombant et une incapacité d’étendre la main/poignet. quel nerf?

radial

quel nerf?

adduction des doigts

ulnaire

vrai ou faux
the flexor pollicis brevis has 2 heads. it acts to flex, adduct, and abduct hte thumb and is therfore also able to oppose the thumb. the superficial head is innervated by the median nerve, while the deep head is innervated by the ulnar nerve

vrai

[…] can cause ape-hand deformity, which is a sign of inability to abduct and oppose the thumb dur to paralysis of the thenar muscles.

Median nerve damaeg

[...] carries mototr fibers to the abductor pollicis brevis, opponens pollicis, and superficial head of the flexor pollicis brevis muscles and the first and second lumbrical muscles. It also supplies sensory innervation to the palmar surface of the thumb, and digits 2,3 and the lateral half of digit 4.

nerf median (c8-t1)

[...] injury at the wrist from slashing of the wirst results in loss of the ability to adduct the thumb.

ulnar nerve injury

thumb felxion is done to test..?

median nerve

Vocal cord paresis or paralysis due to an injury of the [...] is one of the main complications of thyroid surgery.

recurrent laryngeal nerve

composante de la coiffe des rotateurs?

supra épineux infra épineux sous scapulaire petit rond

indications chx coiffe des rotateurs?

partial thickness or full thickness tears in an active individual who does not have improved pain and/or function with a supervised rehabilitation program.

acute rotator cuff tearing --> conduite?

dlr + réduction inflammation relative rest glace (20 min, 3-4 fois par jour) acet, AINS éventuellement physio *pas d'injection de cortico

positive active painful arc test, positive drop arm test, and weakness in external rotation suggest...?

a significant rotator cuff tear.

[...] is an idiopathic condition that most commonly affects patients between the ages of 40-60. DB is the most common risk factor. Sx: shoulder stiffness, loss of active and passive shoulder rotation, severe pain, including night pain. labo N.

Frozen shoulder | capsulite

utilité du RX lors d'une dlr à l'épaule?

r/o fx r/o ostéoathrite r/o lux

conduite pour ddx capsulite ou tendinopathie de la coiffe?

AINS injections de cortico physiotx

[...] is conservatively managed by splinting the affected joint in full extension (x 6 weeks).

Extensor tendon injury at the proximal interphalangeal joint

Delay or improper treatment of [...] may result in a boutonniere deformity (which usually develops over several weeks but can occasionally develop acutely.

blessure du tendon a/n de l'IPP

[...] can occur when the proximal interphalangeal joint is forcibly flexed while the digit is actively extended. The injury is evaluated by holding the joint in a position of 15°-30° of lexion. The patient will not be able to actively extend the joint, but passive extension should be possible. ther will be tenderness over the dorsal aspect of the middle phalanx.

A tendon injury to the central extensor slip

[...] is the most common closed tendon injury of the finger.

injury to the extensor tendon at the distal interphalangeal (IPD) joint, also known as mallet finger injury

common presenting signs of [...] include flexion deformity, pain in the IPD, inability to actively extend the IPD; however lack of passive IPD extension may indicate bony or soft-tissue entrapment requiring surgical tx.

mallet finger injury

[...] presents with midfootswelling, painful weightbearing, inability to stand on toes, and plantar ecchymosis following an acute trauma.

Injury of the tarsometatarsal (Lisfranc) joint complex

A fracture of the base os metatarsal bone indicates possible [...]

Tarsometatarsal (lisfranc) fracture/dislocation

[...] is characterized by damage to the tarsometatarsal joint complex in the foot, which commonly results from the pressure of landing on a plantarflexed foot.

A Lisfranc injury

conduite fx Lisfranc?

tends to be very unstable --> indication chx - closed reduction with percutaneous pinning or - open reduction internal fixation