Trauma management

Question 1

Scaphoid fracture

Answer 1

Need series of films
If no displacement, below elbow cast for 8 weeks
If suspicious but negative X-ray review in 2 weeks
If displacement more than 1mm or angulated needs ORIF
If proximal pole, fix it

Question 2

Lunate and perilunate dislocations

Answer 2

Lunate is split cup
Perilunate everything else moves
Requires open reduction

Question 3

Colle’s fracture

Answer 3

If undisplaced and stable, below elbow POP for 6 weeks
If displaced and stable, closed reduction and POP for 6 weeks
If displaced and stable, closed reduction and fixation

Question 4

Smith’s fracture

Answer 4

Volar buttress plate

Question 5

Barton’s fracture

Answer 5

Internal fixation

Question 6

Greenstick fracture

Answer 6

Closed reduction and above elbow cast

Question 7

Adult radial shaft fracture

Answer 7

POP above elbow if undisplaced

Question 8

Supracondylar fracture

Answer 8

If displaced emergency 
NV status 
Reduced under GA and manipulate 
If displaced use K wires 
Above elbow cast

Question 9

Lateral condyle fractures

Answer 9

Needs ORIF because X-ray makes fragment look small and risk of ulnar palsy

Question 10

Medial condyle

Answer 10

Intra-articular fracture

Also ORIF

Question 11

Medial epicondyle fracture

Answer 11

Long arm cast

Associated with elbow dislocation

Question 12

Lateral epicondyle fracture

Answer 12

Long arm cast

Question 13

Radial head and neck fracture in children

Answer 13

If less than 30 degrees angulation - sling and early mobilisation
30-60 attempt reduction
Over 60 reduce under GA

Question 14

Radial head fracture in adult

Answer 14

Minimally displace - sling fo 1-2 weeks
If displaced - ORIF
If comminuted and displace - replace radial head

Question 15

Clavicle

Answer 15

Broad arm sling

Question 16

Anterior shoulder dislocation

Answer 16

Reduce in A&E
IV morphine and entonox
Collar and cuff

Question 17

Posterior shoulder dislocation

Answer 17

Conservative

Question 18

Femoral shaft fracture

Answer 18

ATLS protocol
Needs splinting before X-ray
Intramedullary nail

Question 19

Tibial shaft fracture

Answer 19

ATLS protocol

Question 20

Ankle fracture

Answer 20

Displaced - reduce in ED and apply back-slab BEFORE x-ray
Stbale (Weber A or B) with no talar displacement, below knee cast
Unstable - backslab, ICE and ORIF, unless elderly and can POP

Question 21

Lisfranc fracture

Answer 21

ORIF

Question 22

Unifacet joint dislocation

Answer 22

Reduction in ED

Cervical collar

Question 23

Triplane

Answer 23

Reduction if more than 2mm displaced

Above knee cast if less than 2mm