Trauma of the Musculoskeletal System

Question 1

What is the imaging used for musculoskeletal trauma?

Answer 1

• x-ray
• CT
• MRI
• US (Doppler)
• Bone scan

Question 2

What is polytrauma?

Answer 2

• trauma to several body areas/organ system

- 1 or more life may be life threatening

Question 3

How much blood loss can there be from a haemorrhage of different bones in the first 2 hours?

Answer 3

• tibula/fibula = 500ml
• femur = 500ml
• pelvis = 2000ml

Question 4

What are the 1st principles of trauma?

Answer 4

• airway and C spine control
• breathing and ventilation
• circulation and haemorrhage control
• disability and AVPU
• exposure and environmental control

Question 5

What is AVPU?

Answer 5

• alert
• verbal stimuli
• painful stimuli
• unresponsive

Question 6

In trauma what are the key messages?

Answer 6

• address life threatening injuries first = apply pressure to haemorrhage from open would
• prevent long term complications = systemic exam

Question 7

What are the reasons for pelvic fractures being problematic?

Answer 7

Haemorrhages =

• posterior pelvic venous plexus (more difficult to control)
• bleeding from cancellous bone surfaces
• <10% arterial bleeding

Question 8

How should a pelvic fracture be stabilised?

Answer 8

• does not have to be sophisticated, bed sheet around fracture and duct tape around feet to limit movement
• external fixation frame left for 8 weeks (
• mal-union if not dealt with appropriately

Question 9

What areas can undergo soft tissue injury?

Answer 9

• skin
• muscles
• blood vessels
• nerves
• ligaments

Question 10

What are examples of skin soft tissue injuries?

Answer 10

• open fractures
• de-gloving injuries
• ischemic necrosis

Question 11

What are examples of muscle soft tissue injuries?

Answer 11

• crush and compartment syndromes

Question 12

What are examples of blood vessel soft tissue injuries?

Answer 12

• vasospasm

- arterial laceration

Question 13

What are some examples of nerve soft tissue injuries?

Answer 13

• neurapraxias
• axonotmesis
• neurotmesis

Question 14

What are some examples of ligament soft tissue injuries?

Answer 14

• joint instability and dislocation

Question 15

How is soft tissue trauma treated?

Answer 15

• urgent treatment
• potential complications
• fixation post treatment
• severe soft tissue injury can delay fracture healing

Question 16

How is a fracture treated?

Answer 16

does it require reduction?

• is it displaced?
• if not -> simple splintage (clavicle, ribs, metacarpals, stress fractures, impacted fractures)
• how accurate a reduction is needed? (closed or open?)
• how will the reduction be held?
• what is the following treatment plan?

Question 17

What are the methods of fracture reduction?

Answer 17

• closed -> anaesthesia
• traction -> fractures/dislocation requiring slow reduction
• open reduction internal fixation

Question 18

When is open reduction internal fixation used? What are the effects?

Answer 18

• allows accurate anatomic reduction
• risk of infection
• when internal fixation needed
• can slow healing if too rigid

Question 19

How can you hold a reduction?

Answer 19

• plaster (semi-rigid)

- internal fixation (rigid)

Question 20

What are the properties of operative fracture treatment?

Answer 20

• rapid rehab
• low risk of joint stiffness
• low risk of malunion
• risk of non-union
• slow healing
• risk of infection

Question 21

What are the properties of non-operative fracture treatment?

Answer 21

• slow rehab
• risk of joint stiffness
• risk of malunion
• risk of non-union
• rapid healing
• low risk of infection

Question 22

What are the indications for operative treatment?

Answer 22

• improved implants
• antibiotic prophylaxis
• minimally invasive methods
• if open fracture
• if displaced intra-articular fractures
• if non-union
• if fracture with vascular injury/compartment syndrome
• if pathological features

Question 23

What are some relative indications for operative treatment?

Answer 23

• loss of position with closed methods
• poor functional result with non-anatomical reduction
• displaced fractures with poor blood supply
• economic and medical indications

Question 24

What factors affect healing time?

Answer 24

• local factors

- systemic factors

Question 25

What is the healing time of the upper and lower limb for adults?

Answer 25

• upper = 6-8 weeks

- lower = 12-16 weeks

Question 26

What is the healing time of the upper and lower limb for children?

Answer 26

• upper = 3-4 weeks

- lower = 6-8 weeks

Question 27

What are the early and late complications?

Answer 27

Early

• other injuries
• PE
• fat embolus syndrome
• acute resp distress syndrome

Late

• chest infection
• UTI
• bed sores

Question 28

What are the early and late bone complications?

Answer 28

Early - infection

Late - non-union, malunion, avascular necrosis

Question 29

What are the early and late soft tissue complications?

Answer 29

Early

• plaster sores
• wound infection
• neurovascular injury
• compartment syndrome

Late

• tendon rupture
• nerve compression
• Volkmann contracture

Question 30

What are the 6 P’s of musculoskeletal assessment?

Answer 30

• paralysis
• pain
• pulse
• paresthesia
• pallor
• polar (temperature)

if pressure within compartment exceeds perfusion pressure of that compartment = venous and capillaries close = compartment syndrome

Question 31

How is compartment syndrome diagnosed?

Answer 31

• clinical presentation
• pressure monitoring
• medical emergency

Question 32

How is compartment syndrome treated?

Answer 32

• fasciotomy (cut skin and open up fascia, 5 days minimum so inflammation goes down before closed up)