Trauma of the musculoskeletal system Flashcards
What comprises the primary survey in advanced trauma life support?
- Airway and C-spinal control
- Breathing and ventilation
- Circulation and haematologic control
- Disability and AVPU
- Exposure and environmental control
What comprises the secondary survey in advanced trauma life support?
- Head-to-toe examination
- Detailed history
- x-rays, blood tests
What is the possible blood loss within first 2 hours when these bones experience haemorrhage:
- tibia/fibula
- femur
- pelvis
- ~500 mL
- ~500mL
- ~2000mL
What is the most common source of bleeding when there is haemorrhaging as a result of a pelvic fracture?
85% of haemorrhages affect posterior pelvic venous plexus and bleeding from cancellous bone surfaces
10% from arterial bleeding
How is a pelvic fracture stabilised? What is the result if it is not fixed properly? What is the mortality rate from pelvic fractures?
External fixation left for 8 weeks (if possible)
Malunion if not dealt with properly
10-20% mortality
What soft tissue injuries can occur in:
- skin
- muscle
- blood vessels
- nerves
- ligaments
- open fractures; degloving; ischaemic necrosis
- crush and compartment syndrome
- vasospasm + arterial laceration
- neurapraxia; axonotmesis; neurotmesis
- joint instability; dislocation
What is neurapraxia?
Nerve injury where there is no axonal discontinuity
What is axonotmesis?
Nerve injury where there is axon disruption, but the endoneural sheath is still intact
What is neurotmesis?
Nerve injury where the axon is disrupted, there is loss of tubules and support cells are destroyed
When is traction used in fracture reduction?
When fractures/dislocations require slow reduction
When would open reduction of a fracture be used? What are the risks/disadvantages?
When very accurate (anatomic) reduction is required
usually done when internal fixation is needed
risk of infection
can slow healing if it is too rigid
How may a reduction be held in place? (semi-rigid/rigid?)
Semi-rigid: plaster
Rigid: internal fixation
What are the absolute indications for operative treatment of a fracture?
- displaced intra-articular fractures
- open fractures
- fractures with vascular injury or compartment syndrome (pathological fractures, non-unions)
What are the relative indications for operative treatment of a fracture?
- loss of position with closed method
- poor functional result with non-anatomical reduction
- displaced fracture with poor blood supply
What is the radiographic definition of fracture union?
When 3 out of 4 cortices have healed on 2 views
- may seen bridging callus formation
- the fracture line is still often present
- might see lucency as a result of remodelling
Compare the fracture healing times of the upper and lower limb between adults and children.
Upper limb
- Adults: 6-8 weeks
- Children: 3-4 weeks
Lower limb
- Adults: 12-16 weeks
- Children: 6-8 weeks
What are the general complications of musculoskeletal trauma + healing?
Early:
- other injuries
- PE
- fat embolism syndrome/ acute respiratory distress syndrome
Late:
- chest infection
- UTI
- bed sores
What are the complications of bone trauma + healing?
Early:
- infection
Late:
- non-union
- mal-union
- AVN
What are the complications of soft tissue trauma + healing?
Early:
- plaster sores
- wound infection
- neurovascular injury
- compartment syndrome
Late:
- tendon rupture
- nerve compression
- volkmann contracture
What is fat embolism syndrome? What organs are most affected?
This is when a fat embolus is released into circulation, usually after physical trauma
- fat may enter for mechanical and biomechanical reasons and basically it just comes down to fat being released from bone marrow into the VENOUS system
*important to emphasise that it is the venous system that is affected, as the lungs are always affect by FES, followed by the brain
What is the clinical triad indicating FES?
- hypoxaemia
- neurological issues (agitation, delirium, coma)
- petechial rash
Can also have haematological problems such as low platelets and anaemia
How should FES be treated?
oxygen
hydration (maintain intravascular volume)
albumin (may decrease fatty acids by binding them)
What are the 6 Ps of the musculoskeletal assessment?
- Pallor
- Pain
- Pulseless
- Paraesthesias
- Paralysis
- Polar
What is the normal pressure within tissues?
0-10 mmHg
At what pressure will capillary blood flow in a compartment become compromised?
> 20 mmHg
At what pressure will muscles and nerve fibres within a compartment become at risk to ischaemic necrosis?
30-40 mmHg
What is delta pressure? (i.e. what is it, what is the value)
Diastolic blood pressure - intracompartment pressure = delta pressure
Normal value >30 mmHg
if <30 mmHg this indicates need for fasciotomy
If the delta pressure of a compartment is <20mmHg, what should be done?
Delta pressure of <20mmHg is a DEFINITIVE indication for fasciotomy
What are the other indications for fasciotomy (apart from delta pressure)?
- clinical signs of acute compartment syndrome
- absolute pressure is >30 mmHg and clinical picture is consistent with compartment syndrome
- arterial perfusion has been interrupted for 4+ hours
