Trauma orthopaedics

Question 1

What is the main classifications system for pelvic fractures

Answer 1

Young-Burgess system

Anterposterior compression
I - Pubic diastasis <2.5cm, stable
II - Diastasis >2.5cm but posterior intact
III - Diastasis >2.5cm, SI joints disrupted

Lateral compression, most common
I - pubic rami # and minor iliac #
II - rami # with fracture dislocation of the iliac wing
III - + contralateral AP compression

Vertical shear
Most severe and unstable, high rate of organ injury, hemi pelvis displaced vertically relative to rest of pelvis

Question 2

What are the signs on examination of an unstable pelvic fracture?

Answer 2

• Haemorrhagic shock without obvious bleeding
• Blood at the penile meatus
• Haematuria
• PR blood
• Gross distortion of the pelvic anatomy externally
• Movement of pelvic bones on springing of the pelvis

Question 3

What are the causes of fat embolism?

Answer 3

Traumatic
- Long bone and pelvic fractures (33% with bilateral femoral fractures)
- Any high marrow bone
- Ortho procedures
- Burns
- Liposuction
- Bone marrow harvesting and transplant

Non-trauma
- Pancreatitis
- Diabetes mellitus
- Ostemyelitis/Panniculitis
- Bone tumour lysis
- Sickle cell
- High steroid therapy
- Lipid infusion (ie propofol syndrome and TPN)
- Altitude sickness

Question 4

What are the features of fat embolism?

Answer 4

• Usually a latent period 48-72hrs
• Tachypnoea, dyspnoea, ARDS
• Haemoptysis (fat globules may be seen in the sputum)
• AMS

Question 5

What are the delayed complications of major pelvic fractures?

Answer 5

• Impotence
• Infection (second most common cause of death)
• Disability and immobility
• Osteoarthritis, malunion
• Incontinence
• Shoulder dystocia with subsequent pregnancies

Question 6

What are the complications of posterior sternoclavicular joint dislocation and how are they assessed for on exam?

Answer 6