Trauma & Orthopaedics Flashcards
Salter Harris classification
1
2
3
4
5
Spinal cord tract locations and functions
Dorsal column (posterior) - fine touch
Spinothalamic (anterolateral) - pain and temp
Corticospinal (lateral) - movement
Supraspinatus action + test
Initiation of abduction of arm to 15 degrees at glenohumeral joint
Empty can test
Infraspinatus action + test
Lateral rotation of arm at glenohumeral joint
Adduct, 90 degrees and attempt lateral rotation against resistance
Teres minor test
Lateral rotation of arm at glenohumeral joint
Horn blowers
A galeazzi fracture is?
Distal 1/3 radial shaft fracture with an associated distal radioulnar joint (DRUJ) injury.
Colles fracture
distal radius points backward
Smith fractures
distal radius points forwards
McLaughlin lesion
Reverse H-S defect
Impaction fracture of anteromedial aspect of the humeral head following posterior dislocation of the humerus.
Anterior shoulder dislocation on XR
Where the humeral head is displaced medially and overlies the glenoid, the dislocation is anterior.
Posterior shoulder dislocation on XR
Light bulb sign, symmetrical appearance of the humeral head
Monteggia fracture
A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation.
Anatomical landmarks for pericardiocentisis
1-2cm inferior and left of the xiphochondral junction at a 45 degree angle towards the left scapula
Early severe complication of rib #
Lung contusion
Treatment for surgical emphysema
Give high flow O2 (gets rid of nitrogen)
Commonest hip dislocation is?
Posterior
Common complication of a posterior hip dislocation
Sciatic nerve compression
What type of pressure is a barton’s #
Crush #
Smiths vs colles management
Colles -> maipulate and cast
Smiths -> usually needs surgical management
Mallet finger cause
Rupture of the extensor tendon attachment at the base of the phalynx.
Deformity linked to metacarpal #
Rotated finger
Radial nerve injury
common location
neurology
mid shaft humerus
Loss of supination
Extensors
Dorsum sensation of hand
Bankart lesion
Fracture of the glenoid labrum
How to recognise a posterior shoulder dislocation
Light bulb sign
Where does the perineus brevis attach
5th metatarsal
Plantar ecchymosis =
Mid foot # (lisfrank)
Calcaneal # often linked to
Contralateral calcaneal #
Tibial plateu #
NOF #
Compression spinal #
How to recognise a calcaneal #
Reduction in this angle
Rotational injury of the knee, most likely injury
Triad
Medial meniscus
Medial collateral
Ant. cruciate
Maisonneuve #
The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament of the ankle. This type of injury can be difficult to detect.
Management of tetanus prone wound
When to give FFP in trauma
INR >1.5
When to give which blood products in bleeding trauma pt depending on blood results
Bennet #
The Bennett fracture is the most common fracture involving the base of the thumb. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal.
XR signs to diagnose SUFE
Trethowan sign
Severs disease
Sever’s disease is the most common cause of heel pain in growing children, especially those who play sports or exercise regularly. Also known as calcaneal apophysitis, Sever’s disease occurs when the growth plate in the back of the heel becomes inflamed and painful.
Garden classification of intracapsular hip fractures
Conservative management for achilles tendon rupture
Equinus cast, crutches, immobilisation and pain relief for 6 weeks and then rehab
Burns fluid resuscitation, UO aim
Adults
Children
0.5ml/kg/hr
1ml/kg/hr IF < 30 KG
Weight used to traction limbs in trauma
10% of body weight
De Quervain’s tenosynovitis is
tenosynovitis of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons.
Where is the pain typically in De Quervain’s tenosynovitis
Radial side of the wrist
Finkelstein’s test
The Finkelstein test is used in the diagnosis of De Quervain’s syndrome.
involves moving the wrist into flexion and ulnar deviation, with the thumb flexed across the palm of the hand:
Febuxostat (Uloric)
an alternative to allopurinol used in the management of chronic gout
Damage to the Ulnar nerve at elbow (vs wrist)
Elbow:
Hand held in abduction
Hypothenar eminence wasting
Froments sign - patient will flex thumb at IPJ when asked to hold piece of paper
Wrist:
Ulnar claw
Hypothenar eminence wasting
Froments sign - patient will flex thumb at IPJ when asked to hold piece of paper
Blunt abdominal trauma, most common organs damaged
Spleen (40-55%)
Liver (35-45%)
Small bowel (5-10%)
Common spinal injury in elderly patients with neck extension
Central cord
It is characterised by disproportionately greater motor loss in the upper extremities than lower extremities. There is generally variable sensory loss below the level of injury with associated bladder dysfunction and urinary retention.
Jones fracture
A Jones fracture is a fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, without joint involvement.
Pivot shift test
The patient lies on one side of their body. The knee is extended and internally rotated and stress applied to the lateral side of the knee, while the knee is being flexed. Subluxation felt at 30 degrees flexion indicates a positive test (ACL injury)
Most commonly associated mechanism of injury for posterior cruciate ligament
Direct blow to proximal tibia with flexed knee (dashboard injury)
Most commonly associated mechanism of injury for anterior cruciate ligament
Non-contact pivoting injury causing forced flexion of hyperextension
Most commonly associated mechanism of injury for medial collateral ligament
Direct blow to lateral knee causing excessive valgus stress
Most commonly associated mechanism of injury for lateral collateral ligament
Direct blow to medial knee causing excessive varus stress
Which of the burn zones represents the point of maximal damage?
Zone of coagulation
‘Terry Thomas sign’
an increased gap >3 mm between the scaphoid and lunate, which indicates scapholunate dissociation
Five pre-existing conditions are highlighted as posing a twofold risk for trauma mortality
Cirrhosis
Coagulopathy
Chronic obstructive pulmonary disease
Ischaemic heart disease
Diabetes mellitus
Nerve damage which can be associated with peri-lunate dislocation?
Median
Differentiate between
Superficial partial-thickness burns
Deep partial-thickness burns
Deep partial thickness don’t blanch to pressure, drier, less painful, red / mottled rather than homogeneously pink
Which muscle should be primarily focused on during his rehabilitation to prevent recurrent dislocation of the patella?
Vastus medialis
ANKLE radiographs are only required if there is pain in the malleolar area and any one of the following:
Bone tenderness over the distal 6 cm of the posterior edge or tip of the lateral malleolus
Bone tenderness over the distal 6 cm of the posterior edge or tip of the medial malleolus
Inability to weight bear immediately and in the Emergency Department
The following patients are excluded from the Ottawa ankle rules:
Pregnant women
Head injury patients with diminished ability to follow test
Intoxicated patients with diminished ability to follow test
Children under 6
FOOT radiographs are only required if there is pain in the midfoot area and any one of the following:
Bone tenderness at the base of the fifth metatarsal
Bone tenderness at the navicular bone
Inability to weight bear immediately and in the Emergency Department
The Weber system is a simple method used to describe lateral malleolar fractures:
Type A
B
C
Type A – fracture below the level of the syndesmosis
Type B – fracture at the level of the syndesmosis
Type C – fracture above the level of the syndesmosis
Spinal cord damage at what level causes flaccid bladder
and what causes it
Below T12
Parasympathetic innervation no longer works so even when the bladder wall is stretched it doesn’t empty
Lisfranc fracture is
fracture-dislocation involving the articulation of the tarsus with the metatarsal bases.
A Galeazzi fracture is
a fracture of the distal radius in association with a dislocation of the distal radioulnar joint.
A Jones fracture is
an extra-articular fracture of the base of the fifth metatarsal bone.
Tillaux fracture
is a Salter-Harris type III fracture extending through the lateral aspect of the left tibial epiphysis.
Segond fracture
an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau
Jefferson fracture
eponymous name given to a burst fracture of C1
fluid resuscitation for all patients with major burns
how much given over 1st 8 hrs
Then the next 16
1/2
then the next 1/2
Schatzker classification system
For tibial plateau #s
‘Terry Thomas sign’
an increased gap >3 mm between the scaphoid and lunate
An X-ray of the knee is only required for patients with knee injuries if any of the following are present:
Age >55 years
Isolated tenderness of the patella
Tenderness of the head of the fibula
Inability to flex knee to 90 degrees
Inability to weight bear both immediately and in the Emergency Department for 4 steps.
Open book pelvic fractures occur as a result of
anteroposterior (AP) compression injury to the pelvis
Intertrochanteric fractures can be classified using…
(2)
Kyle classification (‘Part classification’)
or
Boyd and Griffin
Which complication is most likely to occur if scapoid lunate dislocation is not treated
SLAC wrist - scapholunate advanced collapse
Burns surface area %s in children vs adults (differences)
Head - 18%
Leg - 13.5%
Segond fractures are very frequently (~75% of cases) associated with disruption of the
ACL
When is the dose of tetanus immunoglobulin doubled
4 hours have passed since the injury or the wound is heavily contaminated
Anterior tear drop # of C6
Cooper’s sign
Patient complains of joint line pain in the affected knee when turning over at night and changing the position of their legs.
Sign of meniscal tear
Toddler’s fracture also known as …
Childhood accidental spiral tibial (CAST) fracture
Spiral fracture of the distal third of the right tibia
Hangman #
This X-ray shows a fracture of the pars interarticularis of C2 and disruption of the C2/C3 junction
The triangular fibrocartilage complex (TFCC) is …
The triangular fibrocartilage complex (TFCC) is a load-bearing structure between the lunate, triquetrum, and ulnar head. The function of the TFCC is to act as a stabilizer for the ulnar aspect of the wrist. The TFCC is at risk for either acute or chronic degenerative injury.
Galeazzi fracture
Monteggia fracture
Bennet’s fracture
Jones’ fracture
Kocher’s criteria
Differentiate between transient synovitis vs septic arthritis
Osgood-Schlatter disease:
Presents as
Caused by
Swelling and tenderness over the tibial tuberosity
Repetitive stress on the patellar tendon from activities like running, jumping, and going up and down stairs. It’s more common in athletes, but less active adolescents can also experience it.
Which antibiotic should be used first line for septic arthritis when MRSA is suspected?
Vancomycin
Canadian c-spine rule
High-risk factors
Age of 65 or older
Dangerous mechanism, such as a high-speed collision, a fall from a height of at least 3 ft, or a bicycle collision
Paresthesias in the extremities
Canadian c-spine rule
Low-risk factors
Simple rear-end motor vehicle collision
Sitting in the emergency department
Able to walk at any time since the injury
Delayed onset of neck pain
No tenderness in the midline of the cervical spine
Biggest concern with flail chest?
Lung contusion
How to treat surgical emphysema
High flow o2 to denitrogenate
Sensory deficit in posterior hip dislocation?
Sciatic nerve injury
With Smith’s #, what is the possible complication?
May be unstable after manipulation
When do you need a collar and cuff sling ?
Humeral #
When do you need a high arm sling?
When you need the hand raised (reduced swelling)
Where does fibularis brevis attach?
longus?
Base of the 5th metatarsal
Base of 1st
Lis franc injury
Main concern with lis franc #
Mid foot ligament damage
The primary indication for performing closed reduction (i.e., reduction without surgery) of a displaced fracture of the ankle
subluxation of the talus from under the tibial plafond
Which knee soft tissue injury causes haemarthrosis ?
Cruciate
Which # commonly associated
Lipohaemarthrosis
Tibial plateu
Maisonneuve # common mechanism
Twisting of the lower leg
What blood product should be given to replace fibrinogen?
Cryoprecipitate
Which blood product should be given
INR >1.5 ->
Hb <100 in an actively bleeding ->
Calcium <0.8 ->
Platelets <80 ->
Fibrinogen <1.5 ->
FFP
PRBCs
calcium gluconate
platelets
Cryoprecipitate
Formula for fluid rescuitation in adult burns patients
2 mL Fluid x Body Weight (kg) x % Total Body Surface Area (TBSA)
Jones fracture MOI
Forced inversion with the foot and ankle in plantar flexion
Current guidance on the treatment of animal and human bites recommends the following in terms of abx
First-line recommended antibiotic is co-amoxiclav
If penicillin allergic give doxycycline plus metronidazole
Most common abdominal organ damaged by a stab wound?
Liver
Most common abdominal organ damaged by a gunshot wound?
Small bowel
Most common type of hip dislocation
Posterior
Nerve most commonly damaged by a Galeazzi #
Anterior interosseous (pure motor branch of median nerve)
Position arm should be held in after shoulder dislocation
Arm at 90 degrees to side with palm up
