Trauma Review Flashcards
8 causes of spont. pneumo
Idiopathic (slender, tall), COPD, infection, neoplasms, sarcoid, marfans, endometriosis, crack smoking
How do you treat a pneumatocele
Not necessary
What does a lung contusion look like
Ill defined, patchy alveolar
Hypoxia, petechial rash, trauma, AMS
fat embolism possible
What does fat embolism look like on cxr
ARDS
If you fracture upper 3 ribs?
Think aortic injury
If you fracter lower 3 ribs?
think liver or splenic
What is the threshold for mediastinal widening?
8cm
What are five findings of aortic injury on CXR
Widening of mediastinum, downward displacement of LMSB, tracheal or esophageal displacement, apical capping, left pleural effusion
What is apical capping?
Density in the apices
What percentage of aortic rupture patients have normal cxrs initially?
seven %
What are signs of inhalation injury?
Subglottic edema, diffuse peribronchial infiltration, pulmonary edema, atelectasis.
What are later signs of inhalation injury?
pneumonia, ARDS, barotrauma, atelectasis, fluid overload
What would you see with obstructive aspiration?
hyperinflation of distal segment
What does radiation therapy look like on CXR?
profoundly geometric
When do you expect cardiac injury?
Blunt to chest with sternal fracture, or severe soft tissue injury
What are four manifestations?
Contusions (may have trops), rupture of chordae may lead to pulmonary edema, tricuspid injury, aortic dissesction and pericardial effusion
What are signs of vascular trauma
Hemorrhage, dissection, pseudoaneurysm, arterial spasm, thrombosis, AV fistula
Gold standard for PE?
Angio. BUT CTA is basically the best option since its not as invasive. Can use MRA
When would you use Angio?
When CTA is not diagnosis but there is concern, when there is an UNSTABLE person who might need intervention.
What are the five most common causes of thoracif aortic aneurysm
Athero, trauma, infection, cystic medial necrosis (connective tissue DO, HTN, syphylis), aortitis (colagen vascular dz, takayasu, GCA)
When does a thoracic AA need repair?
6cm
Where are most abdominal aneurysm found?
Abdominal
What does a mycotic aneurysm look like?
perianeurysmal inflammation!
What is the most common location for mycotic aneurysm?
ascending aorta and isthmus
What are the most common organisms?
Staph A, strep, salmonella, neisseria, mycobacteria tuberculosis
What are risk factors for aneurysms?
Ascending see above, descending see above but smoking!
What layer is torn in a dissection?
TUNICA
What are common causes of dissection?
HTN, marfans, athero, bicuspid aortic valve, coarct
What are the two classes of dissection?
Debakey, Stanford
Describe the two
Debakey: B A D, I: ascending/descending, II: ascending, III: descending. Stanford: A: ascending proxima to takeoff of left subclavian, B: descending
What is the treatment for types A or B?
A surgery, B medical
Complications of aortic dissection
Rupture, MI, tamponade, valvular insufficiency, Stroke, mesenteric ischemia, renal insufficiency, paraplegia
What causes most aortic injury?
Sudden decelleration
What are the three sites most often involved?
Injury at the Aortic Root, the Aortic isthmus, the hiatus of the diaphragm
What are plain film signs of aortic injury
Abnormally contoured arch and loss of knob, wide mediastinum, capping, left mediastinal stripe, widened paratracheal area, effusion, broken upper ribs, tracheal deviation
is it more likely to see root or isthmus injuries?
Isthmus 95% of time because root injuries die
Diagnostic imaging of choice for aortic injury?
CTA
When would you use Aortography?
rarely, only if CTA is equivocal or INTERVENTION is planned
What does aortic injury look like?
Pseudoaneurysm, intimal tear or defect, irregular contour, extravasation
What size is a AAA? What size requires intervention?
3cm. >5cm requires intervention
What are four signs of pneumoperitoneum?
Free air under the diaphram, Falciform outline (football sign), Rigler’s sign, air between the liver and abdomen on LLD
Five causes of pneumoperitoneum
ruptured viscus, surgery, pneumatosis intestinalis, steroid therapy (?), air forced through fallopian tubes
How long does post surgical free air last?
4-5 days
Causes of pneumatosis
Necrosis, emphysematous gastritis, ulcers, immunocompromise, pulmonary disease, overdistention
How to tell portal gas from bile duct gas?
Peripheral portal, central for bile. Think about where the FLOW is
Causes of pneumobilia?
ERCP, surgery, fistula, malignancy, gallstone illeus
Four radiographic signs of bowel obstruction
transition point, large dilation and fluid in proximal bowel, stair step sign (greater than 3 air fluid levels), string of pearls sign
Approach to patient with suspected BO
Plain films, CT can help with SBO. barium enema is good for LBO too
Why is the cecum most prone to rupture in distention?
Laplace’s law
What are the two categories of renal trauma?
Minor injuries (85%, nonsurgical hematomas, contusions, lacerations). Major: pedicular injuries, shattered kidney
What are the indications for angiography for trauma patients?
No visualization of kiney on IVP.
What are two types of bladder rupture?
Intraperitoneal, extraperitoneal
What causes extraperiotoneal rupture?
Pelvic fracture
What causes intraperitoneal rupture?
blunt trauma
What is a pear-shaped bladder indicative of?
Could be pelvic lipomatosis, IVC occlusion, lymphocele, pelvic lymphadenopathy, healthy patient with iliac muscle hypertrophy
What are the types of urethral injury?
I: periurethral hematoma with narrowing. II: rupture above orogenical diaphram. III: Rupture at the urogenital diaphram with superior displacement of the bladder
What is the initial treatment for urethral injury?
suprapubic
What is a straddle injury?
injury to soft tissue of bulbous urethra
What are the risks of urethral injury?
Stricture and impotence
What are the four signs of abuse?
Healing fractures of differing ages, multiple fractures, unusual fractures, metaphhyseal fractures
What fracture is pathognomonic for abuse?
bucket handle
When does periosteal new bone formation take place?
7-10 days
When does obliteration of the fracture line show?
14-21 days
When does hard callus formation show?
14-28 days
When does remodeling of bone happen?
12 months
What are five common types of fracture?
Elastic deformation, bowing deformation, torus fracture, greenstick fracture, Salter-Harris fracture
What is the difference between elastic adn bowing deformations
Elastic will return to original, whereas bowing deformities stay
What is a buckle fracture
bowing of one cortex
what is a greenstick fracture?
incomplete fracture in one cortex and periosteal rupture on the opposite side, with intact periosteum on the cortically disrupted side
What is a salter harris fracture
Fractures involving the epiphyseal plate
What are the types?
I: fracture through the physeal plate. II: fracture through the metaphysis and physis. III: Fracture of epiphysis and physis. IV: fracture through all three structures. V: crushed physis
SALTR
Separated, above, lower, through, ruined
Where are the uncovertebral joints?
Luschka: They are cervical vertebral body-vertebral body joints
What are facet joints
Facet joints are zygapophyseal joints created from the superior and inferior articular processes of the thoracic and lumbar
At which levels do you have oncovertebral or facet joints
Cervical uncovertebral, thoracic is facet joints
What are the three columns of the spine
Anterior, middle, posterior. Anterior is anterior part of vertebral body and anterior long ligament, middle is the posterior vertebral body and posterior long ligament, and posterior column is the flavum, interspinous, and all things posterior
Conus at what level
T12
What three bones are the shoulder girdle
scapula, clavicle, humerus
What are the parts of the scapula?
acromion, coracoid, body, spine, glenoid fossa
What are the muscles of the rotator cuff?
SITS: spuraspinatis, infraspinatus, teres minor, subscapularis
Where is the subacromial bursa?
Deep to deltoid, superior to rotator cuff
What muscle tendon (not rotator cuff) passes through the shoulder joint capsule?
Biceps long head
How does the ulna and humerus articulate?
olecrenon process of ulna articulates with the trochlea and olecranon fossa of humerus
How does the radius and humerus articulate?
Capitellum
Bones of the wrist mnemonic?
So Long To Pinky, Here Comes The Thumb
What are the four joints of the wrist?
Distal radiolunar, Radiocarpal, midcarpal, carpometacarpal
What is the scapholunate angle?
measure from the axis that divides the concavity of the scaphoid, to the angle of the lunate, should be 30-60
How does the scaphoid receive it’s blood?
distal to proximal
What is ulnar variance? Normal, Neg/Pos?
Positive ulnar variance is when the ulna is longer than the radius. Normally the articular surfaces should be aligned.
What four structures (nine items) are in the carpal tunel
Median nerve, superficial flexor, deep flexors, and flexor pollicis longus
What are the parts of the metacarpal?
Base, shaft, neck, head
Joints of the fingers?
Carpometacarpal, metacarpophalangeal, interphalageal, distal interphalageal
What are the columns of the pelvis?
Anterior and posterior
What is the posterior column?
From the sciatic notch to the ischial tuberosity
What is the anterior column?
From the anterior superior iliac spine to the pubic symphysis
Why are the columns important?
They determine sugical approach
What is Shentons line?
Line from medial border of the femoral metaphysis and superior border of the obturator foramen – should be undisrupted and smooth!
Identify important lines of the hip
Ileopectineal, ilioischial, anterior and posterior rim of acetabulum, shentons, acetabular roof
How does the femoral head receive blood supply?
Mostly from retrograde arterial supply from the circumflex
What are three articulations of the knee?
Medial tibiofemoral, lateral tibiofemoral, and patellofemoral
What ar ethe stabilty forming ligaments of the knee?
ACL,PCL, MCL, LCL
What are the bones of the hindfoot?
Talus, calcaneus
What are the bones of the midfoot?
Navicular, cuboid, and three cuneiform bones
What are the bones of the forefoot?
metatarsals, and phalanges
WHAT ARE FIVE QUESTIONS you need to answer when looking at plain film?
Alignment, Soft tissue, joint spaces, bone density (sclerosis), cortex
What is a stress fracture?
Either a fatigue or insufficiency. Both are types
What are sites of fatigue fracture?
tibial shafts, metatarsals, distal fibula, femur, calcaneus, pars, navicular, pubic ramus
What are predisposing conditions to insufficiency?
osteoporosis, osteomalacia, fibrous displasia, pagets, hyperparathyroidism, steroids
What is the appearance of a stress fracture?
7-14 days after. sclerotic change, periostitis, cortical fracture
What is the mnemonic for causes of osteonecrosis?
ASEPTIC
What is ASEPTIC
alcohol, sickle, exogenous steroid, pancreatitis, trauma, idopathic, caisson disease (bends)
What is OCD?
Osteochondritis Dessicans
Where do you typically see OCD?
femoral condyles
What are the radiographic features?
Joint effusion, radiolucent separation of the osteochondral fragment from the condyle. said to be from chronic trauma
What is arthrodesis?
Fusion by removal of articular cartilage
Dislocation vs subluxation?
Sublixation is subtotal loss of congruity.
What is pathologic fracture?
Fracture associated around a nidus of disease such as tumor or infection
What is occult fracture?
Not visible on plain film?
What views should you get of a possible fracture site?
Two views taken at 90 degrees of each other, and also views of the joints above and below
What films are required for trauma>
Lateral cervical, Chest, AP pelvic
What four peices of info are required for adequate description of a fracture?
ANATOMIC SITE, FRACTURE PATTERN, ALIGNMENT, ASSOCIATED SOFT TISSUE INJURIES
Anatomic Site
Bones injured, location, intra/extra articular involvement
Fracture Patterns
Simple transverse, comminuted, oblique, spiral, longitudinal, impacted, depressed, avulsion
Fracture alignment
Displacement, angulation, rotation, discrepany
How is displacement described?
Location of the distal fragment
Valgus?
Lateral distal movement, knock-knee
Varus?
Medial distal movement, so this would be bowed legs
What is pseduoarthrosis
Fracture nonunion leading to joint like creation with a synnovial like cavity.
What is malunion, vs nonunion, reactive nonunion, vs infective nonunion?
Different types of nonunion. Malunion is union but not in anatomic alignment
Myositis ossificans
Post trauma bone formation in a chronic hematoma in a muscle with a corticated and central lucency
What types of things would you see in facial fractures?
Cortical disruption, fragment displacement, asymmetry, air fluid in sinuses, orbital emphysema, STS
What view would you get for a nasal fracture?
Water’s view
What is the most common zygomatic (tripod) arch fracture?
FIZL: frontozygomatic suture, infraorbital rim, zygomatic arch, lateral maxillary wall
What is a Lefort fracture?
Fractures that always involve the pterygoid plates and vary in terms of their location through the CC facial structures.
What are the most common levels of spinal fracture?
C1-C2, C5-C6, T10-T12
Does spinal cord injury happen at the time of injury or later?
MOST will happen at the time of injury!
What does flexion extension images show?
ligamentous injury or instability
What is the pitfall of flexion extension films in acute setting?
Paraspinous musclulature can spasm, and give you a false negative. hense C collars for 1-2 weeks
What is a jefferson’s fracture?
Axial loading, splitting of C1 posterior elements
Describe dense fractures
Can be different types, some are stable some are unstable
What is a Hangman’s?
hyperextension. C2 pars fracture.
What is a teardrops?
Severe flexion, tear drop is the anterior vetebral body fragment. very unstable, SAD tear outcome
What conditions are associated with C1-C2 subluxation
RA, JRA, psoriasis, AS, SLE, Downs, trauma
What is a chance injury?
Horizontal fracture
Anterior and posterior shoulder dislocation
Anterior is inferior, posterior you sometimes cant see on AP
What are Bankart and Hill-Sachs
Bankart is injury to inferior glenoid, and hill-sachs is a depression in the humeral head. Both associated with anterior dislocation
What is the posterior fat pad and sail sign?
Indicative of fractures of the elbow, hemarthrosis
What is a Monteggia’s fracture?
Fracture of the ulna with radial head dislocation
What is a Galeazzi’s fracture?
Fracture of the proximal radius with distal radioulnar dislocation
What is a nightstick fracture?
Ulnar fracture distal diaphysis
What is a Colles fracture?
Distal radial fracture falling on outstreatced extended pronated wrist.
How would you asses for scaphoid fracture on physical exam?
anatomic snuffbox tenderness
What makes a pelvic fracture unstable?
Ring disruption
What are four common locations for pelvic avulsions
ASIS: sartorius avulsion, AIIS: rectus femoris, Ischia tuberosity: hamstring avulsion, Lesser trochanter: iliopsoas
What’s the most common hip dislocation? why?
Posterior, knee to dashboard
