Trauma Symposium Quiz Flashcards

1
Q

How does the incidence of facial fracture change with age

A

Triphasic (variable with 3 peaks)
1. children (less than 5 years old)
2. Young people (late teens-30’s)
3. Elderly

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2
Q

What factors result in a change in incidence of facial fractures with age

A
  1. Falls:
    children have a developing neurological system (e.g muscle and balance)

Elderly: neurological generation

  1. Assaults: (more common 20-25) antisocial/ risk behaviour

3.Road traffic accidents (20-25), 75+ increase risks

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3
Q

In patients with multiple injuries, why are injuries to brain, thorax, abdomen, pelvis and lower limbs sometimes treated more urgently than facial fractures

A

Brain: associated with facial injury, may disrupt airway or stop breathing

Thorax: disrupt breathing due to collapsed lung, pneumonothorax, broken rib

abdomen/ pelvic:
- large vessels in abdomen & spaces
- lose a lot of blood and not aware
- potentially life threatening

Lower limbs: long bone injury affect QoL associated spinal/ cervical

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4
Q

Who was Le Fort?
- How did he conduct his research?
-What is the significance of different levels of Lefort fractures

A

Lefort fractures applied to Transverse Fractures of the midface

  • Conducted research on Cadavers in 1901

Le forte 1:
- horizontal maxillary fracture, seperating the teeth from the upper face
- fracture line through alveolar ridge, lateral nose and inferior wall of maxillary sinus

Le forte 2: maxilla and nose
- pyramidal fracture with teeth at pyramid base, nasofrontal suture at its apex

-fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rims and nasal bones

Le forte 3:
maxilla, zygomas and orbital floor
Will involve the occlusion

  • craniofacial disjunction
    -transverse fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and azygomatic arch/ zygomaticofrontal suture
    -highest rate of CFS leakage
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5
Q

What is a pathological fracture?

A

Fracture that occurs in an area of bone that has been critically weakened by disease

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6
Q

What condiitons can be associated with a pathological fracture

A

cancer, osteoradionecrosis, MRONJ, large cysts

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7
Q

Why are mandible fractures often bilateral

A

Mandbile has 2 fixed points (limited mobility at each end)
- mandible is curved so forces applied to the front of the mandible causes forces also at the condyle

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8
Q

A patient presents with a history of assault and a punch to their lower jaw. They have complete anaesthesia in the distribution of the left inferior dental nerve.

Which region of the mandible is likely to be fracture ?

A

Angle of body

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9
Q

What is the difference between displacement and angulation when describing fractures

A

displacement : degree to which the fractured ends are out of alignment with each other (mm/ bone %)

Angulation:Angle by which distal fragment has moved in comparison to its previous position

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10
Q

Why is examination of the eye important for patients who have sustained fractures of the zygomatic complex?

A

Fractures of zygomatic complex can affect vision due to changes in volume of orbit and muscle & fat interacment

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11
Q

What is the difference between subconjunctival haematoma and periorbital ecchymosis

A

Subconjunctival haematoma: bloodshot eye due to trauma to eyeball/ bleeding from fractures of floor or bony orbits

Periorbital ecchymosis (raccoon eye): produced by blood tracking into periorbital tissues, causing blue or purple discolouration of the upper and lower eyelids

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12
Q

what is the significance of the posterior limit of subconjunctival haematoma

A

Haemorrhage without posterior margin extends posteriorly so that the whole extent of the haemorrhage cannot be seen. Potentially associated with intracranial bleed or orbital floor fracture

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13
Q

A patient who has been hit in the eyeball with a tennis ball complains of doublevision when trying to look upward. Plain facial X-rays show no obvious fractures but opacification of the maxillary sinus on the affected side. What is the likely diagnosis?

A

Orbital floor fracture

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14
Q

An OPG shows a fracture of a patients mandible through the left body at the level ofthe lower left first molar and a second fracture of the right condylar neck. What clinical signs would you expect to see in this patient

A
  • pain, bleeding, swelling
    -difficulty speaking, chewing and breathing
  • loose teeth (lower molars)
    deviation of the jaw towards the side of the fracture (left)
  • premature contact on the left & open bite on right
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15
Q

A patient has been assaulted and has some left periorbital bruising and mild subjunctival haematoma with no posterior limit. Their eye movements are normal and there is no palpable fracture on examination. They have had a minor nose bleed on the left side and when they blow their nose they develop a sudden swelling around the left eye and cheek. On examination now you can feel air bubbles under the skin. What is the diagnosis and what is the mechanism?

A

Fractured zygomas & maxillary sinus
mechanism: increased nasal pressure & itnranasal pressure & sinus

consequence: lots of swelling & closing of eye& bubble wrap feel under the skin as air bubbles move beneath and crack

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16
Q

What is a gunning splint?

A

Used to immbolise edentulous/ partially edentulous jaw in correct occlusion and ensures fractures are held in the correct occlusion

  • upper and lower dentures that are wired in place
  • anterior hole for feeding
17
Q

What is the principle of treatment of mandible fractures with intermaxillary fixation?

A

Use upper and lower arch bars Manipulate bone into position by holding pt into occlusion & holding teeth together
- Correct position & angulation of joint required
- Intermaxillary fixation has to be kept into place for 6 weeks→ affect nutrition & OH (PRF) so can cause caries & gum disease

18
Q

What are the principles of fracture healing

A

Speed: how quickly the patient can return to function

safety: how safe the technique is to complete

stability: how well the fracture is held in position

mobility: small amount of physiological stress to encourage callus strength and remodelling

19
Q

What problems can be encountered in fracture healing?

A
  • Malunion: bone heals but not correct length/ angulation - this can affect function

-delayed union: bone has not healed after 6 weeks (can cause stress on plates), risk of failure of plates e.g fracturing/ screws pull out through bone

-Non union: bone fragments heal but do not unite (form pesduo joint), no strength (mobile fracture)

20
Q

Describe the different ways of treating mandible fractures

A
  • Plating: use different size and shapes plates for different parts e.g larger plates for madible

complications: atrophic/ edentulous mandibles are at risk, pulls muscles in awkward positon

external fixation: hold fractures in position as they heal for over 6 weeks
(used for mandibular fractures with high energy injuries with contamination & missing bone)

intermaxillary fixation:
- produce malocclusion
- kept for 6 weeks in place : affect nutrition and OH

21
Q

What is the significance of a fracture in an edentulous, atrophic mandible?

A

treatment difficult:

-lack bone, cortical in nature so lower healing potential
- no teeth present to reduce fractures
- often medically compromised/ elderly
- require bone grafting
- load sharing plates not able to provide sufficient strength

22
Q

What are the commonest modes of blunt force facial injury?

A

blunt force injury (non-penetrating trauma)
most common:
- head injuries from motor cycle accidents,
-pedestrian accidents
-car accidents
- falls
-sport injuries

23
Q

You come across a patient lying in the street who has sustained facial injuries. What are the important questions you should ask the patient?

A

1/ Time and place of injury
2. mechansim of injury
3. visual disturbances
4. Does the patient feel their teeth meet as they normally would
5. Numbness of the face?
6. loss of consciousness?

  1. Clear of head injury
  2. Clear of spinal

ABC

  1. Airway: Can they breath
  2. breathing: consciousness
  3. Circulation: feel like they are bleeding
  4. eye movements & vision- double vision?