Trauma week Flashcards
What AC joint injuries are possible?
Sprain
Subluxation
Dislocation
What tends to cause AC joint injuries?
Fall onto outstretched arm
What is a subluxed AC joint?
Rupture of the AC ligament
What is a dislocated AC joint?
Coracoclavicular and AC ligaments break
How do you treat AC joint injuries?
Sling and physio
Surgery for chronic pain
What are the three directions the glenohumeral joint can dislocate?
Anterior
Posterior
Inferior
How do you diagnose a glenohumeral joint dislocation?
Asymmetry Arm held adducted Loss of sensation on regimental badge 2 plane XR Posterior shows light bulb sign on XR
What are the three common humeral neck fractures?
Proximal- Along surgical neck, Usually osteoporosis
Tuberosity fracture
Head fracture
How does a proximal humeral neck fracture present?
Medial displacement
How do you treat a humeral neck fracture?
Minimally displaced- Sling and gradually mobilize
Displaced- Wait for muscle spasm to ease and see
Permanently displaced- Internal fixation
How do you treat multiple fractures of the humeral neck/head?
Joint replacement but not the best.
What are the two ways a humeral shaft can break?
Direct trauma- Transverse fracture
Falling- Oblique or spiral fracture
How do you fix a broken humeral shaft?
Usually just brace
Can fix with intramedullary nail
High recovery rates
What is a complication of a broken humeral shaft?
Damage to the radial nerve running in groove leading to loss of sensation in 1st dorsal webbing and wrist drop.
What age group do supracondylar fractures tend to occur in?
Children
How are supracondylar fractures occur?
Fall onto outstretched arm or flexed elbow
How do you treat a supracondylar fracture?
Undisplaced- Splint
Displaced- Reduce. Pin w/ wires or open surgery if artery/nerve is trapped.
How do you get an olecranon fracture?
Fall on point of elbow
How do you treat an olecranon fracture?
Open reduction and internal fixation.
What is problematic about forearm fractures?
If one bone breaks other has to break or dislocate normally
What is an ulnar shaft/nightstick fracture?
Isolated fracture of ulna due to direct blow.
How do you manage an ulnar shaft fracture?
Conservative management normally but can be ORIF
What is a Monteggia fracture dislocation?
Fracture of ulna and dislocation of radial head
How do you treat a Monteggia fracture dislocation?
ORIF of fracture which usually relocated radius
What is a Galeazzi fracture dislocation?
Fracture of radius and dislocation of ulnar at distal radioulnar joint.
How do you treat a Galeazzi fracture?
ORIF of radius which normally resets ulnar
What is a both bone fracture of the forearm?
A fracture through diaphysis of both ulnar and radius
How do you treat a both bone fracture of the forearm?
ORIF in adults
Plaster cast in children as will remodel better
What kind of fractures are possible at the distal radius?
Colles Fracture
Smith’s Fracture
Barton’s Fracture
Comminuted intra-articular distal radius fracture
What is the most common cause for distal radius fractures?
Fall on to out stretched arm
What is a Colles fracture?
Fracture of distal radius w/in 1 inch of articular surface with dorsal displacement.
How do you treat a Colles fracture?
Minimal displacement- Splint
Displaced- Manipulate then splint
Then secure with plaster, percutaneous wires or ORIF
What complication can a Colles fracture cause?
Carpal tunnel syndrome
What is a Smith’s fracture?
Fracture of distal radius w/in 1 inch of articular surface with volar displacement.
How do you treat a Smith’s fracture?
ORIF
What is a Barton’s fracture?
Intra-articular fracture of distal radius- carpal bones sublux and break off part of rim.
Can be volar or dorsal
How do you treat a Barton’s fracture?
ORIF
What is a comminuted intra-articular distal radius fracture?
Very traumatic and damaging fracture of radius
How do you treat a comminuted intraarticular distal radius fracture?
External fixation
What normally causes a scaphoid fracture?
FOOSH
How does a scaphoid fracture present?
Tenderness in anatomical snuff box
Pain on compression
Difficult to see on XR therefore splint and asses in 2 weeks
How do you treat a fractured scaphoid?
Undisplaced- Cast for 6-12 weeks
Displaced- Compress and screws
What complications can occur with a broken scaphoid?
Due to poor blood supply can un-union and AVN.
What are the 6 hand injuries we need to know
Phalangeal fractures Metacarpal fractures Flexor tendon injury Penetrating hand injury Extensor tendon injury Mallet fracture
How do you treat phalangeal fractures?
Strap to neighbours
If angles will need manipulated under ring block
How do you treat metacarpal fractures?
3rd, 4th and 5th treat conservatively
5th tend to angle therefore strap digit to neighbour
What is a special form of metacarpal fracture?
Fight bite
What is the danger with fight bite?
Caa get oral bacteria in MCP capsule giving septic arthritis or disrupt extensor mechanism
What is a major problem with flexor tendon injury?
Potential for damage to nerves and arteries
What tendons can be damaged in flexor tendon injury?
FDS
FDP
FPB
How do you treat flexor tendon injury?
Repair and splint in flexed position
What is mallet finger?
Avulsion of extensor tendon from its insertion into terminal phalanx
How does mallet finger occur?
Forced flexion of extended DIP joint
How does mallet finger present?
Pain
Droop at DIP
Inability to extend DIP
How do you treat mallet finger?
Hold extended for 4 weeks
How do you treat extensor tendon injury?
If more than 50% then requires surgical repair with splint in extension for 6 weeks.
Flexion may cause healing failure
What is the danger with penetrating hand injuries?
Volar injuries can damage flexor tendons, digital nerves and arteries
Dorsal injuries can damage extensor tendons
How do you treat penetrating hand injuries
Repair damaged tendons etc
What are the five categories of Salter-Harris physeal injury?
1: Pure separation along physeal line
2: Similar to 1 but with small bit of metaphysis attached.
3: Interarticulate progressing to physis
4: Interarticulate progressing into metaphysis
5: Compression of physis therefore get growth arrest
What is the most common Salter-Harris physeal injury?
Salter-Harris II
What are some indicators of Non-Accidental Injury in children?
Multiple fractures and bruises at different stages of healing.
Multiple trips to A&E
Changes/discrepancy in history- Both between carers and not matching injuries
Atypical injuries
Rib and metaphyseal injury
What is a buckle fracture?
Compression of the bone therefore looks slightly short and wide on XR.
How do you treat a buckle fracture?
3-4 weeks in a splint
What is a greenstick fracture?
Part of bone remains attached and part breaks.
How do you treat a greenstick fracture?
Manipulation and casting
What fractures can you get in the forearm of a child?
Monteggia and Galeazzi fracture dislocations
Fractures of both bones
How do you treat fractures in the forearm of a child?
Monteggia and Galeazzi fracture dislocations- ORIF
Fractures of both bones- Undisplaced cast, displaced need fixed
What is the most common fracture of a child’s elbow?
Supracondylar fracture
How do children tend to obtain supracondylar fractures?
Extensor- fall on outstretched arm
Flexor- fall on point of elbow
How do you treat supracondylar fractures?
Undisplaced- Stabilized and splint
Displaced- MAnipulate ASAP and surgery if artery (no pulse) or nerve (no feeling) involvement
How do kids tend to fracture their femoral shaft?
Fall on bent knee
Direct bending force
Rotation
How do you treat a fractured femur in kids?
<2YO- NAI therefore treat appropriately
2-6YO- Splint or cast
6-12YO- Flexible intramedullary nails
>12YO- Adult type intramedullary nails
What type of tibial fracture is common in toddlers?
Undisplaced spiral fracture
How do you treat a tibial fracture in children?
Cast if stable
If open or unstable- Fix and screws
