U11C2 Trauma And Amputation

Question 1

What is a fracture and the different types?

Answer 1

A fracture is a break in the continuity of the cortex of the bone.

Simple- doesn’t break the skin (closed)
Compound- breaks the skin (open)
Complete- separated into 2 or more pieces
Incomplete- not separated into pieces
Displaced- fractured bone ends don’t align, include: angulation, translation and rotation

Question 2

How are fractures actively managed?

Answer 2

• Pain relief
• Stabilise the broken bone
• Allow it to heal in the correct anatomical position
• Rehabilitate the joint back to full function

Question 3

What are the phases of fracture healing?

Answer 3

Haematoma formation
- Inflammatory or granulation phase

Soft callus formation
- Proliferative phase

Hard callus formation
- Maturing or modeling phase

Remodeling phase

Question 4

What are the prerequisites for bone healing?

Answer 4

• Adequate blood supply
• Adequate mechanical stability

Question 5

Direct vs indirect bone healing

Answer 5

Direct (primary) bone healing
– NO motion at the fracture site
– NO callus formation

Indirect (secondary) bone healing
– Motion at the fracture site
– Callus formation

Question 6

What imaging can be used on the MSK?

Answer 6

X-ray- Electromagnetic Radiation. All about tissue densities and how many x-rays can pass through each structure. Can tell us about fractures, dislocations, osteoarthritis and cancer. Can’t tell us soft tissue injury (MRI), subtle fractures (CT), what type of malignancy or grade (biopsy)

CT- quick, good for fracture configuration, multisystem imaging but radiation and doesnt visualise soft tissues well

MRI- high detail in soft tissues, no radiation, tumour and spinal imaging but relies on patient lying still, long acquisition time, may not be able to have with pacemaker

Ultrasound- dynamic imaging, cheap, mobile, no radiation, good for soft tissues but user dependent, limited detain and poor for bone. Doppler ultrasound shows the blood flow in arteries and veins

Question 7

What is compartment syndrome?

Answer 7

Most commonly associated with acute trauma-related fractures but variety of conditions are associated with development of compartment syndrome. Conditions that:
- Increase fluid volume within a compartment due to bleeding from fracture, vascular injury or extravasation of IV fluids
- Lead to significant soft tissue swelling such as crush injuries, thermal or electrical burns, injecting recreational drugs
- Decrease vol of compartment via external forces e.g. tight dressings, sedated/comatose patients
Pressure within compartment elevates, compromising capillary blood flow and tissue perfusion → tissue ischemia and necrosis

Question 8

What is an IMISTAMBO handover?

Answer 8

I – Identification
M – Mechanism / Medical complaint
I – Injuries / Information related to the complaint
S – Signs
T – Treatment and Trends
A – Allergies
M – Medication
B – Background history
O – Other information

Question 9

What is a secondary trauma survey?

Answer 9

Head to toe examination completed after primary trauma survey

Allergies
Medication
Past medical history
Last ate
Events leading up to incident

Question 10

Autologous vs allogenic saphenous vein graft

Answer 10

Autologous- same person transplant
Allogenic- donor transplant

Procedure-
- General Anaesthetic administered
- Longitudinal incision along inner thigh
- Proximal and distal ends are ligated or clipped around section being used
- Harvested sample is flushed with saline, branches ligated and (valves) reversed inside out
- Graft is anastomosed to the artery to create a bypass using sutures or staples; re-establishing circulation in the lower limb
Neointimal hyperplasia = remodelling of venous tissue after transplant

Question 11

What is external fixation?

Answer 11

Question 12

What happens in an amputation?

Answer 12