W12 - FRACTURES, UL INJURIES, N PALSIES, COMPARTMENT SYNDROME Flashcards
Common Principles for Trauma Radiographs
Rule of 2x
- Views: AP, and lateral
- Joints: above, and below
- Bones: if apt e.g radius ulna, tibia and fibula
- Occasions: e.g scaphoid # nil initial XR but evident 7-14d later
Description of a #: Shape
Transverse: direct trauma
Oblique: d/t bending moment of force
Spiral: d/t rotational force
Complex: combination of forces
Comminution F#
comminuted fracture refers to a bone that is broken in at least two places. Comminuted fractures are caused by severe traumas like car accidents. You will need surgery to repair your bone, and recovery can take a year or longer.
Description of a #: Deformity
Movement of distal fragment with respect to stationary proximal fragment
- DISPLACEMENT: % diameter of bone
- ANGULATION
- ROTATION
- AXIAL DEFORMITY: impaction, overlapping (muscle spasm = shortening), distraction (soft tissue interposition)
Description of a #: Soft Tissue
- Air = open #, gas forming organisms
- Foreign bodies = open #
- Fluid levels = haematoma
Clavicular #
- middle 1/3 commonest
- involve falling on shoulder/outstretched hand
*will unite > analgaesia > sling: 3-4w; progressive mobilization > figure of 8 bandage? > Sx: open #, skin threatened, neurovasc complication, polytrauma
Acromioclavicular #
- AC dislocation
- Fall onto shoulder
> Sprained = Sling 3-4w
Displaced AC joint = early fixation
Proximal Humerus #
- young, high energy
- elderly, osteoporotic injuries,
> conservative, sling mobilise from 6w
sx: plate fixation; joint replacement
Shoulder Dislocation
- most common joint dislocation; anteriorly
- posterior: seizure: check passive external rotation, XR = light bulb sign
- axillary nerve test = badge area
*2 views XR!
> acute reduction under sedation
What is commonly associated with posterior shoulder dislocation?
unilateral loss of passive ext. rotation, XR light bulb sign
Dital Radial #
- young: high velocity
- old: osteoporotic, fall
> Undisplaced = splints/cats
Displaced = reduce
Cast
Sx: plate, external fixator
!Colles #
Colles # Compl.
Complication of Colles (distal radial)
- malunion, DRUJ pain
EPL rupture
carpal tunnel syndrome
Scaphoid #
- commonly occur at waist of scaphoid
- XR rpt at 2w or MRI
- risk of non-union, or avasc. necrosis if in proximal
*pain base of thumb
> 6w Cast
Sx: displaced, nonunion
Ulnar collateral ligament injury of the thumb
- radial force: gamekeepers thimb, skiers thumb
- ligament injury or avulsion #
*weak pinch grip
> Splint, cast
Sx: repair ligament, fix avulsion fragment
Bennett’s #
Intra-articular # at base of 1st MC
- falling on outstreched hand, boxing, displaced by abductor pollicis longus
> Reduction
Maintain reduction: plaster, wire, screw fixation
Boxer’s #
Little finger and metacarpal neck
volar angulated
> conservative mgmt
Flexor tendon injuries of fingers
commonly d/t knife laceration
> early sx repair - partial tears do not need repair !zone 2 no mans land = both FDS & FDP tendons = worst prognosis > early movement = better healing & REHAB
Clinical Features of Axillary N Injury
- Neck of Humerus
- Supplies deltoid and teres mn. thus atrophy
- lateral arm sensory
*d/t shoulder dislocation, surgical neck of humerus #
Clinical Features of Radial N injury
- radial groove, of humerus passes from medial to lateral
- supplies tricpes
=> wrist drop; sensory loss, finger extension (forearm source), handcuff sensation (wrist source), loss of elbow extension (axilla source)
*Compression
Clinical Features of Medial N. injury
- supplies flexors
- sens: 3.5 fingers
- Carpal Tunnel Syndrome = noctural pain, parasthesia, thenar wasting
- Tinnel (T)ap test
Phalens
> Carpal tunnel release
Clinical Features of Ulnar n. injury
- pinky finger + 0.5 ring finer
- Cubital tunnel syndrome = numb ulnar side of hand and difficulty with fine tasks
- palsy = wasting, guttering, hypothenar wasting
- Ulnar claw hand
- Fromens Test = holding paper
Clinical Features of Nerve entrapment
Radial N *ENTRAPMENT = d/t #
Common LL nerve injuries - Sciatic
- sciatic foramen below piriformis muscle, runs deep to glut. max muscle and posterior hamstrings
- terminal branches suppy all lower leg and foot
- posterior dislocation of hip
- intrafluteal injection dmg
Common LL nerve injuries - Common fibular
- smaller and lateral branch of sciatic: passes around lateral aspect of neck of fibula
- divides into superficial and deep fibular n.
= foot drop and slapping gait - commonest nerve injured in LL
