Week 6 - Trauma

Question 1

what is a neurapraxia? how is it resolved?

Answer 1

temporary nerve conduction defect due to stretch / compression. resolves itself in 28 days max

Question 2

what causes an axonotmesis?

Answer 2

sustained compression / high force / stretch of a nerve. nerve cell axons distal to the injury DIE then slowly regenerate. may need nerve grafts / tendon transfers to fix

Question 3

whats the differences between the causes of an atrophic and a hypertrophic non union?

Answer 3

atrophic - trapped tissue / gap too big / chronic disease / shit blood supply

hypertrophic - large gap and a hard callus forms within it

Question 4

Tx of hypertrophic non union

Answer 4

easy - just plating

Question 5

Tx of atrophic non union

Answer 5

removal of infected bone / circular frame external fixates / bone grafting

Question 6

why is a # of C2 more dangerous that a # of C 6?

Answer 6

above C3 - affects supply to C3,4,5 keeps the diaphragm alive.

Question 7

what is spinal shock?

Answer 7

physiological response to spinal cord injury
lasts for 24 hours
loss of sensory, motor function and reflexes

Question 8

what is neurogenic shock?

Answer 8

temporary shut down of sympathetic outflow due to damage at cervical / upper thoracic levels.
lasts for 24-48 hours
systemically, loss of sympathetic causes bradycardia and hypotension

Question 9

incomplete spinal injuries are split into three areas,,??
which is most commonly affected?
how could this one occur?

Answer 9

anterior, central and posterior
central is most common
central occurs through hyperextension of osteoarthritic spines

Question 10

how do you treat septic arthritis in children compared to in adults?

Answer 10

in adults - surgical washour is always best

in children - consider repeat aspirations and IV antibiotics, might be enough

Question 11

are arms or legs more commonly affected by central incomplete spinal injuries? why?

Answer 11

arms more common, because their corticospinal tracts are more “central central”, with arms “outer central”

Question 12

the dorsal column is in the posterior area of the spinal cord. what sensation is lost if it gets damaged?

Answer 12

proprioception
vibration
light touch
(not so hard core things)

Question 13

the corticospinal tract and the lateral spinothalmic tracts are in the anterior area of the spinal cord. what senation is lost if they get damaged?

Answer 13

motor
coarse touch
pain and temperature
(hard core)

Question 14

what is brown sequard syndrome?

Answer 14

a spinal cord injury that causes weakness or paralysis on one side of the body - the side of damage - (hemiparaplegia) and a loss of sensation on the opposite side (hemianesthesia).

Question 15

what is the main concern in anteroposterior pelvic fractures???

Answer 15

the pelvis opens like a god damn book
bigger space means more blood can fill it
leading to clotting and tamponade.

Question 16

what is the major concern in vertical shear pelvic fractures? (2)

Answer 16

haemorrhage and damage to the lumbosacral plexus

Question 17

treatment for hip and proximal femoral fractures…

1. intracapsular:
   a) 80 and not mobile
   b) 65 and fit
2. extracapsular:
3. subtrochanteric:

Answer 17

1 - a) hemiarthropasty

b) THR
2. compression or dynamic screw
3. intramedullary screw. they are typically old and osteoporotic, falling onto side.

Question 18

yesterday Joanne fell off her horse and got herself a full femoral shaft fracture. today she is confused with Sa02 of 94% . what has happened?

Answer 18

a fat embolism.
common with these fractures
also at risk of acute respiratory distress syndrome

Question 19

how to you treat femoral shaft fractures?

• nerve treatement
• long term

Answer 19

femoral nerve block

Thomas splint - traction and elevation

Question 20

johnny falls in the nursing home onto his flexed osteoporotic knee. what injury is most likely?

• knee dislocation?
• patella dislocation?
• distal femoral fracture?
• proximal tibial fracture?

Answer 20

distal femoral fracture !!
will either be intracondylar (intraarticular)
or supracondular (extraarticular)

Question 21

what knee injury is associated with compartment syndrome and neurovascular injury?

Answer 21

a high energy proximal tibial fracture “plateau”

Question 22

what are the ligament / nerve injuries associated with
- lateral plateau fractures

• medial plateau fractures??

Answer 22

lateral = MCL injury, also may ACL. (valgus force)

medial = LCL injury AND STRETCH INJURY TO THE COMMON FIBULAR NERVE!! (varus force)

Question 23

terry fell off his motorbike and got himself a tibial shaft fracture. however, luckily for big tezza, the tibia is only 45% displaced. what is the Tx?

Answer 23

less than 50% displacement - so just an above the knee cast.

Question 24

terry’s pal jerry also fell off his bike, and sustained a nasty 60% displaced tibial shaft fracture (ouch). what is the Tx?

Answer 24

over 50% - so intramedullary stabilisation with a nail behind the patella tendon.

Question 25

what type of fracture is a “pilon”?

mechanism of action?

Answer 25

intra-articular distal tibia
Emergency!!!
rapid deceleration

Question 26

what type of fracture is a Lisfranc ?

Answer 26

fracture of the base of the 2nd metatarsal +/- dislocations of 2nd / other metatarsals.

Question 27

are posterior or anterior humeral neck fractures more common?

Answer 27

anterior boyyyys

95%

Question 28

how would you know that the radial nerve had been damaged by a humeral shaft fracture?

Answer 28

wrist drop xx

Question 29

what arm bone is fractured in a “nightstick” fracture ?

Answer 29

direct blow to the ulnar shaft

Question 30

what arm bone is fractured in a “diaphyseal” fracture?

Answer 30

both ulnar and radius

Question 31

what is wrong in a monteggia fracture?

Answer 31

ulnar fracture plus radial head dislocation

Question 32

what is wrong in a galeazzi fracture?

Answer 32

radial fracture plus ulnar head dislocation

Question 33

what distal radial fracture occurs through a fall on the back of a flexed wrist?

Answer 33

Smiths fracture

Question 34

how to you treat paediatric femoral shaft fractures in
<2 year olds ?
2-6 year olds?

Answer 34

1. gallows traction (90 degree angle) or hip spica

2. Thomas splint or hip spica

Question 35

do toddlers commonly break their femur, tibia or fibula?

Answer 35

tibial shaft !!