Week 6 - Trauma Flashcards
what is a neurapraxia? how is it resolved?
temporary nerve conduction defect due to stretch / compression. resolves itself in 28 days max
what causes an axonotmesis?
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
whats the differences between the causes of an atrophic and a hypertrophic non union?
atrophic - trapped tissue / gap too big / chronic disease / shit blood supply
hypertrophic - large gap and a hard callus forms within it
Tx of hypertrophic non union
easy - just plating
Tx of atrophic non union
removal of infected bone / circular frame external fixates / bone grafting
why is a # of C2 more dangerous that a # of C 6?
above C3 - affects supply to C3,4,5 keeps the diaphragm alive.
what is spinal shock?
physiological response to spinal cord injury
lasts for 24 hours
loss of sensory, motor function and reflexes
what is neurogenic shock?
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
incomplete spinal injuries are split into three areas,,??
which is most commonly affected?
how could this one occur?
anterior, central and posterior
central is most common
central occurs through hyperextension of osteoarthritic spines
how do you treat septic arthritis in children compared to in adults?
in adults - surgical washour is always best
in children - consider repeat aspirations and IV antibiotics, might be enough
are arms or legs more commonly affected by central incomplete spinal injuries? why?
arms more common, because their corticospinal tracts are more “central central”, with arms “outer central”
the dorsal column is in the posterior area of the spinal cord. what sensation is lost if it gets damaged?
proprioception
vibration
light touch
(not so hard core things)
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?
motor
coarse touch
pain and temperature
(hard core)
what is brown sequard syndrome?
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).
what is the main concern in anteroposterior pelvic fractures???
the pelvis opens like a god damn book
bigger space means more blood can fill it
leading to clotting and tamponade.
what is the major concern in vertical shear pelvic fractures? (2)
haemorrhage and damage to the lumbosacral plexus
treatment for hip and proximal femoral fractures…
- intracapsular:
a) 80 and not mobile
b) 65 and fit - extracapsular:
- subtrochanteric:
1 - a) hemiarthropasty
b) THR
2. compression or dynamic screw
3. intramedullary screw. they are typically old and osteoporotic, falling onto side.
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?
a fat embolism.
common with these fractures
also at risk of acute respiratory distress syndrome
how to you treat femoral shaft fractures?
- nerve treatement
- long term
femoral nerve block
Thomas splint - traction and elevation
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?
distal femoral fracture !! will either be intracondylar (intraarticular) or supracondular (extraarticular)
what knee injury is associated with compartment syndrome and neurovascular injury?
a high energy proximal tibial fracture “plateau”
what are the ligament / nerve injuries associated with
- lateral plateau fractures
- medial plateau fractures??
lateral = MCL injury, also may ACL. (valgus force)
medial = LCL injury AND STRETCH INJURY TO THE COMMON FIBULAR NERVE!! (varus force)
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?
less than 50% displacement - so just an above the knee cast.
terry’s pal jerry also fell off his bike, and sustained a nasty 60% displaced tibial shaft fracture (ouch). what is the Tx?
over 50% - so intramedullary stabilisation with a nail behind the patella tendon.
what type of fracture is a “pilon”?
mechanism of action?
intra-articular distal tibia
Emergency!!!
rapid deceleration
what type of fracture is a Lisfranc ?
fracture of the base of the 2nd metatarsal +/- dislocations of 2nd / other metatarsals.
are posterior or anterior humeral neck fractures more common?
anterior boyyyys
95%
how would you know that the radial nerve had been damaged by a humeral shaft fracture?
wrist drop xx
what arm bone is fractured in a “nightstick” fracture ?
direct blow to the ulnar shaft
what arm bone is fractured in a “diaphyseal” fracture?
both ulnar and radius
what is wrong in a monteggia fracture?
ulnar fracture plus radial head dislocation
what is wrong in a galeazzi fracture?
radial fracture plus ulnar head dislocation
what distal radial fracture occurs through a fall on the back of a flexed wrist?
Smiths fracture
how to you treat paediatric femoral shaft fractures in
<2 year olds ?
2-6 year olds?
- gallows traction (90 degree angle) or hip spica
2. Thomas splint or hip spica
do toddlers commonly break their femur, tibia or fibula?
tibial shaft !!
