Trauma

Question 1

Ottawa knee rule

Answer 1

• Αge above 55 years
• Τenderness at the head of the fibula
• Ιsolated tenderness of the patella
• Ιnability to flex the knee to 90 degrees
• Ιnability to bear weight (take four steps) immediately and in the ED

Question 2

Second fracture

Answer 2

A tibial plateau avulsion fracture at the site of lateral capsular ligament insertion
- important marker of ACL disruption +/- medial meniscus injury- indicate severe rotatory instability

Question 3

Knee dislocation

Answer 3

• Orthopedic emergency associated with vascular damage, requires urgent reduction
• high rate of popliteal artery (20-80%) and peroneal nerve injury
• involves rupture of both cruciate ligaments and one collateral ligament
• anterior dislocations most common (described as displacement of tibia in relation to femur)
• risk of developing compartment syndrome increased when reduction is not performed within 6hours
• CTA for those with abnormal ankle-brachial index

Question 4

Adjunctive procedures able to be performed with an emergency thoracotomy

Answer 4

1. Pericardiotomy for tamponade
2. Control cardiac bleeding
3. Compress/ clamp pulmonary trunk
4. Compress/ clamp descending aorta
5. Open cardiac massage
6. Right atrial access for blood or fluid administration

Question 5

Possible complications of tube thoracostomy

Answer 5

a) Trauma to the intercostal neuromuscular bundle
b) Extrapleural placement
c) Intra-fissural placement
d) Intra-pulmonary placement
e) Mediastinal impingement or penetration
f) Trans diaphragmatic placement
g) Infection

Question 6

Complications or problems with cervical immobilisation

Answer 6

1. Patient discomfort- headache, mandibular pain
2. Increased intracranial pressure- average of 2-3mm Hg up to 15mm Hg
3. Cutaneous pressure ulceration- decubitus ulcers
4. Worsening neurological function
5. Reduced access to neck and occiput: masks life threatening injuries
6. Restricts pulmonary function
7. Need for ongoing spinal nursing
8. Increased difficulty of intubation
9. Aspiration risk
10. DVT risk

Question 7

Components of anterior, middle and posterior column of cervical spine

Answer 7

Anterior: anterior longitudinal ligament, anterior 1/2 of vertebral bodies and discs
Middle column: posterior longitudinal ligament, posterior 1/2 of the vertebral bodies and discs
Posterior: Facet joints, pedicles, laminae, ligamentum flavum, spinous process, interspinous ligament