Introduction to Trauma

Question 1

Fracture patterns:

Complete vs Incomplete

Answer 1

• Complete: fracture all the way through the bone
• Incomplete: whole cortex not broken

Question 2

Types of complete fracture

Answer 2

Question 3

Primary Healing

Answer 3

Direct healing without a fracture callus

Requires edges to be in contact perfectly with zero movement

Done with surgery only

Question 4

Secondary healing

Answer 4

The standard way bone heals

• Heamatoma develops filled with osteoblasts
• < 2weeks You get a callous that forms consisting of soft cartilage
• Soft cartilage is replaced by woven bone, this is quick to form but not stress oriented
• Remodelling occurs over years, this is where woven bone becomes lamella bone and it does according to wolff’s law e.g. according to stress

Question 5

Definition: Fracture

Answer 5

A disruption in bone continuity

Question 6

Definition: Dislocation

Answer 6

Complete loss of continuity of two bones forming a joint

Question 7

What do you call the partial loss of continuity of two bones forming a joint?

Answer 7

Subluxation

Question 8

What do you call a fracture consiting of multiple fragments

Answer 8

Comminution

Question 9

What do you call a fracture extending to a joint

Answer 9

Intra-articular

Question 10

Definition: Open Fracture

Answer 10

A fracture in direct communication with the open environment

Question 11

Congenital risk of fracture?

Answer 11

Osteogenesis imperfecta

Question 12

Aquired metabolic risk of fracture?

Answer 12

Rickets

Osteomalacia

Question 13

Aquired degenerative risk of fracture?

Answer 13

Osteoporosis

Question 14

Cancer related fracture risk?

Answer 14

A tumor in the bone can weaken the bone and increase risk of fracture

Question 15

Risk factors that increase risk of injury (not risk of fracture after injury)

Answer 15

• Visual impairment
• Drug/alcohol use
• Neuropathy
• Balance disorder
• Epilepsy

Question 16

Sex patterns with fracture numbers

Answer 16

When young more males tend to get fractures and they tend to be high energy

When old more females tend to get fractures and they tend to be low energy

Question 17

Wolff’s law

Answer 17

Woven bone orients into lamella bone based on the stress it experiences

Question 18

What is a non-union?

Answer 18

This is where there has been too much movement during the callus staging of bone healing. The movement means that osteogens become chondroblasts and never become osteoblasts. If this happens then woven bone never forms and you get a non-union

Question 19

6 extremely important life-threatening things to look out for during trauma

Answer 19

ATOM-FC

• Airway Obstruction
• Tension Pneumothorax
• Open Pneumothorax
• Massive Haemothorax
• Flail Chest
• Cardiac Tamponade

Do you know what each of these mean?

Question 20

Emergency department management of an open fracture

Answer 20

• IV antibiotics
• Anti tetanus
• Splint or cast
• Sterile dressing

Question 21

Surgical management of an open fracture

Answer 21

Primary

• Wound debridement (removal of all contaminants and dead tissue including bone)
• Skeletal stabilisation

Secondary

• Tissue inspection and further debridement
• Wound closure

Question 22

Compartment syndrome signs

Answer 22

• Pain abnormal to inury
• Muscles feel tight

Question 23

Compartment syndrome treatment

Answer 23

Required a fasciotomy

Question 24

Compartment syndrome red herring

Answer 24

Can still have a distal pulse, the pressure doesn’t necessarily cut off arterial flow. The localised hypoxia instead comes from decreased O2 perfusion due to a decreased perfusion pressure because of such high muscle pressure.