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MSK CORTEXT > 6- Trauma > Flashcards

6- Trauma Flashcards

1
Q

What is involved in the primary survey in a trauma case

A

Quick assessment of vital functions and any appropriate management
ABCDE

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2
Q

What is involved in the secondary survey in a trauma case

A

Head to toe survey to detect any other injuries

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3
Q

What are the presentations of hypovolemia

A

Tachycardia
Hypotension
Confusion and lethargy

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4
Q

What score determines level of consciousness

A

Glasgow Coma score

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5
Q

Define polytrauma

A

More than one ling bone injured
OR
major fracture and associated chest or abdominal trauma

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6
Q

Describe primary healing of a fracture

A

Occurs when there is minimal fracture gap

Bone simply bridges gap with new bone from osteoblasts

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7
Q

Describe secondary healing of a fracture

A

Gap at fracture site is filled temporarily to act as a scaffold for new bone
Involves an inflammatory response

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8
Q

List the steps of secondary bone healing

A

Haematoma and inflammation occur
Macrophages & osteoclasts remove debris and resorb bone ends
Granulation tissue forms from fibroblasts
Chondroblasts form cartilage (soft callus)
Osteoblasts lay down bone matrix
Calcium minerlisation produces hard callus (woven bone)
Remodelling occurs into lamellar bone

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9
Q

How long does it take the hard callus to form in a fracture

A

6-12 weeks

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10
Q

Smoking impairs fracture healing - true or false

A

True

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11
Q

What is a transverse fracture

A

Occurs with pure bending force

Snaps across bone (horizontal)

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12
Q

What is an oblique fracture

A

Occurs with shearing force - fall from height

Diagonal fracture

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13
Q

What causes a spiral fracture

A

Torsional forces

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14
Q

What is a comminuted fracture

A

Fracture with 3 or more fragments
Very unstable
Usually very high energy

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15
Q

What is a segmental fracture

A

Bone fractures in 2 separate places

Very unstable

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16
Q

What is the angulation of a fracture

A

Describes the direction in which the distal fragment points and the degree of deformity

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17
Q

What are the clinical signs of a fracture

A

Localised bony tenderness
Swelling
Deformity
Crepitus

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18
Q

List some early local complications of fractures

A

Compartment syndrome
Vascular injury with ischaemia
Nerve compression or injury
Skin necrosis

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19
Q

List some early systemic complications of fractures

A 
Hypovolemia 
Fat embolism 
ARDS 
SIRDS 
acute renal failure 
MODS 
Death
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20
Q

List some late local complications of fractures

A

stiffness, loss of function, Chronic Regional Pain Syndrome, infection, non‐union, mal‐union, Volkmann’s ischaemic contracture, post traumatic osteoarthritis and deep vein thrombosis.

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21
Q

List late systemic complications of fractures .

A

Pulmonary embolism

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22
Q

What are the signs of compartment syndrome

A

Increased pain on stretching
Severe pain out with the clinical context
Swelling
Tender to touch

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23
Q

What causes compartment syndrome

A

Bleeding and exudate (due to fracture or other injury) compresses the venous system
This results in congestion in the muscle and secondary ischaemia

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24
Q

Which injuries are associated with vascular injury

A

Knee dislocation
Supracondylar fracture of elbow in kids
Shoulder trauma
Pelvic fractures

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25
What is degloving
Avulsion of skin from underlying blood vessels | Can result in skin ischaemia and necrosis
26
What are the clinical signs of fracture non-union
ongoing pain ongoing oedema movement at fracture site Bridging callus on imaging
27
What are the symptoms and signs of a fracture healing
Resolution of pain and function Absence of point tenderness No local oedema Resolution of movement at fracture site
28
What can lead to non-union of a fracture
``` Instability Excessive movement at fracture site Lack of blood supply Chronic disease Soft tissue problems Infection ```
29
What is complex regional pain syndrome
Heightened chronic pain response that occurs after injury | poorly understood and hard to treat
30
What is the major complication with an open fracture
Infection
31
How do you prevent infection with an open fracture
IV broad spectrum antibiotics in A&E | Prompt surgery
32
What does delayed presentation of dislocation increase risk of
Requirement of open reduction | Recurrent instability
33
What is the mainstay of treatment for soft tissue injuries
RICE | rest, ice, compression and elevation
34
How do you grade ligament ruptures
Grade 1 - sprain Grade 2 - partial tear Grade 3 - complete tear
35
How does septic arthritis present
Red, hot, tender, swollen joint | Severe pain
36
Who is the most prone to septic arthritis
More common in kids than adults Elderly, IVDU, immunocompromised patients
37
What is the most common cause of C spine fractures
High energy injury | E.g. RTA or fall from height
38
What is the most common cause of thoracolumbar fractures
Car accidents Falls from height In elderly with osteoporosis - compression or wedge
39
What is spinal shock
Physiologic response to injury | Complete loss of sensation, motor function and reflexes below level of injury
40
How long does it usually take spinal shock to resolve
24 hours
41
What reflex is lost in spinal shock
bulbocavernous
42
When does neurogenic shock occur
Secodnary to temporary shutdown of sympathetic outflow from the spinal chord from T1-L2 Usually due to cervical or thoracic chord injury
43
How do you treat neurogenic shock
IV fluid therapy
44
What are the classifications of spinal cord injury
Complete or incomplete
45
Describe a complete spinal cord injury
There will be no sensory or voluntary motor function below level of injury Poor prognosis for recovery
46
Describe an incomplete spinal cord injury
Some neurological function is present distal to injury | Better prognosis for recovery
47
How do you treat a spinal cord injury
Appropriate immobilisation Traction - if dislocated or unstable Surgery - relieve pressure
48
What is the most common injury mechanism for proximal humerus fractures
low energy injuries in osteoporotic bone due to fall onto outstretched hand or shoulder
49
What is the most common fracture pattern for proximal humerus
Fracture of the surgical neck | Medial displacement of humeral shaft
50
How do you treat a proximal humeral fracture
Minimally displaced - sling and gradual mobilisation | Displaced - internal fixation
51
What is a Bankart lesion
Detachment of the anterior glenoid labrum and capsule | Common in anterior shoulder dislocation
52
What is the main sign of axillary nerve injury
Loss of sensation in the regimental badge area
53
How do you manage a dislocated shoulder
Closed reduction under sedation or anaesthetic If delayed presentation then it may need to be an open reduction
54
How ACJ injuries occur
Fall onto the point of the shoulder | Common in sport
55
What type of injury can occur in the ACJ
Sprain Subluxation - ruptures the acromioclavicular ligaments Dislocation - disrupts coraclavicular ligaments as well as AC
56
How do you treat injury to the ACJ
Sling for a few weeks followed by physio Surgery in those with chronic pain
57
What can cause a humeral shaft fracture
Direct trauma - gives transverse of comminuted fracture Fall with or without twist - oblique or spiral
58
How do you treat humeral shaft fractures
Humeral brace - most cases | Internal fixation
59
How do olecranon fractures occur
Fall onto the point of elbow | With contraction of the triceps
60
What is a Nightstick fracture
Fracture to ulnar shaft caused by direct blow
61
How do you treat a fracture of both arms of the forearm
ORIF with plates and screws
62
What is ORIF
open reduction with internal fixation
63
What is a Monteggia fracture dislocation
Fracture of the ulna with dislocation of radial head at elbow
64
How do you treat a Monteggia fracture dislocation
ORIF of ulnar fracture | reduction of joint
65
What is a Galeazzi fracture dislocation
fracture of the radius with dislocation of the ulna at the distal radioulnar joint
66
How do you treat a Galeazzi fracture dislocation
ORIF of radius | should allow radioulnar joint to reduce
67
What is a Colles fracture
Extra‐articular fracture of the distal radius within an inch of the articular surface and with dorsal displacement or angulation
68
What causes a Colles fracture
FOOSH with extended wrist
69
How do you treat a Colles fracture
Minimally displaced - splint Casts Percutaneous wires
70
What is a Smith's fracture
volarly displaced or angulated extra‐articular fracture of the distal radius Very unstable
71
What causes a Smith's fracture
Falling onto the back of a flexed wrist
72
How do you treat a Smith's fracture
ORIF with plates and screws
73
What usually causes a scaphoid fracture
FOOSH
74
What are the signs of a scaphoid fracture
Tenderness in anatomical snuffbox | Pain on compression of thumb metacarpal
75
How do you treat a scaphoid fracture
Plaster cast for 6-12 weeks
76
List some potential complications of scaphoid fractures
Non-union | AVN
77
What are the risks of a penetrating injury to the volar aspect of the hand
Damage to the flexor tendons, digital nerves and digital arteries
78
What are the risks of a penetrating injury to the dorsal aspect of the hand
Damage to extensor tendons
79
How do you treat an extensor tendon injury
Surgical repair | 6 weeks in the splint
80
What is mallet finger
Avulsion of the extensor tendon from its insertion into the terminal phalanx
81
What causes mallet finger
Forced flexion of the extended DIPJ, often from a ball at sport
82
How does mallet finger present
Pain Drooped DIPJ Inability to extend at the DIPJ
83
How do you treat mallet finger
Mallet splint for 4 weeks
84
What is the most common cause of a 5th metacarpal fracture
Punching injury | also called Boxer's fracture
85
What is a fight bite?
Occurs in association with Boxer's fracture Laceration on puncher's hand from victims teeth Can get infected
86
How do you treat metacarpal fractures
Strapping to neighbouring digit
87
How do you treat a phalangeal fracture
Neighbour strapping or splintage | May need wires or fixing if unstable
88
Children's fractures heal faster than adults fractures - true or false
True
89
Why do children's fractures heal faster
Thicker periosteum which has a rich source of osteoblasts | Much better at remodelling
90
What are the benefits of the remodelling potential in children
Need surgical stabilisation less | Greater degrees of displacement and angulation can heal
91
What is the major risk with fractures around the physis
Potential to disturb growth | Can lead to a shortened limb or angular deformity
92
How do you treat buckle fractures
3-4 weeks of splintage
93
How do you treat greenstick fracture
May need manipulation and casting
94
Why are supracondylar fractures common in kids
Weak point in the growing upper limb | Occurs on FOOSH or less commonly fall onto flexed elbow
95
How do you treat an undisplaced supracondylar fracture
Stable so treated with a splint
96
How do you treat an displaced or angulated supracondylar fracture
Closed reduction and pinning with wires to stop deformity
97
How do femoral shaft fractures in children occur
Fall onto flexed knee | Indirect bending Rotational forces
98
How do you treat a femoral shaft fracture in kids
``` By age <2 - gallows traction and hip cast 2-6 - Thomas splint or cast 6-12 flexible intermedullary nails 12> - adult type intermedullary nail ```
99
What must you consider with femoral shaft fractures in the under 2's
non-accidental injury
100
How do you treat a tibial fracture in kids
Casting for a short time | Nails etc if very unstable
101
How do hip fractures usually occur
Young - high energy injury (RTA) Elderly - low energy falls if osteoporotic
102
What is a lateral compression fracture
Occurs with side impact One half of pelvis is displaced medially Often accompanied by sacral compression fracture or SI joint issues
103
What is a vertical shear fracture
Occurs due to axial force on one hemipelvis Affected hemipelvis is displaced superiorly High risk of injury to sacral nerve roots or lumbosacral plexus
104
What is a anteroposterior compression injury
Results in wide disruption of pubic symphysis Pelvis opens like book Leads to substantial bleeding
105
What is the acetabulum
The intra-articular section of the pelvis | Forms the 'cup' in the hip joint
106
How do acetabular injuries usually occur
High energy injury in young or low energy in elderly | Associated with hip dislocation as femoral head breaks it when it pops out
107
How do you treat acetabular fractures
Undisplaced - conservatively May need reduction and fixation THR in elderly
108
What is the most common cause of hip fractures
Osteoporosis in the elderly
109
What sex is more prone to hip fractures
Females
110
Is management of hip fractures surgical or conservative
Almost always surgical - within 24 hrs
111
How do you classify hip fractures
Intracapsular or extracapsular
112
What normally causes femoral shaft fractures
High energy injury | Stress fracture in those with underlying bone disease
113
What is the major risk with displaced femoral shaft fractures
Significant blood loss
114
How do you manage a femoral shaft fracture
Analgesia Thomas splint Closed reduction and stabilisation with intramedullary nail
115
How do you treat a true knee dislocation
It is a surgical emergency due to vascular risk Urgent reduction If unstable then use fixation
116
what predisposes you to a patellar fracture
Generalised ligamentous laxity Valgus alignment of the knee Rotational malalignment (including femoral neck anteversion), Shallow trochlear groove.
117
Describe a tibial plateau fracture
Intra‐articular fractures with either a split in the bone, a depression of the articular surface or a combination of both
118
How do you treat a tibial plateau
Surgery to reduce the articular surface and fix it for stabilisation
119
What are some of the other risks with tibial plateau fractures
Neurovascular injury | Compartment syndrome
120
What usually causes a tibial shaft fracture
Indirect force Bending (transverse fracture) or rotational energy (spiral fracture), compressive force from deceleration (oblique fracture) or a combination
121
What is the commonest cause of compartment syndrome after trauma
Tibial shaft fracture
122
Describe the non-operative treatment of tibial shaft fracture
Repositioning Above knee cast
123
Describe the operative treatment of tibial shaft fracture
Internal fixation Surgical stabilisation - ORIF Intermedullary nails
124
What are Pilon fractures
Intra-articular fractures of the distal tibia
125
What movement most commonly causes ankle injury
inversion injury and/or rotational force on a planted foot.
126
What is the key symptom of ankle sprain
Pain, bruising and mild to moderate tenderness over the involved ligaments
127
What is the treatment for a stable ankle fracture
Walking cast or splint for around 6 weeks
128
What is the treatment for an unstable ankle fracture
ORIF - plates and screws | anatomical reduction
129
How does a midfoot dislocation/fracture present
Grossly swollen and bruised foot Unable to weight bear X-ray may appear normal
130
How do you treat a midfoot dislocation/fracture
Closed or open reduction with fixation (screws)
131
Describe common metatarsal fractures
base of 5th common - inversion injury 2nd is common place for stress fracture Lesser ones common to fracture but 1st is uncommon as so strong
132
How do you treat metatarsal fractures
Walking cast or boot - 4-6 weeks | Stabilized with K wires
133
How do you treat a toe fracture
Protection in stout boot Open fractures need debridement and stabilisation with wires

MSK CORTEXT (13 decks)

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