CORTEXT: Trauma Flashcards
1
Q
what is remodelling of bone?
A
change shape with bone laid down along areas of stress
2
Q
what is the main role of the periosteum?
A
increases width/circumference of growing long bones
3
Q
do adults or children have a thicker periosteum?
A
children
4
Q
what would you do if a child had a moderate displaced fracture?
A
just cast them, bone can remodel better than adults
5
Q
when would a child’s fracture be treated as an adults fracture?
A
12-14
6
Q
what causes an angular deformity?
A
one side of the physis affected by growth arrest
7
Q
which salter harris fracture has the best prognosis?
A
salter harris 1 fracture
8
Q
which salter harris type are most physeal fractures?
A
type 2
9
Q
what salter harris type are unable to be seen on x ray?
A
type 5
10
Q
why is there greater potential for growth arrest in type 3 and 4 salter harris fractures?
A
fracture splits the physis as they are intraarticular
11
Q
how long should a splint be left on for a buckle fracture?
A
3-4 weeks
12
Q
treatment for greenstick fractures?
A
manipulation and casting
13
Q
name a common area for a salter haris type 2 fracture in older children?
A
distal radius
14
Q
what would you do if a complete fracture is very unstable after reduction
A
do wire stabilisation or plate fixation
15
Q
what are the only type of fractures to be improved by 1st line recuction and rigid fixation?
A
monteggia and galeazzi fractures
16
Q
how should a displaced fracture of both forearm bones be managed?
A
flexible intramedullary nails
17
Q
how should an angulated fracture of both forearm bones be managed?
A
manipulation then cast
18
Q
what movement tends to cause a supracondylar elbow fracture?
A
heavy fall onto extended outstretched hand
19
Q
how to treat undisplaced supracondylar fracture of the elbow?
A
splint
20
Q
how to treat angulated, displaced or rotated fractures of the supracondylar elbow?
A
closed reduction and pinning with wires
21
Q
why can some patients with an extension type supracondylar elbow fracture not make the OK sign?
A
median nerve and brachial artery are compressed by a fragment of bone
22
Q
what nerve injuries make up the majority in a supracondylar fracture of the elbow?
A
neurapraxias
23
Q
what symptoms would make you consider nerve entrapment from a fracture?
A
unpleasant shooting or burning pain radiating to the sensory distribution of the nerve
24
Q
most common movement causing a femoral shaft fracture?
A
flexed knee
25
most common cause of femoral shaft fracture in kids under 2
NAI
26
treatment for femoral shaft fracture in kids aged 2-6?
thomas splint
| hip spica cast
27
treatment for femoral shaft fractures in kids under 2?
hip spica
| gallows traction
28
treatment for kids age 6-12 for femoral shaft fracture?
flexible intramedullary nails
29
treatment for femoral shaft fracture in kids over 12?
adult intramedullary nail
30
what is a toddlers fracture?
undisplaced spiral fractures of tibial shaft
31
mainstay treatment for tibial fractures for kids?
cast
32
why do you not treat adults in a cast for tibial fractures?
risk of compartment syndrome much higher
33
name the 4 ways in which the spinal cord can get damaged?
contusion
compression
laceration
stretch
34
what is spinal shock?
physiologic response to injury with loss of sensation, motor function and reflexes below the level of injury
35
how long does spinal shock take to recovr?
24hrs
36
what test would you use to see if spinal shock is present?
bulbocavernous reflex to see if anal spincter contracts
37
neurogenic shock occurs secondary to temporary shutdown of x outflow from what nerve roots?
x = sympathetic
| T1-L2
38
injury in what area is most likely to cause neurgenic shock?
cervical or upper thoracic cord
39
how long does it take for neurogenic shock to resolve itself?
24-48hrs
40
treatment for neurogenic shock?
IV fluid therapy
41
difference between complete and incomplete spinal cord injury?
no sensory or voluntary motor function below level of injury in complete BUT in incomplete there is still some neurologic function distal to injury
42
how do you determine the level of the injury in complete spinal cord injury?
most distal spinal cord level with partial function
43
what vessels are at risk in a pelvic fracture?
internal iliac arterial system
| pre sacral venous plexus
44
3 main patterns of injury to the pelvis?
lateral compression fracture
vertical shear fracture
anteroposterior compression injury
45
cause of a lateral compression fracture of pelvis?
side impact eg in RTA
46
cause of a vertical shear fracture?
axial force on one hemipelvis eg in fall from heigh, rapid deceleration
47
if a lateral compression fracture is in the pubic rami or ischium, what else are the going to have?
SI joint disruption or
| sacral compression fracture
48
what of the 3 pelvis fractures will present with a shortened leg?
vertical shear
49
what pelvic fracture is described as an open book fracture due to the way the pelvis moves after injury?
anterioposterior compression injury
50
immediate management of a fractured pelvis?
fluids/transfusion if blood loss
apply tied sheet or pelvic binder around it
angiogram/embolisation if bleeding
PR exam
51
what would rectal bleeding after pelvic injury suggest?
open fracture causing rectal tear
52
most common pelvic fracture to occur in elderly?
minimally displaced lateral compression injuries
53
what other pathologies can be present in a posterior wall fracture?
hip dislocation
54
can acetabular fractures be treated conservatively?
yes, if small and undisplaced
55
are proximal humerus fractures usually high or low energy?
low, usually osteoporotic
56
is fracture of the surgical or anatomical neck of the humerus more common
surgical
57
does the humerus tend to displace medially or laterally
medially
58
treatment for displaced humeral neck fractures?
internal fixation
59
what do you could an impaction fractue of the posterior head of the humerus?
hill sachs lesion
60
principle sign of axilalry nerve injury?
loss of sensation in regimental badge area
61
what fractures can happen along with a shoulder dislocation?
surgical neck
| greater tuberosity
62
treatment for shoulder dislocation?
closed reduction under anaesthetic
| sling for 2-3 weeks
63
is age inversely proportional to likelihood of future dislocation?
yes
64
what causes posterior shoulder dislocations?
posterior force on an adducted, internally rotated arm
65
3 forms of injury that can happen to the AC joint?
sprain
subluxation
dislocation
66
treatment for AC joint injury?
sling
| physio
67
what is the only fracture alignment that can increase bone length?
distraction
68
what would you call a fracture that has shortened the overall bone but hasnt affected the alignment?
impacted fracture
69
what is an avulsion fracture?
ligament or tendon pulling off a bone fragment
70
cause of a stress fracture?
permanent low impact trauma to normal bone
71
only visible x ray abnormality of a stress fracture?
subtle calcification of periosteum
72
what do you call a transverse and partially comminuted fracture of the radius?
colles fracture
73
what other fracture is common along with a colles fracture?
transverse fracture of ulnar styloid
74
how is the distal radius' position changed as a result of a colles fracture?
dorsal displacement
| angulation
75
what is diastasis?
separation of 2 normally adjacent parts
76
treatment for mild and severe colles fractures?
```
mild = splintage
severe = manipulation then ORIF/percutaneous wires
```
77
what nerve injury can happen with a colles fracture and why?
median nerve compression via stretched nerve/carpal tunnel bleed
78
late local complication of colles fracture?
extensor pollicis longus rupture
79
what happens to the distal radius in a smith's fracture?
it is volarly displaced/angulated
80
where is the volar surface of the wrist?
the side on the same as the palm
81
treatment for smiths fracture?
ORIF using plate and screws
82
which of these fractures is intraarticular?:
bartons
smiths
colles
bartons
83
what area of the body does a bartons fracture affect?
distal radius
84
another name for a volar bartons fracture?
intraarticular smiths fracture
85
clinical signs of a scaphoid fracture?
tenderness in anatomical snuffbox
| pain on compression of thumb
86
the anatomic snuffbox is located between which tendons?
abductor pollicis brevis
| extensor pollicis longus
87
how many views are taken of a scaphoid fracture? what are they?
4: AP, lateral, 2 obliques
88
what is a clinical scaphoid fracture?
suspected scaphoid fracture that doesn't appear on x ray
89
treatment for undisplaced scaphoid fractures?
plaster cast for 6-12 weeks
90
treatment for displaced scaphoid fractures?
fixation with special compression screw
91
what structure(s) are at risk of injury in a volar fracture of the hand?
flexor tendons
digital nerves
digital arteries
92
what structure(s) are at risk of injury in a dorsal hand fracture?
extensor tendons
93
how do you manage a complete or significant partial tendon injury?
surgical repair always
94
clinical presentation of mallet finger?
pain
drooped DIPJ
inability to extend at DIPJ
95
most common cause of a 5th metacarpal fracture?
punching
96
what metacarpal fractures are treated conservatively?
3, 4, 5
97
what is a fight bite?
punchee's teeth penetrating tendons in finger?
98
mortality from a hip fracture at 1 month?
10%
99
mortality from a hip fracture at four months?
20%
100
mortality from a hip fracture at one year?
30%
101
arterial supply to the femoral head?
anastomosis of the circumflex femoral arteries (branch of deep femoral artery)
102
what type of hip fracture poses a risk to the arterial supply of the femoral head?
intracapsular
103
what type of hip fracture poses a risk of avascular necrosis?
intracapsular
104
treatment for extracapsular hip fracture?
internal fixation
105
what medication can cause a femoral shaft fracture?
bisphosphonates long term
106
why are thomas' splints good for emergencies?
stabilises a fracture to minimise blood loss and fat embolism
107
management of femoral shaft fracture?
closed reduction and stabilisation with intramedullary nail
108
treatment for unstable knee dislocation?
external fixation
109
what ligament injuries make the knee particularly unstable?
PCL
| LCL
110
do you get a haemarthrosis in patellar dislocation?
yes
111
clinical presentation of patellar dislocation?
obviously displaced patella
tenderness over medial retinaculum
haemarthrosis
112
treatment for patellar dislocation?
splintage then physio
113
are tibial plateau fractures intra or extraarticular?
intra
114
most common management for intraarticular fractures?
surgical fixation to reduce articular surface
115
cause of a lateral plateau fracture?
valgus stress injury
116
what fracture is a blow from a car bumper most likely to cause?
proximal fibular
117
what tools are used in surgical fixation of a tibial plateau fracture?
plates and screws
118
what should be checked before starting ORIF?
check for soft tissue swelling or injury
119
what kind of force is the most likely cause of a transverse tibial shaft fracture?
bending
120
what kind of force is the most likely cause of a spiral tibial shaft fracture?
rotation
121
what kind of force is the most likely cause of a oblique tibial shaft fracture?
compressive eg by deceleration
122
can you get open tibial fractures?
yes, not uncommon as tibia is subcutaneous
123
commonest cause of compartment syndrome after trauma?
tibial fracture
124
how much displacement and angulation of the tibia is tolerated to be conservatively treated?
50% displacement
| 5 degree angulation
125
operative management of tibial fractures?
internal fixation
126
method of surgical stabilisation used for tibial shaft fractures?
intramedullary nailing
127
how can non unions be managed in tibial fractures?
bone grafting
| special circular frames
128
clinical presentation of an ankle sprain?
pain
bruising
mild to moderate tenderness
129
what symptoms would make you give an x ray for an ankle fracture?
severe localised tenderness of the distal tibia/fibula
| inability to weight bear for 4 steps
130
what ankle fractures are deemed to be unstable?
distal fibular fractures with rupture of deltoid ligament
131
what management is needed for any talar shift?
anatomic reduction
| rigid internal fixation
132
management for bimalleolar fractures?
ORIF
133
major association with a base of 2nd metatarsal fracture?
2nd base of metatarsal dislocation
134
what does a metatarsal fracture look like on x ray?
normal usually
135
clinical presentation of metatarsal fracture?
swollen
bruised
unable to weight bear
136
most common site for a stress fracture in the foot?
2nd metatarsal
