Injuries and management Flashcards
Key cases: Upper Limb
Case 1
Plane radiograph in left shoulder. Possibly dislocation.
Looking for humerus to articulate with the glenoid and if it doesn’t then it is a shoulder dislocation.
Note in normal arm-ball of humerus should be directly under the acromion.
SHOULDER DISLOCATION: OVERVIEW
- Often traumatic injury, if slender person it might be obvious.
- Have to do X-ray as can’t distinguish from fracture, as just pain and holding arm.
- Assess neurovascular status-axillary nerve. Test for sensation over regimental patch
SHOULDER DISLOCATION: TYPES
bimodal distribution so peaks in young and old
Light bulb sign-where humeral head looks different to how it should-this is rare and is often presented with seizure. Thoroughly assess patient as they may have had an undiagnosed seizure.
SHOULDER DISLOCATION: MANAGEMENT
In line traction is safest. Give muscle relaxants to make sure they are relaxed and it is gentle traction not hard tugging
One hand on affected limb and other arm pulls opposite way.
Stimson method used if don’t have helper.
CASE 1: REDUCTION
What does this show?
Y-view shows humeral head is lined up nicely.
In AP view can see little irregularity and also on true AP=Hill-Sachs defect.
SHOULDER DISLOCATION: COMPLICATIONS
Hill-sachs=damage to Humeral head
Bankart lesion=damage to labrum or glenoid
Shoulder Dislocation: Complications
Case 2-what does X-ray show?
Humeral head no longer looks the same as before, on Y view can see it isn’t lined up properly. Posterior dislocation-Light bulb defect.
Case 3
Plane radiograph-Can see a proximal humerus fracture. Not dislocated this time.
PROXIMAL HUMERUS FRACTURE: OVERVIEW
Typically this is caused by a fall onto an outstretched hand.
Elderly patient with osteoporosis so more likely to fracture humerus than dislocate wrist as younger person would.
GT=greater tuberosity
PROXIMAL HumerUS fracture: classification
PROXIMAL Humerus fracture: management
Case 4
Have an AP or AP and plane radiograph
Thumb is where radius is
Extraarticular ie not within articular surface of that bone. Need to work out which way it is displaced, so we look at radius long axis and distal fracture fragments. Distal fracture part is dorsally angled.
DISTAL RADIUS FRACTURE: OVERVIEW
DISTAL RADIUS FRACTURE: CLASSIFICATION
Is intra or extra and what way is it displaced?
volar=palmar
DISTAL RADIUS FRACTURE: MANAGEMENT
Case 5
Plane radiograph-can see irregularity in cortex of scaphoid bone.
Look at radius and ulna and then scaphoid and lunate. Can get dedicated view of scaphoid
CARPAL INJURY: OVERVIEW
Some lovers try positions that they can’t handle! Lateral to medial, lateral to medial.
UM of trapezium and thumb
SCAPHOID FRACTURE: OVERVIEW
palpate anatomical snuff box
Often don’t show up acutely on x-ray. Important as scaphoid has retrograde blood supply so proximal pole can have interupted blood supply so can undergo necrosis and will lose blood supply of radius.
SCAPHOID FRACTURE: MANAGEMENT
Case 6
Plane lateral view
Radial, lunate and capitate should line up
but in perilunate, only lunate and radius align, and in lunate disclocation, only capitate and radius align
PERILUNATE INSTABILITY: OVERVIEW
Perilunate vs Lunate dislocation
A perilunate dislocation is disruption of the normal relationship between the lunate and capitate. A lunate dislocation is separation of the lunate from both the capitate and the radius. Perilunate and lunate dislocations result when great force is applied to a hyperextended wrist.
PERILUNATE INSTABILITY: CLASSIFICATION
think clockwise from corner of lunate bone closest to thumb
PERILUNATE INSTABILITY: MANAGEMENT
Needs to be picked up, as beyond 8 weeks it has poor outcome.
Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery.
Key cases: Lower Limb
Case 7
PELVIC FRACTURE: OVERVIEW
PELVIC FRACTURE: CLASSIFICATION
PELVIC FRACTURE: MANAGEMENT
Closure of the pelvic ring is thought to tamponade (close off/block-think tampon) bleeding by diminishing the pelvic volume and accelerating the clotting of a pelvic hematoma.
Case 8
Shenton’s line goes from the medial aspect of the femur all the way up and down
PROXIMAL FEMUR FRACTURE: OVERVIEW
PROXIMAL FEMUR FRACTURE: ASSESSMENT
PROXIMAL FEMUR FRACTURE: PREOPERATIVE MANAGEMENT
PROXIMAL FEMUR FRACTURE: CLASSIFICATION
If a fracture occurs within the capsule, the blood supply to the femoral head can become compromised, so they can get avascular necrosis of the femoral head and have more oucomes.
Extracapsular fractures don’t compromise blood supply.
Proximal femur fracture: management
Extraarticular
-DHS=dynamic hip screw
Is used for intertrochanteric fractures, and the reason it’s used is because the screw goes in a perpendicular fashion to the fracture line, and therefore it applies a compression.
Whereas a nail would work for a fracture that isn’t perpendicular, so it’s the other way eg reverse oblique, because otherwise the DHS would slip.
PROXIMAL FEMUR FRACTURE: POSTOPERATIVE
CASE 9
FEMORAL SHAFT FRACTURE: OVERVIEW
FEMORAL SHAFT FRACTURE: MANAGEMENT
Intramedullary nail or ORIF
Case 10
TIBIAL PLATEAU FRACTURE: OVERVIEW
TIBIAL PLATEAU FRACTURE: CLASSIFICATION
TIBIAL PLATEAU FRACTURE: MANAGEMENT
Case 11:
ANKLE FRACTURE: OVERVIEW
ANKLE FRACTURE: CLASSIFICATION
ANKLE FRACTURE: MANAGEMENT
Case 12:
MAISONNEUVE FRACTURE: OVERVIEW
TAKE HOME MESSAGES
Extracapsular-don’t need to replace femoral head as blood supply is not compromised.
