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Acute Care > Limb Trauma > Flashcards

Limb Trauma Flashcards

1
Q

What is the mortality associated with #NOF?

A
  • 10% die within one month

- 25-30% die within one year

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2
Q

What are the risk factors for #NOF?

A
  • age
  • osteoporosis
  • osteomalacia
  • falls
  • instability
  • lack of core strength
  • gait abnormality
  • sensory impairment
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3
Q

How are #NOF classified and sub-classified?

A
  • Intracapsular
      • sub capital
      • transcervical
      • basal
  • Extracapsular
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4
Q

What are the clinical features of #NOF?

A
  • hip pain radiating to the knee
  • inability to weight bear
  • affected leg appears shortened, adducted and externally rotated
  • rotation is painful
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5
Q

How is #NOF diagnosed?

A
  • AP pelvic and lateral hip XR
  • CT to determine determine displacement and comminution
  • MRI useful in ruling out occult #, e.g. # suspected but not shown on XR
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6
Q

What is the initial management of #NOF?

A
  • ABCDE assessment and intervention
  • DVT assessment
  • ECG
  • adequate analgesia
  • early assessment for cognitive impairment
  • catheter
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7
Q

What are the principles of secondary management of #NOF?

A
  • surgery as soon as medically fit

- early mobilisation post-surgery

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8
Q

What surgeries may be used to manage #NOF and when is each type used?

A
  • Hemi- or total arthroplasty for intracapsular #
  • Dynamic hip screw fixation for extra capsular fracture
  • Cannulated screw fixation for undisplaced intra- or extra capsular #
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9
Q

Femoral # is almost always due to _____, e.g. ________

A

almost always due to high energy trauma

e.g. RTA, gunshot wound, fall from height

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10
Q

Where do pathological femoral # occur?

A

metaphyseal/diaphyseal junction

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11
Q

If the degree of trauma is inconsistent with the # that has been identified, what should you do?

A

Investigate to r/o pathological #

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12
Q

What are the clinical features of femoral fracture?

A
  • pain
  • swelling
  • deformity: complete external rotation
  • shorting of the affected leg
  • features of shock due to haemorrhagic hypovolaemia (up to 1.5L loss)
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13
Q

How is femoral # in children managed?

A
  • r/o NAI
  • gallows traction for children <2y
  • hip spica
  • external fixation, plate or elastic nails in older children
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14
Q

What is a Salter-Harris Type I injury? and what is the prognosis?

A

Injury straight through the growth plate (physis) - excellent prognosis, managed non-operatively

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15
Q

What is a Salter-Harris Type II injury? and what is the prognosis?

A

Injury above the growth plate (involving the physis and metaphysis) - excellent prognosis, managed non-operatively

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16
Q

What is a Salter-Harris Type III injury? and what is the prognosis?

A

Injury lower than the growth plate (involving the physis and epiphysis, extending into the joint) - often unstable

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17
Q

What is a Salter-Harris Type IV injury? and what is the prognosis?

A

Injury through the growth plate (involving metaphysis, physis, epiphysis and joint surface) - prone to limb length discrepancies

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18
Q

What is a Salter-Harris Type V injury? and what is the prognosis?

A

Crush injury resulting in erasure of the growth plate (physis) - prone to limb length discrepancies

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19
Q

What are the most common acute knee injuries?

A
  • acute patellar dislocation
  • collateral ligament rupture
  • contusion
  • meniscus injury
  • ACL injury
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20
Q

How is patellar dislocation managed?

A
  • brace for 2-4 weeks

- physiotherapy

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21
Q

How are collateral ligament ruptures managed?

A
  • brace if the knee is lax

- physiotherapy

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22
Q

How do ACL injuries occur?

A
  • twisting injuries e.g. changing direction suddenly while running, tackles in football
  • hyperextension of the knee due to a fixed foot and onward motion of rest of the body e.g. skiing, landing incorrectly from a jump
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23
Q

What are the most common long bone fractures?

A

tibia and fibula

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24
Q

What is the management of knee injuries?

A
  • investigate with MRI
  • rest
  • ligament repair if indicated
  • arthroscopic intervention if meniscal injury
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25
Q

What percentage of tibial fractures are open?

A

23%

26
Q

What are the common causes of tibia/fibula #?

A
  • RTA
  • Sports
  • Assault
  • Falls
27
Q

What are the clinical features of tibia/fibular #?

A
  • pain

- deformity

28
Q

How are suspected tibia/fibula # investigated?

A
  • acute: AP and lateral view XR

- delayed: AP, lateral and oblique view XR showing knee and ankle joints

29
Q

What are the indications for managing a tibia/fibular # with closed reduction under GA and a long leg cast?

A
  • closed #
  • undisplaced or minor-moderate displacement
  • low energy trauma
  • young adults
30
Q

When is ORIF indicated for tibia/fibula #?

A
  • vascular or neural injuries
  • segmental #
  • inadequate reduction
  • displaced intra-articular #
31
Q

What is a tibial plafond #?

A

Intra-articular distal tibia #

32
Q

What is a tibial plateau #?

A

Intra-articular proximal tibia #

33
Q

What are the potential complications of tibial #?

A
  • compartment syndrome
  • delayed union
  • non-union
  • malunion
  • shortening
  • infection
  • joint stiffness
  • refracture
  • fat embolism
34
Q

How are ankle fractures classified?

A

Danis-Weber classification

35
Q

What is a Weber A #? what is their prognosis?

A

of the lateral malleolus distal to the syndesmosis

usually stable so can be treated in below knee cast or boot for 6 weeks

36
Q

What is a Weber B #? what is their prognosis?

A

of the fibula at the level of the syndesmosis

variable stability - may be possible to treat with immobilisation or may need surgery

37
Q

What is a Weber C #? what is their prognosis?

A

fibula # proximal to the syndesmosis

unstable - required ORIF

38
Q

What is a Pilon #? how do they occur and what is their prognosis?

A

intra-articular distal tibia #

caused by rotational or axial forces

often co-morbid with other associated injuries, often produce comminution

requires emergency orthopaedic consult, immobilisation and likely surgery

39
Q

A major complication of displaced talar fractures is _____

A

avascular necrosis

40
Q

How are calcaneal # managed?

A
  • non WB immobilisation for 12 weeks

- fixation if articular surface affected (to reduce future arthritis)

41
Q

How are undisplaced metatarsal # managed?

A

conservative

BK cast or boot

42
Q

How are phalangeal # managed?

A

neighbour strapping

43
Q

What are the 6 basic steps to describe a #?

A
  1. which bone?
  2. where on the bone? (think in thirds)
  3. type of fracture?
  4. number of fragments?
  5. any displacement?
  6. intra-articular involvement?
44
Q

What are the types of fracture displacement?

A
  • translation (post/ant, med/lat, rad/uln)
  • angulation
  • distraction
  • shortening
  • rotation
45
Q

What are the types of complete fracture? Describe them

A

Transverse: fracture at right angles to the shaft
Oblique: fracture at an angle to the shaft
Spiral: caused by twisting injury
Comminuted: 2 or more bone fragments
Impacted: fractured bone forced together

46
Q

Displacement of a # is described in terms of the distal fragment in comparison to the proximal fragment. True or false?

A

True

47
Q

What does a DEXA scan measure?

A

bone mineral density

48
Q

What does the t score from a DEXA scan represent?

A

how many SD the individuals BMD is from the ideal BMD

49
Q

What does the z score from a DEXA scan represent?

A

how many SD the individuals BMD is from that of comparable individuals (matched for sex and age)

50
Q

What are the types of incomplete fracture? Describe them

A

Torus/Buckle: a bulge in the cortex
Bowing: associated bend in the bone shaft
Greenstick: bending of the shaft with a fracture on the convex surface
Salter-Harris: involving the growth plate

51
Q

Adults are more likely to sustain incomplete fractures than children, due to their greater bone mineral density. True or false?

A

False - incomplete fractures most commonly occur in children

52
Q

There is a greater risk of infection with closed fractures. True or false?

A

False - there is a greater risk of infection with open fractures

53
Q

What are the components of the ABCS approach to XR interpretation?

A

Alignment and joint space
Bone texture
Cortices
Soft tissues

54
Q

How would you interpret a DEXA t score?

A

T-score of -1.0 or above = normal bone density
T-score between -1.0 and -2.5 = low bone density, or osteopenia
T-score of -2.5 or lower = osteoporosis

55
Q

How long do fractures in smaller bones e.g. the clavicle take to heal?

A

~6weeks

56
Q

How long to fractures in long bones e.g. the femur take to heal?

A

12-18weeks

57
Q

What does it mean if a fracture is “off-ended”?

A

If the distal fragment is translated further than the width of the bone, it is said to be ‘off-ended’

58
Q

In a flexor tendon injury to the hand, what will be the impact on passive and active movements?

A
  • passive unaffected (but may be painful)

- active impaired

59
Q

How do you test whether flexor digitorus profundus is intact?

A
  • Immobilise MCP, PIP and ask patient to flex DIP

- If possible to flex then FDP is at least partially intact and able to pull on the PP

60
Q

How do you test whether flexor digitorus superficialis is intact?

A
  • Fix all but suspect finger in the extended position to remove the effect of FDP (mass action muscle, no independent action) and ask patient to flex suspect finger
  • If FDS is not intact then patient cannot flex the finger
61
Q

What is the “fallout sign”?

A

Abnormal cascade of digits of the hand due to both flexor tendons being severed

62
Q

How does the shoulder typically dislocate?

A

Anteriorly

Acute Care (4 decks)

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