MSK trauma

Question 1

Blood loss from femur fracture

Answer 1

Up to 2L

Question 2

Blood loss from tibia fracture

Answer 2

Up to 1.5L

Question 3

Do not use traction splint for fractures if

Answer 3

combined femur and tibial fractures in same extremity

Question 4

Stopping extremity bleeding, 4 methods in order of use:

Answer 4

1. Manual pressure to the wound
2. Pressure dressing
3. Compression of the artery proximal to injury
4. Tourniquet

Question 5

Life threatening extremity injuries

Answer 5

Major arterial haemorrhage
Bilateral femoral fractures
Crush syndrome
Pelvic disruption

Question 6

Management of fracture with open haemorrhaging wound

Answer 6

Realign and splint it
Second person applies direct pressure to open wound
Reduce joint dislocations when possible

Question 7

Management of crush syndrome (traumatic rhabdomyolysis)

Answer 7

Early, aggressive fluid therapy
Intravascular fluid expansion

Question 8

Fracture immobilisation

Answer 8

Apply inline traction to realign the extremit, maintain traction with an immobilisation device

Apply splint to control bleeding, reduce pain and prevent complications
(prevent motion at fracture site)

Question 9

Management of open fracture

Answer 9

Reduce fracture
Pull bone ends back into the wound
Clean the wound
Administer antibiotics
Attempt to reduce joint dislocations if possible

Question 10

Shoulder dislocation appearance

Answer 10

Anterior: squared off
Posterior: locked in internal rotation

Question 11

Elbow dislocation appearance

Answer 11

Posterior: olecranon prominent posteriorly

Question 12

Hip dislocation appearance

Answer 12

Anterior: extended, abducted, externally rotated
Posterior: flexed, adducted, internally rotated

Question 13

Knee dislocation appearance

Answer 13

Loss of normal contour, extended

Question 14

Ankle dislocation appearance

Answer 14

Lateral is most common: externally rotated, prominent medial malleolus

Question 15

Subtalar joint dislocation appearance

Answer 15

Lateral is most common: laterally displaced calcaneus

Question 16

Logical systematic review of each extremity

Answer 16

Skin
Neuromuscular function
Circulatory status
Skeletal and ligamentous integrity

Question 17

Management open fracture (basic)

Answer 17

IV abx
Clean wound and cover with moist sterile dressing
Immobilise extremity
Request surgical consult or arrange for transfer

Question 18

Signs of non occlusive vascular injury in extremity

Answer 18

Cool
Prolonged CRT
Diminished peripheral pulses
Abnormal ankle/brachial index

Question 19

In vascular injury, operative revascularisation should happen within

Answer 19

6 hours

Question 20

Common areas of compartment syndrome

Answer 20

Lower leg (tibia fracture)
Forearm

Question 21

Signs and symptoms of compartment syndrome

Answer 21

Pain out of proportion
Pain on passive stretch of affected muscle
Tense swelling of affected compartment
Paraesthesias or altered sensation distal to affected compartment

Question 22

Immobilisation of fracture must include

Answer 22

Joint above and below

Question 23

Immobilisation guidelines for knee

Answer 23

Commercial immobiliser or posterior long-leg plaster splint
Allow 10 degrees of flexion

Question 24

Ankle immobilisation guidance

Answer 24

Use a well padded splint

Question 25

Forearm and wrist fracture immobilisation guidance

Answer 25

Padded or pillow splints Splitn wrist and fingers in functional position if possible

Question 26

Elbow immobilisation guidance

Answer 26

Partially flexed, with padded splints or direct immobilisation with respect to the body usinga sling-and-swath device

Question 27

Upper arm and shoulder immobilisation device

Answer 27

Sling-and-swath

Question 28

Hand injury immobilisation guidance

Answer 28

Wrist dorsiflexed and fingers gently flexed 45 degrees at the MCP joint - immobilise hand over a large roll of gauze and use a short-arm splint

Question 29

How to splint a leg with both femur and tibia/fibula fractures

Answer 29

Long-leg posterior splint with additional sugar tong splint for the lower leg not traction