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MSK > O: Trauma > Flashcards

O: Trauma Flashcards

1
Q

signs of fractures?

A

bruising, swelling, bony tenderness

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2
Q

what’s important to check when a fracture presents?

A

peripheral nerves to check neural status, and vascular integrity

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3
Q

when should you use an ex-fix?

A

in soft tissue injuries + fracture

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4
Q

investigation for trauma?

A

x-ray

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5
Q

what to look for in a trauma x-ray…

A
  1. type of #: complete, transverse, oblique, spiral, bowing, buckle, greenstick, growth plate
  2. location of bone #: diaphysis, metaphysis, epiphysis
  3. displacement?
    4: jt integrity?
    5: other fractures
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6
Q

mx for acute trauma #?

A

restore alignment, reduce/ stabilise

analgesia, splintage, check for open fractures/ compartment syndrome, surgery?

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7
Q

what are some upper limb fractures?

A 
proximal humeral fracture
humeral shaft fracture 
olecranon fracture 
forearm fracture 
distal radial fracture 
hand fractures
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8
Q

epi of proximal humeral fracture?

A

very common low energy, osteoporotic bone, FOOSH

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9
Q

which humeral neck is usually affected by proximal humeral fracture?

A

surgical as opposed to anatomical neck

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10
Q

which nerve is commonly injured in proximal humeral fracture?

A

axillary nerve

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11
Q

mx of proximal humeral fracture?

A

collar and cuff or operative (ORIF, hemiarthroplasty)

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12
Q

aetiology of humeral shaft fracture?

A

falling on arm (oblique/ spiral), direct trauma (transverse or comminuted)

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13
Q

which nerves are commonly injured in humeral shaft fractures?

A

radial nerve injury

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14
Q

mx of humeral shaft fracture?

A

conservative- humeral brace, U-slab cast

op- ORIF, IM nail

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15
Q

aetiology of olecranon fracture?

A

falling on point of elbow

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16
Q

mx of olecranon fracture?

A

cast or operatives wires

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17
Q

anatomy of forearm fracture?

A

radius and ulna connected with radioulnar jt forming a ring

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18
Q

types of forearm fractures?

A

nightstick injury: ulnar break

monteggia: kids- fall type injury
gallezzi: dislocation of distal ulnar jt with radial fracture

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19
Q

T/F: mx of nightstick injury is operative

A

F: nightstick= cast. Monteggia/Gallezzi is ORIF

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20
Q

what is aetiology of distal radial fracture?

A

FOOSH

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21
Q

types of distal radial fracture?

A

Colles: dorsally angulated broken bone
Smith’s: volar angulated (palmar) broken bone
Barton’s

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22
Q

which injury is at risk with distal radial fracture?

A

median nerve

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23
Q

mx of colles?

A

conservative- cast/split

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24
Q

mx of Smith’s?

A

operative: ORIF, MUA+ K-wires, ex-fix

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25
Q

what are types of hand fractures?

A

mallet finger and Bennett’s fracture

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26
Q

what is mallet finger?

A

deformity caused by disruption of the terminal extensor tendon distal to DIP jt

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27
Q

s/s of mallet finger?

A

can’t extend finger, pain

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28
Q

mx of mallet finger?

A

mallet splint for 6/52, wire fix if displaced avulsion fracture

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29
Q

what is Bennett’s fracture?

A

fracture at base of thumb metacarpal

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30
Q

mx of Bennett’s fracture?

A

wires or screws to fixate

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31
Q

what are some lower limb fractures?

A

pelvic fracture, hip fracture, femoral shaft fracture, tibial plateau fracture, tibial shaft fracture, ankle fracture, metatarsal break, lis franc injury, calcaeneus fracture

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32
Q

epi of pelvic fractures?

A

elderly- associated with pubic rami fractures

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33
Q

s/s of pelvic fracture?

A

pelvis is ring bone so often multiple fractures

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34
Q

ix for pelvic fracture

A

CT

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35
Q

what is the classification used for pelvic ring fractures?

A

Young-Burgess (A (1-3), B (1-3), C)

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36
Q

mx of pelvic fracture

A

acute: pelvic binder*
conservative: mobilise and analgesia
operative: ORIF, external fixation, internal fixation

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37
Q

why is a pelvic binder necessary in an emergent pelvic fracture?

A

to reduce the volume into which bleeding can go

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38
Q

epi of hip fractures?

A

very common, F>M, 30% mortality

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39
Q

risks of hip fractures?

A

> 50
osteoporosis
smoking & alcohol, malnutrition
neuro/ impaired visual conditions

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40
Q

types of hip fracture?

A

intra-capsular: proximal to intra-trochanteric line
extra-capsular: distal to intra trochanteric line

can also be displaced v undisplayed

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41
Q

types of extra-capsular hip fracture?

A

intertrochanteric, subtrochanteric, basicervical, reverse-oblique

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42
Q

what are the 3 main arteries of the hip?

A
  1. intramedullary artery of shaft of femur
  2. medial and lateral circumflex
  3. favel artery
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43
Q

ligamentum teres receives blood flow from which artery?

A

favel artery

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44
Q

ix of hip fracture?

A

imaging: x-ray, MRI (bone oedema)

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45
Q

which line is important to look for on x-ray for a broken hip?

A

Shenton’s Line

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46
Q

mx of hip fracture?

A

operate (screws/ fixation/ arthroplasty), and early mobilisation

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47
Q

T/F: extra capsular hip fractures are at greater risk of AVN?

A

F: intra-capsular hip fractures are at greater risk

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48
Q

how many types of femoral shaft fractures can there be?

A

7

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49
Q

name 3 types of femoral shaft fractures?

A 
3 out of...
transverse
linear
non-displaced 
displaced/ compound 
spiral
greestick 
comminuted
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50
Q

mx of femoral shaft fracture?

A

acute: thomas splint
operative: nial/ORIF, may take 12 weeks to heal

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51
Q

what is a tibial plateau fracture?

A

fracture of tibial head/ tibial plateau

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52
Q

what is the classification used for plateau fracture?

A

Schatzer Classification (1-6)

53
Q

mx of tibial plateau fracture?

A

conservative- above knee cast then hinge cast

operative: nails, ORIF, ex-fix

54
Q

what are the 2 main complications/risks of tibial plateau fracture?

A

NV injury of popliteal structures, peroneal nerve injury

55
Q

how do ankle fractures occur?

A

inversion and rotational force applied to planted foot

56
Q

types of ankle fractures?

A

stable: no medial malleolus fracture or deltoid ligament rupture
unstable: medial malleolus fracture and deltoid ligament rupture

57
Q

a pilon fracture is a fracture of…

A

the tibia near the ankle

58
Q

classification for ankle fractures?

A

Webber A,B,C

- level of fracture in relation to syndesmosis of ankle

59
Q

what should you look for on x-ray of broken ankle?

A

talar shift

60
Q

mx for ankle fractures (weber A & B/C)

A 
A= stable. cast/moonboot 
B/C= ORIF surgery
61
Q

which metatarsal is most common to break?

A

5th

62
Q

types of metatarsal break?

A

avulsion by peroneus brevis= tearing away of bone from main bony mass
Jones fracture= break between base and middle of MT
proximal shaft= stress fracture

63
Q

aetiology of metatarsal break?

A

unaccustomed walking, new shoes, osteoporosis, soldiers, runners, dancers

64
Q

which ix is indicated for metatarsal break and why?

A

MRI/ isotope bone scan as not well picked up by x-ray

65
Q

mx of metatarsal break?

A

no wt bearing and rigid soled boot

66
Q

what is a Lis Franc injury

A

tarsometatarsal break/ dislocation

67
Q

which fracture is most common if you fall from height and land on feet?

A

calcaneus fracture

68
Q

what are some early local fracture complications?

A

compartment syndrome, vascular injury, nerve injury, soft tissue injury

69
Q

what are some early systemic fracture complications?

A

hypovolaemia, fat embolism, ARDS, systemic inflammatory response syndrome

70
Q

what are the 3 nerve injuries one can sustain…

A 
Neurapraxia= temporary conduction block, resolves within a month 
Axontemesis= nerve cell axon dies distally from point of injury but regenerates 
Neurotemesis= nerve transected- nerve grafting needed
71
Q

how to assess an open fracture?

A

mechanism, energy, wound, contamination

72
Q

mx of open fracture?

A

ABCDE (pressure, reduce, remove debris, cover, stabilise) + Abx + tetanus?

73
Q

which broad spec abx are given in an open fracture scenario?

A

co-amoxi/ metronidazole

74
Q

what is compartment syndrome?

A

muscle compartment pressure exceeds perfusion pressure > muscle swells > loss of blood supply to muscle

75
Q

pathophysiology of compartment pressure?

A

tissue pressure rises > capillary collapses > inc blood flow > oedema & pressure rise again > venous occlusion > ischameia & muscle necrosis

76
Q

compartment syndrome is most common with which fractures?

A

anterior & deep leg compartments: tibia, foot, calf, buttock
forearm

77
Q

risk factors for compartment syndrome?

A

open fractures, PWIDs, anticoags, burns

78
Q

s/s of compartment syndrome?

A

4 Ps: pain, pallor, paraesthesia, pulselessness

79
Q

which of the 4Ps of compartment syndrome is a late sign?

A

pulselessness

80
Q

mx of compartment syndrome?

A

fasciotomy to release compartment

81
Q

late local complications of fractures?

A

loss of function, post-traumatic arthritis, non-union, malunion, Volkmann’s ischaemic contracture of forearm, osteomyelitis, AVN

82
Q

systemic late complications of fractures?

A

DVT, PE

83
Q

what are 2 types of non-union?

A

atrophic: nothing happens at fracture site due to poor blood supply/ fracture gap too big/ smoking
hypertrophic: too much movement + callous growth resulting in soft tissue

84
Q

what is Volkmann’s ischaemic contracture?

A

late complication of compartment syndrome- muscles die and atrophy of muscle occurs

85
Q

what is a tell-tale sign of volkmann’s ischaemic contracture?

A

swan like deformity of hand

86
Q

what are dislocations?

A

complete loss of contact between 2 joint surfaces (sublaxity is partial loss)

87
Q

epi of joint hyper mobility syndrome?

A

F, 3rd decade

88
Q

s/s of joint hypermobility syndrome?

A

arthralgia, premature osteoarthritis

89
Q

classification for joint hypermobility syndrome?

A

modified Brighton score

90
Q

3 upper limb dislocations are…

A

shoulder, elbow, phalanx

91
Q

aetiology of shoulder dislocation?

A

contact sports, fall from height, traction injuries

92
Q

direction of shoulder dislocation?

A

anterior, posterior, inferior

93
Q

anterior shoulder dislocation:

A

fall with shoulder in external rotation, humeral head anterior to glenoid

94
Q

T/F: posterior shoulder dislocation has humeral head anterior to glenoid

A

F: it is posterior to glenoid

95
Q

which of the 3 types of shoulder dislocations requires prompt NV check?

A

inferior

96
Q

ix for shoulder dislocation and how to differentiate between anterior and posterior dislocations?

A

x-ray

- posterior= lightbulb sign

97
Q

axillary nerve damage is most common with which type of shoulder dislocations?

A

anterior

98
Q

mx of shoulder dislocations?

A

reduce (Hippocratic, in-line traction), sling, physio

99
Q

aetiology of elbow dislocation?

A

FOOSH, parent yanking child’s arm, divergent- force from above pushing down

100
Q

direction of elbow dislocation

A

posterior, anterior, medial/lateral, divergent

101
Q

mx of elbow dislocation?

A

reduce (open reduction/ closed under sedation), sling, physio

102
Q

what is a phalanx dislocation?

A

PIP/ DIP dislocation

103
Q

aetiology of phalanx dislocation?

A

hyperextension injury, direct axial blow

104
Q

T/F: PIP dislocations tend to also have fractures

A

True

105
Q

ix for phalanx fracture?

A

clinical, stress test (lateral, hyperextension, elson tests), V-sign on x-ray

106
Q

mx of phalanx fracture?

A

reduce, sling (buddy strapping/ solar slab if unstable), physio

107
Q

what are the 3 lower limb dislocations?

A

hip, knee, patella

108
Q

aetiology of hip dislocations?

A

flexed, internal rotation and adducted knee- high energy RTA dashboard injury, fall form height

109
Q

direction of hip dislocation?

A

posterior

110
Q

important nerve assessment with hip dislocation?

A

sciatic nerve assessment

111
Q

mx for hip dislocation?

A

urgent reduction and stabilisation in traction, follow up imaging

112
Q

mechanisms of injury for knee dislocations?

A

high energy= high complications

elderly from low velocity injuries

113
Q

dislocation following a twisting injury with planted foot commonly results in a ______ dislocation

A

posterior

114
Q

for a knee to dislocate, what must usually happen and is a common complication?

A

soft tissue injuries e.g. ligamental tears

115
Q

mx for knee dislocation

A

reduce in theatre, may need ex-fix/splint, follow up surgery to repair ligaments

116
Q

which nerve damage (often caused by knee injury) may result in a foot drop?

A

peroneal nerve

117
Q

epi of patellar dislocation?

A

F>M, teens, not high risk

118
Q

aetiology of patellar dislocation

A

sudden quad contraction with flexed knee, rapid turn or direct blow

119
Q

what are some risk factors for patellar dislocation

A

hyper mobility, under developed later femoral condyle, inc Q angle (Genu Valgum)

120
Q

direction of patellar dislocation?

A

lateral

121
Q

mx for patellar dislocation

A

tend to self-resolve and fall back into place

physio, brace, follow up x-rays, repeat dislocations consider surgery

122
Q

what is a diagnostic test for patellar dislocation

A

patella apprehension test +ev

123
Q

why do ankles sprain?

A

elastic limit of ligaments

124
Q

common ligaments affected by ankle sprains?

A

AFTL, CFL

125
Q

mx for ankle sprains?

A

RCE, physio- conservative

brostrum ghould/ chrisman snook- operative

126
Q

what are the principles of tx for severe mutilating injuries?

A 
. preserve all amputated parts on ice in a moist gauze 
. debride early 
. establish stable bony support 
. establish vascularity 
. repair all tissues- nerves, tendons etc 
. establish skin cover via grafts 
. prevent infection 
. aggressive mobilisation
127
Q

in burns, what is the thick leathery skin that forms called?

A

eschar

128
Q

mx of burns?

A

escharotomy & skin grafts, early mobility

MSK (26 decks)

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