Regional Adult Trauma

Question 1

C -spine fractures are common after what type of injury?

Answer 1

high energy e.g RTA, fall from height

Question 2

when should you go C spine control

Answer 2

during A (airways ) of ABCDE

Question 3

what criteria must be satisfied before clearing the C spine?

Answer 3

no history of loss of consciousness
GSC 15 with no alcohol intoxication
no significant distracting injury e.g head injury
no neuro symptoms in limbs
no midline tenderness on palpation of C spine
no pain on gentle active neck movement

Question 4

a full neuro exam might include?

Answer 4

peripheral motor function
coarse touch sensation
upper and lower limb reflexes
cranial nerve evaluation
rectal exam
assessment of bulbocavernous reflex

Question 5

more stable c spine injuries can be treated with what?

Answer 5

cervical collar

Question 6

more unstable c spine injuries may require immobilization with what?

Answer 6

halo vest

Question 7

what tends to cause thoracolumbar spinal fractures?

Answer 7

RTA or fall from height

can get wedge fractures in elderly if osetoporosis

Question 8

what is spinal shock?

Answer 8

physiologic response to injury with complete loss of sensation and motor functions and loss of reflex below the level of injury

Question 9

how long does spinal shock last

Answer 9

can resolve in 24 hours

Question 10

what is the bulbocavernous reflex?

Answer 10

a reflex contraction of anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urinary catheter

Question 11

is the bulbocavernous reflex present in spinal shock?

Answer 11

no

Question 12

what is neurogenic shock and when does it occur?

Answer 12

occurs secondary to temporary shut down of sympathetic outflow from the cord from T1 to L2

Question 13

how do you treat neurogenic shock?

Answer 13

Iv fluid

Question 14

what is a complete spinal cord injury?

Answer 14

when there is no sensory or motor function below level of injury

prognosis is very poor

Question 15

what is an incomplete spinal injury

Answer 15

when there is some neurologic (sensory and or motor) present distal to site of injury

Question 16

what does sacral sparing indicate?

Answer 16

an incomplete spinal cord injury and a much better prognosis

Question 17

what is the most common incomplete spinal cord injury?

Answer 17

central cord syndrome

Question 18

what type of injury tends to cause central cord syndrome?

Answer 18

hyper extension injury in cervical spine

Question 19

in central cord syndrome what gets paralysed more-arms or legs?

Answer 19

arms

because the corticospinal motor tracts of the upper limbs are more central than those of lower limbs

sacral sparing is usually present

Question 20

what does anterior cord syndrome result in?

Answer 20

loss of motor function as well as loss of coarse touch, pain, and temperature sensation

Question 21

what does posterior cord syndrome result in?

Answer 21

loss of dorsal column function-vibration sense, light touch, proprioception

Question 22

loss of dorsal column function-vibration sense, light touch, proprioception

Answer 22

posterior cord syndrome

Question 23

loss of motor function as well as loss of coarse touch, pain, and temperature sensation

Answer 23

anterior cord syndrome

Question 24

what causes Brown-sequard syndrome?

Answer 24

hemisection of cord

usually from penetrating injury e.g stab wound

Question 25

hemisection of cord usually from penetrating injury e.g stab wound

Answer 25

Brown -sequard syndrome

Question 26

what does brown -sequard syndrome cause?

Answer 26

ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation

Question 27

ispilateral paralysis and loss of dorsal column sesnation with contralateral loss of pain, temperature and coarse touch sensation

Answer 27

brown -sequard syndrome

Question 28

if the pelvic ring is broken in one place is there likely to be another fracture?

Answer 28

yes

Question 29

what is a lateral compression fracture of the pelvis?

Answer 29

occurs with side impact e.g RTA where one half of pelvis is displaced medially. fractures through pubic rami or ischium are accompanied by sacral compression fracture or SI joint disruption

Question 30

occurs with side impact e.g RTA where one half of pelvis is displaced medially. fractures through pubic rami or ischium are accompanied by sacral compression fracture or SI joint disruption

Answer 30

lateral compression fracture of the pelvis

Question 31

what is a vertical shear fracture of the pelvis?

Answer 31

occurs due to axial force on pelvis e.g fall from height affected hemipelvis is displaced superiorly sacral nerve roots and lumbosacral plexues are at high risk of injury leg on affected side may appear shorter

Question 32

occurs due to axial force on pelvis e.g fall from height affected hemipelvis is displaced superiorly sacral nerve roots and lumbosacral plexues are at high risk of injury leg on affected side may appear shorter

Answer 32

vertical shear pelvis fracture

Question 33

what is an anteroposterior compression fracture of the pelvis?

Answer 33

may result in wide distribution of pubic symphysis

Question 34

open book pelvis fracture

Answer 34

anteroposterior compression fracture of the pelvis

Question 35

may result in wide distribution of pubic symphysis

Answer 35

anteroposterior compression fracture of the pelvis

Question 36

what do you need to do to assess sacral nerve root function?

Answer 36

PR exam

Question 37

what are humeral neck fractures causes by usually?

Answer 37

falling onto an outstretched hand

Question 38

how do you treat a humeral neck fracture?

Answer 38

sling and gradual return to mobilization persistently displaced ones can be surgically treated with internal fixation

Question 39

if the humeral head splits, what is usually done?

Answer 39

shoulder replacement

Question 40

what type of shoulder dislocation is more common?

Answer 40

anterior shoulder dislocation

Question 41

what causes anterior shoulder dislocation?

Answer 41

excessive external rotation force or a fall onto back of shoulder can occur due to a seizure

Question 42

how do you confirm anterior shoulder dislocation?

Answer 42

x ray

Question 43

how do you treat anterior shoulder dislocation?

Answer 43

closed reduction under sedation or anaesthetic then placed in sling for 2-3 weeks physio

Question 44

can ligamentous laxity cause shoulder dislocations?

Answer 44

yes

Question 45

what causes a posterior shoulder dislocation?

Answer 45

a posterior force on the adducted and internally rotated arm

Question 46

light bulb sign on x ray

Answer 46

posterior shoulder dislocation

Question 47

when do injuries of the acromioclavicular joint occur?

Answer 47

after a fall onto the point of the shoulder

Question 48

how do you treat acromioclavicular joint injuries?

Answer 48

mainly conservatively - sling then physio surgery for those with chronic pain

Question 49

what can cause humeral shaft fractures?

Answer 49

direct trauma e.g RTA causing transverse or comminuted fractures a fall (with or without twisting injury) resulting in oblique or spiral fracture

Question 50

what nerve is susceptible to injury in a humeral shaft fracture?

Answer 50

radial nerve

Question 51

how do you treat a humeral shaft fracture?

Answer 51

most with a functional humeral brace internal fixation with intramedullary nail

Question 52

what causes a Olecranon fracture?

Answer 52

falling onto point of elbow with a contracted tricep usually in the elderly

Question 53

how are olecranon fractures treated?

Answer 53

simple ones- tension band wiring complicated- ORIF with plates and screws

Question 54

what usually causes radial head and neck fractures?

Answer 54

fall onto outstretched arm

Question 55

in what direction do most elbows dislocate?

Answer 55

posterior

Question 56

what is a nigthstick fracture?

Answer 56

ulnar shaft fracture

Question 57

what causes an isolated fracture of ulna?

Answer 57

direct blow

Question 58

if there is a fracture of both bones in forearm , what is the treatment?

Answer 58

ORIF with plates and screws

Question 59

what causes Monteggia Fracture dislocation?

Answer 59

dislocation of radial head at elbow and fracture of ulna it requires ORIF

Question 60

dislocation of radial head at elbow and fracture of ulna

Answer 60

Monteggia Fracture dislocation

Question 61

what is a Galeazzi fracture dislocation?

Answer 61

fracture of radius and dislocation of ulna at distal radioulnar joint

Question 62

fracture of radius and dislocation of ulna at distal radioulnar joint

Answer 62

Galeazzi

Question 63

what is a colles fracture?

Answer 63

extra articular fracture of distal radius caused by a fall onto outstretched hand

Question 64

what nerve could be damaged in a colles fracture?

Answer 64

median nerve

Question 65

what is a smiths fracture?

Answer 65

volarly displaced displaced or angulated extra-articular fracture of distal radius usually occurs after falling onto back of flexed wrist

Question 66

volarly displaced displaced or angulated extra-articular fracture of distal radius usually occurs after falling onto back of flexed wrist

Answer 66

smiths fracture

Question 67

what is a bartons fracture?

Answer 67

intra articular fractures of distal radius involving dorsal or volar rim, where the carpal bones sublux with the displaced rim fragment...can be classified as dorsal or volar

Question 68

what do scaphoid fractures usually occur after?

Answer 68

FOOSH

Question 69

pain and tenderness an anatomical snuff box?

Answer 69

scaphoid fracture

Question 70

how many x ray views are needed to confirm a scaphoid fracture and why?

Answer 70

4 because it has a funny kidney bean shapeit can be difficult to visualize

Question 71

how are undisplaced scaphoid fractures treated?

Answer 71

plaster cast for 6-12 weeks

Question 72

what are the complications of scaphoid fractures?

Answer 72

non union | AVN

Question 73

what is peri-lunate dislocation?

Answer 73

dislocation of one of the carpal bones around the lunate

Question 74

what causes a scapho-lunate dissociation?

Answer 74

rupture of scapho-lunate ligaments

Question 75

penetrating volar hand injuries risk damaging what?

Answer 75

flexor tendons, digital nerve and digital arteries

Question 76

penetrating dorsal hand injuries risk damaging what?

Answer 76

extensor tendons

Question 77

what is mallet finger?

Answer 77

an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ

Question 78

an avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of extended DIPJ

Answer 78

mallet finger

Question 79

treatment for mallet finger?

Answer 79

mallet splint holding DIPJ extended which should be worn continuously for 4 weeks

Question 80

how are fractures of 3rd, 4th and 5th metacarpals treated?

Answer 80

conservatively

Question 81

how do fractures of 5th metatarsal occur?

Answer 81

punching injury

Question 82

boxers fracture?

Answer 82

5th metatarsal inury

Question 83

how do you treat fracture of the 5th metatarsal?

Answer 83

strap it to 4th finger

Question 84

how do you treat phalangeal fractures?

Answer 84

neighbour strapping/splintage

Question 85

what are the 2 types of hip fracture?

Answer 85

intracapsular extracapsular

Question 86

which type of hip fracture can lead to AVN of femoral head?

Answer 86

intracapsular

Question 87

how should intracapsular hip fracture be treated?

Answer 87

replacement

Question 88

how can extracapsular hip fractures be treated?

Answer 88

internal fixation

Question 89

can patients with pagets disease get femoral shaft fractures?

Answer 89

yes

Question 90

how much blood loss can occur with a displaced femoral shaft fracture?

Answer 90

up to 1.5L of blood

Question 91

initial management of femoral shaft fracture?

Answer 91

resuscitation analgesia with femoral nerve block application of thomas splint

Question 92

what does a thomas splint minimise?

Answer 92

more blood loss and fat embolism

Question 93

what is the definitive management of femoral shaft fracture?

Answer 93

closed reduction and stabalization with intramedullary nail or plate fixation can be used

Question 94

why is a knee dislocation so bad?

Answer 94

vascular injury nerve injury compartment syndrome

Question 95

what tends to cause knee dislocation?

Answer 95

high energy injury severe hyperextension and/ or rotational forces with a sporting injury

Question 96

management of dislocated knee?

Answer 96

urgent reduction with thorough neurovascular assessment and vascular surgery referral if knee is unstable an external fixator may be applied

Question 97

in which direction does the patella usually dislocate?

Answer 97

laterally

Question 98

what can cause patella dislocation?

Answer 98

direct blow | contraction of quads with a rotational force with patella not engaged in trochlea

Question 99

what predisposes patella dislocations?

Answer 99

ligamentous laxity valgus alignment of the knee rotational malalignment shallow trochlear groove

Question 100

who most commonly gets dislocated patella?

Answer 100

adolescents (esp females)

Question 101

are proximal tibia fractures intra or extra articular?

Answer 101

intraarticular

Question 102

high energy injuries causing proximal tibia fractures are associated with what>

Answer 102

compartment syndrome | neurovascular injury

Question 103

what causes a tibial shaft fracture?

Answer 103

indirect force and either a bending or rotational energy, compressive force from deceleration, a combination of the above or high energy injury

Question 104

most common cause of compartment syndrome

Answer 104

tibial shaft fracture

Question 105

how do you treat a tibial shaft fracture?(non operative)

Answer 105

above knee cast

Question 106

how do you treat a tibial shaft fracture?(operative)

Answer 106

internal fixation intramedullary nail=most common way of stabilization

Question 107

what is a pilon fracture?

Answer 107

distal tibia

Question 108

how do you treat a stable ankle fracture?

Answer 108

walking cast or splint for approx 6 weeks

Question 109

is a bimalleolar fracture stable or unstable?

Answer 109

unstable and needs ORIF

Question 110

what causes calcaneal fracture?

Answer 110

fall from height onto heel

Question 111

what is a lisfranc fracture/dislocation

Answer 111

fracture of base of 2nd metatarsal associated with dislocation of base 2nd metatarsal

Question 112

can there be a normal looking x ray with a lisfranch fracture?

Answer 112

yes

Question 113

how do you treat a lisfranc fracture?

Answer 113

open or closed reduction with fixation using screws is recommended

Question 114

what metatarsal is a common site for a stress fracture?

Answer 114

2nd

Question 115

what treatment is needed for toe fractures?

Answer 115

stout boot if intra articular it may benefit from fixation and reduction