Regional Adult Trauma

Question 1

How do you clinically clear a c spine?

Answer 1

No LOC
GCS 15, no alcohol intoxication
No head injury/chest trauma
No neuro symptoms
No midline tenderness
No pain

Question 2

How to treat c spine injury?

Answer 2

Stable - firm cervical collar

Unstable - Halo vest (external fixator)

Question 3

Indications for thoracolumbar surgery

Answer 3

Neuro deficits

Unstable - lig damage, displacement

Question 4

Spinal shock

Answer 4

Physiologic response to injury with complete loss of sensation and motor function and loss of reflexes below point of injury, absent bulbocavernous reflex (contraction of anal sphincter)
Resolves in 24 hours

Question 5

What signals end of spinal shock?

Answer 5

Return of bulbocavernous reflex (contraction of anal sphincter)

Question 6

Neurogenic shock

Answer 6

After temporary shutdown of sympathetic chain = hypotension and bradycardia
Resolves in 24-48 hours
Priapism

Question 7

Treatment of neurogenic shock

Answer 7

IV fluids

Question 8

Complete spinal cord injury

Answer 8

No sensory or motor below level of injury

Question 9

Define level of injury

Answer 9

Most distal spinal level with partial function (dermatomal sensation, myotomal movement)

Question 10

Incomplete spinal cord injury

Answer 10

Some function below level of injury
Sacral sparing
Greater the function = faster the recovery

Question 11

Central cord syndrome

Answer 11

Incomplete cord injury due to hyperextension injury in c-spine with OA
Paralysis of arms more than legs, loss of movement, pain and temperature
Can feel position, vibration and touch
Sacral sparing

Question 12

Anterior cord syndrome

Answer 12

Incomplete cord injury
Loss of motor function , coarse touch, pain and temperature
Proprioception, vibration sense and light touch are preserved (dorsal columns)

Question 13

Posterior cord syndrome

Answer 13

Incomplete cord injury

Loss of dorsal column function = loss of proprioception, vibration and light touch

Question 14

Brown-Sequard syndrome

Answer 14

Incomplete cord injury
Hemisection of cord from penetrating injury = ipsilateral paralysis with loss of dorsal column function (proprioception, vibration, light touch) AND contralateral loss of pain, temperature and deep touch
Due to spinothalamic tract crossing

Question 15

Lateral compression fracture (pelvis)

Answer 15

Side impact (RTA), hemipelvis displaced medially
Sacral compression fracture or SI joint disruption

Question 16

Vertical shear fracture (pelvis)

Answer 16

Axial force on hemipelvis (fall from height/deceleration)
Displaced superiorly
Shorter leg on affected side
Lumbosacral plexus damage

Question 17

Anteroposterior compression injury

Answer 17

Pubic symphysis disturbed = open book fracture

Substantial bleeding = pelvic binder

Question 18

Signs of bladder/urethral injury

Answer 18

Blood at urethral meatus

Urethrography, CT, call urologists

Question 19

Fractures of which acetabulur wall associated with dislocation?

Answer 19

Posterior acetabular wall

Question 20

Treatment of humeral neck fracture

Answer 20

Conservative sling (minimally displaced)
Displaced may improve with time
Consistently displaced = reduce and fix

Question 21

How does anterior shoulder dislocation happen?

Answer 21

External rotation force
Fall onto back of shoulder
Seizure

Question 22

Bankart lesion

Answer 22

Due to anterior shoulder dislocation
Anterior glenoid labrum tear where biceps attaches (SLAP)
Bankart repair

Question 23

What nerve/artery can be damaged in shoulder dislocation?

Answer 23

Axillary nerve (regimental badge area)
Axillary artery

Question 24

Signs of anterior dislocation

Answer 24

Loss of symmetry/roundness
Arm held in adduction
Loss of sensation in regimental badge area (axillary nerve damage)

Question 25

Sign of ACJ dislocation

Answer 25

Step at ACJ

Question 26

Cause of posterior shoulder dislocation

Answer 26

Posterior forced on adducted and IR arm | Need lateral xray

Question 27

Signs of posterior humeral head dislocation

Answer 27

Head palpable posteriorly | Lightbulb sign

Question 28

What is vulnerable to injury in humeral shaft fracture?

Answer 28

Radial nerve in spiral groove = wrist drop and loss of sensation in 1st dorsal web space

Question 29

Supracondylar fractures usually occur in:

Answer 29

Kids

Question 30

Signs of radial head/neck fracture

Answer 30

Fat pad sign on lateral xray

Question 31

Nightstick fracture

Answer 31

Fracture of ulna on its own after direct blow | Make sure there is no Monteggia injury (also dislocated radial head)

Question 32

Monteggia

Answer 32

MUS - Ulna fractured superiorly | Radial head dislocation

Question 33

Galeazzi

Answer 33

GRI - radius fractured inferiorly | Dislocation of ulna at DRUJ

Question 34

Colles fracture

Answer 34

Extra-articular fracture of distal radius Dorsal displacement Due to FOOSH onto extended wrist Conservative or ORIF

Question 35

Smith's fracture

Answer 35

Volarly displaced distal radius after fall onto flexed wrist | Unstable = ORIF

Question 36

Barton's fracture

Answer 36

Intra-articular fracture of distal radius = carpal bones sublux ORIF

Question 37

Cause of scaphoid injury

Answer 37

FOOSH

Question 38

Signs of scaphoid injury

Answer 38

Pain in anatomical snuffbox | Pain on compressing thumb metacarpal

Question 39

Investigation and treatment of scaphoid injury

Answer 39

4 views on xray (AP, lateral, 2 oblique) Can show up 2 weeks later Splint/cast/fix

Question 40

Complications of scaphoid fracture

Answer 40

Non-union | AVN of proximal pole

Question 41

Peri-lunate dislocation

Answer 41

``` High energy, hyperdorsiflexion Loss of alignment of capitate and lunate Associated scaphoid fracture, median nerve injury Split cup sign Emergency reduction ```

Question 42

Mallett finger

Answer 42

Avulsion of extensor tendon from insertion onto distal phalanx Due to forced flexion of DIP Pain, drooped DIP, inability to extend treat with mallett splint

Question 43

Boxer's fracture

Answer 43

Fracture of 5th metacarpal

Question 44

Management of hip fractures

Answer 44

Surgery within 24 hours - replacement in intracapsular, fixation in extracapsular Early mobilisation

Question 45

Branches of profunda femoris

Answer 45

Medial and lateral circumflex arteries

Question 46

Knee dislocation

Answer 46

Surgical emergency | Reduce, NV assessment

Question 47

Predispose to patella dislocation:

Answer 47

Female Laxity Genu valgum Femoral neck anteversion

Question 48

What criteria used to identify ankle fracture?

Answer 48

Ottawa

Question 49

Lisfranc fracture

Answer 49

Midfoot | TMT joints