Trauma Flashcards by John Tan

Pneumonic for Pathological fractures?

Osteoporosis
Metabolic - hyperPTH, HyperT, rickets, osteogenesis imperfecta
Infection/Iatrogenic - radiation, surgical defect
Tumour

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Rule of 2s for imaging?

2 sides
2 views
2 joints
2 times before and after reduction

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Garden classification of Hip NOF?

Undisplaced, incomplete fracture
Undisplaced, complete fracture
Incompletely displaced, complete fracture
Completely displaced, complete fracture

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Weber’s classification for ankle fracture?

A = Fracture below level of syndesmosis
B = Fracture at level of syndesmosis
C = Fracture above level of syndesmosis

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Early local complications of fractures?

Neurovascular injury
Compartment syndrome
Soft tissue blister -> infection

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Late local complications of fractures?

Malunion, Nonunion, delayed union
AVN, post-traumatic arthritis and stiffness
OM
Heterotrophic ossification
Joint instability
Nerve compression/entrapment
Reflex sympathetic dystrophy

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Early systemic complications of fractures?

Fat embolism, DVT/PE
ARDS
Haemorrhagic shock

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Operative treatment of indirect fracture healing?

Intramedullary nailing
Bridge plating

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Operative treatment for direct fracture healing?

Lag screw, compression plates

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External stabilization for fracture?

Slings in UL, Splint, cast, traction in femur, external fixator

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Internal stabilization for fracture?

Perc pinning
Extramedullary or intramedullary fixation

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Examples of fragility fractures? They are often low-mechanism fractures

Vertebral compression
Hip fractures
Proximal humerus
Distal radius
Sacral fractures

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Rule of 11s for distal radius fracture?

Radial height 11mm
Volar tilt 11 degrees
Radial inclination 22 degrees
More means will recommend surgery

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Internal vs external fixation?

External fixation means outside skin e.g. rods/pins

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5 ligaments for syndesmotic injury?

AITFL
PITFL
Interosseous membrane
Interosseous ligament
Inferior transverse ligament

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What is stable vertebral fracture and its features?

Structural ability of spine is compromised
1. Spine can move as multiple independent units, which can cause spinal cord injury
2. Mid-column and posterior column features

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What sling for humerus fracture?

Collar and cuff sling

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What sling for clavicle fracture?

Arm sling

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What fixture to put right and a while after fracture?

Back slab to give space to swell and prevent compartment syndrome

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what fixture is put a while after fracture?

Cast - circumferental tc.

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Where to use splint/brace or other fixtures?

Splint for smaller joint fractures
For bigger joints use brace e.g. knee
Can use aircast boot for feet

During long-term healing of clavicle fracture there can be a _________

Can have slight bony bump over clavicle. But its normal.
Some pts can feel shoulder is sagging or narrower, but its fine.

When u walk with a healing ankle fracture it will 100% ____.

It will definitely swell. But its fine

Humerus or femur fracture can have _____ fractures within the head. Seen in trauma clinic

3 segmental fracture

Always look for ______ deformity as they predispose to functional problems. For hand!

Always look for ROTATIONAL deformity as they predispose to functional problems. Mild deformities are generally tolerated

Borders of the 3 Gilula lines in AP view of hand?

Arc 1: proximal surface of proximal carpal row Arc 2: Distal surface of proximal carpal row 3: Proximal surface of capitate and hamate

What is position of "safety' in hand fractures? For conservative Mx in unsure situations

Wrist extended 20°, MCP flexed 90°, DIPJ and PIPJ fully extended

Differentials of radial wrist pain?

Scaphoid fracture Distal radius fracture 1st CMCJ fracture/dislocation Sprain/contusion

Clinical presentation of scaphoid fracture

Snuffbox tenderness Tuberosity tenderness - volar forearm Resisted pronation Axial grind

_____% of scaphoid bone fractures are initially undetectable on XR

25%!!!

Best initial test for scaphoid fracture

Wrist XR in PA, Lateral, oblique, and possibly scaphoid view.

Where do eschars occur?

On full thickness injuries - wounds that extend below epidermis and dermis

Complications of scaphoid fracture

Carpal tunnel syndrome Avascular necrosis - Scaphoid Nonunion Advanced Collapse

What sign for Lunate dislocation?

Spilled tea-cup sign. Lunate does not articulate with radius

What is seen for perilunate dislocation?

Capitate does not articulate with lunate and radius

Mechanism of mallet fracture of finger?

Stubbed finger! Volleyball, Basketball, falls

Seddon's classification of nerve injury?

Neuropraxia -> Axonotmesis -> Neurotmesis ## Footnote Neuropraxia = minor injury Axonotmesis = Nerves stretch + damaged Neurotmesis = severed

What is Maisonneuve fracture?

Spiral fracture of upper third of fibula | likely Weber C

Criteria for stable / unstable acute spine fractures?

Number of affected columns! 1 = stable 2 or more = unstable Disruption of post ligamentous complex = chronic unstable

Why is scaphoid prone to AVN?

Scaphoid is under a lot of stress from motion of carpal bones Scaphoid is unattached to any muscle -> poorer blood supply ## Footnote Scaphoid supplied by dorsal carpal branch of Radial artery

What bones are prone to AVN? Why?

Talus NOF Scaphoid ## Footnote Talus and Scaphoid are watershed zones.

Why is NOF prone to AVN? Compare to intertrochanteric # ## Footnote What supplies NOF?

NOF is site of anastomoses of medial and lateral circumflex arteries that branch from Profunda femoris. IT # does not disrupt any blood supply.

What does lunate/perilunate dislocation show on XR?

AP view = Assess Gilula lines - carpal alignment shows more overlap btw lunate and capitate Lat view = line of radius-lunate-capitate [apple on cup shape] ## Footnote Scaphoid view if want to TRO scaphoid #

What is Volkmann's ischemic contracture?

Fibrotic contracture of skeletal muscle weeks of months after severe ischemic insult of compartment syndrome

How good is healing potential of NOF frac? Why?

- Femoral neck is intracapsular, bathed in synovial fluid. - Lacks periosteal layer - Callus formation limited, which affects healing

In which part of NOF frac is risk of complications particularly high?

Subcapital and Transcervical. They're intra-capsular. Basicervical is extra-capsular | Risks include AVN, malunion

Gustilo-Anderson classification for open fracs?

Mechanism energy Soft tissue damage Wound size Contamination Frac comminution Periosteal stripping Skin coverage | Lol go google its too long

What is greenstick fracture?

Fracture in immature bone. Cortex bends rather than breaks