Trauma Flashcards
(23 cards)
What are the two fractures most at risk of leading to compartment syndrome?
Supracondylar fractures and Tibial shaft injuries.
What investigation is used to diagnose compartment syndrome?
Measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic
What is the emergency treatment for compartment syndrome?
Prompt and excessive fasciotomies to relieve the pressure.
Aggressive fluid therapy may be needed as a result of myoglobinuria following fasciotomy.
What is the most common mechanism of lateral ankle sprain?
Inversion of the plantar flexed foot
What is the most common mechanism of syndesmotic (high ankle) sprain (syndesmotic ligaments are the combination of the interosseous ligament and lower tibiofibular ligaments)?
Dorsiflexion and eversion of the ankle with internal rotation of the tibia - eg, during skiing or football.
When is an ankle or foot X-ray to check for fracture indicated according to the Ottawa ankle rules?
If there is pain in malleolar region and 1+ of:
Bony tenderness at posterior edge or tip of lateral or medial malleous
Bony tenderness at base of 5th metatarsal or navicular
Inability to weight bear for 4 steps either immediately after the injury or in the ED
What is the Weber classification of fibular fractures?
Type A: fibular fracture below the syndesmosis, which is intact.
Type B: fibular fracture at the level of the syndesmosis.
Type C: fibular fracture above the syndesmosis, indicating rupture of the syndesmosis.
What is the typical mechanism that leads to a Colles’ fracture?
A fall on to an outstretched hand that results in forced dorsiflexion of the wrist - giving a characteristic dinner fork deformity
What is the typical mechanism that leads to a Smith’s fracture?
Usually caused by falling backwards - a fall on to the palm of the outstretched hand with the arm above it pronating as the body falls - leads to ‘garden spade deformity’
What is a Barton’s fracture?
A distal radius fracture but with an additional dislocation of the radiocarpal joint
(basically it is a Colles’ or Smith’s fracture with dislocation)
How might the leg of a patient with a hip fracture appear?
Shortened and externally rotated
What classification system is used to describe intracapsular hip fractures?
Garden system
Type 1 to 4
What is the recommended surgical management of intratrochanteric extracapsular hip fractures?
Dynamic hip screw
What is the recommended surgical management of subtrochanteric extracapsular hip fractures?
Use intramedullary device
What are the surgical management options for a displaced intracapsular hip fracture?
Under 70: internal fixation if poss, hip arthroplasty if not
Over 70: total hip arthoplasty
Major co-morbidities (any age): hemiarthroplasty
What is the recommended surgical management of an undisplaced intracapsular hip fracture?
Internal fixation
What is a comminuted fracture?
When there are three or more resulting bone pieces
Where is the most common site of proximal humerus fracture?
Surgical neck of the humerus
An externally rotated and abducted arm is likely to correlate to which type of shoulder dislocation?
Anterior dislocation
What sign may be seen on X-ray in posterior shoulder dislocation?
‘Light bulb sign’
What are the criteria for immobilising a patient’s C-spine pre-hospital if they have a head injury?
GCS is <15 at any time since the injury. Neck pain or tenderness. Focal neurological deficit. Paraesthesia in the extremities. Any other clinical suspicion of cervical spine injury exists.
What are the NICE criteria for a CT scan of the brain within 1 hour of assessment?
Glasgow Coma Scale (GCS) <13 when first assessed or GCS <15 two hours after injury
Suspected open or depressed skull fracture
Signs of base of skull fracture*
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting
All patients with a head injury on oral anticoagulant therapy or a coagulopathy should have a CT head within how long after assessment (providing they haven’t met the criteria for urgent (1 hr) CT)?
8 hours
