trauma: complications of trauma

Question 1

name 4 early local complications of fractures

Answer 1

compartment syndrome, ischaemia, nerve compression, skin necrosis

Question 2

name 5 early systemic complications of fractures

Answer 2

hypovolaemia, shock, ARDS, acute renal failure, systemic inflam response syndrome (SIRS), death

Question 3

name 6 late local fracture complications

Answer 3

stiffness, loss of function, chronic pain syndrome, non-union, OA, DVT

Question 4

name a late systemic fracture complication

Answer 4

PE

Question 5

what is compartment syndrome

Answer 5

bleeding and inflam response causing rise in pressure in fascia compartment –> compressed venous system and secondary ischaemia

Question 6

what are symptoms and signs of compartment syndrome

Answer 6

severe pain, loss of function, paraesthesia, severe pain out of clinical context, tensely swollen and tender, volkmann’s ischaemic contracture

Question 7

what is volkmann’s ischaemic contracture

Answer 7

compartment syndrome where muscles necroes after being left too long

Question 8

how do you treat compartment syndrome

Answer 8

remove tight clothing, fasciotomy

Question 9

how do vascular injuries arise on trauma

Answer 9

penetrating/ blunt, vessels can be compressed and torn, partial tears of arterial intima can thrombose to an occlusion

Question 10

what can digital limb ischaemia lead to

Answer 10

amputation

Question 11

what can haemorrhage lead to

Answer 11

hypovolaemic shock

Question 12

what vessel can be damaged in knee dislocations

Answer 12

popliteal artery

Question 13

what vessel can be damaged in paediatric supracondylar fracture of the elbow

Answer 13

brachial artery

Question 14

what vessel can be damaged in shoulder

Answer 14

axillary

Question 15

fractures where can lead to life threatening haemorrhage

Answer 15

pelvis

Question 16

how do you treat vascular injuries from fractures

Answer 16

shunt and repair (bypass r stent)

Question 17

what are skin problems that can arise from fractures

Answer 17

laceration from bone, skin fragility, pressure –> blanching –> necrosis, shearing/ degloving

Question 18

what are fracture blisters

Answer 18

from inflamm exudate causing lifting of epidermis

Question 19

what are symptoms of non-union fracture

Answer 19

pain, oedema, movement at fracture site, bridging callus on imaging

Question 20

what is delayed union

Answer 20

doesn’t heal in expected time, tibia and femoral shaft slow, can lead to infection

Question 21

what is hypertrophic non-union

Answer 21

from excessive movement at fracture site

Question 22

what is atrophic non-union

Answer 22

rigid fixation with fracture gap, lack of blood

Question 23

what fractures can have a poor blood supply

Answer 23

scaphoid, distal clavicle, femur

Question 24

when can DVT

Answer 24

after pelvic or major lower limb fracture to then being immobile

Question 25

how do you prevent, identify and treat DVT after fracture

Answer 25

prophylactic LMWH to at risk patients, duplex scans and anticoag

Question 26

what is fracture disease

Answer 26

stiffness and weakness from cast, resolves in time

Question 27

where does AVN commonly occur

Answer 27

femoral neck, scaphoid, talus

Question 28

how would you manage end stage AVN of common sites

Answer 28

hip - THR, scaphoid/ talus = arthrodesis

Question 29

what fractures are at risk for OA

Answer 29

intra-articular and malunion

Question 30

what is complex regional pain syndrome

Answer 30

heightened pain after injury, constant burning, throbbing, increased sensitivity, swelling and pain on movement