Trauma Ortho Flashcards
(149 cards)
1
Q
How do you describe a radiograph?
A
What images - when and who is it from.
Type of fracture:
- Complete, transverse, oblique, spiral, comminuted.
- Incomplete, bowling, buckle, greenstick.
- Growth plate injuries.
Location - diaphysis, metaphysis, epiphysis.
Displace - angulation, translation, rotation, distracted, impacted.
Joint involvement - intra-articular, extra-articular.
Another fracture - joint above and below especially forearm and ankle.
2
Q
What does FOOSH mean?
A
Fallen on outstretched hand.
3
Q
What is a fight bite?
A
Punching injury in which the punchee’s tooth causes a laceration in the 5th MCP as the tooth goes into the joint, inoculating the joint with somebody’s oral bacteria.
This is a surgical emergency as it is septic arthritis until diagnosed otherwise.
4
Q
How are traumatic fractures examined?
A
Likely pattern of injury based on age and mechanism.
Distracting injuries.
Zone (area) of injury.
Open or closed (open requires quicker treatment due to infection risk).
Skin integrity.
Assess function, neural and vascular status.
Image, plain radiology and/or CT scan and/or MRI.
5
Q
What does 0NVD mean?
A
No neurovascular deficit.
- Don’t say this as many patients have very subtle injuries.*
- To say this you need to understand peripheral innervation of upper and lower limbs and examine sensation and motor for each main peripheral nerve.*
- Usually, unless axial spine is involved this is NOT a check on dermatomes.*
6
Q
What neurovascular exam of the peripheral nerves of the upper limb should be carried out following a traumatic fracture?
A
Pressing thumb.
Making a fist and extending digits.
Pressing 5th MCP.
7
Q
What is compartment syndrome?
A
Results from interstitial pressure increases in closed osseofascial compartments.
Causes microvascular compromise.
Commonly due to abnormalities in the microcapillary or capillary level not arterial.
Should be treated within 6 hours of onset.
8
Q
Which people have an increased risk of acute compartment syndrome?
A
Tibia fractures, especially in male 10-35 years.
Forearm fractures.
IVDAs, comatose prolong lie.
Anticoagulation and trivial trauma.
May not involve a fracture.
Burns.
9
Q
Which is the commonest compartment that can develop acute compartment syndrome?
A
Anterior compartment (first and second toes become numb).
Deep posterior compartment - second commonest (foot is tingling).
10
Q
What are the clinical signs of acute compartment syndrome?
A
Disproportionate pain.
Pain on passive stretch of muscles in involved compartment.
Paraesthesiae.
11
Q
What is the treatment of acute compartment syndrome?
A
Immediate release all dressings/cast to skin.
Do not elevate.
Phone senior help.
Theatre.
Emergency fasciotomy and stitch up again 24-48 hours later.
12
Q
What is a Weber classification?
A
Classifies where the ankle fracture is in relation to the syndesmosis.
13
Q
What is the median age of hip fractures currently?
A
84 years old.
14
Q
What information do you need from elderly patients with a hip fracture?
A
Corroborated history from patient and relatives/friends to gather a baseline.
Anticoagulation status.
Medication changes, full medicines reconciliation - must know if their GP has recently made any changes to medications.
Missed injuries.
Cognitive impairment? Delirium on dementia? Just delirium or was it the analgesia in the ambulance?
MDT medicine for the elderly and friends.
15
Q
How can you tell if a patient has a broken hip if the xray is normal?
A
Gently rock the patient’s knee from side to side and if they scream in pain, vomit or give any similar indication the hip is broken until otherwise proven.
Urgent MRI required.
16
Q
What is the best hip replacement currently?
A
Ceramic on plastic couple bearing with metal stem and cap.
17
Q
What should you assess in an open wound?
A
Location, size of the wound.
Nature of wound (incised or laceration).
Degloving?
Capillary refill?
Pulses.
Tendon damage - wiggle things around.
18
Q
Who can suffer from a neck of femur (proximal femoral) fracture?
A
Elderly patients (92%).
Females more likely (73%).
Young adults in high energy trauma.
19
Q
What are the risk factors for proximal femur fractures?
A
Risk doubles every 10 years after age 50.
Osteoporosis (3x more common in females).
Smoking.
Malnutrition.
Excess alcohol.
Neurological impairment.
Impaired vision.
20
Q
What is the blood supply to the femoral head?
A
Intramedullary artery of the shaft of femur.
Medial and lateral circumflex branches of profunda femoris.
Artery of ligamentum teres (deteriorates as you get older).
21
Q
What are the consequences of an intra-capsular fracture of femur?
A
Blood supply is disrupted meaning that healing won’t occur and increased risk of avascular necrosis.
Non-union (20%).
Avascular necrosis (6%).
22
Q
What are the consequences of an extra-capsular fracture of the femur?
A
There will be a blood supply on both side of the fracture so it is able to heal and may require surgical fixation.
Malunion.
Non-union.
23
Q
How are intracapsular fractures of the femur classified?
A
There is the Garden classification but most say whether it is displaced or undisplaced.
24
Q
What types of extra-capsular fractures of the femur are there?
A
Basicervical.
Intertrochanteric.
Subtrochanteric.
25
What history and signs are suggestive of a proximal femoral fracture?
History (fall, pain, unable to weight-bear).
Signs (shortening, external rotation).
26
What investigations are used in diagnosing proximal femoral fractures?
Xray (Shenton's line).
MRI.
27
What is Shenton's line?
Shenton line is an imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur. This line should be continuous and smooth.
Interruption of this line indicates either fractured neck of femur or developmental dysplasia of the hip.
28
What are the principles of management of hip fracture?
Return patient to pre-fracture level of function.
Usually by operation followed by mobilisation.
Early mobilisation is done to avoid complications of recumbency (which can lead to pneumonia, UTIs, DVTs, pressure sores).
29
What xray views do you do for suspected proximal femur fractures?
AP.
Lateral.
30
What is the management of proximal femoral fractures if both sides of the fracture are vascular (have a blood supply)?
Fix the fracture with screws, etc.
31
What is the management of proximal femoral fractures if only one side is vascular (have a blood supply)?
Total hip replacement.
32
What are the key elements of good care of fragility fractures?
Prompt admission to orthopaedic care.
Rapid comprehensive assessment – medical, surgical and anaesthetic.
Minimal delay to surgery.
Accurate and well-performed surgery.
Prompt mobilisation & prevention of complications.
Early multidisciplinary management rehabilitation.
Early supported discharge.
Secondary prevention including falls and bone health assessments.
33
What are the current standards required for hip fracture care pathway?
1. Be transferred from the ED (emergency dept) to the orthopaedic ward within 4 hours.
2. Have the ‘Big Six’ interventions in the ED.
3. Receive the ‘Inpatient Bundle of Care’ within 24h.
4. Undergo surgery with 36h of admission.
5. Not be fasted repeatedly and should be given fluids up to 2 hours before surgery.
6. Have a cemented hemiarthroplasty unless otherwise indicated.
7. Receive geriatric assessment within 3 days of admission if frail.
8. Receive early mobilisation by end of first day after surgery and physiotherapy assessment by end of day 2 after surgery.
9. Receive occupational therapy assessment by end of day 3 following admission to ward.
10. Receive assessment of bone health prior to leaving acute orthopaedic ward.
11. Have recovery optimised by MDT so can be discharged within 30 days of admission.
34
During the initial admission of a hip fracture what should be done in the emergency department before the patient is admitted to the orthopaedic ward?
Rapid triage through A&E.
rapid X-rays.
Minimise delays in reaching orthopaedic ward (unless indicated to stay for essential interventions).
Avoid long uncomfortable periods on trolleys.
35
What are the 'big six' interventions that should be done before a patient with a hip fracture leaves the emergency department to go to the orthopaedic ward?
Analgesia (especially for xrays).
Early warning score.
Pressure area inspection.
Blood tests.
Fluid therapy.
Delirium screening.
36
What analgesia is given pre-op for a hip fracture?
Local nerve blocks (into the fascia).
Can last intraoperatively and post-op.
Delivered in A&E.
37
What is delirium?
Acute confusion.
38
What is the management of delirium?
Predisposing factors e.g. age, dementia.
Precipitating factors e.g. pain, drugs, constipation.
Propagating factors e.g. change in environment, constipation, infection.
Treat the underlying cause.
Non-pharmacological methods e.g. ensure, same nursing team, use families.
39
What are the criteria used to identify delirium and what is the tool used?
Confusion assessment method.
Acute change/fluctuating cognitive level.
Inattention.
Altered conscious level or disorganised thinking.
4AT tool helps identify delirium.
40
What is the inpatient bundle of care that every patient with a hip fracture should receive within the first 24 hours of admission?
Cognitive screening.
Nutritional (MUST) screening.
Pressure area screening.
Falls screening.
41
How long does it take for pressure ulcers to develop?
They can start to develop within 30 mins of lying on a hard surface e.g. A&E trolley or floor at home.
42
In which patients are pressure ulcers more likely?
Delays in surgery.
Frail/malnourished patients.
Failure to mobilise early.
43
Who's involved in the assessment for a patient with a hip fracture awaiting surgery?
Orthopaedic surgeon (review patient and films and produce an appropriate management plan).
Anaesthetist (suitability for type of anaesthetic; assessment of cardio-respiratory system).
Medical (assess fluid status, comorbidities; start fluids; manage comorbidities; address any acute cause of falls; medication review).
44
Which patients may not receive a cemented hemiarthroplasty implant as standard?
Patients who had a very high independence level of living before admission.
45
What are the frailty syndromes?
**Falls** (e.g. collapse, legs gave way, 'found lying on the floor').
**Immobility** (e.g. sudden change in mobility, 'gone off legs', 'stuck in toilet').
**Delirium** (e.g. acute confusion, muddledness, sudden worsening of confusion in someone with previous dementia or know memory loss).
**Incontinence** (e.g. change in continence).
**Susceptibility to side effects of medication** (e.g. confusion with codeine, hypotension with antidepressants).
46
What is the CSHA Clinical Frailty Scale?
A classification of the spectrum of frailty:
1. Very fit.
2. Well.
3. Well, with treated comorbid disease.
4. Apparently vulnerable.
5. Mildly frail.
6. Moderately frail.
7. Severely frail.
47
What is the post-op management of pain in hip fractures?
WHO pain ladder is the recommended treatment post-operatively.
48
What is the pragmatic appropriate of post-op analgesia following hip fractures in patients identified as frail?
Paracetamol regularly oral of IV.
Codeine starting small dose (15mg) but can be increased.
Morphine as required or regular; oxycodone if confused on morphine (small doses of both).
49
When should a post-op hip fracture patient be assessed by physiotherapy?
Mobilisation should have begun by the end of the first day after surgery and every patient should have physiotherapy assessment by the end of day 2.
50
When should a post-op hip fracture patient be assessed by occupational therapy?
Patients with a hip fracture should have an OT assessment by the end of day 3 post-operation.
51
What is resuscitation?
The process of correcting physiological disorders in an acutely unwell patient.
52
Why do people undergo cardiorespiratory arrest?
Failure of one of the vital organs due to lack of oxygen.
53
What is the pathophysiology of cardiac arrest?
Inadequate oxygen delivery to organs leading to organ failure.
Vital organ failure can lead to cardiorespiratory arrest.
54
What are required for oxygen delivery to organs?
Airway.
Breathing.
Circulation.
55
What is the approach to treating the acutely unwell patient?
Recognition.
Structured assessment.
Structured correction of the abnormal pathophysiology.
Treat the underlying cause.
56
What are the clinical indicators of deterioration before hospital cardiac arrest?
Tachypnoea.
Tachycardia.
Hypotension.
Reduced conscious level.
*Look for trends in clinical observations.*
57
What is involved in a rapid assessment of a patient with acute illness?
General impression.
**A**irway assessment.
**B**reathing assessment.
**C**irculatory assessment.
**D**isability (neuro).
**E**xposure.
58
What is involved in an airway assessment?
Open or closed.
Is it obstructed (foreign body; swelling, jaw being loose and occluding airway, blood)?
Is action required?
Do you need an adjunct (head lift, chin tilt, oropharyngeal or nasopharyngeal airway)?
Do I need anaesthetic support?
59
What is involved in an assessment of breathing?
Present or absent? - if absent the bag and mask and start CPR.
Adequate ventilation?
Oxygen source and means of delivering oxygen.
60
What oxygen do you give to patients who are acutely unwell and at risk of cardiorespiratory arrest?
All patients get high flow oxygen.
61
What is hypoxic drive?
Longstanding pulmonary disease results in CO2 retention as chemoreceptors in medulla get downregulated.
So there is a switch from the hypercapnic drive to hypoxia drive of ventilation.
High concentration of inhaled oxygen results in hypo-ventilation and further CO2 retention.
62
What happens if a COPD patient is at risk of cardiopulmonary arrest?
Measure the ABGs closely: if CO2 is OK observe closely and if CO2 is rising treat with the aim oxygen sats of 88-92%.
## Footnote
*Unless someone is a known CO2 retainer give all breathless patients oxygen.*
63
What is the Sepsis Six?
**Oxygen** (high flow but care if COPD).
**Blood cultures** (sample 10ml blood into each bottle).
**IV antibiotics** (see local guidelines).
**Fluid challenge** (Hartmann's or 0.9% saline; if SBP\<90 then STAT 20ml/kg; not hypotensive then at least 500ml).
**Lactate** (blood gas analyser or discuss with lab).
**Urine output** (accurate fluid balance chart, may need catheter).
64
What is involved in a circulation assessment?
Presence or absence of pulse, BP, CRT, ECG.
Is there adequate perfusion (colour, conscious level)?
65
What questions should you ask in relation to IV access?
If present, is it working?
If not, what sort of cannula? - big bore cannulas centrally.
Where to put it?
What blood samples to take? - FBC, cross-match, cultures, everything.
Do you want to give fluids? - start with saline and if losing blood then blood too.
66
What will be done in a disability assessment?
AVPU.
Pupils equal and reactive?
GCS.
Lateralising signs?
67
What should be done during exposure?
Check colour, for rashes, blood loss and drains.
68
What should you never forget as part of disability?
GLUCOSE.
Hypoglycaemia is a cause of decreased conscious level.
Appear acutely unwell.
Treatment is dextrose orally or IV, IM glucose and it will show a rapid reversal.
69
What do you do after resuscitating someone?
Re-evaluate (ABCDE).
Continuous monitoring.
Further investigations.
Specialist involvement is required.
Inform/involve relatives.
70
When are the 2 age peaks in which children are more likely to suffer a fracture?
Around age 7.
Around age 13.
71
What is plastic deformation?
Bending of bone in children when they have a fracture.
Requires manipulation to correct the deformity.
72
What is the physis?
Growth plate of bone.
73
What is Wolff's law?
Bone in a healthy person or animal will adapt to the loads under which it is placed.
74
What is Hueter Volkman law?
Compression forces inhibit growth and tensile forces stimulate growth.
75
What laws of physics are relevant to remodelling of bone?
Wolff's law.
Hueter Volkman law.
76
What should you ask specific to an orthopaedic trauma history?
Mechanism of injury.
How high?
How fast?
Forces involved.
These all predict injury patterns to exclude or confirm patterns of injury.
77
What history can indicate non-accidental injury?
History that does not match the nature or the severity of the injury.
Vague parental accounts or accounts that change during the interview - inconsistency.
Accusations that the child injured him/herself intentionally.
Delay in seeking help.
Child dresses inappropriately for the situation.
78
What are features of non-accidental injury?
Any obvious or unsuspected fracture in a child under 2 years particularly pre-walking.
Injuries in various stages of healing, especially burns and bruises.
More injuries that usually seen in children of the same age.
Injuries scattered on many areas of the body.
Increased intracranial pressure in an infant.
Suspected intra-abdominal trauma in a young child.
Any injury that does not fit the description of the cause given.
79
What are the radiological features of non-accidental injury?
Metaphyseal corner fractures.
Rib fractures.
Proximal knee fractures.
Tibial fractures.
Humeral fractures.
Femoral fractures.
80
What are the features of a fracture that you should look for in examination?
Deformity.
Swelling.
Bruising.
Asymmetry.
81
What are the features of a fracture that you should feel for in examination?
Point tenderness that will correlate with an xray.
82
What are the features of a fracture that you should feel for in a neurovascular examination?
(Colour).
Capillary refill.
Skin temperature.
(O2 saturation).
Pulse (last of the things to go in terms of severity).
Sensation.
Sweating.
Skin wrinkling on immersion in water.
83
What are the features of a fracture that you should move in examination?
Often too painful but need to remember distal neurovascular assessment.
In terms of upper limb NV assessment check for sensory and motor function of radial, median and ulnar nerves.
84
How do you test motor function of the radial, median and ulnar nerves in paediatrics?
Thumbs up (radial).
Starfish (ulnar).
OK sign (median).
85
What displaces fractures?
Initial force on impact.
Muscle action and gravity.
86
What are the principles of fracture management?
**Reduce** - remodelling potential reduces need for accurate reduction (age dependent - possible in children).
**Retain**.
**Rehabilitate**.
87
Why do you need to apply traction to a femoral fracture?
Application of force in the opposite direction used to oppose/offset traction and deformities.
88
What is the purpose of flexible nailing?
INcreasingly used for long bones (femur, tibia, humerus, radius and ulna).
Allows early joint mobilisation and weight-bearing because you're stabilising the fracture.
Predictable position rapid healing.
*Disadvantages are infection risk and risk of anaesthesia.*
89
What is the purpose of a collar and cuff?
Doesn’t take the weight off and uses gravity to aid healing i.e. humeral fractures.
Provides traction.
90
What is the purpose of a sling?
Weight of forearm is taken by the back of the neck.
Don’t want traction in shoulder injuries so removes traction and the action of gravity.
91
How much of the limb is put in a cast in a diaphyseal fracture and why?
Immobilise joint above and below fracture involved to prevent rotation.
92
How much of the limb is put in a cast in metaphyseal fractures?
The adjacent joint only.
93
When would you operate fractures in children and why?
Displaced intra-articular fractures - if not fixed will end up with post-op osteoarthritis or avascular necrosis.
Displaced growth plate injuries - risk of growth plate closing early causing discrepancy in leg lengths and deformity.
Open fractures - increased risk of infection and sometimes need surgical fixation but not always.
94
What is the diaphysis?
Shaft of bone.
95
What are the Salter-Harris fractures?
Type I - **S**traight across.
Type II - **A**bove.
Type III - **L**ower.
Type IV - **T**hrough **E**verything.
Type V - c**R**ush.
96
What injuries require external fixation in the first instance?
Contamination wounds.
Acute vascular injury.
Burns.
Multiple injuries.
97
What is a dislocation?
Loss of contact between the joint surfaces.
98
What structures are at risk during a joint dislocation?
Ligaments, tendons, nerves and blood vessels.
99
What is the management of a joint dislocation?
Closed reduction under sedation.
Open reduction.
Stabilisation and rehabilitation.
Anaesthesia, sedation and analgesia are given.
100
What are the common areas of joint dislocation?
Shoulder.
Elbow.
Interphalangeal joints.
Hip.
Patella.
Knee.
Ankle.
101
What trauma can cause dislocation?
Fall.
RTC.
Sports injury.
Seizure.
102
What directions can the shoulder joint dislocation?
Anteriorly - common.
Posteriorly.
Inferiorly - very rare.
103
What is the mechanism of injury of an anterior shoulder dislocation?
Fall onto an outstretched hand, the shoulder is in external rotation meaning the humeral head is likely to come out anterior the glenoid.
104
How do you check for damage of the axillary nerve in a shoulder dislocation?
Test the sensory function of the regimental badge area of the shoulder.
105
What is the mechanism of injury of a posterior shoulder dislocation?
Fall with shoulder in internal rotation or a direct blow to the anterior shoulder causes the humeral head to go out of the glenoid posteriorly.
106
What is the classic radiological sign of a posterior shoulder dislocation?
Lightbulb sign.
107
What is the mechanism of injury of an inferior shoulder dislocation?
Arm held in abduction during injury causing the humeral head to displace inferiorly to the glenoid.
108
What is the recurrent instability risk following a shoulder dislocation?
It is related to age.
The risk of recurrence decreases with age.
109
What reduction methods can reduce a dislocation shoulder?
Hippocratic manoeuvre.
In-line traction.
110
What is the mechanism of injury of an elbow dislocation?
Fall onto an outstretched hand.
111
What are the associated injuries with an elbow dislocation?
Fracture of the radial head.
Fracture of the coronoid process.
112
What directions can an elbow dislocate?
Posterior.
Anterior.
Medial/lateral (divergent).
113
What is the mechanism of injury in a pulled elbow causing a radial head dislocation which may be associated with an elbow dislocation?
To test motor function ask a child to make a starfish (ulnar nerve), point (radial nerve), an O (median nerve).
114
What is the management of an elbow dislocation?
Closed reduction under sedation.
Open reduction (rarely required).
2 weeks in a sling and rehabilitation.
115
What are the reduction methods for an elbow dislocation?
Traction in extension +/- pressure over the olecranon.
116
What is the recurrent instability risk of an elbow dislocation?
Low.
117
What is the mechanism of injury of interphalangeal joints?
Hyperextension injury due to a direct axial blow.
118
In which directions can the interphalangeal joints dislocate?
Almost always posterior.
119
What are the associated risks from an interphalangeal joint dislocation?
Head of phalanx button-holes through the volar plate.
Recurrent instability due to associated fracture.
120
What is the management of interphalangeal joint dislocation?
Closed reduction under digital or metacarpal block.
Open reduction rarely required.
2 weeks in neighbour strapping.
Volar slab in the Edinburgh position if unstable (image shows this).
121
What are the reduction methods for an interphalangeal joint dislocation?
In-line traction + corrective pressure.
122
What is a ring block?
Anaesthetic is injected into the web space of the dorsal and volar aspect of the affected finger.
123
What is the mechanism of injury for a patella dislocation?
Sudden quadriceps contraction with a flexing knee.
124
What is the direction of dislocation in a patella dislocation?
Always lateral.
125
What are the associations/causes of a patella dislocation?
Hypermobility.
Under-developed (hypoplastic) lateral femoral condyle.
Increased Q-angle (genu valgum; increased femoral neck anteversion).
Weakness in lateral quadriceps insertions or vastus medialis.
126
What is the Q-angle?
Line drawn from ASIS to the midpoint of the patella and a second line is drawn from the tibial tubercle to the midpoint of the patella.
The Q-angle is the angle between these 2 lines.
*Can be measured on appropriate xrays.*
127
Why does the patella dislocate laterally instead of medially?
Patella has a tendency to move laterally is the medial retinaculum and medial structures are damaged or lax.
128
What is the management of a patella dislocation?
Reduce the knee with extension.
Radiographs.
Aspiration.
Brace.
Physiotherapy.
129
What is the management of repeat patella dislocations?
Lateral release/medial reefing.
Patella tendon realignment.
Reconstruct the torn MPFL with a graft.
130
What is the common presentation of a patella dislocation?
Clear history of patella dislocating laterally.
Often self-relocating.
131
What examination is involved in patella dislocations?
Pain medially (from torn medial retinaculum).
Effusion (hemarthrosis).
Patella apprehension test positive.
132
What is the mechanism of injury in a knee dislocation?
High-velocity injuries (e.g. RTC).
Low-velocity injuries.
133
What are the consequences of a spontaneous relocation of a knee dislocation?
Do not miss this diagnosis.
Injuries associated can be lateral collateral ligament injury and peroneal nerve injury.
134
In which directions can the knee dislocate?
Posterior (potential to injury popliteal artery).
Anterior.
Medial, lateral and rotatory.
135
Why is an assessment of the knee essential after a knee dislocation?
Vascular injuries - popliteal artery/vein injury (may not be an obvious intimal tear or thrombus).
Nerve injuries - peroneal nerve.
Ligamentous stability - examination (may need to be done under anaesthetic if the patient is needing other surgical treatment).
136
What is the urgent management of a knee dislocation?
Reduction under sedation.
May require surgical reduction if the condyle has button-holed through the capsule.
Stabilise in a splint or external fixation.
137
What imaging is required of a knee dislocation?
Plain radiographs for associated fractures.
MRI.
138
What is the early surgical treatment for a knee dislocation?
Vascular repair (have a 6 hour window for this).
Nerve repair.
139
What is the definitive surgical treatment for a knee dislocation?
Sequential ligamentous repair.
140
What are the complications following surgical treatment of a knee dislocation?
Arthrofibrosis and stiffness.
Ligament laxity.
Nerve or arterial injury.
141
What is the mechanism of injury of a native hip dislocation?
High-velocity injuries - e.g. RTC dashboard injury, fall from a height.
142
In which direction do native hip joints dislocate?
Most commonly posterior.
143
What are the associated fractures with a native hip dislocation?
Posterior acetabular wall.
Femoral fractures.
Pelvic fractures.
Other fractures of the spine, calculus, femoral neck, sacroiliac joint, etc most likely in a polytrauma.
144
What is the presentation of a native hip dislocation?
Flexed, internally rotated and abducted knee.
145
What is the early management of a native hip dislocation?
Neurovascular assessment (particularly the sciatic nerve).
Radiographs (changes can be subtle).
Urgent reduction.
Stabilise in tractions if required.
Further imaging (CT).
146
What is the definitive management of native hip dislocation?
Fixation of associated pelvic fractures.
Fixation of other injuries in poly-trauma patients.
147
What are the complications of native hip dislocation?
Sciatic nerve palsy.
Avascular necrosis of the femoral head.
Secondary osteoarthritis of the hip.
148
What deformity does remodelling not correct?
Rotational deformity.
149
What are the clinical findings of sacral sparing in spinal injury?
Perianal sensation.
Anal sphincter activity.
Activity in toes in plantar/dorsiflexion.
