Trauma week Flashcards by Finlay Strivens

What AC joint injuries are possible?

Sprain
Subluxation
Dislocation

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What tends to cause AC joint injuries?

Fall onto outstretched arm

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What is a subluxed AC joint?

Rupture of the AC ligament

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What is a dislocated AC joint?

Coracoclavicular and AC ligaments break

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How do you treat AC joint injuries?

Sling and physio

Surgery for chronic pain

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What are the three directions the glenohumeral joint can dislocate?

Anterior
Posterior
Inferior

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How do you diagnose a glenohumeral joint dislocation?

Asymmetry
Arm held adducted
Loss of sensation on regimental badge
2 plane XR
Posterior shows light bulb sign on XR

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What are the three common humeral neck fractures?

Proximal- Along surgical neck, Usually osteoporosis
Tuberosity fracture
Head fracture

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How does a proximal humeral neck fracture present?

Medial displacement

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How do you treat a humeral neck fracture?

Minimally displaced- Sling and gradually mobilize
Displaced- Wait for muscle spasm to ease and see
Permanently displaced- Internal fixation

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How do you treat multiple fractures of the humeral neck/head?

Joint replacement but not the best.

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What are the two ways a humeral shaft can break?

Direct trauma- Transverse fracture

Falling- Oblique or spiral fracture

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How do you fix a broken humeral shaft?

Usually just brace
Can fix with intramedullary nail
High recovery rates

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What is a complication of a broken humeral shaft?

Damage to the radial nerve running in groove leading to loss of sensation in 1st dorsal webbing and wrist drop.

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What age group do supracondylar fractures tend to occur in?

Children

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How are supracondylar fractures occur?

Fall onto outstretched arm or flexed elbow

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How do you treat a supracondylar fracture?

Undisplaced- Splint

Displaced- Reduce. Pin w/ wires or open surgery if artery/nerve is trapped.

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How do you get an olecranon fracture?

Fall on point of elbow

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How do you treat an olecranon fracture?

Open reduction and internal fixation.

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What is problematic about forearm fractures?

If one bone breaks other has to break or dislocate normally

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What is an ulnar shaft/nightstick fracture?

Isolated fracture of ulna due to direct blow.

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How do you manage an ulnar shaft fracture?

Conservative management normally but can be ORIF

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What is a Monteggia fracture dislocation?

Fracture of ulna and dislocation of radial head

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How do you treat a Monteggia fracture dislocation?

ORIF of fracture which usually relocated radius

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What is a Galeazzi fracture dislocation?

Fracture of radius and dislocation of ulnar at distal radioulnar joint.

How do you treat a Galeazzi fracture?

ORIF of radius which normally resets ulnar

What is a both bone fracture of the forearm?

A fracture through diaphysis of both ulnar and radius

How do you treat a both bone fracture of the forearm?

ORIF in adults | Plaster cast in children as will remodel better

What kind of fractures are possible at the distal radius?

Colles Fracture Smith's Fracture Barton's Fracture Comminuted intra-articular distal radius fracture

What is the most common cause for distal radius fractures?

Fall on to out stretched arm

What is a Colles fracture?

Fracture of distal radius w/in 1 inch of articular surface with dorsal displacement.

How do you treat a Colles fracture?

Minimal displacement- Splint Displaced- Manipulate then splint Then secure with plaster, percutaneous wires or ORIF

What complication can a Colles fracture cause?

Carpal tunnel syndrome

What is a Smith's fracture?

Fracture of distal radius w/in 1 inch of articular surface with volar displacement.

How do you treat a Smith's fracture?

ORIF

What is a Barton's fracture?

Intra-articular fracture of distal radius- carpal bones sublux and break off part of rim. Can be volar or dorsal

How do you treat a Barton's fracture?

ORIF

What is a comminuted intra-articular distal radius fracture?

Very traumatic and damaging fracture of radius

How do you treat a comminuted intraarticular distal radius fracture?

External fixation

What normally causes a scaphoid fracture?

FOOSH

How does a scaphoid fracture present?

Tenderness in anatomical snuff box Pain on compression Difficult to see on XR therefore splint and asses in 2 weeks

How do you treat a fractured scaphoid?

Undisplaced- Cast for 6-12 weeks | Displaced- Compress and screws

What complications can occur with a broken scaphoid?

Due to poor blood supply can un-union and AVN.

What are the 6 hand injuries we need to know

``` Phalangeal fractures Metacarpal fractures Flexor tendon injury Penetrating hand injury Extensor tendon injury Mallet fracture ```

How do you treat phalangeal fractures?

Strap to neighbours | If angles will need manipulated under ring block

How do you treat metacarpal fractures?

3rd, 4th and 5th treat conservatively | 5th tend to angle therefore strap digit to neighbour

What is a special form of metacarpal fracture?

Fight bite

What is the danger with fight bite?

Caa get oral bacteria in MCP capsule giving septic arthritis or disrupt extensor mechanism

What is a major problem with flexor tendon injury?

Potential for damage to nerves and arteries

What tendons can be damaged in flexor tendon injury?

FDS FDP FPB

How do you treat flexor tendon injury?

Repair and splint in flexed position

What is mallet finger?

Avulsion of extensor tendon from its insertion into terminal phalanx

How does mallet finger occur?

Forced flexion of extended DIP joint

How does mallet finger present?

Pain Droop at DIP Inability to extend DIP

How do you treat mallet finger?

Hold extended for 4 weeks

How do you treat extensor tendon injury?

If more than 50% then requires surgical repair with splint in extension for 6 weeks. Flexion may cause healing failure

What is the danger with penetrating hand injuries?

Volar injuries can damage flexor tendons, digital nerves and arteries Dorsal injuries can damage extensor tendons

How do you treat penetrating hand injuries

Repair damaged tendons etc

What are the five categories of Salter-Harris physeal injury?

1: Pure separation along physeal line 2: Similar to 1 but with small bit of metaphysis attached. 3: Interarticulate progressing to physis 4: Interarticulate progressing into metaphysis 5: Compression of physis therefore get growth arrest

What is the most common Salter-Harris physeal injury?

Salter-Harris II

What are some indicators of Non-Accidental Injury in children?

Multiple fractures and bruises at different stages of healing. Multiple trips to A&E Changes/discrepancy in history- Both between carers and not matching injuries Atypical injuries Rib and metaphyseal injury

What is a buckle fracture?

Compression of the bone therefore looks slightly short and wide on XR.

How do you treat a buckle fracture?

3-4 weeks in a splint

What is a greenstick fracture?

Part of bone remains attached and part breaks.

How do you treat a greenstick fracture?

Manipulation and casting

What fractures can you get in the forearm of a child?

Monteggia and Galeazzi fracture dislocations | Fractures of both bones

How do you treat fractures in the forearm of a child?

Monteggia and Galeazzi fracture dislocations- ORIF | Fractures of both bones- Undisplaced cast, displaced need fixed

What is the most common fracture of a child's elbow?

Supracondylar fracture

How do children tend to obtain supracondylar fractures?

Extensor- fall on outstretched arm | Flexor- fall on point of elbow

How do you treat supracondylar fractures?

Undisplaced- Stabilized and splint | Displaced- MAnipulate ASAP and surgery if artery (no pulse) or nerve (no feeling) involvement

How do kids tend to fracture their femoral shaft?

Fall on bent knee Direct bending force Rotation

How do you treat a fractured femur in kids?

<2YO- NAI therefore treat appropriately 2-6YO- Splint or cast 6-12YO- Flexible intramedullary nails >12YO- Adult type intramedullary nails

What type of tibial fracture is common in toddlers?

Undisplaced spiral fracture

How do you treat a tibial fracture in children?

Cast if stable | If open or unstable- Fix and screws