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A2 ME3031 MSK > W12 - FRACTURES, UL INJURIES, N PALSIES, COMPARTMENT SYNDROME > Flashcards

W12 - FRACTURES, UL INJURIES, N PALSIES, COMPARTMENT SYNDROME Flashcards

1
Q

Common Principles for Trauma Radiographs

A

Rule of 2x

  • Views: AP, and lateral
  • Joints: above, and below
  • Bones: if apt e.g radius ulna, tibia and fibula
  • Occasions: e.g scaphoid # nil initial XR but evident 7-14d later
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2
Q

Description of a #: Shape

A

Transverse: direct trauma

Oblique: d/t bending moment of force

Spiral: d/t rotational force

Complex: combination of forces

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3
Q

Comminution F#

A

comminuted fracture refers to a bone that is broken in at least two places. Comminuted fractures are caused by severe traumas like car accidents. You will need surgery to repair your bone, and recovery can take a year or longer.

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4
Q

Description of a #: Deformity

A

Movement of distal fragment with respect to stationary proximal fragment

  • DISPLACEMENT: % diameter of bone
  • ANGULATION
  • ROTATION
  • AXIAL DEFORMITY: impaction, overlapping (muscle spasm = shortening), distraction (soft tissue interposition)
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5
Q

Description of a #: Soft Tissue

A
  • Air = open #, gas forming organisms
  • Foreign bodies = open #
  • Fluid levels = haematoma
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6
Q

Clavicular #

A
  • middle 1/3 commonest
  • involve falling on shoulder/outstretched hand
*will unite
> analgaesia
> sling: 3-4w; progressive mobilization
> figure of 8 bandage?
> Sx: open #, skin threatened, neurovasc complication, polytrauma
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7
Q

Acromioclavicular #

A
  • AC dislocation
  • Fall onto shoulder

> Sprained = Sling 3-4w
Displaced AC joint = early fixation

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8
Q

Proximal Humerus #

A
  • young, high energy
  • elderly, osteoporotic injuries,

> conservative, sling mobilise from 6w
sx: plate fixation; joint replacement

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9
Q

Shoulder Dislocation

A
  • most common joint dislocation; anteriorly
  • posterior: seizure: check passive external rotation, XR = light bulb sign
  • axillary nerve test = badge area

*2 views XR!

> acute reduction under sedation

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10
Q

What is commonly associated with posterior shoulder dislocation?

A

unilateral loss of passive ext. rotation, XR light bulb sign

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11
Q

Dital Radial #

A
  • young: high velocity
  • old: osteoporotic, fall

> Undisplaced = splints/cats
Displaced = reduce
Cast
Sx: plate, external fixator

!Colles #

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12
Q

Colles # Compl.

A

Complication of Colles (distal radial)
- malunion, DRUJ pain
EPL rupture
carpal tunnel syndrome

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13
Q

Scaphoid #

A
  • commonly occur at waist of scaphoid
  • XR rpt at 2w or MRI
  • risk of non-union, or avasc. necrosis if in proximal

*pain base of thumb

> 6w Cast
Sx: displaced, nonunion

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14
Q

Ulnar collateral ligament injury of the thumb

A
  • radial force: gamekeepers thimb, skiers thumb
  • ligament injury or avulsion #

*weak pinch grip

> Splint, cast
Sx: repair ligament, fix avulsion fragment

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15
Q

Bennett’s #

A

Intra-articular # at base of 1st MC
- falling on outstreched hand, boxing, displaced by abductor pollicis longus

> Reduction
Maintain reduction: plaster, wire, screw fixation

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16
Q

Boxer’s #

A

Little finger and metacarpal neck
volar angulated

> conservative mgmt

17
Q

Flexor tendon injuries of fingers

A

commonly d/t knife laceration

> early sx repair
- partial tears do not need repair
!zone 2 no mans land = both FDS & FDP tendons = worst prognosis
> early movement = better healing
& REHAB
18
Q

Clinical Features of Axillary N Injury

A
  • Neck of Humerus
  • Supplies deltoid and teres mn. thus atrophy
  • lateral arm sensory

*d/t shoulder dislocation, surgical neck of humerus #

19
Q

Clinical Features of Radial N injury

A
  • radial groove, of humerus passes from medial to lateral
  • supplies tricpes
    => wrist drop; sensory loss, finger extension (forearm source), handcuff sensation (wrist source), loss of elbow extension (axilla source)

*Compression

20
Q

Clinical Features of Medial N. injury

A
  • supplies flexors
  • sens: 3.5 fingers
  • Carpal Tunnel Syndrome = noctural pain, parasthesia, thenar wasting
  • Tinnel (T)ap test
    Phalens
    > Carpal tunnel release
21
Q

Clinical Features of Ulnar n. injury

A
  • pinky finger + 0.5 ring finer
  • Cubital tunnel syndrome = numb ulnar side of hand and difficulty with fine tasks
  • palsy = wasting, guttering, hypothenar wasting
  • Ulnar claw hand
  • Fromens Test = holding paper
22
Q

Clinical Features of Nerve entrapment

A

Radial N *ENTRAPMENT = d/t #

23
Q

Common LL nerve injuries - Sciatic

A
  • sciatic foramen below piriformis muscle, runs deep to glut. max muscle and posterior hamstrings
  • terminal branches suppy all lower leg and foot
  • posterior dislocation of hip
  • intrafluteal injection dmg
24
Q

Common LL nerve injuries - Common fibular

A
  • smaller and lateral branch of sciatic: passes around lateral aspect of neck of fibula
  • divides into superficial and deep fibular n.

= foot drop and slapping gait - commonest nerve injured in LL

25
Q

LL - nerve entrapment: anterolateral cutaneous nerve of thigh

A
  • sensory to lateral aspect thigh
    = compression = meralgia paraesthetica

= characterized by tingling, numbness and burning pain in the outer part of your thigh

26
Q

Classic causes to Brachial Plexus Lesions

A
  • falling on side of neck
  • C5, 6, dmg
  • Breech delivery
  • T1 dmg
27
Q

Aetiology of Compartment Syndrome

A
  • post-trauma, +#
  • aggrv. by tight bandaging
  • vascular reperfusion of acutely ischaemic limb
  • d/t burns
  • more common in low energy tibial # = fascial compartments intact
  • ACS can occur in open #
28
Q

Definition and presentation of acute compartment syndrome

A

WHEN INTRAMUSCULAR PRESSURE ELEVATED TO REDUCE BLOOD SUPPLY = ISCHAEMIC INJURY

  • HIGH INTERSTITIAL PRESSURES *
  • lower leg most at risk then forearm, hand
  • small vasculature affected meanwhile main artery still same thus foot pink and warm and pulse present

*progressive dmg

29
Q

Patients at risk (acute compartment syndrome)

A

(+)Trauma
young fit males
adolescent tibial #

(-)Trauma
older medically unfit
f>m

(-)#
• crush
• blunt trauma
• stab wounds

30
Q

Dx of Acute Compartment Syndrome

A 
5 Ps:
P ain (passive movement)
P araesthesiae
P aresis/paralysis
P allor
P uleslessness - very late

*Stryker slit catheter = pressure monitoring
= persistent delta pulse <30mmHg

31
Q

Approach to mgmt

A
  • DO NOT ELEVATE
  • remove any bandages/casts
  • Measure pressure if possible

> Decompress: long incision, inspect all muslces, DEBRIDEMENT
2nd look 48hrs

32
Q

Missed compartment sybndrome

A

untreated:
ischaemia => necrosis

delayed # healing

muscle contractures

limb amputation?

A2 ME3031 MSK (20 decks)

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