week 6: trauma

Question 1

all major trauma patients are given ___ of __ ____ initially

Answer 1

2L

IV ``crystalloid

Question 2

the first manifestation of hypovolaemia is __ followed by reduction in __ ___. ___ or ___ may also be present

Answer 2

tachycardia
blood pressure
Lethargy
Confusion

Question 3

hypovolaemia should respond to ___ ___. Transient response suggests ongoing bleeding. No response with chest trauma, particularly penetrating injuries, may indicate ___ ____(look for distended neck veins and muffled heart sounds) which can be confirmed with an ____ and may require ____ or surgery.

Answer 3

fluid resuscitation
cardiac tamponade
echocardiogram
pericardiocentesis

Question 4

pelvic fractures can result in substantial blood loss from arterial bleeding. which artery is affected

Answer 4

internal iliac artery + branches

Question 5

open book pelvic fracture

Answer 5

the 2 hemi pelvises are sprung apart

Question 6

external bleeding controlled by

Answer 6

direct pressure with gauze (plug, press, elevate)
or
temporary tourniquet

Question 7

A quick neurologic assessment should be performed to establish the level of consciousness, identify signs of severely raised intracranial pressure from intracranial haemorrrhage - ____ __ and ____

Answer 7

pupil fixed

dilated

Question 8

Level of consciousness is determined by the Glasgow Coma Score (Eye, Motor & Verbal response). GCS of___ or less implies severe head injury with potential loss of airway control and requires a ____ ____ ___

Answer 8

8

placement of a definitive airway

Question 9

signs of significant head injury (7) which will require CT scanning

Answer 9

loss of consciousness >5mins 
<1 episode of vomiting 
amnesia >30mins 
severe headache
obvious skull fracture 
focal neurologic deficit 
GCS <15 (2hrs post) or GCS <12 at any time

Question 10

significant head injuries increase risk of __-__ injury

Answer 10

C-spine

Question 11

define decorticate posture

Answer 11

abnormal posturing (damage to 1/oth corticospinal tracts)
arms adducted and flexed, wrisrs and fingers flexed on chest
legs - extended and internally rotated, with plantar flexion of the feet

Question 12

With major trauma involving multiple injuries, unstable major long bone fractures can cause ongoing blood loss with _____, ___, increased ___ ___ , amplfication of the __ and ___ ___ which can result in deterioration of the patient’s clinical condition

Answer 12

pain 
hypovolaemia 
sympathetic response
inflammation
fat embolism

Question 13

Systemic inflammatory response ocurs when there is an amplification of ___ ___ in response to trauma with pyrexia, ___, ___ and leukocytosis

Answer 13

inflammatory cascades
tachycardia
tachypnea

Question 14

ARDS may occur due to 4

Answer 14

hypoperfusion
SIRS
aspiration
fat embolism (causing inflame of lung parechyma)

Question 15

in polytrauma, rapid skeletal stabilisation is required, why

Answer 15

limits biological load of trauma

limits bblood loss

Question 16

primary bone healing

Answer 16

minimal fracture gap ( <1mm)

bone bridges gap with new bone

Question 17

cells responsible for bone regrowth in primary bone healing

Answer 17

osteoblasts

Question 18

secondary bone healing

Answer 18

gap at fracture site, scaffolding required for new bone to be laid

Question 19

seconday bone healing is an inflammatory response and requires __ ___ __

Answer 19

pluripotent stem cells

Question 20

outline the fracture process of secondary bone healing

Answer 20

fracture
haematoma + inflame from damaged tissues
macrophages + osteoclasts remove debris
granulation tissue forms (from fibroblasts + new blood vessels)
chondroblasts form cartilage (soft callus)
osteoblasts lay done bone matrix - enchondral ossification (collage 1)
calcium mineralisation - immature bone (hard callus)
remodelling

Question 21

soft callus is usually formed by __/__ week whilst hard callus takes approx _____

Answer 21

2nd/3rd

6-12 wekks

Question 22

smoking may impair fracture healing, why

Answer 22

vasospasm

vascular disease

Question 23

define atrophic non union and give causes

Answer 23

bone does not heal properly - due to lack of blood supply, no mvoement, too big a gap, or tissue trapped in fracture

Question 24

hypertrophic non unions occur due to 2

Answer 24

excessive movement

too much hard callus

Question 25

5 types of fractures

Answer 25

transverse - bending force, cortex side 1 fails in compression, cortex side 2 fails in tension oblique - shearing force (fall from height), screws spiral- torsional force, screws comminuted - 3+ fragments, high energy injury/poor bone segmental - fractured in 2 separate places

Question 26

transverse fractures may not shorten but may ___ or result in ___ ____

Answer 26

angulate | rotational malalignment

Question 27

oblique fractures tend to __and may also ___

Answer 27

shorten | angulate

Question 28

spiral fractures are most unstable to __ __ but can also ___

Answer 28

rotational forcces | angulate

Question 29

comminuted fractures are very ___ and tend to require

Answer 29

unstable | surgery

Question 30

segmental fractures are very ___ and require stabilization with ___ __ or __

Answer 30

unstable long rods plates

Question 31

A fracture of a long bone can be described according to the site of the bone involved in terms of the ____, ___ or ___ ___ It can also be described according to the type of bone involved –____, ___ or ___

Answer 31

``` proximal middle distal third diaphyseal (shaft) metaphyseal epiphyseal ```

Question 32

A fracture at the end of a long bone (metaphyseal / epiphyseal) can be ____ or ____

Answer 32

intra-articular (extends into joint) extra-articular Intra‐articular fractures have a greater risk of stiffness, pain and post‐traumatic osteoarthritis

Question 33

Translation of the distal fragment can described as ___ or __ displaced and medially or laterally ____

Answer 33

anteriorly posteriorly translated (in hand - volar/palmer and dorsal instead of ant./post,. ulnar and radial instead of medial/lateral)

Question 34

Angulation desribes the direction in which the distal fragment points towards and the degree of this deformity. IN the upper limb, ___ or __ and __or __ angulaton are used. In the lower limb, __ and __ are used instead of medial or lateral

Answer 34

radial or ulnar dorsal or volar varus valgus

Question 35

how is angulation measured

Answer 35

longlitudinal axis of the diaphysis of a long bone

Question 36

signs of fracture 4

Answer 36

localised bony tenderness swelling deformity crepitus (cracking/popping)

Question 37

when shd an x-ray be requested in suspected fractures

Answer 37

if patient cannot weight bear

Question 38

assessment of an injured limb 4

Answer 38

injury - open or closed distal neurovascular status (Cap refil, pulse,temp ect) compartment syndrome present assess status of skin/soft tissue envelope

Question 39

when would a ct be used

Answer 39

assess fractures of complex bones

Question 40

what imaging is used to detect stress fractures

Answer 40

technetium bone scans

Question 41

initial management of long bone fracture

Answer 41

assess analgesia splintage/immobilisation investigation

Question 42

early local complications of fractures 4

Answer 42

compartment syndrome vasuclar injury nerve compression skin necrosis

Question 43

early systemic complications of fractures 8

Answer 43

``` hypovolaemia fat embolsism shock ARDS acute renal failure SIRS MODS Death ```

Question 44

late local complications

Answer 44

``` stiffness loss of function chronic regional pain syndrome infection non/mal union ischaemic contracture (VOlkmanns) post traum. osteoarthrtiis DVT ```

Question 45

late ssystemic complications of fractures

Answer 45

PE - days to weeks

Question 46

compartment syndrome

Answer 46

groups of muscle bound in tight fascial compartments - limits capacity to swell

Question 47

Rising pressure can compress the venous system resulting in____ within the muscle and____ ___as oxygenated arterial blood cannot supply the congested muscle. Muscle ischaemia is manifested by___ ___, and pressure rises can also compress nerves resulting in ____ and ____ ___

Answer 47

Rising pressure can compress the venous system resulting in congestion within the muscle and secondary ischaemia as oxygenated arterial blood cannot supply the congested muscle. Muscle ischaemia is manifested by severe pain and pressure rises can also compress nerves resulting in paraesthesiae and sensory loss

Question 48

clinical signs of compartment syndrome

Answer 48

incr pain on passive stretching of muscle involved severe pain - outwith anticipated severity tensely swollen, tender

Question 49

in compartment syndrome if there is a loss of pulse this indicates

Answer 49

end stage ischaemia | too late

Question 50

initial management of compartment syndrome

Answer 50

removal of bandages | fasciotomy

Question 51

after fasciotomy, the wound is left open for a few days t/f

Answer 51

true | most likely require skin graft

Question 52

nerve injury associated with fractures is usually a neurapraxia or axonotmesis, define eac h

Answer 52

neurapraxis - nerve has temporary conduction deficit (compression or stretch) resolves over time axonotmesis - systained compression/ stretch - long nerve cells axons distal to point die (wallerian degeneration) , regenerate, recovery time variable

Question 53

define neurotmesis

Answer 53

complere transection of nerve | penetrating injuries

Question 54

nerve injury is not an indication for surgical exploration, when would surgical exploration take place

Answer 54

nerve entrapment within fracture, causing sev. neuralgic pain,

Question 55

most fracture related nerve injuries require surgery t/f

Answer 55

false | observation usually best

Question 56

A shearing force on the skin can result in avulsion of the skin from its underlying blood vessels known as ______which can result in ___ __ and ____

Answer 56

de-gloving skin ischaemia necrosis

Question 57

signs of degloving

Answer 57

skin wiil not blanch on pressure | no physical sensation on touch

Question 58

signs of non-union

Answer 58

ongoing pain ongoing oedema movement at fracture site bridging callus

Question 59

bones prone to problems (due to poor blood supply)

Answer 59

scaphoid waste fractures distal clavicle subtrochanteric fractures of femur jones fracture of 5th metatarsal

Question 60

intra-articular fractures may not unite, why

Answer 60

synovial fluid inhibits healing if a fracture gap exists

Question 61

3 fractures prone to AVN

Answer 61

femoral neck scaphoid talus

Question 62

other than intra-articular fracture, 2 causes of post-traum OA

Answer 62

ligamentous instability | fracture malunion

Question 63

define sprained

Answer 63

intra-substance tearing of some fibres

Question 64

presenting features of septic arthritis

Answer 64

``` severly painful red hot swollen and tender joint pain on any movement ```

Question 65

2nd most common organism causing SA

Answer 65

strep

Question 66

in elderly, IVDU, and seriously, most common organism causing SA

Answer 66

e.coli