Trauma Management & Orthopaedic Emergencies

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Questions and Answers

Which stage of fracture healing is characterized by tissue destruction and haematoma formation?

Callus formation

Tissue destruction and haematoma formation (correct)

Consolidation

Inflammation and cellular proliferation

What is NOT a factor adversely affecting fracture healing?

Smoking

Inadequate reduction and immobilization

Age

Proper nutrition (correct)

Which term describes fractures that involve a break into multiple pieces?

Undisplaced fracture

Simple fracture

Displaced fracture

Comminuted fracture (correct)

Which of the following is a method of immobilization?

Casting Signup and view all the answers

What does the Rule of Two's emphasize in fracture assessment?

Two planes of x-ray and two joints above and below Signup and view all the answers

What does subluxation refer to?

A partial or incomplete joint dislocation Signup and view all the answers

Which classification is used for open fractures?

Gustilo-Anderson classification Signup and view all the answers

What is the most common joint involved in adult septic arthritis?

Knee Signup and view all the answers

Which of the following is a predisposing factor for developing adult septic arthritis?

Prosthetic joint or recent joint surgery Signup and view all the answers

What should be assumed when there is an open wound near a joint?

The wound may have entered the joint Signup and view all the answers

Which of the following is NOT a management step for open fractures?

Use of non-sterile conditions for wound inspection Signup and view all the answers

What is a typical presentation of adult septic arthritis?

Hot swollen joint with pain on movement Signup and view all the answers

Which investigative procedure is essential for diagnosing adult septic arthritis?

Joint aspiration and fluid analysis Signup and view all the answers

What is the primary risk associated with open fractures?

Infection and poor healing Signup and view all the answers

What does the presence of purulent fluid in joint aspiration typically indicate?

Bacterial infection Signup and view all the answers

What type of fracture occurs when the cortex bends rather than breaks?

Greenstick fracture Signup and view all the answers

Which of the following is NOT a type of fracture classification mentioned?

Segmented fracture Signup and view all the answers

Which principle is the first step in the management of fractures according to ATLS guidelines?

Manage life-threatening injuries Signup and view all the answers

In the context of fracture management, what is essential to check before and after any intervention?

Neurovascular status Signup and view all the answers

What is typically required for unstable or poorly reduced fractures?

Operative intervention Signup and view all the answers

Which type of fracture involves a break in the bone that is exposed to the outside through the skin?

Open (Compound) fracture Signup and view all the answers

What immediate action should be taken for fracture dislocations?

Reduce as soon as possible Signup and view all the answers

In fracture management, what is the role of analgesia?

To manage pain Signup and view all the answers

What is the primary characteristic of compartment syndrome?

Rise of tissue pressure exceeding capillary pressure Signup and view all the answers

What are early signs of compartment syndrome?

Disproportional pain and pain on passive movement Signup and view all the answers

Which factor is NOT a common cause of compartment syndrome?

Chronic joint inflammation Signup and view all the answers

What is the first step in the management of suspected compartment syndrome?

Call for help early Signup and view all the answers

Which symptom is most strongly associated with cauda equina syndrome?

Loss of bowel or bladder function Signup and view all the answers

What type of imaging is recommended for suspected cauda equina syndrome, but should not cause delays in treatment?

MRI Signup and view all the answers

What is a late sign of compartment syndrome?

Pale skin Signup and view all the answers

Which of the following is NOT a recommended action in the event of suspected compartment syndrome?

Compress the limb tightly Signup and view all the answers

Study Notes

Trauma/Fracture Management & Orthopaedic Emergencies

Trauma/fracture management and orthopaedic emergencies are covered.
Learning objectives include basic fracture management, stages of fracture healing, fracture examination and appropriate radiology, infection in orthopaedics, limb-threatening conditions, and spine emergencies.
A fracture is a break or interruption in the continuity of a bone.
Fractures can be displaced or undisplaced, and closed or open (compound).
Simple fractures involve a single break, while comminuted fractures involve multiple fragments.
Pathological fractures occur due to weakened bone from disease.
Greenstick fractures occur in immature bone, where the cortex bends rather than breaks.
Management of fractures involves following ATLS guidelines, checking neurovascular status, reducing fracture dislocations promptly, cleaning open wounds with IV antibiotics, providing analgesia, and considering surgery for unstable fractures.
Fracture treatment principles include resuscitation (stabilizing life-threatening issues first), reduction (realignement), immobilization (using casts, splints, or surgery), and rehabilitation (mobilization, exercise).
Methods of immobilization include backslab casts, casts with inner/outer layers, and internal fixation.
Stages of fracture healing include: tissue destruction and hematoma formation (immediate), inflammation and cellular proliferation (acute), callus formation (few days to weeks), consolidation (few weeks to months), and remodeling (months to more than a year).
Factors adversely affecting fracture healing include the severity of trauma, inadequate reduction and immobilization, infection, fracture location, and disturbances in bone healing (like poor nutrition, smoking, diabetes).
Clinical examination involves looking, feeling, and moving the affected area, assessing for pain, tenderness, swelling, bruising, loss of function, crepitus, and signs of blood loss/injury to other structures.
Radiographic assessment involves identification of bone anatomy, direction of fracture line (transverse, oblique, spiral), displacement (displaced/undisplaced), fracture type (simple/comminuted), angulation, and deformities (varus/valgus). Imaging must follow a "rule of twos" including multiple views, two joints above and below, multiple occasions to monitor progression, comparing to the unaffected side and two opinions.
Dislocations occur when joint surfaces separate fully; subluxations involve a partial or incomplete separation of joint surfaces.
Orthopaedic emergencies include poor fracture healing, infection, and septic arthritis.

Open Fractures & Joint Injuries

Open fractures are fractures with communication between the external environment and the bone, causing muscle/skin damage and potential bacterial contamination.
Open fractures are prone to infection, poor healing, and poor function.

Septic Arthritis

Septic arthritis refers to infection in a joint.
It can be bacterial, fungal, or viral.
Adults and paediatrics present differently. Adults are more likely to have infections triggered by surgery, age, and intra-articular corticosteroid injection. Children are affected by other predisposing factors like IV drug abuse.

Diagnostic Investigations for Septic Arthritis

Joint aspiration and fluid analysis (potentially including ultrasound guidance).
Complete blood count (WBC) and differential.
Gram stain and culture of fluid from the joint.
Light microscopy for crystals.
Blood tests (FBC, ESR, CRP, blood cultures)
X-ray of the infected joint.

Septic Arthritis Treatment

Antibiotics are used, initially intravenously, based on the specific organism involved and/or local guidelines.

Compartment Syndrome

Compartment syndrome occurs when tissue pressure in a muscle compartment exceeds capillary pressure, compromising perfusion and function, sometimes resulting in muscle/nerve damage.
Common causes include fractures, crush injuries, contusions, burns, extravasation of IV fluids, and external compression of muscles (casts, dressings, or surgical procedures).
Signs include early disproportional pain in the limb, pain on passive movement of distal joints, and late signs including paresthesia, pulselessness, pallor, paralysis.
Treatment includes early intervention via removal of constricting elements, reassessment, intracompartment pressure measurement, blood test CK evaluation, and decompressive fasciotomy (incision of muscle covering).

Cauda Equina Syndrome

Cauda equina syndrome stems from compression of the nerve roots of the cauda equina (part of the spinal cord).
Symptoms frequently involve bowel and bladder dysfunction, saddle anesthesia, and varying degrees of lower extremity sensory and motor impairment.
Presentation involves low back pain, groin/perineal pain, bilateral sciatica, loss of bowel or bladder function, subtle hesitancy, and eventual overflow incontinence. Imaging, such as MRI, may help in diagnosis but should not delay treatment.
Prompt surgical intervention is critical to prevent further nerve damage.

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Description

This quiz covers essential topics in trauma and fracture management, focusing on orthopaedic emergencies. You'll explore fracture types, healing stages, examination techniques, and management strategies, including radiological assessment and infection considerations. Ideal for students in medical disciplines or those interested in orthopaedics.