Trauma and Orthopaedics

Angela Gardner

Topics Covered
ACT conditions
Compartment syndrome Spinal cord compression Septic arthritis Temporal Arteritis

Trauma & Orthopaedics

Fractured Hips Multisystem trauma Sprained Ankle Back Pain Types of fractures

Know of Conditions
Facial Injuries Shoulder fracture The injured hand Soft tissue knee injuries Foot and ankle fractures Pelvic and acetabular fractures Ilizarov frame surgery

Compartment Syndrome
SURGICAL EMERGENCY
Definition: Raised interstitial pressure in a closed compartment causing microvascular compromise
Causes: Fractures, Crush Injuries, Burns, Trauma Recognise it: Pain disproportionate to the injury, Pain on passive stretching, erythema, tightness, Pallor, pulseless Investigations: compartment pressures, CK, urine myoglobin Management: ABCDE, lie flat elevate limb,

GET HELP!

Septic Arthritis
Definition: Infection of a joint either directly or via haematogenous spread. Recognise It: Red, hot, painful, swollen joint, reduced ROM, Systemic symptoms Causes: Prosthesis, DM, joint injection, IVDU Investigations: Aspiration, Cultures, ESR, CRP, FBC, XR Management: ABCDE, Analgesia IV flucloxacillin and ben.pen. Surgical drainage and irrigation before abx

GET HELP!

Spinal Cord Compression

Definition: Anything that compresses arterial, venous, CSF or the cord istelf Causes: Trauma, fracture, metastatic disease, infection (discitis / TB / Abscess) Recognise it: Altered sensation below a certain level, hemisensory loss, Weakness / paralysis, constipation, urinary retention Ix: URGENT T2 weighted MRI AP & Lateral Bloods, cultures if ?infection

Mx: ABCDE, stabilise spine with collar and head straps Acute IV methylprednisolone Malignancy IV dexamethasone

GET HELP!! - Neurosurgical RV urgently!

Temporal Arteritis
Definition: Immune mediated vasculitis of large and medium sized arteries usually branches of the external carotid artery Recognise it: new onset headache, temporal, scalp tenderness, visual disturbances, jaw claudication, low grade fever, malaise Investigations: ESR >50mm/hr, CRP, temporal artery biopsy (granulomatous infiltrate) Management: ABCDE, Prednisolone 1mg/kg/day upto 80mg for 4 weeks. Reducing regime over 6-12months. Aspirin Bone protection Opthalmic opinion

GET HELP!

Hip Fracture
Little old ladies falling! Recognise it: Pain groin, greater trochanter, worse on movement, unable to weight bear. Shortened externally rotated leg. Unable to straight leg raise. Investigations: XR AP and lateral hip and pelvis. Bloods, ECG, CXR prior to surgery Management: Pre-op analgesia, IV fluids, Abx Post-op vitamin D, bisphosphonates

Types

Intracapsular Classification Garden Classification 1, 2 undisplaced would unite if left alone 3, 4 displaced wont unite if left alone

Back Pain
<20 / >55 Thoracic HIV Sytemic Symptoms Neurology
Age 15-30 30-50 >50 Causes Postural, mechanical, prolapsed disc, trauma, AS Postural, degenerative, prolapsed disc Postural, degenerative, osteoprotic changes, malignancy

Non-mechanical Past Hx of carcinoma On Steroids Weight loss Structural deformities

Other

Referred pain, stenosis, cauda equina, spinal infection

Types of Fractures

Colles Vs Smiths Fracture

Multisystem Trauma
GET HELP! ABCDE

Some wise words

Know your ACT conditions well Know your list 1 conditions quite well Maybe look at list 2 if you have time! Practice for OSCEs in groups you cant do it alone!

Questions?