Trauma Revision Notes
This section aims to teach the large area of musculoskeletal trauma. This makes up a significant part of the syllabus and is an important part of the exams. Trauma is something that all doctors should have a basic working knowledge of as they are likely to see it throughout their working lives (often when they least expect it). Good examples are the fractured neck of femur missed in the elderly medical patient admitted 'off legs', or the patient complaining of shoulder pain two days after a seizure with a missed posterior dislocation.
Initial Management of Trauma
Before we go on to look at the specific injuries which may occur as a result of trauma, we will look at a basic overview of the management of the trauma patient.
There are many specific complications related to each type of fracture pattern that we will discuss in later lessons. However, all fractures have a set of general complications which you should know.
Complications of Surgical Management
Many patients who sustain fractures go on to have surgery. Any surgical procedure carries risk and this section breaks these down into pre-operative, intra-operative and post-operative complications.
You should also have a basic knowledge of the ways that fractures heal which is what you will learn in this section.
Long Bone Fractures
Long bone fractures are common injuries. The long bones are the humerus, radius and ulna, tibia and fibula, and the femur.
Proximal Femur Fractures
Fractures of the proximal femur are an important part of clinical practice. In general they affect the elderly and occur as a result of minimal trauma. They are sometimes seen in younger patients but in this group are seen in high energy trauma.
Distal radius fractures are also a common fragility fracture seen in the elderly, although they are sustained in a wide range of age groups, including children. The commonest wrist fracture is the Calles' fracture, but others include the Smith's fracture and the Barton's fracture.
Elbow and Forearm Fractures
Fractures of the elbow and forearm are commonly seen in younger patients and are often the result of direct trauma. Radial head fractures can be very difficult to see, especially when undisplaced, so it is important to understand the concept of the 'fat pad sign'.
Ankle fractures are common and complex injuries. The key to understanding these injuries is the mechanism of injury which then leads to their management.
Spinal fractures tend to fall into two groups, either high energy trauma or low energy fragility fractures in the elderly. The two are very different though both can lead to neurological compromise.
Shoulder instability is a complex thing. We all think of it as traumatic with a structural problem occurring as a result but a large number of these patients have other reasons for instability.
Ligamentous Injury in the Knee
Ligamentous injury in the knee tends to be seen in younger patients with sporting injuries. The the most basic there are two collateral and two cruciate ligaments. When reading around the topic you will see that the problem is much more complex than this but concentrate on the basics first. As with ankle fractures the mechanism of injury and also the history is key to understanding the injury.
Meniscal Pathology in the Knee
The menisci are there to act as load moderators in the knee. They are often injured acutely but inevitably become involved in degenerative disease in the knee such as osteoarthritis. The treatment for the two groups is very different.