Surgery: Ortho_extra notes

Question 1

Components of vascular assessment

Answer 1

• skin temperature (is it warm?)
• skin appearance (is it pale?)
• cap refill
• pulse and its character

Compare both sides

Question 2

What to do if you can’t feel the pulse?

Answer 2

Use doppler

(if still cannot do with doppler → CT angiogram to confirm vascular compromise)

Question 3

What does triple immobilisation of spinal cord consist of? (3)

Answer 3

• hard collar
• block (sides)
• tape over forehead

Question 4

What is used to look for internal haemorrhage in the trauma setting?

Answer 4

FAST scan

Focussed Assessment with Sonography for Trauma (FAST)

Question 5

Where to look for haemorrhage using FAST scan? (4)

Answer 5

• thorax
• abdo
• pelvis
• limbs

Question 6

Why do we put a pelvic binder on every patient in a trauma setting?

Answer 6

to close pelvic injury/fracture → to minimise potential bleed

Question 7

What to do first in a fracture of a long bone and a bleed?

Answer 7

Put the bone in a better alignment to prevent significant bleed

Question 8

What is the secondary assessment in trauma setting?

Answer 8

• head to toe examination done by an orthopaedic

(looking and assessing any lesions, bruises, deformities, fractures)

• to identify the need for extra imaging

Question 9

What’s a tertiary assessment?

Answer 9

• Done on the ward (once a traumatic patient has stabilised)
• It is a repetition of secondary assessment to make sure nothing has been missed during a trauma setting (pressure, easy to miss some minor injuries)

Question 10

What the most important analgesic in the management of fractures?

Answer 10

Reduce the fracture!

This helps to reduce pain (due to less tension on soft tissues, vessels and skin)

Question 11

Do we leave a ‘metalwork’ in? E.g. plate and screws

Answer 11

Usually in unless:

• infection
• children up to 16 years of age (as the bone will grow)
• clavicle/ ankle → thin skin so the metalwork will be visible and maybe catching on clothes etc

Question 12

Mono-lateral external fixator

• use
• how long do we leave it in for?

Answer 12

Use: When a tissue around the fracture is to distorted/swollen to be able to close in again after a potential surgery → to temporarily fixate the bone until swelling settles down → further surgery will be required to fix the bone properly

How long for: max 2 weeks due to risk of infection → then further fixation (surgery)

Question 13

Mechanism of injury leading to spiral fracture

Answer 13

twisted/torsional force

Question 14

A child with a long bone spiral fracture - what is the possible mechanism of injury?

Answer 14

Possibly non-accidental injury

Question 15

Possible mechanism of a transverse fracture?

Answer 15

Side force

Question 16

Where to test for sensation (possible neurological compromise) for medial, radial and ulnar nerve? (3)

Answer 16

In the point where there is no anatomical overlap

• Medial: in between of thumb and index finger (hand surface)
• Ulnar: little finger (palm surface)
• Radial: dorsum of the hand

Question 17

How to test for a motor function of (neuro compromise assessment):

• Median n.
• Ulnar n.
• Radial n.

Answer 17

• Median → ‘OK’ sign (circle made of thumb and index finger)
• Ulnar → fingers spread out and back together
• Radial → wrist and finger extension (‘cock wrist back’)

Question 18

How to test for motor function (neuro compromise) in children?

Answer 18

Play ‘paper, rock, scissors’

• Median n. → rock
• Radial n. → paper (wrist + finger extension)
• Ulnar n. → scissors

Question 19

What do we MUST do before attempting a reduction of a shoulder dislocation?

Answer 19

Check for axillary nerve injury:

• ‘regiment badge’ sensation (below deltoid)
• motor function - ask to move deltoid muscle (even little flicker will be enough for a positive motor function) we can do it by asking a patient ‘can you push in’ (with shoulders)