Trauma

Question 1

Indications for lateral canthotomy

Answer 1

• Raised intra ocular pressure >40mmHg in unconscious patient with retrobulbar
  haemorrhage (normal pressure is 10-21)
• RAPD
• Dilated pupil in absence of central cause and CT suggesting retrobulbar haematoma
• Normal indications of decreased acuity, significant pain and ophthalmoplegia *only with reasonable GCS

Question 2

Le Fort I - fracture pattern and symptoms

Answer 2

Horizontal across alveolar ridge, then propagating through the anterior, medial, and posterolateral maxillary sinus walls

Swelling of upper lip
Buccal surface bruising
Malocclusion
Loosening of teeth

Question 3

Le Fort II - fracture pattern and symptoms

Answer 3

Pyramidal fracture of posterolateral maxillary sinus wall and anterior maxillary wall, extending through the inferior orbital rim into the orbital floor, medial orbital wall, and the region of the nasofrontal suture

Deformity and swelling of mid-face
Widening of intercanthal space
Mobility of upper jaw and nose
Malocclusion
Periorbital oedema and ecchymoses
Epistaxis
Vestibule plate bruising
CSF rhinorrhoea

Question 4

Le Fort III - fracture pattern and symptoms

Answer 4

Craniofacial dislocation with fractures extend through the nasal bridge, medial orbital wall, posterior orbital floor, and lateral orbital wall near the frontozygomatic suture. The zygomatic arch is always fractured as well

Type II symptoms +
Enophthalmos
Mastoid bruising
Haemotympanus
CSF otorrhoea

Question 5

Morel-Lavallee lesion - definition, associations and management

Answer 5

Closed traumatic soft tissue degloving injury characterized by separation of the dermis from the underlying fascia due to a shearing force

High energy, shearing trauma
Most commonly proximal lateral thigh
8% acetabular fractures

Mx:
Conservative - compression therapy
Perc drainage
Surgical debridement

Question 6

Tetanus-prone wounds

Answer 6

Compound fractures
Deep, penetrating injuries
Retained foreign bodies
Associated burns
Heavily contaminated
Bite wounds