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Cervical Spine (Imaging (Alignment: 4 lines (Ant. vertebral bodies, Ant.…

- - - - Pt. doesn’t meet criteria for clinical clearance
    - - Radiograph initially
        Clear if normal radiograph and clinical exam
      - CT C-spine if abnormal radiograph or clinical exam
  - - - Neurological deficit
      - Spinal tenderness in the midline
      - Altered consciousness
      - Intoxication
      - Distracting injury
    - - Examine for bruising or deformity
      - Palpate for deformity and tenderness
      - Ensure pain-free active movement
- - - - <55: ORIF w/ screws.
        f/up in OPD and do arthroplasty if AVN develops (in 30%)
      - Over 55: THR or hemiarthroplasty
- - - - Incomplete #, undisplaced
      - Complete #, undisplaced
      - Complete #, partially displaced
      - Complete #, completely displaced
- - - - Extension: distal fragment displaces posteriorly
      - Flexion: distal fragment displaces anteriorly
    - - Compartment syndrome
      - Malunion: gunstock deformity (cubitus varus)
      - NV: brachial artery and median nerve mainly
- - - - Neuropraxia: temporary interruption of conduction
      - Axonotmesis
        Disruption of axon w/ preservation of connective tissue framework
        Recovery possible
      - Neurotmesis
        Disruption of entire nerve fibre
        Recovery incomplete
  - - - Oedema → ↑ compartment pressure → vascular compromise
        Compartment pressure > capillary pressure → ischaemia
        Pain > clinical findings and pain on passive stretch
      - Mx
        Elevate limb and remove bandages and cast
        Fasciotomy
  - - - Types
        
        Delayed union: union takes longer than expected
        
        Non-union: # fails to unite
        
        Mal-union: # unites in imperfect position
      - Causes: 5Is
        
        Infection
        
        Ischaemia
        
        Interfragmentary movement
        
        Interposition of soft tissue
        
        Intercurrent illness
      - Mx
        Optimise biology: infection, bone graft, blood supply, bone graft, BMPs
        Optimise mechanics: ORIF
    - - 1: Sudek’s Atrophy
        Presentation
        
        Wks – months after injury
        
        Affects neighbouring area
        
        Pain, hyperalgesia and allodynia
        
        Vasomotor: hot and sweaty or cold and cyanosed
        
        Skin: swollen or atrophic
        
        NM: weakness, contractures
      - Mx
        Usually self-limiting
        May need amitriptyline / gabapentin
    - - Heterotopic ossification of muscle @ sites of haematoma formation → restricted, painful movement
        Commonly affects the elbow and quadriceps
      - Rx: excise