Trauma Vivas for the FRCS (Tr & Orth) A Case-Based Approach http://taylorandfrancis.com Trauma Vivas for the FRCS (Tr & Orth) A Case-Based Approach Raymond Anakwe Scott Middleton CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2018 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-4987-8097-1 (Paperback); 978-1-1380-6203-0 (Hardback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com CONTENTS Preface ix Authors xi Section I: Lower Limb and Pelvic Trauma 1 Talus Fracture 3 2 Lisfranc Injury 7 3 Subtalar Dislocation 11 4 Calcaneal Fracture 13 5 Triplane Fracture 17 6 Ankle Fracture 21 7 Ankle Fracture 23 8 Infected Ankle 25 9 Pilon Fracture 27 10 Midshaft Diaphyseal Tibia Fracture 33 11 Compartment Syndrome 37 12 Tibial Diaphyseal Fracture (Proximal) 41 13 Mangled Extremity 43 14 Tibial Plateau Fracture 47 15 Knee Dislocation 51 16 Floating Knee 55 17 Distal Femoral Fracture 57 18 Young Femoral Fracture 59 19 Ipsilateral Femoral Neck and Shaft Fracture 63 20 Hip Fracture (Subtrochanteric) 65 21 Pathological Fracture 67 22 Intracapsular Hip Fracture Young Patient 71 23 Hip Fracture 75 24 Periprosthetic Fracture 79 25 Posterior Dislocation of the Hip 81 26 Acetabulum Fracture 83 27 Pelvic Fracture 87 28 Pelvic Fracture 89 Section II: Spine and Upper Limb Trauma 29 Bilateral Cervical Facet Dislocation 95 30 Thoracolumbar Spine Injury 97 31 Proximal Humerus Fracture 99 v Contents 32 Proximal Humerus Fracture 101 33 Greater Tuberosity Fracture 103 34 Anterior Shoulder Dislocation 105 35 Posterior Dislocation of Shoulder 109 36 Clavicle Fracture 113 37 Acromioclavicular Joint Injury 115 38 Midshaft Humerus Fracture 117 39 Holstein–Lewis Fracture 121 40 Distal Humerus Fracture 123 41 Elbow Dislocation 127 42 Terrible Triad Injury 131 43 Radial Head Fracture 133 44 Olecranon Fracture 135 45 Monteggia Fracture 137 46 Galeazzi Fracture 139 47 Both Bones Forearm Fracture 141 48 Distal Radius Fracture 143 49 Scaphoid Fracture 145 50 Perilunate Dislocation 147 51 Lunate Dislocation 151 52 Fight Bite 153 53 Jersey Finger 155 Section III: General Trauma Principles 54 ATLS 161 55 Open Fracture 165 56 Damage Control Orthopaedics 171 57 Gunshot Injury 173 58 Screws 175 59 Plates 179 60 Nails and External Fixators 181 61 Non-Union 183 62 Non-Accidental Injury 187 63 Osteoporosis 191 Section IV: Surgical Approaches 64 Deltopectoral Approach 195 65 Anterior Approach to Humerus 197 66 Anterolateral Approach to Humerus 199 vi Contents 67 Posterior Approach to Distal Humerus 201 68 Anterior/Volar (Henry’s) Approach to the Forearm 203 69 Kocher’s and Kaplan’s Approaches 207 70 Smith–Petersen Approach 209 71 Ilioinguinal Approach 211 72 Posterolateral Approach to Ankle 215 73 Leg Fasciotomy (Two-Incision/Four-Compartment Fasciotomy) 217 Index 219 vii http://taylorandfrancis.com PREFACE The trauma viva should not present any surprises for the well-prepared candidate. Trauma forms a key part of orthopaedic training from day one and the examination aims to test the knowledge expected of a new consultant in the generality of trauma. In this respect, the top- ics likely to be raised can often be predicted and questions are usually presented in the form of a clinical vignette, photograph or an x-ray to initiate discussion. The exact format will vary from examiner to examiner and between candidates but will often start with a straightfor- ward opening question that a safe candidate would be expected to address without difficulty. Subsequent questions may then test the boundaries of knowledge with extra marks for aware- ness of the literature and current areas of debate. The examiner is looking to have a conversa- tion with a colleague about the range of trauma that may present in everyday practice and to establish the experience and confidence of the trainee in this area. This text aims to present key issues in a case-based format. As ever, there are often several ways to address any problem. One safe and accepted way is presented for the cases here. At a basic level, the candidate should be able to recognise the injury, potential problems and com- plications and explain the rationale and evidence behind their management. The viva exami- nation is not the ideal time to describe an operation that you have never seen or read about. Describing what you have seen and done in your training will usually be sufficient as long as it represents safe practice and recognises that certain areas of treatment may be contentious, debated or require particular expertise. As always, it is important to listen to the question. The examiner will often steer the dis- cussion to cover specific areas in the allotted time but it is useful to demonstrate that you recognise a particular injury as a ‘high-energy injury’, that you are familiar with established resuscitation systems such as the ATLS system, that you recognise the potential for associated injuries in severely injured patients and that there may be a variety of options for treatment. Once it is clear that this is routine for the candidate, the examiner will often move you on. If asked what you would do, answer the question succinctly but briefly say why or what factors would make you choose this treatment option. Keep calm. Stay safe. Good luck! ix
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