Trauma Vivas for the FRCS : a Case-Based Approach

244 Pages·2017·52.42 MB·English

by  Anakwe

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
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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
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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
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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!
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