TRAUMA (UPPER LIMB) OSCE

OSCE 1

Abnormal findings:
- AP view: Complete # of the radius
- Lateral view: displacement of the distal radioulnar joint
Diagnosis: Galleazzi fracture-dislocation
Definitive treatment:
- #: ORIF (plate & screw)
- Joint: CMR then if failed do ORIF
CX:
- Early: Compartment syndrome, stiffness of the radioulnar joint
- Late: CRPS (complex regional pain syndrome), malunion and non-union

OSCE 2

Name the deformity: dinner-fork deformity

X-ray findings:
- extra-articular fracture of the distal radius with dorsal angulation and dorsal
displacement
Diagnosis: colles #
Treatment:
- Painkiller
- CMR (since its extra-articular)
- Put below elbow cast
 - Keep the patient in observation ward to see if there’s any signs of compartment
syndrome (swelling and tenderness)
Underlying pathology (risk factor for this condition):

OSCE 3

X-ray findings:
- An x-ray of a young patient (epiphyseal plate is open)
- Proximal 1/3 of ulnar #, comminution # and dislocation of the radial head.
Diagnosis: Monteggia #
Management:
ADULT
- If radius and ulnar or just radial shaft # : surgery
- If isolated ulnar shaft #: not displaced- POP , if displaced – surgery
CHILDREN
- Conservative mx: POP
Complication: recurrent dislocation, non-union

OSCE 4

Abnormal finding: Scaphoid #

Diagnosis: scaphoid #
Management:
- Thumb spica (surgery is not done cause its undisplaced)
CX: AVN
TRAUMA (LOWER LIMB) OSCE

OSCE 1

Describe X-ray:
- Complete # of the distal femur
- Displaced, spiral #
Classification: Winquist classification
Treatment: surgery (ALWAYS!)
- Neck/intertrochanteric: screw
- Subtrochanteric: interlocking nail
- Shaft: interlocking nail
- Condylar/distal femur: plating
Complications: fat embolism syndrome

OSCE 2

Describe X-ray: supracondylar # in a child

Classification: salter harris type 2 (this is the commonest one)
Treatment:
- 1 & 2: extra-articular #, so reduce anatomically by putting k-wire.
- 3 & 4: intra-articular #, must get anatomical reduction! May need to do open
reduction.
Complications:
- Joint stiffness
- Vascular injury (popliteal artery injury) – always check for vascularity
OSCE 3

Describe X-ray:
- Comminuted # of the proximal tibia and fubula, complete #, smashed bone of the
fibula.
- Open # may have foreign particles, wounds.
*proximal fibula ada common peroneal nerve , Injury to this leads to foot drop.
*open fracture classification: Gustilo-Anderson classification
3A: reservation of skin tissue
3B: loss of reservation of the skin
3C: vascular injury, regardless the size of wound
Treatment:
- Wound irrigation (Copious amount of NS)
- Antibiotic
- Tetanus
- Temporary immobilization
- Surgery: debridement.
Complications: infection, malunion, compartment syndrome.

EXTRA!
When to use external fixator?
- When we suspect high risk of contamination.
*infection risk is higher for ORIF than external fixator
*UL risk of infection is lower than LL