Learning MRCS part A - applied surgery

• - trauma (excessive forces applied to bone)
• - stress related (repetitive low velocity injury)
• - pathological (abnormal bone, # during normal use / minimal trauma)

• - assessing fracture - site, type
• - associated injuries 
• - distal NV deficit
• (so o/e +/- imaging)

• Gustilo and Anderson classification 
• - Grade 1: low energy wound <1cm
• - Grade 2: >1cm wound with moderate soft tissue damage
• - Grade 3: >10cm with extensive soft tissue damage
• + 3A: adequate soft tissue coverage
• + 3B: inadequate soft tissue coverage
• + 3C: associated artery injury

• Loss vibration and proprioception
• Tabes dorsalis, SACD

Loss of pain, temperature (lateral), crude touch and pressure (anterior)

Flaccid paralysis of the upper limbs

Dorsal column signs (loss of proprioception and fine discrimination) (jQuery112408195846008499672_1614906298310 not vibration)

• UMN signs
• Malignancy
• Haematoma
• Fracture

• - Normally progressive
• - What
• + Staph aureus in IVDU, normally cervical region affected
• + Fungal infections in immunocompromised
• + Thoracic region affected in TB

• Hemisection of the spinal cord
• Ipsilateral paralysis
• Ipsilateral loss of proprioception and fine discrimination
• Contralateral loss of pain and temperature