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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [18] Tibia and Fibula Fractures > Flashcards

[18] Tibia and Fibula Fractures Flashcards

1
Q

What are the tibia and fibula?

A

Bones of the leg

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2
Q

What is the most frequent site of fracture in the tibia and fibula?

A

The tibial shaft

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3
Q

Where else in the tibia and fibula can fractures occur?

A
  • Tibial plateau
  • Tibial and fibular diaphysis
  • Ankle
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4
Q

Why is the tibia prone to trauma?

A

Due to its superficial position in the leg

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5
Q

Are open fractures of the tibia common?

A

Yes

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6
Q

What dictates the type of tibia fracture?

A

The mechanism of injury

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7
Q

What movements cause low-energy tibia fractures?

A

Twisting, inversion, or eversion

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8
Q

What do low-energy tibia fractures often occur following?

A

Falling from standing height

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9
Q

What are high-energy fractures of the tibia caused by?

A

Typically by a direct blow to the tibia or fibula

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10
Q

What do high energy fractures of the tibia lead to?

A
  • Fracture comminution
  • Soiling of the wound
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11
Q

How should any patient with a fracture or trauma be initially assessed?

A

A-E approach, resuscitated as required

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12
Q

What should be done when a patient presents with a tibia or fibula fracture?

A
  • Detailed history, including mechanism of injury
  • Examination of limb
  • Check neurovascular status
  • Assess for evidence of compartment syndrome
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13
Q

What should the limb be examined for in tibia or fibula fracture?

A
  • Swelling and bruising
  • Deformity
  • Skin tenting or piercing
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14
Q

When is it particularly important to assess for evidence of compartment syndrome?

A

In high energy injuries

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15
Q

What investigations should be done in suspected tibia or fibula fracture?

A

Plain radiograph

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16
Q

What should be included in the plain radiograph for suspected tibia and fibula fractures?

A

The entire tibia and fibula, with the knee and ankle joints included

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17
Q

When is a CT scan required in tibia or fibula fractures?

A

In tibial plateau fractures and Pilon fractures, to aid in operative planning

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18
Q

What are Pilon fractures?

A

Intra-articular fractures of the ankle joint

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19
Q

What should be termed ‘ankle fractures’?

A

Only extra-articular fractures of the ankle joint

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20
Q

What can ankle fractures be classified according to?

A

The Weber Classification

21
Q

What is the Weber classification useful for?

A

Determining treatment

22
Q

What is a Weber A fracture?

A

Fracture occuring below the syndesmosis

23
Q

What is a Weber B fracture?

A

A fracture occuring at the level of the syndesmosis

24
Q

What is a Weber C fracture?

A

A fracture occuring above the level of the syndesmosis

25
Q

Give two examples of other classification systems for tibia and fibular fractures?

A
  • Schatzker Classification for tibial fractures
  • Ruedi and Allgower Classification for Pilon fractures
26
Q

What do efforts need to be made to do in tibia and fibula fractures?

A
  • Preserve the skin
  • Limit soft tissue damage
27
Q

How is fracture reduction typically performed in tibia or fibula fractures?

A

Under sedation

28
Q

Is speedy fracture reduction required in tibia and fibulda fractures?

A

Yes

29
Q

How should a tibia or fibula fracture be managed initially?

A

Place in back-slab

30
Q

What should be done once the limb has been placed in a back-slab following a tibia or fibula fracture?

A
  • Repeat neurovascular examination
  • Obtain a repeat plain film radiograph
31
Q

Should the back-slab applied for tibia and fibula fractures be above knee or below knee?

A
  • Above knee for tibial plateau and diaphyseal fractures
  • Below knee for Pilon and ankle fractures
32
Q

What should be done if reduction is found to not be adequate on repeat radiograph in tibia or fibula fracture?

A

Repeat reduction attempts will be required

33
Q

What should be done if there are signs of compartment syndrome in tibia or fibula fractures?

A

Any signs of compartment syndrome should be recognised and managed early

34
Q

How is compartment syndrome prevented in many centres?

A

A compartment monitor is inserted for all high-energy injuries and diaphyseal fractures

35
Q

What is the definitive management of tibia or fibula fractures?

A

Skeletal stability - almost all these injuries require surgical fixation

36
Q

When might tibial plateau fractures be treated conservatively?

A

Schatzker 1 injuries in elderly patients with low functional demand

37
Q

What fractures will always require fixation?

A

Tibial diaphysis and Pilon fractures

38
Q

When may ankle fractures be treated conservatively?

A

If deemed intrinsically stable

39
Q

What needs to be done if a tibia or fibula fracture is open?

A

Additional management is warranted to reduce the risk of contamination and infection

40
Q

How should the risk of contamination and infection be reduced in an open tibia or fibula fracture?

A
  • Wound cleaned, any gross contamination removed
  • Photograph of the wound should ideally be taken, before being covered with saline-soaked guaze
  • Start patient on IV antibiotics as per local policy
41
Q

How quickly should definitive management be performed in open tibia or fibula fractures?

A

It should be expedited, however management can be delayed if presenting overnight to ensure a properly equipped theatre is accessed

42
Q

What are the immediate complications of tibia or fibula fractures?

A
  • Compartment syndrome
  • Neurovascular compromise
43
Q

What are the delayed complications of tibia or fibula fractures?

A
  • Infection
  • Wound dehiscence
  • Malunion
  • Non-union
  • Joint stiffness
44
Q

What is hallux valgus?

A

A deformity at the first metatarsophalangeal joint

45
Q

What is hallux vagus characterised by?

A

Medial deviation of the first metatarsal, and lateral deviation +/- rotation of the hallux, with associated joint subluxation

46
Q

How common is hallux valgus?

A

It is one of the most common foot problems in the adult population, with a prevalence of around 35% in those aged >65%

47
Q

Which gender is hallux valgus more common in?

A

Women

48
Q

What should happen to the digits during the gait cycle?

A

The digits should remain parallel to the long axis of the foot

49
Q

What allows the digits to remain parallel to the long axis of the foot in the gait cycle?

A

Balance between the static stabilisers (bones and ligaments) and dynamic stabilisers (muscles and tendons)

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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