3.3.2 Injuries of the Lower Extremity

Question 1

What are the 6 Ps of compartment syndrome?

Answer 1

Want to address the concern during the presentation of pressure and pain. If you get to the other four Ps, the horse has already left the stable.

Question 2

What is the main vascular supply to the head of the femur?

Answer 2

Terminal branch of the medial circumflex femoral (MFC) - ~80%

Artery of ligamentum teres and lateral femoral cutaneous provide some supply

Question 3

What type of emergency is a joint dislocation?

Answer 3

relative emergency

Question 4

What type of emergency is an open fracture?

Answer 4

Absolute emergency

Question 5

What is this type of fracture?

Answer 5

Open book pelvis fracture

Question 6

What is the standard of care for all femoral neck fractures in elderly patients?

Answer 6

Operative

Question 7

What is this the definition of?

Answer 7

Compartment syndrome

Question 8

What is the goal in caring for a patient with an open fracture?

Answer 8

Convert a contaminated open fracture to a clean, stablized limb

Question 9

What does ATLS stand?

Answer 9

Advanced trauma life support

Question 10

There is a great amount of pressure and pain in this pt. What might they have?

Answer 10

Compartment syndrome

Question 11

A fracture along this line is called what?

Answer 11

A femoral neck fracture

Question 12

What is the goal of care in a crush injury?

Answer 12

Viable, stable, sensate extremity

Question 13

What can preclude a good outcome in a crush injury?

Answer 13

Neurovascular injury

Question 14

What is the treatment for compartment syndrome?

Answer 14

Emergent Fasciotomy!

Question 15

What are the different types of fixation available for long bone fractures?

Answer 15

intramedullary, external, internal

Question 16

What is the treatment recommendation for young patients with non-displaced femoral neck fractures?

Answer 16

Urgent ORIF (open reduction and internal fixation)

Question 17

Why are hip fractures increasing in incidence?

Answer 17

Incidence of hip fractures doubles with each decade beyond age 50, and more people are reaching older ages

Question 18

What are some of the common causes of mortality in open book pelvis fractures?

Answer 18

Hemorrhage w/ shock (75%), urogenital injury (12%)

60-80% of pts w/ high energy pelvic fractures have other MSK injuries

Question 20

What is the treatment recommendation for displaced femoral neck fractures in young patients?

Answer 20

Emergent ORIF - risk of AVN

Question 21

What type of leg rotation is seen with open book fractures?

Answer 21

External hyper rotation

Question 22

What type of shear pattern regarding femoral neck injuries have a lower rate of success?

Answer 22

High Pauwels Angle (vertical shear pattern)