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3. E Med & Surgery > 4- Lower Extremity > Flashcards

4- Lower Extremity Flashcards

1
Q

What is the typical MOI for pelvic fractures?

A

High energy

(can be low energy/ fall in elderly)

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2
Q

50% of pelvic fractures are a/w internal injuries with high risk of what?

A

Vascular hemorrhage (pelvic viscera)

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3
Q

Pt presents with pain, B+B incontinence, numbness, weakness and bleeding. Pt is hemodynamically unstable. What are you concerned for and what should be included on PE?

A

Pelvic fx

Include rectal and vaginal exam

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4
Q

What imaging should you perform for pelvic fx and what is gold standard?

A

CT scan = gold standard

Xray- AP pelvis, Judet views, inlet + outlet views for pelvic ring

Bedside US if blunt trauma

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5
Q

What is the most common pattern for pelvic fx?

A

Posterior wall fx +/- femoral head dislocation

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6
Q

What type of pelvic injury is more common in skeletally immature athletes?

A

Avulsion fx

(not a trauma pt)

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7
Q

Pelvic ring typically is unstable with how many fractures? And with the exception of what population?

A

2 fractures

Exception: pediatric population

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8
Q

What included in the tx for pelvic fx if hemodynamically unstable?

A

Pelvic wrapping w/ sheet or pelvic binder

(stabilize fx, minimize bleeding)

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9
Q

What is the tx for pelvic fx?

A

Conservative- avulsion or stable fx

Surgical- ORIF/ external fixation

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10
Q

Survival of femoral head w/ hip dislocation requires reduction within how long after injury?

A

6-8 hrs

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11
Q

What is the typical MOI for hip dislocation?

A

High energy trauma (MVA)

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12
Q

What is the most common type of hip dislocation?

A

Posterior dislocation

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13
Q

What is the difference between simple vs complex hip dislocation?

A

Simple- dislocation only

Complex- dislocation a/w fx

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14
Q

Pt presents with leg adducted and internall rotated. They are in pain, unable to bear weight on leg, and their leg appears shorter. What are you concerned for?

A

Posterior hip dislocation

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15
Q

What should be the focus of the NV function check for hip dislocation?

A

Sciatic nerve distribution

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16
Q

What imaging is ordered to confirm hip dislocation and r/o fx?

A

Pre-reduction AP/ lateral

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17
Q

When should you order a CT scan for hip dislocation?

A

If suspicious for fx not evident on xray/ to eval pelvis and femur

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18
Q

What is the tx for hip dislocation?

A

Emergent reduction w/i 6 hrs

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19
Q

Proximal femoral fxs are a/w with what in elderly populations?

A

Increased risk of death and major mobidity

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20
Q

Femoral neck fractures are what type of fracture and are a risk for ___ requiring emergent fixation if stable?

A

Intracapsular

Retrograde blood

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21
Q

Pt presents holding leg in external rotation/ abduction with pain to groin that radiates to the inner thigh. You note difficulty with flexion and internal rotation and leg appears shorter. What are you concerned for?

A

Proximal femoral fx

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22
Q

What imaging should you order for proximal femoral fx?

A
  1. AP/ lateral xray and full femur, include knee joint
  2. CT to eval displacement
  3. MRI if high suspicion + neg xrays
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23
Q

What complications are a/w proximal femoral fx? (4)

A

AVN

Infection

DVT/ PE

Nonunion

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24
Q

What is the tx for proximal femoral fx?

A

Surgery if medically stable +/- prophylaxis for DVT

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25
Q

What MOI is typically a/w femoral shaft fx?

A

Severe trauma

(young men highest risk population)

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26
Q

Pt presents with obvious deformity of leg, inability to bear weight, and loss of ROM due to pain. What are you concerned for?

A

Femoral shaft fx

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27
Q

What imaging should be ordered for femoral shaft fx?

A

AP and lateral

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28
Q

What is the tx for femoral shaft fx?

A

Urgent ortho consult (blood loss can be life threatening)

Surgery (except medically unstable and some peds fxs)

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29
Q

What complications are a/w femoral shaft fx? (3)

A

Malunion, delayed union, nonunion

Infection

Pain a/w hardware

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30
Q

What lower leg injury is a surgical emergency w/ high incidence of NV injury?

A

Knee dislocation

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31
Q

What are the most common MOIs a/w knee dislocation?

A

Dashboard injuries (posterior dislocation)

Hyperextension (anterior dislocation)

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32
Q

What associated injuries are common with a knee dislocation?

A

Peroneal > tibial nerve

Fractures

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33
Q

Why is a vascular exam critical for knee dislocation?

A

Risk for amputation significantly increases > 8 hrs

If pulses absent, must reduce and confirm reperfusion

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34
Q

What imaging is ordered for knee dislocation?

A

Pre and post reduction AP/ lateral xray

+/- CT/ MRI (post reduction)

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35
Q

What is included in the management for a knee dislocation? (3)

A

Emergent reduction w/ assessment of limb perfusion

Eval for spontaneous reduction

Splint in 20 deg flexion

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36
Q

What is the most common direction of patellar dislocation?

A

Lateral

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37
Q

What is the typical MOI for patellar dislocation?

A

Twisting on flexed knee

38
Q

Pt presents with hx of knee “giving way” w/ severe pain. Knee is fixed in 20-30 deg flexion, deformity, swlling, and hemarthrosis. What are you concerned for?

A

Patellar dislocation

39
Q

Is imaging prior to reduction necessary for patellar dislocation?

A

NO

40
Q

What is included in the initial management for a patellar dislocation?

A

Immediate reduction if does not spontaneously reduce

41
Q

What is included as part of the post-reduction eval for patellar dislocation?

A

Repeat PE, eval for fx/ soft tissue injury

AP/ lateral/ sunrise xrays

42
Q

What is included in post-reduction management for patellar dislocation?

A

RICE, NSAIDs, knee immobilizer/ crutches

Referral

43
Q

When is surgery indicated for patellar dislocation?

A

Repeat dislocation

44
Q

What is the typical MOI for patellar fx?

A

Direct force in knee flexion

45
Q

Pt presents with knee effusion, hemarthrosis, and inability to extend knee. What are you concerned for?

A

Patellar fx

46
Q

What imaging should be ordered for a patellar fx?

A

AP/ lateral/ sunrise xrays

47
Q

What is included in the management for patellar fx?

A

Splint in full extension + NWB

Activity restriction + PT

Ortho referral

48
Q

When is surgical vs nonsugical management indicated after ortho referral for patellar fx?

A

Surgery if displaced or complex fx

49
Q

What is the typical MOI for tibial plateau fx?

A

High energy

50
Q

What concomitant injuries are often a/w tibial plateau fx?

A

Meniscus, ligament injury

51
Q

Pt presents with localized knee pain/ swelling, knee effusion, restricted ROM and pain w/ WB. What are you concerned for?

A

Tibial plateau fx

52
Q

What imaging is ordered for tibial plateau fx?

A

AP/ lateral/ intercondylar notch xrays

+/- CT, MRI

53
Q

What is included in the management for a tibial plateau fx?

A

Splint in full extension

NWB for up to 6 weeks

Ortho consult (brace, casting, ORIF)

54
Q

What is the typical MOI for ankle injuries?

A

Inversion or eversion

55
Q

What is a bimalleolar vs trimalleolar fx?

(BOTH unstable vs non-displaced are stable)

A

Bimalleolar- medial and lateral

Trimalleolar- medial, lateral, and posterior

56
Q

What population is a/w Tilleaux/ triplace fxs and what imaging is used for evaluation?

A

Adolescents

CT scan

57
Q

What rules are used to determine necessary imaging for ankle injury?

A

Ottawa ankle rules

58
Q

What imaging is ordered for an ankle fx? (3)

A

2 view- AP/ lateral

Ankle series- AP/ lateral and mortise

CT for ankle mortise/ fx alignment

(ankle mortise = slight internal rotation)

59
Q

What is included in the management for ankle fx aside from RICE, NWB, and analgesics?

A

Splinting, brace, CAM boot

Ortho consult

60
Q

What type of fx can occur w/ abrupt increase in activity or chronic overload?

A

MT stress fx

61
Q

What is the most commonly fractured MT in adults and what is the associated risk?

A

5th MT

Risk of AVN

62
Q

What type of MT fx is a metaphyseal-diaphyseal junction fx and is a/w with risk of non-union?

A

Jones

63
Q

What type of MT fx involves the proximal tubercle and is NOT commonly a/w non-union?

A

Pseudo-Jones/ avulsion

(can be confused w/ apophysis in peds pts)

64
Q

What xrays should be ordered for MT fx?

A

AP/ lateral/ oblique

65
Q

What are the conservative tx options for MT fx?

A

Rigid shoe or CAM boot

66
Q

When is casting/ surgery indicated for a MT fx?

A

Jones fx, delayed union, unstable fx

67
Q

What is a Lisfranc injury?

A

Fx/ dislocation of 1st and 2nd MT = mid foot pain

(“keystone” of the foot)

68
Q

What imaging is indicated for a Lisfranc (1st/ 2nd MT) fx?

A

AP WB BL feet, lateral xray, CT scan

69
Q

What is the tx for Lisfranc (1st/ 2nd MT) fx?

A

Early recognition/ stabilization

Casting vs surgery if > 2mm

70
Q

Calcaneal fx is typically a/w a fall from a high height. What imaging should be ordered and what view is the most helpful?

A

3 views- lateral most helpful

71
Q

What is the tx for calcaneal fx?

A

Casting w/ NWB

Surgery if displacement

72
Q

Where is acute compartment syndrome most common?

A

Lower leg, anterior compartment

73
Q

What injuries are at high risk for acute compartment syndrome?

A

High-energy trauma or crush injuries

74
Q

What medical interventions can contribute to acute compartment syndrome?

A

Tight bandages, splints, early casting

75
Q

What is the first/ most important sign of acute compartment syndrome?

A

Pain OOP to injury

Worse w/ passive stretching

76
Q

What are the 6 P’s of acute compartment syndrome?

A

PAIN

Paresthesia (nerve hypoxia)

Pallor

Pulselessness (late)

Poikilothermia (late)

Paralysis (8-24 hrs)

77
Q

When are intra-compartmental pressure measurements helpful if suspicion for acute compartment syndrome?

A

If dx unclear

(higher the measurement, quicker the tissue damage occurs)

78
Q

What intra-compartmental pressure is concerning and warrants fasciotomy?

A

> 30 mmHg

79
Q

What is included in the management for acute compartment syndrome if diagnosed w/i 8 hrs?

A

Fasciotomy +/- fracture fixation (wounds remain open + skin grafts)

80
Q

What is included in the management for acute compartment syndrome if diagnosed late (> 8 hrs)?

A

Amputation more likely +/- fracture fixation (wounds remain open + skin grafts)

81
Q

What complications are a/w acute compartment syndrome? (4)

A

Infection

Amputation

Volkmann’s ischemic contracture- forearm

Rhabdo

82
Q

(Irreversible) cartilage destruction a/w septic arthritis starts in how long?

A

Destruction in 8 hrs

Becomes irreversible in 48 hrs

83
Q

What is the most commonly associated location for septic arthritis?

A

Knee (adults)

Knee and hip (peds)

84
Q

What is the pathophysiology of septic arthritis?

A

Hematogenous spread > direct inoculation

Staph aureus most common, MRSA > Strep

N. gonorrhoeae if sexually active adolescent

85
Q

Pt presents with acute monoarthritis w/ associated erythema, edema, and warmth. You note limited ROM/ NWB due to pain. What are you concerned for?

A

Septic arthritis

86
Q

What population w/ septic arthritis typically presents w/ fever, constitutional sxs, joint pain, and NWB?

A

Children and adolescents

87
Q

What population w/ septic arthritis typically presents with irritability and poor feeding, limited ROM, and fever?

A

Neonate

88
Q

What position will a peds pt typically presents if septic arthritis?

A

Limited passive ROM

FABER position (hip involved)

89
Q

What risks are a/w septic arthritis in peds? (3)

A

Femoral venipuncture, JRA, STI

90
Q

What is the gold standard for dx of septic arthritis?

A

Prompt arthrocentesis - watery, cloudy, WBC > 50,000, leukocytes > 90%

91
Q

In addition to arthrocentesis (gold standard), what other dx studies should be ordered for septic arthritis? (4)

A

CRP

AP/ lateral xrays- increased joint space, effusion

US- effusion and guide aspiration

MRI- peds require sedation

3. E Med & Surgery (19 decks)

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