Applied Anatomy of LL - Long bone fractures

Question 1

What is the aprroach to long bone fractures ?

Answer 1

• CABCDE (c- catastrophic haemorrhage).
• Stabilise the patient
• Assess the injured limb (open or closed, and heck neurovascular supply).
• Image - to confirm the fracture
• Reduce - Immediately?
• Hold- Temporarily / definitively.

Question 2

What do you need to consider regarding mid-shaft fracture ?

Answer 2

• average blood loss is around 1L + - This can lead to cardiovascular shock.
• The fracture may also be open which can lead to additional complications associated with infection.
• There could be damage to femoral artery and femoral vein.
• Contraction of adductors distal to fracture and abductors proximal can add to the displacement of the fracture.

Question 3

How would a patient with a femoral shaft fracture present ?

Answer 3

• The patient would have a history of high impact trauma
• The patient would be in extreme pain and may be in severe shock due to blood loss
• There would be gross swelling and deformity to the thigh
• There will be a high likelihood of further injuries

Question 4

What is the most commonly injured long bone ?

Answer 4

Exposed position
The tibia’s exposed position makes it the most commonly injured long bone, either from direct or indirect trauma.

Significant direct trauma typically occurs in car versus pedestrian collisions

In contrast indirect tibial trauma may occur when the leg twists on a fixed foot (e.g. during a football tackle or skiing). This kind of mechanism, especially during skiing, can result in a spiral fracture.

Question 5

What fracture is this ?

Why is this a limb threatening injury ?

Answer 5

Fibula

Fractures of the fibula are also common and typically occur within 6cm of its distal end (Fig.X). Consequently these can be associated with fracture-dislocations of the ankle joint (Fig.Y).

Can also result in an open fracture.