Blue Boxes - Bones of LE

Question 1

The _______ ________ are discs of hyaline cartilage between the metaphysis and epiphysis of a mature long bone that permits the bone to grow longer.

Answer 1

Epiphysial Plates

Question 2

Explain why adolescents are more vulnerable to lower limb injuries.

Answer 2

Their bones are still developing and they still have epiphysial plates. During growth spurts, bones actually grow faster than the attached muscle. The combined stress of rapid growth and physical activity on the epiphysial plates can result in irritation and injury of the plates and developing bone.

Question 3

Fractures of the hip bone are referred to as ________ fractures. The term “hip fracture” is most commonly applied to fractures of the femoral head, neck, or trochanters.

Answer 3

Pelvic

Question 4

What type of fractures of the hip bone can occur during sports that require sudden acceleration or deceleration (i.e., sprinting, kicking, hurdling)?

Answer 4

Avulsion fractures of hip bone

Question 5

Avulsion fractures of the hip bone occur at ________, or bony projections that lack secondary ossification centers.

Answer 5

Apophyses

Question 6

Avulsion fractures occur where muscles or ligaments are attached. What are the common areas for avulsion fractures of the hip?

Answer 6

ASIS
AIIS
Ischial tuberosities
Ischiopubic rami

Question 7

When the angle of inclination between the long axis of the femoral neck and the femoral shaft is decreased, it is called…

Answer 7

Coxa vara (shaft of femur deformed toward midline)

***Knock knees – Remember this is opposite from knee. Knee is Genu Valgum

Question 8

When the angle of inclination between the long axis of the femoral neck and the femoral shaft is increased, it is called…

Answer 8

Coxa valga (shaft of femur deformed away from midline)

***Bow-legged – Remember this is opposite from knee. Knee is Genu Varum

Question 9

Coxa (VARA/VALGA) causes a mild shortening of the lower limb and limits passive abduction of the hip.

Answer 9

Vara

***Decreased angle between femoral neck and shaft

Question 10

In older children and adolescents, the epiphysis of the femoral head may slip away from the femoral neck because of a weakened epiphysial plate. How is this caused?

Answer 10

Acute trauma

Repetitive microtraumas that put increased shearing stress on epiphysis

***Especially with abduction and lateral rotation of thigh

Question 11

When there is a dislocation of the epiphysis of the femoral head, the epiphysis will slowly slip and result in a progressive _______ _______.

Answer 11

Coxa vara

Question 12

What is the common initial symptom of a dislocated epiphysis on the femoral head? How is it diagnosed?

Answer 12

– Hip discomfort that may be referred to the knee

– Radiographic exam of the superior end of the femur

Question 13

What part of the femur is most often fractured?

Answer 13

Femoral neck

Question 14

The type of femoral fraction that can be sustained is often related to what?

Answer 14

Age

Sex

Question 15

The femoral neck becomes increasingly vulnerable with age, especially in females, secondary to __________.

Answer 15

Osteoporosis

Question 16

Transcervical (middle of neck) and intertrochanteric fractures of the proximal femur usually occur as a result of what?

Answer 16

Indirect trauma – can be from stumbling or stepping down hard, like off a curb or step

Question 17

What happens to the limb as a result of a transcervical (middle of neck) or intertrochanteric femur fracture?

Answer 17

Impaction and muscle spasm can cause limb to shorten

Question 18

Fractures of the Greater Trochanter and Femoral Shaft usually result from a (INDIRECT/DIRECT) trauma.

Answer 18

Direct (i.e., motor vehicle accidents and sports)

Question 19

Inferior or distal femur fractions may be complicated by separation of the condyles, resulting in misalignment of the articular surfaces of the knee joint or a hemorrhage due to what?

Answer 19

Due to the large Popliteal A. that runs directly on the posterior surface of the bone.

***This type of fracture can compromise blood supply to leg, should always be considered in knee fractures or dislocations!

Question 20

What is the most frequent site of fracture for the Tibia?

Answer 20

Middle and inferior thirds (most narrow area)

Question 21

Due to the anterior surface of the Tibia being subcuanteous, the Tibial shaft is the most common site for what type of fractures?

Answer 21

Compound fractures

***This type of fracture has bone sticking out of skin

Question 22

This type of fracture can occur in the Tibia to people who take long hikes before they are conditioned.

Answer 22

Transverse march (stress) fractures

Question 23

Frequently during skiing a fractures results from a high-speed forward fall, which angles the leg over the rigid ski boot, producing what type of fracture?

Answer 23

Boot-top fracture (transverse)

Question 24

Severe torsion during skiing may produce a _________ fracture of the tibial shaft at the junction of the middle and inferior thirds, as well as a fracture of the ________. These types of fractures are often associated with limb shortening.

Answer 24

Diagonal

Fibula

Question 25

This is the term for the disease that causes a disruption of the epiphysial plate at the tibial tuberosity, causing inflammation and chronic pain during adolescence.

Answer 25

Osgood-Schlatter disease

Question 26

In Osgood-Schlatter disease, the child’s quadriceps pull on tendons that insert at the _______ _______. This can cause pain and swelling at that spot. In some cases a small bone growth may occur to try to close the gap.

Answer 26

Tibial tuberosity

Question 27

Where does a the fibular fracture occur that is associated with fracture-dislocations of the ankle joint?

Answer 27

2-6 cm above distal end of lateral malleolus

Question 28

Fibular fractures associated with fracture-dislocations of the ankle joint are usually combined with tibial fractures during (EVERSION/INVERSION).

Answer 28

Eversion

Question 29

During excessive (EVERSION/INVERSION), the ankle ligaments tear and tilt the Talus against the Lateral Malleolus and may shear it off the Fibula.

Answer 29

Inversion

Question 30

This is a common source of bone for grating, and usually has normal function after removal.

Answer 30

Fibula

Question 31

How does a fibular bone graft survive after being taken out and placed in another area?

Answer 31

Nutrient foramen is located in the middle third of the Fibula, so it’s important to move the bone graft with this so it has a blood supply to the medullary cavity.

***When bone graft is put in place, it heals as if it were a fracture on either end

Question 32

Due to its extensive subcutaneous location, the anterior ______ is accessible for obtaining pieces of bone for grating in children.

Answer 32

Tibia

Question 33

This is a method of delivering hydration, blood, and medications directly to the medullary cavity of bone when peripheral venous access is difficult or impossible.

Answer 33

Intraosseous Infusion

Question 34

What is the most common site for Intraosseous Infusion?

Answer 34

Proximal Tibia

***Can also be done in Femur, Fibula, Humerus, and Manubrium

Question 35

When is Intraosseous Infusion primarily used?

Answer 35

Cases of traumatic shock

In children with circulatory collapse

Question 36

A hard fall onto the heel (i.e., from a ladder) may fracture the Calcaneus into several pieces. What type of fracture is this?

Answer 36

Comminuted fracture

***This fracture is often disabling because it disrupts the Subtalar (Talocalcaneal) joint.

Question 37

What is often fractured during a severe dorsiflexion of the ankle (i.e., when a person is pressing extremely hard on the brake pedal of a vehicle during a collision)?

Answer 37

Fracture of talar neck

Question 38

Fractures of ________ occur when a heavy object falls on the foot or is run over by a heavy object.

Answer 38

Metatarsals

Question 39

What is a “Dancer’s Fracture”?

Answer 39

Occurs in pointe dancers that lose balance and put their full body weight on the metatarsals, causing fractures.

Question 40

Fatigue fractures of the metatarsals are usually transverse and occur due to what?

Answer 40

Prolonged walking

Question 41

When the foot is suddenly and violently inverted, the tuberosity of the 5th metatarsal may be avulsed by the tendon of which muscle?

Answer 41

Fibularis brevis M.

Question 42

Avulsion fractures of the 5th metatarsal is common in basketball and tennis players and is usually associated with what type of injury?

Answer 42

Severe ankle sprain

Question 43

During ossification of the Talus, the secondary ossification center, which becomes the lateral tubercle of the Talus, occasionally fails to unite with the body of the Talus. This can be due to applied stress during early teens and may result in a bone (accessory ossicle) called an…

Answer 43

Os Trigonum

***Occurs in 14-25 percent of adults

Question 44

The sesamoid bones of the great toe in the tendon of the Flexor Hallucis Longus M. bear the weight of the body, especially during the latter part of the stance phase of walking. How are the sesamoid bones usually fractured?

Answer 44

From crushing injury