Blue Boxes: Lower Extremity Flashcards
Why are epiphysial plates more prone to injury in adolescents?
What is this type of injury called?
- Adolescents are still growing and the epiphysial plate are what allows the long bones to grow.
- During growth spurts, bones can grow faster than muscles.
- Can result in irritation and injury to the plate and developing bone
- Also known as ostechondrosis
What is considered a pelvic and hip fracutre?
Hip Fracture:
- Femoral Head
- Femoral Neck
- Femoral trochanters
Pelvic Fracture: Fractures of hip bone (yes this seems counterintuitive)
- Pubic rami
- Bony pelvic ring
Where do avulsion fractures of the hip tend to occur?
- Occur at Apophyses: Bony projections that lack secondary ossification centers
- ASIS and AIIS
- Ischial Tuberosities
- Ischiopubic rami
Remember avulsion fractures occur where muscles or ligaments are attached
What is the difference between Coxa Vara and Coxa Valga?
Coxa Vara and Valga are the angle of inclination between the long axis of the femoral neck and the femoral shaft
- Coxa Vara: angle of inclination is decreased
- Coxa Valga: angle of inclination is increased
What can cause a dislocated epiphysis of the femoral head?
- Repetitive microtraumas that place increased shearing stress on the epiphysis
- Especially w/ abduction and lateral rotation of thigh
- Epiphysis often dislocates, slowly resulting in a progressive coxa vara
- Symptoms: hip discomfort referred to knee
- Need radiographic examination to confirm diangosis
Femoral Fractures
Which part of the femur is most frequently fractured?
What are other common fractures?
-
Femoral Neck Fracture
- Most common
- Weakest part of the bone
- Intertrochanteric Fracture
- Due to indirect trauma (e.g. stepping of curb)
- Greater Trochanter Fractures
- Due to direct trauma
- Spiral Fractures of Femoral Shaft
- Distal Femur Fractures
- Separation of condyles
- Can compromise blood supply to leg
Femur vulnerable to osteoporosis
Tibial Fractures
Where is the most common fracture?
What other common fractures are there?
-
Tibial Shaft Fractures: Most Common
- Narrowest part
- Poor blood supply
- Anterior surface is subcutaneous (makes it most common site for a compound fracture)
- Transverse Stress Fractures
- Distal part of tibia
- Common with hikers
- Diagonal Fracture
- Middle/Inferior part
- Common with skiing
Why are tibial fractures serious in adolescents?
- Primary Ossification center is at superior end of tibia
- Epiphysial Plate can be damaged
- Osgood-Schlatter Disease
What are the most common Fibular Fractures?
- Distal end of lateral malleolus
- Most common
- Also seen in medial malleolus
What bone would you use for a bone graft?
Why?
Fibula: Nutrient foramen is located in the middle third of the fibula in most cases, this segment of the bone is used for transplanting when the graft must include a blood supply to the medullary cavity as well as to the compact bone of the surface (via the periosteum).
How can Calcaneal Fractures happen?
What joint is normally involved?
Hard fall on heel (eg falling from ladder)
-Disrupts Subtalar joint
What can cause a fracture of the talar neck?
Severe Dorsiflexion of the ankle
-Body of talus can dislocate posteriorly
What can cause a metatarsal fracture?
Heavy object falls on foot
-Common in dancers
What is Os Trigonum?
- Secondary ossification center (lateral tubercle of the talus) occasionally fails to unite with the body of the talus.
- This failure may be caused by applied stress (forceful plantarflexion) during the early teens.
- Occasionally, a partly or even fully ossified center may fracture and progress to nonunion.
- Either event may result in a bone (accessory ossicle) known as an os trigonum
- Increased prevalence among soccer players and ballet dancers
How can the sesamoid bone be injured?
Crushing injury
