Blue Boxes Lower limb Flashcards
Two types of injuries to hip bone, where do they specifically occur?
Pelvic fractures occurs to the femoral head neck or trochanters.
Avulsion fractures of hip can occur during sports with sudden acceleration/deceleration forces. Small part of bone with tendon or ligament is torn away. Occurs at apophyses most commonly ASIS AIIS, ischial tuberosities, and ischiopubic rami
Most common lower limb injuries
Knee leg and foot due to acute trauma during contact sports and over endurance. Adolescents are most vulnerable to these due to their epiphyseal plates.
Coxa Vara and Coxa Valga?
When the angle of inclination is decreased betweeen the long axis of femoral neck and femoral shaft it is called coxa vara. When the angle is increased it is coxa valga.
Coxa vara causes mild shortening of the limb and limits passive abduction of hip.
Dislocated epiphysis of femoral head.
Epiphysis dcan slip away from the femoral neck due to a weakened epiphyseal plate, caused by repetitive microtrauma or acute trauma. Especially abduction and lat rotation of thigh. It slowly results in a progressive coxa vara (decreased angle). The initial symptom is referred pain to the knee.
Femur fractures:
Most common area, proximal fractures, intercapsular, greater trochanter, inferior distal
Neck of the femur is the most common fractured bc it is narrow and weak.
More vulnerable with increaseing age and females and with osteoperosis.
Proximal femur fractures occur transcervical and intertrochanteric as a result of indirect trauma. Impaction occurs with these fractures.
Intracapsular fractures occur within hip joint capsule
Greater trochanter and shaft are caused by direct trauma and most common during active years, MVA and sports. Can take up to a year to heal.
Inferior or distal femur can be complicated by separation of condyles resulting in misalignment of articular surfaces of knee or hemorrhage from popliteal artery. COMPROMISES BLOOD FLOW TO LEG.
Tibial fractures:
Transverse and Diagonal and Compound
Narrowest at junction of middle and inferior thirds most common site fracture also poor blood flow. Tibial shaft common for compound fracture due to direct trauma. Fracture of tibia through nutrient canal predisposes to nonunion of bone fragments.
Transverse march (stress) fractures of inferior third are common in people who take hikes before they’re in shape. Indirect force applied to shaft when bone turns with foot fixed with a fall can fracture shaft.
Severe torsion during skiing can produce diagonal fracture of the shaft at jxn of middle and inferior thirds and also fracture the fibula. Diagonal fractures assoc. with shortening of limb.
Epiphyseal plate fractures
Tibial fractures are serious in kids if they involve these plates bc it can impact growth. Disruption can also cause inflammation of tibial tuberosity and chronic recurring pain in adolescence. (osgood-schlatter disease)
Fibular fractures:
Commonly occur 2-6 cm proximal to distal end of lat malleolus also associated with fracture dislocations of the ankle joint. Slipping resulting in the foot forced into excessive inversion the ligaments tear tilting the talus against lat malleolus and can shear it off.
Lateral and medial malleoli common in basketball and soccer.
Bone grafts.
Fibula is common source of bone for grafting, walking running jumping can still be normal with a segment of the fibula removed. The nutrient artery and periosteum are removed with the piece of bone to allow it to grow at a new site. The healing happens as if a fracture occurred.
Anterior tibia is used for bone grafting in kids also for intraosseous infusion in dehydrated children or with shock.
Intraosseous infusion
Way to deliver blood, hydration and medications into the medullary cavity of a bone when you can’t get a vein. Proximal tibia is most common site. Other sites are distal femur tibia or fibula, proximal humerus and manubrium.
IO infusion MUST be replaced within 24 hours with a peripheral venous or central line due to risk of osteomyelitis.
Calcaneal fractures:
Hard fall onto the heal can result in comminuted fracture and it is disabling bc subtalar joint is distrupted.
Talar neck fractures
Can occur during severe dorsiflexion of ankle. Can occur when pressing hard on brake pedal during a head on collision. Body of talus can dislocate posteriorly.
Metatarsal fractures
heavy objects fall on foot or run over. Common in dancers, “dancers fracture” occurs when ballet dancer loses balance putting full weight on metatarsals and fracturing the bone.
“fatigue fractures” can result from prolonged walking usually transverse from repeated stress on metatarsals.
Avulsion fracture of tuberosity of 5h metatarsal can occur when food si suddenly violently inavefrted and can be torn away by the tendon of fib brevis.
Os Trigonum
The secondary ossification becomes the lateral tubercle of the talus can fail to unite with the body of the talus. It can be caused by forceful plantar flexion during early teens. Partly or even fully ossified center can fracture and progress to nonunion resulting in an accessory ossicle called os trigonum. Increased prevalence in soccer players and ballet dancers.
Fracture of sesamoid bones
Can result from crushing injury and are located in great toe in the tendon of flexor hallucis longus. They bear weight of body especially in latter part of stance phase.
