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Musculoskeletal > Common fractures and dislocations of the lower limb > Flashcards

Common fractures and dislocations of the lower limb Flashcards

1
Q

Classify the types of hip fracture

A

Intracapsular/subcapital: NOF

  • Subcapital: below the femoral head
  • Transcervical: across the mid-femoral neck
  • Basicervical: across the base of the femoral neck

Extracapsular

  • Intertrochanteric
  • Subtrochanteric
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2
Q

What are the common clinical signs of a hip fracture?

When may these be absent?

A

Shortened and externally rotated leg

May be absent if fracture is not displaced

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3
Q

Describe three X-ray features of a hip fracture

A

Obtain AP pelvis and lateral hip radiographs

  • Shenton’s line disruption
  • Lesser trochanter more prominent: external rotation
  • Femur flexion and external rotation: unopposed iliopsoas
  • Asymmetry of lateral femoral neck/head
  • Sclerosis in fracture plane; smudge sclerosis from impaction
  • Bone trabecular angulation
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4
Q

Which artery supplies most of the blood to the femoral head?

A

Medial femoral circumflex artery

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5
Q

What imaging should be offered in suspected occult hip fracture?

A

MRI within 24hr

Otherwise, consider CT

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6
Q

Describe the preoperative pain management for hip fractures

A

Assess pain:

  • Immediately upon presentation at hospital
  • Within 30 minutes of administering initial analgesia
  • Hourly until settled on the ward
  • Regularly as part of routine nursing observations

Analgesia should allow passive external rotation of leg, nursing care and rehabilitation

Paracetamol every 6 hours preoperatively; consider opioids and nerve blocks

NSAIDs not recommended

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7
Q

Describe the postoperative pain management for hip fractures

A
  • Paracetamol every 6 hours postoperatively
  • Additional opioids if insufficient postoperative pain relief

NSAIDs not recommended

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8
Q

What is the aim behind operating on hip fractures?

A

Operate with the aim to enable full weight bearing (without restriction) in the immediate postoperative period

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9
Q

When is a total hip replacement, rather than hemiarthroplasty, offered to patients with a displaced intracapsular hip fracture?

A

Total hip replacement if all of the following:

  • Prior, walked independently outdoors using a stick at most
  • Not cognitively impaired
  • Medically fit for anaesthesia and the procedure
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10
Q

What surgical procedures are offered for the different types of hip fracture?

A
  • Screw fixation or conservative: undisplaced intracapsular
  • Replacement arthroplasty: displaced intracapsular
    • Total or hemiarthroplasty depending on patient
  • Extramedullary implants (DHS): trochanteric fractures
  • Intramedullary nail: subtrochanteric fracture.
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11
Q

Describe the clinical features of hip dislocation

A

Hip dislocation usually occurs posteriorly, with:

  • Leg shortening
  • Flexion
  • Internal rotation

May also have fracture of acetabulum or soft tissue injury

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12
Q

Which nerve may be damaged with hip dislocation?

State an associated complication of this

A

Sciatic nerve

Equinus foot deformity

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13
Q

Which patients are more likely to suffer an hip dislocation?

A

Patients with total hip replacement (THR)

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14
Q

How is hip dislocation treated?

A
  • Reduction under GA
  • Traction for 3 weeks: promotes joint capsule healing
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15
Q

Describe the typical cause of a femoral shaft fracture

A

High force trauma eg. RTA

Otherwise, pathological fractures should be considered

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16
Q

Describe the common radiographic findings of a femoral shaft fracture

A
  • Proximal bone fragment:
    • Flexed (iliopsoas)
    • Abducted (gluteus medius)
    • Externally rotated (gluteus maximus)
  • Distal fragment
    • Shortened (hamstrings)
    • Adducted
    • Externally rotated (adductors)
17
Q

What is the treatment of a femoral shaft fracture?

A
  • Stabilise with resuscitation and traction
  • Locked intramedullary nail
18
Q

What is the typical cause of a tibial fracture?

A

High force trauma Stress injury may occur with chronic low force trauma

19
Q

Define a toddler’s fracture

A

Spiral distal tibial fracture seen in young children. Associated with a twisting injury, may present with refusal to weight-bear. Should never occur in children not yet walking ➔ consider non-accidental injury and alert paediatric team

20
Q

Name 3 reasons to revise a total hip replacement

A

Aseptic loosening (most common reason)

Pain

Dislocation Infection

21
Q

Describe the 3 types of patella fractures

A
  1. Undisplaced fracture across the patella
  2. Comminuted fracture: fall or direct blow
  3. Transverse fracture with a gap: forced passive flexion whilst quadriceps contracted
22
Q

Describe the clinical features of a patella fracture

A
  • Painful swollen knee
  • If separated, gap may be palpable
  • Usually blood in joint

Helpful to establish if patient can extend knee, as this will influence treatment

23
Q

Outline the treatment of a undisplaced patellar fracture

A

As extensors are intact, treatment is protective

  1. Aspirate if haemarthrosis threatens skin
  2. Plaster cast for 4-6 weeks
  3. Daily quadricep exercises
24
Q

Outline the treatment of a comminuted patellar fracture

A

Extensors are intact, but patella is irregular

Attempts should be made to preserve the patella

  1. Partial patellectomy + circlage wire
  2. Hinge brace to mould fragments
  3. Resurfacing if still symptomatic
25
Q

Outline the treatment of a displaced transverse patella fracture

A

Disrupted extensor mechanism

  1. Internal fixation of fragments: tension band
  2. Brace worn until active extension regained
  3. Daily flexion and extension exercises
26
Q

What is the commonest cause of patella dislocation?

A

Traumatic disloaction due to sudden contraction of quadriceps muscles while the knee is stretched in valgus and external rotation

27
Q

Describe the clinical features of dislocation of the patella

A
  • Displaced patella sits laterally
  • Uncovered prominent medial femoral condyle
  • Loss of active and passive knee movement
28
Q

What x-ray changes are seen with dislocation of the patella?

A
  • Patella displaced laterally
  • Tilted or rotated
  • 5%: associated osteochondral fracture
29
Q

How is discloation of the patella treated?

A
  1. Closed reduction
  2. Plaster back-slab for 2 weeks
  3. Physiotherapy to regain flexion
  4. Patella holding brace may be used for 4 weeks

Musculoskeletal (17 decks)

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