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PAMS: Orthopaedics and Rheumatology > deck_Lower limb fractures > Flashcards

deck_Lower limb fractures Flashcards

1
Q

What determines the stability, severity and need for emergent management in pelvic fractures ?

A

Mechanism of fracture. That is high energy or low energy trauma.

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2
Q

What is the percentage of mortality in pelvic fractures?

A

15-25% for closed fracturesUp to 50% for open fractures

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3
Q

What are stable pelvic fractures ?

A

These are fractures with only 1 break point in the pelvic ring. There should only be limited bleeding and the bone should stay in place.

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4
Q

What is the management of stable pelvic fractures?

A
  • If the fracture doesn’t extend to acetabulumearly mobilisation, bed rest and analgesiausually suffice* If extends into acetabulum may requireoperative management
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5
Q

What are unstable pelvic fractures ?

A

These are fractures with 2+ breaks in pelvic ring and risk of massive haemorrhage. Early stabilisation with pelvic binder is essential.

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6
Q

What are pubic rami fractures ?

A

This is a significant issue in older patients and more common in woman than in men. It present with pain on walking or the inability to mobilise/reduce mobility. It is diagnosed on x-Ray.

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7
Q

What is the management of pubic rami fracture?

A

Weight bear as tolerated (WBAT vs NWB orFWB)* Mobilising is better!– Analgesia– Physiotherapy

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8
Q

What are the complications of pelvic fractures?

A

– Death from haemorrhage– Osteoarthritis– Urogenital Injury– DVT/PE– LRTIs

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9
Q

What are neck of femur fractures ?

A

It is the most common fracture in elderly. 80% occur in woman. It has a bimodal distribution as majority occur in elderly and minority in young patients.

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10
Q

What are the risk factors for NOF fractures ?

A

female sex, Caucasian, osteoporosis/paenia, recurrent falls,diabetes mellitus, tobacco and alcohol use

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11
Q

What is the presentation of NOF fracture ?

A

Pain and non weight bearing on affected limb– Shortened & externally rotated limb– If high clinical suspicion but xray unequivocal, CT or MRI (goldstandard)

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12
Q

What are intra-capsular NOF fractures ?

A

Fracture line within capsule of hip joint. It has High risk of disruption of blood supply to head of femur causing avascular necrosis of femoral head.

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13
Q

What are extra-capsular NOF fractures ?

A

Fracture line distal to hip joint capsule. Inter-trochanteric (between greater and lesser trochanter fractures.

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14
Q

What are subtroacateric fractures?

A

These are pathological fractures or high energy fractures in elderly. May need Thomas splint.

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15
Q

What is the blood supply of the NOF ?

A

Via intraosseous nutrient vessels of the trochanteric anastomosis formed by the medial and lateral femoralcircumflex arteries which originates from the deep femoral artery.

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16
Q

What is Shenton’s line ?

A

It is an imaginary line formed by the medial edge of NOF and the inferior edge of the superior pubic ramus. Loss of contours of the Shenton’s line is a sign of fractured NOF.

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17
Q

What is the Garden’s classification of the intracapsular NOF fractures ?

A

Type 1: Incomplete/valgus impacted* Type 2: Complete fracture line and non-displaced on APand lateral views of X-ray* Type 3: Complete with partial displacement* Type 4: Complete displacement of fragments

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18
Q

What is the management of intracapsular NOF fractures ?

A

-Risk of blood supply disruption high. therefore it is Usually treated with hip hemiarthroplasty, Total hip arthroplasty and ORIF for young patients even for undisplaced fractures. Also undisplaced factures can be treated with cannulated screw fixation.

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19
Q

What is the management of extra-capsular NOF fractures ?

A

Dynamic Hip Screw +/ -cephalomedullary/intramedullary nail for more distal fractures .

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20
Q

What are the complications of NOF fractures ?

A
  • Avascular necrosis (AVN) of femoral head* PE/DVT* Non-union or Mal-union* Osteoarthritis* Fracture* Limb-length discrepancy* Mortality: Pre-injury morbidity is the most significant determinantof post-operative survival.
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21
Q

What is hip dislocation ?

A

It usually occurs from RTA or falls from heights. In 90% of the case dislocation is in the posterior direction and in 10 % in the anterior direction. There may be swelling and discolouration at the hip with inability to weight bear.

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22
Q

What is the appearance of the knee and leg in posterior hip dislocation ?

A

they point inward

23
Q

What is the appearance of the knee and leg in anterior hip dislocation ?

A

They point outward and side can appear shortened.

24
Q

What is the approach to hip dislocation ?

A

Check neurovascularstatus- reduce ASAP with concomitant analgesia and muscle relaxation- Perform post reduction X-Ray and re-check neurovascular status. If can’t reducemanually, then surgery.

25
Q

What are patellar dislocations ?

A

These are lateral dislocations of the patella due to Sudden muscular contraction or blow toknee or sudden change in direction. It occurs commonly in females in their second decade of life spontaneously due to laxity. It may present with hemarthrosis.

26
Q

What is the management of PATELLAR DISLOCATION?

A

Extend knee and push patella medially, once reduced brace and imobilize it for 3 weeks.

27
Q

What is the mechanism of tibial fracture ?

A

High Energy fracture occurs in young people sporting injuries/fall fromheight. Vast majority are open as the tibia is close to skin. The poor blood supply affects the healing.

28
Q

What is the management of undispalced and closed tibial fracture ?

A

Conservative management with long cast.

29
Q

What is the management of open or displaced tibial fractures ?

A

Locking plate– Intramedullary nail- Most Common– External fixation

30
Q

What is the Danny-Webber classification of ankle fractures ?

A

It is based on the level of fibular fracture. The more proximal the injury, greater risk of syndesmosisdisruption and instability. A: Below SyndesmosisB: At the SyndesmosisC: Above Syndesmosis

31
Q

What is the management of Danny-Webber type-A ankle fracture ?

A

Undisplaced or minimally displaced Type A ankle fractures can be treated operatively with below knee walking cast/boot.

32
Q

What is the management of Danny-Webber type-B ankle fracture ?

A

Undisplaced or minimally displaced Type B can be treated non-operatively with non weight bearing.

33
Q

What is the management of displaced type B and C ankle fracture ?

A

ORIF

34
Q

What are the complications of ankle fracture ?

A

– Malunion, nonunion, and prothesis failure. – Osteoarthritis– Infection– DVT

35
Q

What is the Ottawa rule for ankle X-ray?

A

Ankle X-ray is only required, If there is any pain in Malleolar zone and any one following finding: A) Bone tenderness at the posterior edge or tip of lateral malleolus.B) Bone tenderness at the posterior edge of medial malleolus. + inability to bear weight immediately or later.

36
Q

What is the Ottawa rule for Foot x-ray ?

A

A foot X-ray series is only required If there is any pain in the midd-Foot zone and bone tenderness at either navicular bone or bone tenderness at the base of the 5th metatarsal + inability to bear weight immediately or later.

37
Q

What are metatarsal fractures ?

A
  • For Metatarsal shaft fractures Usually require only a soft dressing, firm/supportive footwear and progressive weight bearing. * Stress fractures of 1-4 MT shafts typically heal well with rest alone and immobilization is not required. * Non-displaced #s of proximal 1-4 MT require Posterior splint followed by NWB short leg cast.
38
Q

What are phalangeal fractures ?

A

They are often traumatic fractures and will only require a buddy strap to treat it.

39
Q

What is the pathogenesis and presentation of RETROPATELLAR PAINSYNDROME?

A

Chondromalacia patella causes degeneration of the deep layers of the articular cartilage of the patella. It is Common in adolescents and young females. The patients may present with non-severe limiting pain worse with prolonged sitting / walking up inclines.

40
Q

What is the diagnostic finding in Skyline view X-ray of the knee in retropatellar pain syndrome ?

A

maltracking of the patella.

41
Q

What is the Tx of retropatellar pain syndrome ?

A

– Avoid what annoys!– Quadriceps building exercises

42
Q

What is Osgood-Schlatter disease?

A

It is a traction apophysitis often presents bilaterally in young adolescents. It causes mild pain which may worsen with exercise. The physical examination may show point tenderness over the tibial tubercle.

43
Q

What is the Dx approach in Osgood-Schlatter disease?

A

-Mostly clinical dx– Lateral xray shows displacement or fragmentation of the apophysis

44
Q

What is the Tx of Osgood-Schlatter disease?

A

– Condition is self-limiting– If refractory, 6 wks immobilisation in a plaster case may be required

45
Q

What is OSTEOCHONDRITIS DESSICANS?

A

It is a condition in which a small fragment of bone just deep to the articular surface is rendered avascular along with the healthy cartilage capping it, it becomes detached from the healthy structures. Can form a loose body and cause locking of the joint.

46
Q

What is the aetiology of osteochondritis dessicans?

A

The exact aetiology is uncertain, Contact b/t the femoral condyles & tibial spines or ACL may be significant. 70% of defects involve the lateral aspect of the medial femoralcondyle.

47
Q

What is the presentation of osteochondritis dessicans?

A

May be bilateral* Initially, symptom free; Later = mild pain in the joint + effusion

48
Q

What is the dx approach in osteochondritis dessicans?

A

Often confirmed by routine x-rays of the knee. Arthroscopic assessment is helpful in deciding whether fragment is becoming detached & likely to form a loose body#.

49
Q

what is the Tx of osteochondritis dessicans?

A

If the Fragment remains in situ, observe with serial X-Rays. If the fragment become mobile, Could drill the area and defect could be pinned into the place to promote healing. Arthroscopic removal of loose bodies can also be done.

50
Q

What is total Knee replacement ?

A

It consist of Femoral + tibial components removal Separated by polyethylene liners.

51
Q

What is Unicondylar Knee Replacement?

A

In this Medial, Lateral and Patellofemoral compartments can be separated by polyethylene liners as 10-30% have wear in only one compartment.

52
Q

What are the advantages of Unicondylar Knee Replacement?

A

Smaller incision, easier rehab, shorter hospital stay, less blood loss, lower infection risk. – Disadvantages: Less reliable long-term

53
Q

What are the specific complications of TKR ?

A

Femoral notching / peri-prosthetic fracture. Peroneal nerve palsy (tourniquet / retractor)Vascular complicationExtensor mechanism rupture* Leg length discrepancyStiffness / limited ROM post opInfection* Unhappy patient

PAMS: Orthopaedics and Rheumatology (17 decks)

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