Fractures 5 (Hip and Knee) Flashcards
1
Q
How many Proximal Hip Fractures occur annually?
A
240,000
2
Q
What percentage of patients with a Proximal Hup Fracture die within a year?
A
12-20% die within a year
3
Q
What percentage of patients with Proximal Hip Fractures are unable to live independently afterwards?
A
50% of survivors are unable to live independently
4
Q
What are the average patient demographics for a Proximal Hip Fracture?
A
- Average of 70
- Females>Males
5
Q
Where do Intra-capsular femoral fractures commonly occur?
A
- epiphyseal plate
- subcapital
- midcervical
- Basicervical
6
Q
How much higher of a risk is there of avascular necrosis in an Intra-capsular fracture?
A
8-30%
7
Q
What percentage of Intra-capsular femoral fractures are Nonunion?
A
25%
8
Q
How does avascular necrosis occur in a Proximal Femoral fracture?
A
AVN from disruption of the lateral
and/or medial femoral circumflex
arteries
9
Q
How long does it take to see radiographic changes in a proximal femoral fracture?
A
1 year after injury
10
Q
What advanced imaging is best when a proximal femoral fracture is present?
A
Bone scan/MRI
* Sensitive modalities
11
Q
What percentage of acute fractures cannot be detected until 24 hours after injury?
A
20%
12
Q
What percentage of proximal femoral fractures are not visible for the first 72 hours?
A
5-10%
13
Q
Where do Extra-capsular fractures commonly occur?
A
- intertrochanteric
- trochanteric
- Subtrochanteric
14
Q
Extra-capsular femoral fractures are typically not affected with AVN or non-union: true or false?
A
True
15
Q
Where is the most common site for a Subcapital fracture?
A
Head-neck junction
16
Q
What are some common features of a Subcapital fracture?
A
- Often difficult to visualize
- Disruption of the cortex
- Zone of impaction
17
Q
For a Subcapital fracture, what type of imaging would be appropriate for osteoporotic patients, if clinically indicated?
A
MRI
18
Q
What is an Intracapsular (midcervica) fracture?
A
It is an Intra-capsular fracture in the
middle of the neck of the femur. There is loss of cortical continuity and increased radiopacity secondary to impaction.
19
Q
What are the MOIs for an Intracapsular (midcervical) fracture?
A
- Falls
- MVAs
- Pathological
20
Q
What angle changes when an Intracapsular (midcervical) fracture is present?
A
femoral angle
21
Q
How do you treat an Intracapsular (midcervical) fracture in younger patients?
A
Surgical stabilization is required in younger patients
22
Q
How do you treat an Intracapsular (midcervical) fracture in older patients?
A
Hip replacement may be needed in older osteoporotic patients
23
Q
What complicates an Intracapsular (midcervical) fracture?
A
Avascular necrosis
24
Q
What is an Anterior Hip dislocation?
A
The head of the femur is displaced
anterior and inferior to the
acetabulum.
25
What is the MOI of an Anterior Hip dislocation?
Direct blow to the posterior aspect
of the hip or head-on collisions with the flexed hip in abduction, in which the flexed knee hits the dashboard
26
What is the incidence rate of an Anterior Hip dislocation?
15%
27
How do you treat an Anterior Hip dislocation?
Reduction under anesthesia with
bracing afterwards
28
What may occur with an Anterior Hip dislocation?
Avascular necrosis
29
What is an Posterior Hip dislocation?
Head of the femur is displaced
posterior and superior to the
acetabulum
30
What is the MOI of a Posterior Hip dislocation?
Direct blow in head-on collisions
on the flexed knee with the hip in
flexion and adducted or a fall from
a height
31
What is the incidence rate of a Posterior Hip dislocation?
85%
32
How do you treat a Posterior Hip dislocation?
Reduction under anesthesia with
bracing afterwards
33
What may occur in a patient with Posterior Hip dislocation?
Avascular necrosis and damage to
the sciatic nerve may occur
34
What is a Central Hip dislocation?
The head of the femur is displaced medial through the acetabulum (traumatic protrusio acetabuli)
35
What is the MOI of a Central Hip dislocation?
Direct blow forcing the femoral
head into the fractured acetabular
floor
36
What line is disrupted in a Central Hip dislocation?
Disrupted Kohler’s line
37
How do you treat a Central Hip dislocation?
Reduction under anesthesia with
bracing afterwards
38
What may occur in a Central Hip dislocation?
* Avascular necrosis may occur
* May damage the obturator
neurovascular bundle
39
What is a Slipped Capital Femoral Epiphysis?
Intra-capsular fracture through the
epiphyseal plate - Type I Salter Harris fracture.
40
What population is a Slipped Capital Femoral Epiphysis commonly seen in?
Overweight teenagers
41
Slipped Capital Femoral Epiphysis bilateral ____% within ____ year.
20-30%;1 year
42
Slipped Capital Femoral Epiphysis: Males or Females more?
Males
43
Slipped Capital Femoral Epiphysis: Left or Right more?
Left
44
What are the clinical features of a Slipped Capital Femoral Epiphysis?
* MC hip disorder of adolescence
* Hip pain referred to thigh and knee
* Limp + Trendelenberg
- Gluteus medius weakness
* Limitation of abduction and internal rotation
45
Slipped Capital Femoral Epiphysis: What happens at the head of the femur?
Offset epiphysis of the head of the femur
46
Slipped Capital Femoral Epiphysis: Which line is disrupted?
Klein's line is disrupted
47
Slipped Capital Femoral Epiphysis: What lies lateral to the acetabulum?
Metaphysis lies lateral to the acetabulum (Capener's sign)
48
Slipped Capital Femoral Epiphysis: What deformity is at the proximal femur?
Pistol-grip deformity of the proximal femur
49
Slipped Capital Femoral Epiphysis: What sign do we see?
Ice cream falling off the cone sign
50
How do we treat a Slipped Capital Femoral Epiphysis?
Surgical fixation is necessary
51
What a Slipped Capital Femoral Epiphysis result in?
May result in permanent short leg,
premature OA and coxa vara deformity
- Hip replacement around the age of 40 is typically seen
52
What is an Extracapsular Intertrochanteric fracture?
Extra-capsular fracture through
the trochanteric region.
There is loss of cortical continuity.
53
What does the fracture line pass through in an Extracapsular Intertrochanteric fracture?
Fracture line passes through the
greater and lesser trochanters
54
What are the MOIs of an Extracapsular intertrochanteric fracture?
- Falls
- MVAs
- Pathological
55
What angle is decreased in an Extracapsular Intertrochanteric fracture?
Femoral angle may be
decreased
56
How do you treat an Extracapsular Intertrochanteric fracture?
Surgical stabilization is
necessary
57
What is a Subtrochanteric Proximal Femoral fracture?
Extra-capsular fracture below
the trochanteric region.
Fracture line passes 2 inches
below the greater and lesser
trochanters.
There is also loss of cortical continuity.
58
What are the MOIs of a Subtrochanteric Proximal Femoral Fracture?
- Falls
- MVAs
- Pathological
59
Subtrochanteric Proximal Femoral Fracture: Stable or Unstable?
Unstable fracture
60
How do you treat a Subtrochanteric Proximal Femoral Fracture?
Surgical stabilization is
necessary
61
What are the Ottawa Knee Rules? (5)
- Age 55 or under
- Fibular head tenderness
- Isolated patellar tenderness
- Inability to flex 90 degrees (inability to flex 60 degrees increases specificity)
- Inability to bear weight for 4 steps after injury AND in the clinic
62
Describe a Comminuted Supracondylar Fracture.
- Distal metaphyseal fracture occurring above the femoral condyles
- Severe impaction forces
- Radiolucent breaks above the femoral condyles with loss of cortical continuity
63
What artery may be damaged in a Comminuted Supracondylar fracture?
Femoral Artery
64
How do you treat a Comminuted Supracondylar fracture?
Surgical stabilization is needed
65
Describe an Intercondylar Femoral Fracture.
- Intra-articular longitudinal fracture between the medial and lateral femoral condyles
- Severe impaction forces
- T or Y shaped radiolucent break between the femoral condyles into the articular surface
66
Intercondylar Femoral Fracture: Stable or Unstable?
Unstable fracture
67
What artery may be damaged in an Intercondylar femoral fracture?
Popliteal artery
68
How do you treat an Intercondylar femoral fracture?
Requires surgical stabilization
69
Describe a Salter Harris Type II Lower Femur fracture.
- Fracture involving both the epiphyseal plate and the distal metaphysis
- Salter Harris Type II fracture (M.C. one)
70
What is the MOI for a Salter Harris Type II Lower Femur fracture?
Falling on the flexed knee in a teenager
71
What may be damaged in a Salter Harris Type II Lower Femur fracture?
Growth Plate
72
How do you treat a Salter Harris Type II Lower Femur fracture?
Surgical intervention is needed
73
Describe a Patellar fracture.
- Fracture through the patella
- Potential for severe displacement
- May be undisplaced (contour is retained) or displaced (contour is abnormal)
74
What are the MOIs for a Patellar fracture?
- Falls
- Direct trauma
- Avulsion
75
What are the 4 main types of patellar fracture orientations?
- Transverse (60%)
- Stellate (25%)
- Vertical (15%)
- Osteochondral fracture (secondary to dislocation)
76
How do you treat a Patellar fracture?
Surgical stabilization is required from the displaced patella fracture
77
Describe a displaced patellar fracture.
- Fracture through the patella
- Fragments are widely separated
- Loss of cortical continuity
- Contour is abnormal
78
What are the MOIs for a displaced patellar fracture?
- Falls
- Direct trauma
- Avulsion
79
How do you treat a displaced patellar fracture?
Surgical stabilization is required to approximate the displaced patella fracture fragments
80
Describe a patellar dislocaiton.
Transient and recurrent
81
What type of patellar dislocation is most common?
Lateral dislocation is most common
82
What might a Lateral patellar dislocation be associated with?
Medial patellofemoral ligament tear
83
What conditions can a patellar dislocation be seen with?
Osteochondral fracture or Bone Bruise
84
What view is a Patellar dislocation best seen on?
Sunrise view
85
Describe a Femorotibial dislocation.
- Severe injury
- Anterior or posterior injury
- All intracapsular and extracapsular ligaments are usually ruptured
86
What are the MOIs for a Femorotibial dislocation?
- MVC
- Fall from a height
87
Which damaged artery and nerve are associated with a Femorotibial dislocation injury?
- Popliteal artery
- Peroneal nerve
88
Anterior Cruciate Ligament (ACL): Common or uncommon injury?
Common
89
ACL Injuries: More common in Males or Females?
Females
90
What is the MOI of an ACL injury?
Pivot- shift mechanism
91
What do patients feel with ACL injury?
Patients fell a "pop" and knee giving out
92
What is necessary for ACL injury diagnosis?
MRI is necessary for diagnosis
93
What is the MOI of Kissing contusions?
Patellofemoral dislocations or pivot shift injuries
94
Components of Kissing Contusions (4):
- Lateral femoral condyle
- posterior tibial plateau
- Medal patellar facet
- Lateral femoral condyle
95
What are the components of O'Donoghue Unhappy Terrible Triad?
- ACL tear
- Posterior horn of the medial meniscus
- Medial collateral ligament
96
PCL Injury: More or Less common than ACL injury?
Less common
97
What is the MOI of a PCL injury?
Direct blow to the tibia (Anterior to Posterior)
- traumatic posterior drawer
98
Tibial Plateau fracture aka
Bumper or Fender fracture
99
Describe a Tibial Plateau fracture (3)
- Depressed impacted fracture of the tibial plateau
- Femoral condyle impacting the tibial plateau
- Lateral part of the tibial plateau is depressed
100
Tibial Plateau fracture: Lateral or Medial more?
Lateral (80%) more than medial
101
What demographic are tibial plateau fractures commonly seen in?
Elderly osteoporotic patient
102
What do we also seen frequently with Tibial Plateau fractures (2)?
- loss of cortical continuity
- Fat-Blood interface (FBI sign) AKA Lipohemarthrosis
103
How do we treat tibial plateau fractures?
Surgical stabilization is needed
104
What may a Tibial plateau fracture lead to?
May lead to secondary OA
105
What is a Segond fracture?
Small avulsion fracture of the anterolateral rim of the tibia
- Avulsion of the IT band insertion
106
What is the MOI for a Segond fracture?
Excessive varus (bowed legs) force with internal rotation of the leg (Pivot-shift)
107
What do you order if there is a Segond fracture?
Order an MRI
- 75-100% are associated with rupture of the ACL
- 70% have meniscal tears
108
What is needed if the ACL is torn in a Segond fracture?
Surgical repair
109
What is a Reverse Segond fracture?
Small avulsion fracture of the posteromedial rim of the tibia condyle
110
What is the MOI of a Reverse Segond Fracture?
Excessive Valgus (knocked knees) force with external rotation of the leg
111
Reverse Segond fracture: Medial or Lateral side?
Medial side
112
What % of Reverse Segond fractures are associated with rupture of the PCL?
75%
113
What % of Reverse Segond fractures have meniscal tears?
70%
114
How do you treat a Reverse Segond fracture?
Surgical repair is needed for the torn PCL
115
What is the DDX for a Reverse Segond fracture?
Pelligrini-Stieda Process
116
What is the aka for an Osteochondral fracture?
Osteochondritis Dissecans
117
Describe an Osteochondral fracture
- Osteochondral fracture
- Traumatic etiology
118
What population are osteochondral fracture commonly seen in?
Children and adolescents
119
What is the most common location for an Osteochondral fracture?
Knee
- seen on the non-weight bearing surface of the lateral aspect of the medial femoral condyle
120
How do patients present with an Osteochondral fracture?
Patients present with locking and clicking of the knee
121
What type of fragments are observed in an Osteochondral fracture?
Elliptical or ovoid osseous or cartilaginous fragment
122
What kind of defect is seen at the femoral condyle in an Osteochondral fracture?
Concave defect
123
Osteochondral fracture: Define displaced.
Loose body or joint mice
124
Osteochondral fracture: Define non-displaced.
Separated from the femur but in situ (in its original place)
125
What is the aka for a Spontaneous Insufficiency Fracture of the Knee (SIFK)?
AKA Spontaneous Osteonecrosis of the knee (SONK)
126
What portion of the medial femoral condyle is impacted in SIFK?
Weight-bearing portion
127
Describe SIFK
- Articular surface is flattened with collapse
- Concave articular defect
128
What is Osgood-Schlatter's disease?
Traction apophysitis causing partial separation of the tibial tuberosity
129
What population is Osgood-Schlatter's disease commonly seen in?
- Adolescents
- Males > Females
130
What activities can cause Osgood-Schlatter's?
Jumping sports like basketball and volleyball
131
How does a patient with Osgood-Schlatter's present?
- Anterior knee pain
- Swelling and tenderness over the tibial tuberosity where the patellar tendon is inserted
132
What do we see radiographically in a patient with Osgood-Schlatter's?
- Soft tissue swelling
- Fragmentation of the tibial tuberosity
133
How do you treat a patient with Osgood-Schlatter's?
- Ice
- Limiting provocative activities
134
What is Sinding-Larsen Johansson disease?
- Chronic traction injury
- Anterior knee pain with point tenderness at the inferior pole of the patella
135
What demographic is Sinding-Larsen Johansson disease commonly seen in?
- 10-14 year old
- Males > Females
136
What may be present radiographically at the patellar tendon in Sinding-Larsen Johansson disease?
Dystrophic calcification may be present in the upper end of the patellar tendon
137
How do you treat Sinding-Larsen Johansson disease?
- Ice
- Limiting activities
138
What is a Maisonneuve fracture?
Spiral fracture of the proximal fibula with an associated fracture of the medial malleolus
139
What is the MOI of a Maisonneuve fracture?
Forceful inversion and rotation of the ankle as seen in soccer injuries
140
What do we see radiographically with a Maisonneuve fracture?
- Radiolucent spiral fracture of the proximal fibula just below the neck
- Loss of cortical continuity of the distal end of the tibia
- Separation of the distal tibiofibular joint (fibrous)
141
How do you treat a Maisonneuve fracture?
Surgical stabilization is required
142
Describe a Salter Harris Type I Fracture of the Lower Tibia
- Fracture passes through the distal epiphyseal plate of the tibia
- Salter Harris type I
143
How do you treat a Salter Harris Type I Fracture of the Lower Tibia?
- Immobilization for 6-8 weeks is needed
- Weight-bearing cast is used
144
What is needed to treat Salter Harris types III and IV?
Surgical intervention
145
What Salter Harris type may require surgery?
Type II
146
Describe a Salter Harris Type II Fracture of the Lower Tibia
- Fracture passes through the distal metaphysis and distal epiphyseal plate of the tibia
- Salter Harris type II
147
How do you treat a Salter Harris Type II Fracture of the Lower Tibia?
- Immobilization for 6-8 weeks is needed
- Weight-bearing cast is used
148
What may be required in a Salter Harris Type II Fracture of the Lower Tibia?
Surgery may be required depending on the degree of displacement of the metaphyseal fragment
149
What is a Medial Malleolar fracture?
Isolated (single) malleolar fracture of the distal tibia
150
What is the MOI for a Medial Malleolar fracture?
Inversion injury
151
What do we see radiographically with a Medial Malleolar fracture?
- Radiolucent transverse or oblique fracture line through the medial malleolus
- Loss of cortical continuity
152
How do you treat a Medial Malleolar fracture?
Closed reduction plus a weight bearing cast for 6-8 weeks
153
What might complicate a Medial Malleolar fracture?
Non-healing
154
What is a Lateral Malleolar fracture?
Isolated (single) fracture through the distal end of the fibula
155
What is the MOI of a Lateral Malleolar fracture?
Eversion injury
156
What do we see radiographically with a Lateral malleolar fracture?
Radiolucent transverse or oblique fracture line through the distal end of the fibula
157
How do you treat a Lateral Malleolar fracture?
Closed reduction plus a weight bearing cast for 6-8 weeks is necessary
158
What may complicate a Lateral malleolar fracture?
May be complicated by instability due to concomitant torn ligaments
159
What is a Bimalleolar fracture?
Fracture involving the medial and lateral malleoli
160
What do we see radiographically with a Bimalleolar fracture (3)?
- Outwards and posterior displacement of the leg while the foot is fixed
- Radiolucent oblique or transverse fractures through both malleoli
- Loss of cortical continuity
161
How do we treat a Bimalleolar fracture?
Opening fixation is often needed
162
What may complicate a Bimalleolar fracture?
Ankle instability may complicate this injury due to torn ligaments
163
Describe a Cotton's (Trimalleolar) fracture
- Fractures involving the medial, lateral, and posterior malleoli
164
What is the MOI of a Cotton's (Trimalleolar) fracture?
Severe external rotation of the foot
165
What radiographic features are present in a Cotton's (trimalleolar) fracture (3)?
- Radiolucent oblique or transverse fracture lines
- Loss of cortical continuity
- Fragments are often displaced
166
What is needed to treat a Cotton's (trimalleolar) fracture?
Surgical intervention
167
What may follow due to torn ligaments in a Cotton's (trimalleolar) fracture?
Instability
168
What is a Pott's Fracture?
Fractures of the distal fibula and subluxation of the distal tibiofibular joint due to an upward displacement of the distal fragment
169
What is the MOI of a Pott's fracture?
Combination of abduction and internal rotation forces from an eversion injury
170
What are the radiographic features of a Pott's fracture?
Radiolucent fracture line in the fibula with an offset of the tibiotalar joint
171
How do you treat a Pott's fracture?
Surgical immobilization is needed
172
What can a Pott's fracture lead to?
Ankle stability due to torn ligaments
173
What is a Pilon fracture?
Comminuted fractures of both lower ends of the tibia and fibula
174
What is the MOI of a Pilon fracture?
High-energy axial force
175
What demographic are Pilon fractures commonly seen in?
Common between 35 and 40 years of age
176
What radiographic features are seen in Pilon fractures?
Multiple radiolucent fracture lines with several displaced fragments
177
How do you treat a Pilon fracture?
Surgical reduction and fixation is necessary
178
What can complicate a Pilon fracture?
Instability
179
What are AKAs for a Jumper fracture?
Lover's Heel and Don Juan Fracture
180
Jumper Fracture: What is seen in the calcaneus?
Comminuted compression fracture of the calcaneus with disruption of Boehler's angle (>28 degrees)
181
Jumper Fracture: What is seen in the lower thoracic spine?
Burst fracture in the lower thoracic spine with widening of the AP diameter with disruption of George's line posteriorly
182
What is needed to treat a Jumper fracture?
Spinal surgery is needed
183
What is the normal range for Boehler's angle?
28-40 degrees
184
What is a Break fracture?
Fracture through the tuberosity of the calcaneus
185
Break Fracture: ___ displacement of the ___ fragment
upward; superior
186
A break fracture is due to the pull of the ___ and ___ muscles.
soleus; gastrocnemius
187
Break fracture: What is the appearance of the fractured bone and the gap?
Appearance of a bead
188
Break fracture: Boehler's angle increased or decreased?
Decreased; <28 degrees
189
What population commonly experiences Break fractures?
Osteoporotic people
190
Describe a Calcaneal fracture through the anterior process
Avulsion fracture through the anterior process of the calcaneus
191
What is the MOI for a Calcaneal fracture through the anterior process?
Inward twisting or compression injury when the foot is twisted outwards
192
What is seen radiographically in a Calcaneal fracture through the anterior process?
Bone fragment is displaced above the root of the anterior tubercle of the calcaneus
193
Calcaneal fracture through the anterior process: Boehler's angle affected or unaffected?
Unaffected
194
How do you treat a Calcaneal fracture through the anterior process?
Management may be conservative or surgical depending on the extent of the injury
195
What are two DDX for a Calcaneal fracture through the anterior process?
- Congenital ossicle
- Chronic Fx.
196
What is the MOI for a Calcaneal Stress fracture?
- Repetitive stress on the heel
- Jumping or brisk walking with excessive weight
197
How do patients with a Calcaneal stress fracture present?
Pain on the inner or outer aspect of the heel which increases with impact
198
What population are more prone to Calcaneal stress fractures?
More prone in overweight postmenopausal women
199
What do we see radiographically with Calcaneal stress fractures?
Linear amorphous whitish area posterior and inferior to the sustentaculum tali
200
What are the management options for a Calcaneal stress fracture?
- Rest and wear walking shoes
- For persistent pain, refer to a podiatrist or an orthopedist
201
What is a Snowboarder's fracture?
Fracture of the lateral process of the talus
202
What population are Snowboarder's fractures common in?
Snowboarders
203
What is the MOI of a Snowboarder's fracture?
Axial loading on a foot that is held in dorsiflexion and inversion
204
What are the radiographic features of a Snowboarder's fracture?
Radiolucent break on the lateral aspect of the talus
205
How do you treat a Snowboarder's fracture?
Weight bearing cast for 6-8 weeks
206
What is a Shepherd fracture?
Fracture of the posterior process of the talus
207
What is the MOI of a Shepherd fracture?
Sudden extension of the foot when its plantar flexed
208
What is a DDX for a Shepherd fracture?
Os Trigone
209
What are treatment options for a Shepherd fracture?
- Conservative care with a non-weight bearing cast for 6-8 weeks
- Surgery is needed if there is non-union or a large displaced fragment
210
What is an Aviator astragulus fracture?
- Vertical fracture through the neck of the talus
211
What is the most common Talar fracture?
Aviator astragulus fracture
212
What is the MOI for an Aviator astragulus fracture?
Head on collisions with shearing force on the pedals applied to the foot
213
What do we see radiographically with an Aviator astragulus fracture?
Vertical radiolucent break through the neck of the talus with superior displacement of the distal fragment
214
How do you treat an Aviator astragulus fracture?
Surgical immobilization is needed
215
What complication can be seen with an Aviator astragulus fracture?
Avascular necrosis
216
What is the aka of a Fracture of the dome of the talus?
Osteochondral fracture
217
Describe a Fracture of the dome of the talus
- Impaction injury
- Changes may be subtle
- May not be seen right away
218
What is the least common talar fracture?
Fracture of the dome of the talus (Osteochondral fracture)
219
What can be seen radiographically with a fracture of the dome of the talus?
Radiolucent break through the lateral edge of the dome of the talus
220
How do you treat a fracture of the dome of the talus?
- rest, immobilization with a non-weight bearing cast for 6 weeks (conservative)
- Surgical intervention may be needed
