Fractures in the Lower Limb Flashcards
What are the possible causes for a femoral shaft fracture?
Why can this be a life threatening injury?
There is a fairly large risk of a fat embolism. What does this cause?
What are the treatment options?
High energy injury or a pathological fracture
Lots of blood loss, associated hypovolaemic shock
Confusion, hypoxia, ARDS
Splintage until settled, then closed reduction and IM nailing
Who do distal femoral fractures usually occur in and what is their mechanism of injury?
What are these known as if they are a) extra-articular, b) intra-articular?
Unless the patient is frail and not fit for surgery, what is the treatment?
Usually osteoporotic bone, usually associated with a fall onto a flexed knee
a) Supracondylar, b) Intercondylar
Plate and scews (difficult position to maintain in a cast)
Are proximal tibial fractures intra or extra articular?
These fractures have high risks of what complications?
These fractures are usually associated with what direction of stress?
What ligaments may a lateral tibial plateau fracture disrupt?
What imaging is used for these?
Intra
Compartment syndrome and neurovascular injury
Valgus (makes lateral fracture)
MCL and ACL
CT
What type of fracture most commonly causes foot drop?
Proximal fibular fractures
A high proportion of tibial plateau fractures get what complication a few years down the line?
How are these treated?
The outcomes of surgery are often disappointing and patients end up requiring what?
Post-traumatic OA
Usually ORIF with plates and screws (may need temporary external fixation)
Total knee replacement
Tibial shaft fractures usually occur as a result of indirect forces. What type of fracture(s) will each of the following mechanisms cause:
Bending?
Rotational?
Compression from deceleration?
A combination of these?
Transverse
Spiral
Oblique
Comminuted
Why should all cases of tibial shaft fractures be monitored overnight?
How much angulation is accepted?
What can be used if non-unions occur?
High risk of compartment syndrome
5 degrees
Bone grafting or circular frame fixators
What is the conservative management for a tibial shaft fracture? When can this be used?
What is the operative management for a tibial shaft fracture?
Any of what movement of the distal fragment is not accepted?
What complication do 25% of people suffer after surgical treatment for a tibial shaft fracture?
Up to 50% displacement and 5 degrees angulation can be treated in an above knee cast
IM nailing
Internal rotation
Anterior knee pain
If there is a fracture of the tibial shaft and the fibula is not also fractured, in what direction does the tibia move?
If there is a fracture of the tibial shaft and the fibula is also fractured, in what direction does the tibia move?
Varus
Valgus
If a distal tibial fracture is intra-articular, what is this known as?
How is this treated?
This is usually what type of injury?
What imaging is often needed?
Pilon fracture
ORIF (surgical emergency)- may need temporary external fixation
High energy
CT
Which types of ankle fractures are stable and can be treated conservatively?
Isolated distal fibular fractures
Displaced medial malleolus fractures
Which type of ankle fractures are unstable?
What will these show on x-ray?
Bimalleolar fractures and high medial malleolar fractures, distal fibular fracture with ruptured deltoid ligament
Talar shift
How can you assess if the deltoid ligament has been ruptured in an ankle fracture?
Obvious bruising/swelling and painful to touch
What is the treatment for an ankle fracture with >1mm talar shift?
Why?
How are isolated distal fibular fractures treated?
ORIF
Risk of post-traumatic OA
Walking cast or splint for 6 weeks
What is usually the mechanism of action of an ankle fracture or sprain?
In an ankle sprain, typically which ligaments are affected?
What is the management for an ankle sprain?
Twisting, usually inversion
Lateral ligaments
RICE, physiotherapy
