Fractures LE Flashcards
normal gait cycle
heel strike - outer heel
foot flat - lateral column
first metatarsal head
heel lift - push off
swing phase of walking
- 40%
- hip and knee flexion with ankle dorsiflexion
- ankle must bend in order to clear the forefoot from hitting ground
stance phase of walking
- 60%
- hip and knee extension with ankle plantar flexion
- knee straight and ankle push down to push off
t/f the running cycle has the same percentage per phase
false, has reverse in terms of percentage. forward recovery (swing phase) is 60%
fractures that affect alignment
long bones
- femoral shaft fractures
- supracondylar fractures of the femur
- tibial plateau fractures
- tibial shaft fractures
fractures that affect swing and stance phase
joints
- hip fractures
- patellar fractures
- ankle fractures
- foot fractures
fractures of the pelvic ring
- lateral compression
- ap compression
- vertical shear
mechanism for lateral compression
- force comes from side of pelvis
- hits iliac wing -> fracture in pubic rami in front or iliac wing itself
“closed book” injury
mechanism for ap compression
- frontal blow or force
- milder: AP-I separation of symphisis pubis
- severe: AP II/III sacroiliac joint posteriorly
“opening up/book” injury
most severe, unstable, and disastrous type of pelvic ring fracture
vertical shear
- rotatory and vertical mechanism
important lines in pelvis (radio)
- iliopectineal line: ilium to superior ramus (ant column)
- ilioischial line: ilium to ischium (post column)
- ring of acetabulum: curved line on lateral part of xray (ant and post wall)
what is judet (oblique) view
- order if asymmetry of pelvis is present
- iliac (external) view: ant wall and post column
- obturator (internal) view: post wall and ant column
I-ISA OPP
treatment for pelvic fractures
- reconstruction plate
- open reduction and internal fixation
treatment of acetabular fractures
- open reduction and internal fixation using screws
characteristics of the hip
- multidirectional locomotion
- allows support to and receives weight transference from spine to LE
fractures of the hip
femoral neck fracture and intertrochanteric fracture
characteristics of femoral neck fracture
- intracapsular
- worse prognosis due to poor healing
causes of poor wound healing in femoral neck fracture
- circulation depends on endosteal blood supply (no periosteum in capsule)
- presence of synovial fluid will lyse blood of hematoma from fracture
- precarious blood supply
- increasing pressure within capsule = tamponade
treatment for femoral neck fracture
- younger: immediate open reduction with internal fixation
- older: hip replacement
levels of femoral fractures
- subcapital = just below head
- transcervical = goes through neck
- intertrochanteric = bottom of the neck
- subtrochanteric = below lesser trochanter
- greater or lesser trochanter = tiny avulsions
characteristics of intertrochanteric fracture
- extracapsular
- better prognosis
- blood supply is endosteal and periosteal circulation
treatment for intertrochanteric fracture
- internal fixation > hip replacement
factors predisposing to poor healing of femoral neck fractures
- precarious blood supply
- no periosteal layer
- presence of synovial fluid
other treatment considerations for femoral neck fractures
- amount of displacement -> intact blood supply
- time from injury
- age of patient (old = osteoporosis)
- previous level of activity
the golden period for doing closed reduction in femoral neck fractures is ___
6 hours from the time of injury
what is the femoral shaft
area 5 cm below lesser trochanter to the adductor tubercle
anatomical axis: angle created by the direction of the femur and another line drawn in the middle of the tibia
what are femoral fractures
- bimodal incidence
- high energy trauma in young patients
- low energy trauma in older patients
type of surgery in femur fractures
intramedullary nailing > OR plating > external fixation
timing of surgery for femur fractures
- early stabilization (DCO)
- later stabilization (riskier): increased inflammatory response from second hit phenomenon caused by prolonged surgery
dco method of fixation of choice for unstable and borderline patients
- initial: external fixator
- definitive fixation with intramedullary nail within 48 hrs (when stable)
t/f only intramedullary nail produces a secondary fracture healing via calluses
false, both intramedullary nail and plating do this
intramedullary nail vs plating
- nail = load sharing
- plating = load bearing
characteristics of distal femur
- trapezoid
- angulated
- periarticular
- weight bearing
functions of distal femur
read
valgus (genu valgum) and varus (genu varum) deformities
GUM and RUM
- valgus = displacement towards midline
- varus = displacement away from midline
important to regain anatomic and mechanic axes
treatment for distal femur fractures
- plates and screws: < 4 cm from joint line
- intramedullary devices: > 4 cm from the joint line
- external fixation temporary
tibial plateau fracture
- due to low energy trauma with poor bone quality
- axial load with valgus
- depression of 10 mm or widening of 8 mm: meniscal tear
treatment of tibial plateau fractures
- joint restoration and rigid fixation with buttress plating and early range of motion
- bone graft and meniscal repair
largest sesamoid bone in the bdoy
patella
- protects condyles
- nourishes cartilage
- increases lever arm of the knee
mechanisms of injury of patellar fractures
indirect
- avulsion injury from eccentric contraction of quadriceps
- transverse configuration
direct mechanism
- contact applied on patella itself
- comminuted fracture
indications for surgery in patellar fracture
- fracture widening more than 3 mm (retinaculum tears)
- articulating step off 3 mm or more
- open fractures
- no active knee extension
what is tension band wiring
- converts tension to compression forces
what are bimalleolar fractures
- sustained eversion or inversion injuries (ankle twists)
- positive direct tenderness with difficulty in weight bearing (needs xray)
treatment for bimalleolar fractures
- casting if not displaced
- open reduction and internal fixation if displaced
t/f the talus has limited blood supply and poor periosteum
- true
talar fracture types
- type 1: 15% blood supply lost
- type II: 50% bs lost
- type III: 90% bs lost
- type IV: 100% bs lost
read table!!
treatment of talar fractures
open reduction and internal fixation asap
