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18 ORR > Fractures LE > Flashcards

Fractures LE Flashcards

1
Q

normal gait cycle

A

heel strike - outer heel
foot flat - lateral column
first metatarsal head
heel lift - push off

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2
Q

swing phase of walking

A
  • 40%
  • hip and knee flexion with ankle dorsiflexion
  • ankle must bend in order to clear the forefoot from hitting ground
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3
Q

stance phase of walking

A
  • 60%
  • hip and knee extension with ankle plantar flexion
  • knee straight and ankle push down to push off
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4
Q

t/f the running cycle has the same percentage per phase

A

false, has reverse in terms of percentage. forward recovery (swing phase) is 60%

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5
Q

fractures that affect alignment

A

long bones

  • femoral shaft fractures
  • supracondylar fractures of the femur
  • tibial plateau fractures
  • tibial shaft fractures
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6
Q

fractures that affect swing and stance phase

A

joints

  • hip fractures
  • patellar fractures
  • ankle fractures
  • foot fractures
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7
Q

fractures of the pelvic ring

A
  • lateral compression
  • ap compression
  • vertical shear
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8
Q

mechanism for lateral compression

A
  • force comes from side of pelvis
  • hits iliac wing -> fracture in pubic rami in front or iliac wing itself
    “closed book” injury
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9
Q

mechanism for ap compression

A
  • frontal blow or force
  • milder: AP-I separation of symphisis pubis
  • severe: AP II/III sacroiliac joint posteriorly
    “opening up/book” injury
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10
Q

most severe, unstable, and disastrous type of pelvic ring fracture

A

vertical shear

- rotatory and vertical mechanism

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11
Q

important lines in pelvis (radio)

A
  • 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)
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12
Q

what is judet (oblique) view

A
  • 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

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13
Q

treatment for pelvic fractures

A
  • reconstruction plate

- open reduction and internal fixation

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14
Q

treatment of acetabular fractures

A
  • open reduction and internal fixation using screws
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15
Q

characteristics of the hip

A
  • multidirectional locomotion

- allows support to and receives weight transference from spine to LE

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16
Q

fractures of the hip

A

femoral neck fracture and intertrochanteric fracture

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17
Q

characteristics of femoral neck fracture

A
  • intracapsular

- worse prognosis due to poor healing

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18
Q

causes of poor wound healing in femoral neck fracture

A
  • 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
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19
Q

treatment for femoral neck fracture

A
  • younger: immediate open reduction with internal fixation

- older: hip replacement

20
Q

levels of femoral fractures

A
  • subcapital = just below head
  • transcervical = goes through neck
  • intertrochanteric = bottom of the neck
  • subtrochanteric = below lesser trochanter
  • greater or lesser trochanter = tiny avulsions
21
Q

characteristics of intertrochanteric fracture

A
  • extracapsular
  • better prognosis
  • blood supply is endosteal and periosteal circulation
22
Q

treatment for intertrochanteric fracture

A
  • internal fixation > hip replacement
23
Q

factors predisposing to poor healing of femoral neck fractures

A
  • precarious blood supply
  • no periosteal layer
  • presence of synovial fluid
24
Q

other treatment considerations for femoral neck fractures

A
  • amount of displacement -> intact blood supply
  • time from injury
  • age of patient (old = osteoporosis)
  • previous level of activity
25
Q

the golden period for doing closed reduction in femoral neck fractures is ___

A

6 hours from the time of injury

26
Q

what is the femoral shaft

A

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

27
Q

what are femoral fractures

A
  • bimodal incidence
  • high energy trauma in young patients
  • low energy trauma in older patients
28
Q

type of surgery in femur fractures

A

intramedullary nailing > OR plating > external fixation

29
Q

timing of surgery for femur fractures

A
  • early stabilization (DCO)

- later stabilization (riskier): increased inflammatory response from second hit phenomenon caused by prolonged surgery

30
Q

dco method of fixation of choice for unstable and borderline patients

A
  • initial: external fixator

- definitive fixation with intramedullary nail within 48 hrs (when stable)

31
Q

t/f only intramedullary nail produces a secondary fracture healing via calluses

A

false, both intramedullary nail and plating do this

32
Q

intramedullary nail vs plating

A
  • nail = load sharing

- plating = load bearing

33
Q

characteristics of distal femur

A
  • trapezoid
  • angulated
  • periarticular
  • weight bearing
34
Q

functions of distal femur

A

read

35
Q

valgus (genu valgum) and varus (genu varum) deformities

A

GUM and RUM

  • valgus = displacement towards midline
  • varus = displacement away from midline

important to regain anatomic and mechanic axes

36
Q

treatment for distal femur fractures

A
  • plates and screws: < 4 cm from joint line
  • intramedullary devices: > 4 cm from the joint line
  • external fixation temporary
37
Q

tibial plateau fracture

A
  • due to low energy trauma with poor bone quality
  • axial load with valgus
  • depression of 10 mm or widening of 8 mm: meniscal tear
38
Q

treatment of tibial plateau fractures

A
  • joint restoration and rigid fixation with buttress plating and early range of motion
  • bone graft and meniscal repair
39
Q

largest sesamoid bone in the bdoy

A

patella

  • protects condyles
  • nourishes cartilage
  • increases lever arm of the knee
40
Q

mechanisms of injury of patellar fractures

A

indirect

  • avulsion injury from eccentric contraction of quadriceps
  • transverse configuration

direct mechanism

  • contact applied on patella itself
  • comminuted fracture
41
Q

indications for surgery in patellar fracture

A
  • fracture widening more than 3 mm (retinaculum tears)
  • articulating step off 3 mm or more
  • open fractures
  • no active knee extension
42
Q

what is tension band wiring

A
  • converts tension to compression forces
43
Q

what are bimalleolar fractures

A
  • sustained eversion or inversion injuries (ankle twists)

- positive direct tenderness with difficulty in weight bearing (needs xray)

44
Q

treatment for bimalleolar fractures

A
  • casting if not displaced

- open reduction and internal fixation if displaced

45
Q

t/f the talus has limited blood supply and poor periosteum

A
  • true
46
Q

talar fracture types

A
  • type 1: 15% blood supply lost
  • type II: 50% bs lost
  • type III: 90% bs lost
  • type IV: 100% bs lost

read table!!

47
Q

treatment of talar fractures

A

open reduction and internal fixation asap

18 ORR (21 decks)

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