Injuries to bones and joints of the lower limbs Flashcards
What is a fracture?
Breach of the integrity of part or whole of the bone
What is a subluxation?
Partial separation of the articular surface of a joint
What is a dislocation?
Complete separation of the articular surface of a joint
What is a fracture dislocation?
A dislocation where there is also a fracture involving one or more articular surfaces of a joint
What is a sprain?
Stretching of the joint capsule and ligaments of a joint, insufficient to produce subluxation or dislocation
What factors can contribute to fracture?
Strength of bone (weak bone e.g. due to osteoporosis or pathology such as metastasised tumours)
Force (excess force or normal force to a weak bone)
What are the clinical signs and symptoms of a fracture?
Pain Swelling Tenderness Bruising Deformity Crepitus Abnormal movement
How does fracture cause pain?
No nerves in bones but surrounding nerves
Bleeding can also cause pain due to increased pressure (within compartment)
What is a compound fracture?
Fracture where skin has been breached
Can be from within (e.g. tibia breaking skin) or from without (external source - trauma)
What is delayed union?
Fracture takes longer to heal than expected
What is a non-union?
Fracture fails to reunite
What is mal-union?
Fracture heals in wrong alignment (can cause deformity and weakness)
[Nb. common in humerus fractures]
What is the process for diagnosing a fracture?
- History and examination
- Standard X-ray
- Can use CAT scan or MRI if necessary
- Ultrasound
- Bone scan can be used if necessary (e.g. if fracture is failing to heal)
When is CAT scan useful in diagnosing fractures?
Useful for soft-tissue injury as well as bone
When is MRI useful in diagnosing fractures?
Useful for seeing surfaces of bone, blood supply and fluid in joint
When is ultrasound useful in diagnosing fractures?
Useful for fractures in children
What complications can occur with pelvic fractures?
Blood loss (veins unable to contract to prevent blood loss unlike arteries) Abdominal injury (esp. colon or bladder/ urethra) Nerve damage
How is the ilium most commonly damaged?
Lateral blow
Which group of patients most commonly fracture the pubic ramus?
Elderly patients (esp. if osteoporotic)
What should be prioritised in pelvic injuries? **
Maintenance of pelvic ring (sacroiliac joints to pubic symphysis)
Commonly injured together
What is a subcapital fracture?
Intracapsular NOF# where fracture line extends through the junction of the head and neck of femur
What causes a short, externally rotated leg in NOF fractures?
Contraction of gluteal muscles
What is the timeframe for reducing a NOF fracture?
Within 6 hours
What can cause tibial shaft fractures?
Direct trauma
Rotational strain
How can tibial shaft fractures be treated?
External or internal immobilisation
Prevent rotation with metal rod and screws through tibia (or metal plate if fragmented)
What is compartment syndrome and what are the 5 Ps used to identify this?
Increased pressure within compartment - pressure within fascia greater than systolic pressure
5 Ps: increasing pain, pallor, parasthesia, pulselessness, paralysis
What fractures can occur at the ankle joint?
Lateral malleolus
Medial malleolus
How does a ruptured achilles tendon occur?
Cannot happen to a healthy tendon
Degeneration occurs first (due to damage to synovial sheath)
How is a ruptured Achilles tendon diagnosed?
Simmond’s Test - squeeze calf - no movement of foot if Achilles tendon is ruptured
Ultrasound
What is the treatment for a ruptured Achilles tendon?
Conservative - plaster/ immobilisation
Operative - tendon repair
