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MJM > L17 - Lower limb trauma > Flashcards

L17 - Lower limb trauma Flashcards

1
Q

What could be the possible anatomical consequences of an injury?

A
  • Fracture
  • Dislocation
  • Soft tissue injury
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2
Q

What could be the possible physiological consequences of an injury?

A
  • Bleeding and shock
  • Coagulopathy; coagulation change as clotting factors used up
  • Multiple organ failure depending on reaction to injury (how fast or slow)
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3
Q

Describe the anatomy and energy of pelvic fractures?

A

Energy + anatomy = injury
Energy - often high (e.g. going at v fast speed into stationary object)
Anatomy - often strong bone and ligaments

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4
Q

What are the two main ligaments of the pelvis?

A
  1. Sacrospinous ligament
  2. Sacrotuberous ligament
  • Also iliolumbar ligament
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5
Q

What is the main function of ligaments within the pelvis?

A

Control of sagittal tilt of spine

- Mechanical stabilisers of the pelvic girdle, primarily against rotational forces in the sagittal and horizontal planes

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6
Q

What are the ligaments of the sacroiliac joint?

A
  1. Anterior sacroiliac ligament
  2. Interosseous sacroiliac ligament
  3. Posterior sacroiliac ligament
    - Transfers weight and forces between your upper body and legs
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7
Q

What are the ligaments of the pubic symphysis?

A
  1. Superior pubic ligament

2. Arcuate ligament

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8
Q

Describe the APC mechanism of injury

A

Antero-posterior compression

  • anterior or posterior forces applied to the anterior or posterior superior iliac spine areas
  • Pelvic fractures (espec APC) are notorious for mortality owing to bleeding
  • Pelvic floor may be torn by injury
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9
Q

What is a dynamic hip screw?

A
  • Sliding screw fixation
  • Allows controlled dynamic sliding of the femoral head component along the construct
  • Used for internal fixation of fractures of the femoral neck and intertrochanteric region
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10
Q

What are the different classifications of an APC injury?

A
  1. APC-I
  2. APC-II
  3. APC-III
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11
Q

What are the features of an APC-I injury?

A
  • Slight widening of pubic symphysis and/or anterior SI joint
  • Stretched BUT INTACT anterior SI, sacrotuberous and sacrospinous ligaments
  • Intact posterior SI ligaments
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12
Q

What are the features of an APC-II injury?

A
  • Widened anterior SI joint, disrupted anterior SI, sacrotuberous, sacrospinous ligaments
  • Intact SI ligaments
  • Splaying of anterior pelvis with external rotation of iliac wings swinging open at posterior aspect of SI joints
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13
Q

What are the features of an APC-III injury?

A
  • Complete SI joint disruption with lateral displacement

- Disrupted anterior SI, sacrotuberous, sacrospnous ligamentsand disrupted posterior SI ligaments

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14
Q

What volume of blood leaking per min is lethal within 2 hours?

A

20mlmin^(-1) of bleeding for 2 hours would be lethal

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15
Q

How could you treat the bleed?

A

Using an angiogram, use an embolisation coil to stop the bleeding

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16
Q

Describe the energy and anatomy of hip fractures

A

Fractured neck of femur
Energy - usually low (e.g. fall<2m)
Anatomy - usually weak bone (may be from osteoporosis)
- Common in elderly where they are frail

17
Q

What are the 3 types of hip fractures?

A
  1. Intracapsular
  2. Trochanteric
  3. Subtrochanteric

ARE NOT:

  • Acetabular fractures
  • Femoral head fractures
18
Q

What is an intracapsular hip fracture?

A
  • Makes up 58% of hip fractures
  • Occurs at the level of the neck and the head of the femur
  • Generally within the capsule
19
Q

What is a trochanteric fracture?

A
  • Makes up 34% of hip fractures
  • Occurs between the greater trochanter, (where the gluteus medius and the gluteus minimus attach) and the lesser trochanter (where the iliopsoas attaches)
20
Q

What is a subtrochanteric fracture?

A
  • Makes up 5% of hip fractures

- Occurs between lesser trochanter and 5cm below lesser trochanter

21
Q

Describe the deformity seen in hip fractures

A
  • Can be observed from end of bed
  • Lower limb is shortened and externally rotated
  • Heel height of damaged limb is higher than the other limb
  • Internal rotation can be easily lost
  • Lesser trochanter appears more prominent in external rotation
22
Q

Why can the lower limb be shortened in a hip fracture?

A
  • Shortening by pull of muscles crossing hip

- Muscles may spasm due to the fracture therefore leading to the shortening

23
Q

Which artery could be injured in an intracapsular hip fracture?

A
  • Lateral femoral circumflex artery
  • Retinacular arteries
  • Medial femoral circumflex artery
    (- Profunda femoris artery)
24
Q

What does bone healing depend on?

A
  • Stability

- Blood supply

25
Q

What are the main complications following fractures of the femoral neck>

A
  • Nonunion (lacking adequate stability of blood flow)

- Avascular necrosis of the femoral head

MJM (31 decks)

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