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Artritis > LE Trauma > Flashcards

LE Trauma Flashcards

1
Q

Powerful musculature of the thigh usually is the cause of frequent
displacement

A

femoral shaft injury

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2
Q

Femoral shaft injury can cause fatty marrow escape into circulation which may lead to

A

fat pulmonary embolism

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3
Q

3 types of femoral shaft fractures:

A

Type I - Spiral or transverse (most common)
Type II - Comminuted
Type III - Open

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4
Q

m/c type of femoral shaft fracture

A

Type I - Spiral or transverse

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5
Q

After signifiant trauma or as a pathological fracture due to metastatic bone
disease or primary bone neoplasms or other osseous pathology

A

Diaphysis fracture

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6
Q

Increased use of Bisphosphanates medications in treatment of osteoporosis
may result in

A

femoral shaft fractures

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7
Q

Clinical manifestations of femoral shaft fracture

A
  • severe pain
  • inability to stand or ambulate
  • regional and systemic
    complications such as neurological and vascular injury
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8
Q

m/c type of femoral shaft fracture

A

spiral or transverse-oblique fracture

may involve bayonet deformity

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9
Q

Often intra-articular and frequently comminuted

A

Supracondylar and Condylar distal femur fracture

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10
Q

Supracondylar and Condylar distal femur fractures usually occur as a result of?

A

1) low-energy trauma in osteoporotic bone in the elderly

2) high-energy trauma in young patients

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11
Q

clinical signs of supracondylar and condylar distal femur fracture?

A

Pain, deformity, weakness, and inability to ambulate/stand

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12
Q

complications for supracondylar and condylar distal femur fracture?

A
  • compartment syndrome

- vascular and nerve injury

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13
Q

key mechanism of
injury leading to fracture in osteoporotic
patients

A

Low force or even trivial trauma

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14
Q

may develop following total knee arthroplasty

A

Supracondylar fractures

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15
Q

two configurations types for femoral condyle fractures

A

“T” or “Y”

always intraarticular

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16
Q

Femoral condyle fractures can be complicated by

A

delayed healing and comminuted fragments.

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17
Q

Femoral condyle fractures may co-exist with

A

Tibial plateau fracture

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18
Q

were originally termed a bumper or fender fracture

A

Tibial plateau fractures

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19
Q

what % of tibial plateau fractures result from impact with automobile
bumpers

A

25%

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20
Q

most common

mechanism of tibial plateau fractures

A

Axial loading I.e. fall from a height

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21
Q

In younger patients the tibial plateau fracture often involves

A

splitting

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22
Q

In older, osteoporotic patients, what type of fractures are typically are seen?

(difficult to detect radiographically)

A

depression fractures

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23
Q

occur in

approximately 10% of patients with tibial plateau fracture

A

Soft tissue injuries (e.g. to cruciate and collateral ligaments)

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24
Q

Fractures of the lateral or medial tibial plateau or more common?

A

lateral plateau from lateral femoral condyle

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25
Q

Type 1 Shatzker tibial plateau fracture

A

wedge (low force)

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26
Q

Type 2 Shatzker tibial plateau fracture

A

wedge with depression

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27
Q

Type 3 Shatzker tibial plateau fracture

A

depression with no wedge

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28
Q

Type 4 Shatzker tibial plateau fracture

A

Like type 1 but invovles medial plateau

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29
Q

Type 5 Shatzker tibial plateau fracture

A

both plateaus

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30
Q

Type 6 Shatzker tibial plateau fracture

A

both plateaus + part of proximal metaphysis/diaphysis

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31
Q

results from an intra-articular fracture with escape of

fat and blood from the bone marrow into the knee joint

A

Lipohemarthrosis

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32
Q

Lipohemarthrosis is most frequently associated with what fracture?

A

tibial plateau fracture or distal femoral

fracture

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33
Q

Patella fractures may also result in

A

lipohemarthrosis

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34
Q

sign of lipohemarthrosis

A

FBI sign or fat-blood-interphase

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35
Q

Fat-fluid level is seen on any horizontal beam radiograph, but best achieved with what view?

A

cross-table horizontal lateral view

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36
Q

Indication of intra-articular/intra-capsular fracture about the knee,
typically tibial plateau fractures

A

FBI sign

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37
Q

may occur especially in young or adolescent

patients as a result of pull and tear by the ACL

A

Tibial spine avulsion

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38
Q

avulsion likely from pull of lateral capsular knee ligaments and
possibly IT band

A

Segond fractures

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39
Q

Important radiographic clue to ACL tear

A

Segond fracture-avulsion

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40
Q

occur in children

while jumping on a trampoline

A

Transverse fractures of the proximal tibial metaphysis (trampoline fracture)

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41
Q

most often seen in children 2

to 5 years of age.

A

trampoline fracture

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42
Q

Most occur in adolescents

with immature bone and active growth apophysis

A

Tibial tuberosity avulsion fractures (uncommon)

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43
Q

Associated with sports and jumping

A

Tibial tuberosity avulsion fractures

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44
Q

Tibial tuberosity avulsion fractures occurs with

A

violent contraction
of quadriceps or passive flexion
against contracted quadriceps

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45
Q

Osgood-Schlatter disease is associated with what fracture?

A

Tibial tuberosity avulsion fractures

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46
Q

swelling and pain over the patella with point tenderness and
reduction in extension strength
(Large joint effusion or hemarthrosis)

A

Patella fracture

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47
Q

most common type of patella fracture?

A

“split” or transverse fracture in mid patella

>60%

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48
Q

comminuted patella fracture, also called?

A

“stellate” type - 25%

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49
Q

vertical patella fracture occurs what percent of the time?

A

15%

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50
Q

usually from medial facet due to lateral patella

A

osteochondral defect

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51
Q

Transverse (most common) patella fracture exerted by?

A

sudden forceful quad

contraction

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52
Q

Stellate fracture, usually from

A

direct impact and burst

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53
Q

best view for Lateral patella dislocation and osteochondral defect?

A

Sunrise view

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54
Q

Patella fractures need to be differentiated from

A

multipartite patella

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55
Q

important to recognize because coexistent vascular

(popliteal artery) injury complications

A

Knee Joint or Femoral-Tibial dislocation

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56
Q

Knee dislocation are classified in relation of

A

Tibial displacement compared to

the Femur

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57
Q

5 types of Knee dislocations

A
  1. anterior (40%) often hyperextension injury
  2. posterior (30%) may be due to direct falls or MVA “dashboard” injury
  3. lateral (20%)
  4. rotatory (5%)
  5. medial (5%)
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58
Q

most commonly torn ligament of the knee

A

ACL

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59
Q

imaging required for diagnosis and management of ACL tear?

A

MR

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60
Q

potential radiographic signs of ACL tear

A
  • anterior tibial translocation sign
  • Segond fracture
  • arcuate fracture
  • joint effusion
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61
Q

indicates avulsion of fibular attachment of biceps femoris and
lateral collateral ligament.

A

Arcuate sign

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62
Q

High suspicion for ACL tear and potential posterolateral

instability and failed ACL reconstruction

A

Arcuate sign

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63
Q

Acute ACL tears typically occur in the what portion of the ligament?

A

middle portion

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64
Q

Normal ACL angle should be aligned along femoral condyles known as the

A

Blumensaat’s line

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65
Q

O’Donogheu’s triad is typically due to

A

pivot shift and srong valgus

force

66
Q

O’Donogheu’s triad

A

1) ACL tear
2) MCL tears and
3) tear of the medial meniscus (can be bucket handle tear)

67
Q

m/c type of meniscal tear

A

horizontal or cleavage tear

68
Q

Meniscal tears are best evaluated with

A

MRI

69
Q

the meniscus that is torn much more frequently due to its

fixed attachment to corresponding tibial plateau

A

Posterior horn of medial meniscus

70
Q

Acute meniscal tears that only involve the ______ of the outer fibres can be
managed conservatively or heal on their own

A

red zone

71
Q

inversion stress is the most common cause of ankle injuries for 2
anatomic reasons

A

1) medial malleolus is shorter than the lateral malleolus

2) deltoid ligament is stronger than the lateral ligaments.

72
Q

commonly associated with distal fibular fractures and are unstable

A

posterior malleolar fractures

73
Q

classification of lateral malleolar fractures

A

Weber ankle fracture classification

74
Q

Clinical diagnosis of suspected ankle fractures and the need for radiographic
examination can be successfully determined by applying the Ottawa Ankle
Rule

A

Ottawa Ankle

Rule

75
Q

Weber __ : below syndesmosis

A

A

76
Q

Weber __ at the level of

syndesmosis

A

B

77
Q

Weber __ above syndesmosis

A

C

78
Q

Lateral malleolus/distal fibula

fracture above syndesmosis is stable or unstable?

A

unstable

79
Q

Lateral malleolus/distal fibula

fracture above syndesmosis is also referred to as?

A

Pott’s fracture

6cm above lateral malleolus

80
Q

is combination of oblique or spiral fracture of the

proximal fibula and unstable ankle injury

A

Maisonneuve fracture (high ankle sprain)

81
Q

Manifests by widening of the ankle joint due to distal tibiofibular syndesmosis
and/or deltoid ligament disruption
(sometimes fracture of the medial
malleolus)

A

Maisonneuve fracture (high ankle sprain)

82
Q

Maisonneuve fracture is considered Weber __

A

C

83
Q

positive squeeze test can indicate fracture or

A

high ankle sprain

84
Q

Fracture of both lateral (fibula) and medial (tibial) malleolus and considered to
be unstable due to frequent disruption of distal tibiofibular syndesmosis and
sometimes deltoid ligament

A

Bimalleolar ankle fractures

85
Q

transverse fracture through tibial

malleolus and oblique or spiral fracture through distal fibular

A

Bimalleolar ankle fractures

86
Q

Bimalleolar fractures of this type may be described by some as

A

Dupuytren

fracture

87
Q

Associated deltoid ligament
disruption and lateral dislocation
of the talus may exist

A

Bimalleolar fractures

88
Q

Three-part (Trimalleolar) fracture of the ankle

involves what three structures?

A
  1. medial malleolus
  2. posterior aspect of the tibial plafond
    (referred to as the posterior malleolus)
  3. lateral malleolus
89
Q

Triplanar fractures primarily

occur in ______ patients

A

younger

90
Q

Results from an abduction-external rotation mechanism when anterior tibiofibular
ligament avulses the anterolateral corner of the distal tibial epiphysis

A

Tillaux fracture

91
Q

Tillaux fracture requires an open physis and considered a Salter-Harris __
injury of ______

A

3, distal tibia

92
Q

represents an anterolateral distal tibial epiphysis avulsion

A

Tillaux fracture

93
Q

Tillaux avulsion fracture is rarely seen in adults because

A

the ligament gives out before avulsion

94
Q

undisplaced spiral fractures usually of the tibia in toddlers either due to fall or when the leg is stuck in between the wooden spacing of the crib/cot

A

Toddler fractures

usually spiral and undisplaced

95
Q

Occasionally in toddler fractures both tibia and fibula are fractured, referred by some as

A

Both Bones

fracture

96
Q

Occasionally spiral or comminuted oblique tib & fib fractures occur as

A

Ski-boot or

Boot-top fractures

97
Q

most frequently fractured foot

bones

A

calcaneus and talus

98
Q

Most commonly fractured tarsal bone

A

calcaneus (60%)

99
Q

Calcaneal fractures can be classified as…

A
  • Extra-articular:
    25-30%
  • Intra-articular:
    70-75%
100
Q

calcaneal tuberosity avulsion fracture, calcaneal w/o

talocalcaneonavicular (subtalar) extension

A

Extra-articular

101
Q

Lover’s/Don Juan/Casanova fracture of which 10% can be associated with the TL fracture

A

Intra-articular

102
Q

If bilateral calcaneal fractures are seen, then

A

the spine should be evaluated (xrays

and CT scanning)

103
Q

Angle between two tangent lines drawn across the anterior and posterior
borders of calcaneus on the lateral view

A

Bohler’s angle

is less than 20- degrees it indicates a calcaneal fracture

104
Q

Bohler’s angle less than ___ degrees it indicates a calcaneal fracture

A

20

105
Q

a significant finding that should prompt active search for

fracture.

A

marked opacification of Kagar’s fat pad

106
Q

Overuse injury seen in athletes, especially with running and aerobics, and
military recruits

A

Calcaneal Stress Fracture

107
Q

Stress fractures in general may take how long to appear on conventional radiographs?

A

7-14 days

108
Q

key radiographic feature of calcaneal stress fracture?

A

vertically oriented zone of increased density on lateral radiograph
that is perpendicular to the trabecular lines

109
Q

considered most sensitive and specific imaging of stress fractures of the
lower extremity

A

MRI

110
Q

Radiographic evaluation of a talur fracture must include what views?

A

DP, Oblique and lateral ankle/foot

views

111
Q

Fractures of the talus can be divided into 3 main regions:

A

Body, neck, and head

112
Q

extend through the thinnest portion of the talus, just

proximal to the talar head

A

Talar neck fractures

113
Q

Common types of talus fracture are

A

avulsion fractures or vertical fractures

114
Q

talur avulsions are typically due to

A

twisting foot injuries

115
Q

Hawkins talus fracture classification

type I

A

non displaced fracture

116
Q

Hawkins talus fracture classification

type II:

A

displaced fracture with subluxation or dislocation of the subtalar joint and
a normal ankle joint

117
Q

Hawkins talus fracture classification

type IIl

A

displaced fracture with body of talus dislocated from both subtalar and
ankle joint

118
Q

Talar neck fractures may be complicated with the risk of

A

avascular

necrosis (AVN)

119
Q

AVN risk increases with increase in complexity

A

type I fractures has 0%–15% risk

type II fractures have 20%–50% risk

type III fractures approach 100% risk

120
Q

The most common mechanism of potentially significant talar neck fractures is a

A

dorsally directed force on a braced foot

(such as in head-on motor vehicle
accidents when foot is pressing on the breaks)

121
Q

Talar neck and to some degree talar body fractures were once known as

A

“Aviator’s astragalus fractures or Aviator’s fractures”

122
Q

describes subchondral lucency/osteopenia line of the talar dome
that occurs secondary to subchondral atrophy 6-8 weeks after a talar neck fracture

A

Hawkins sign

123
Q

Hawkins sign indicates that there is sufficient _______ in the talus

A

vascularity

124
Q

Osteochondral injuries may be complicated by

A

early/secondary advanced DJD

125
Q

can mimic a lateral ankle sprain

A

Lateral talar process fractures aka “snowboarder” fractures

126
Q

Lateral talar process (“snowboarder”) fractures occur when the foot is

A

dorsiflexed and inverted

127
Q

As many as ____ of lateral talar process fractures are missed on radiographs

A

40-50%

128
Q

Posterior talar process fractures may involve

A

medial or lateral tubercle of the

posterior process of talus

129
Q

Posterior talar process fractures are caused by

A

inversion

130
Q

Unfused ossification center of the lateral tubercle forms the

A

os trigonum

131
Q

Shepherd fracture is Injury of the

A

lateral tubercle

132
Q

Cedell fracture is injury to the

is uncommon and is
caused by forced dorsiflexion and pronation

A

medial tubercle

133
Q

Injury to the medial tubercle (Cedell fracture) is caused by

A

forced dorsiflexion and pronation

134
Q

Injury to the medial tubercle (Cedell fracture) is treated using a

A

Short leg cast or ankle brace until signs of union appear

135
Q

main DDx of posterolateral talar process fracture

A

Os trigonum

136
Q

most common type

of dislocation involving the foot

A

Lisfranc fracture/dislocations

137
Q

mechanism of Lisfranc fracture/dislocations include

A

direct crush injury, or an indirect load

onto a plantar flexed foot

138
Q

the two types of Lisfranc fracture-dislocation are?

A

Homolateral and

Divergent

139
Q

lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains aligned

A

Homolateral

140
Q

lateral dislocation of the 2nd to 5th metatarsals with medial
dislocation of the 1st metatarsal

A

Divergent

141
Q

fracture/dislocation of the mid-tarsal joint of the foot, i.e. talonavicular and calcaneocuboid joints

A

Chopart injury

142
Q

Chopart injury the commonly fractured bones are the

A

calcaneus cuboid and navicular

143
Q

In chopart injury the foot is usually dislocated

A

medially and superiorly

144
Q

most common stress fractures

A

2nd and 3rd metatarsal (march fracture)

145
Q

occur at the base of the fifth metatarsal

A

Jones fractures

Dance Fx

146
Q

Jones fractures occur at the metadiaphyseal

junction with OUT

A

distal or intra-articular extension

147
Q

Jones fractures occur as a result of significant ______ force to the forefoot with
the ankle in __________

A

adduction, plantar flexion

148
Q

fracture located approximately 2 cm (1.5-3 cm)

from the tip of the 5th metatarsal

A

Jones fracture

149
Q

Jones fractures are prone to

A

non-union

with rates as high as 30-50%

150
Q

non-union Jones fractures usually take ___ months heal

A

2

151
Q

distal horizontal fracture line w/o

intra-articular extension

A

Jones Fx

152
Q

one of the more common

foot avulsion injuries

A

pseudo-Jones fracture

153
Q

Over 90 % of fractures of the base of the 5th metatarsal are?

A

pseudo-Jones fracture

154
Q

pseudo-Jones fracture is occasionally

referred to as a

A

“tennis fracture“

155
Q

pseudo-Jones fracture is caused by insertion of peroneus brevis and forcible

A

inversion of the foot in plantar flexion

156
Q

tip of the proximal 5th metatarsal, oriented mostly transversely

A

pseudo-Jones fracture

157
Q

Toe fractures most frequently are caused by a

A

crushing injury or axial force such

as stubbing a toe (Bedroom fracture)

158
Q

Most children with fractures of the physis should be referred, but children with

A

selected nondisplaced Salter-Harris types I and II fractures may be treated by
family physicians

159
Q

considered an open fracture and may carry

risk of osteomyelitis

A

Toe fractures involving the nail

160
Q

Stable toe fractures can be treated with

A

Buddy taping

Artritis (7 decks)

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