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PCM 4 Midterm > LE XR > Flashcards

LE XR Flashcards

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1
Q

Distal femur fracture

  1. Tests
  2. Exam
  3. Managment
  4. Disposition
A
  1. AP/lateral XR; CT angiogram if diminished pulses after reduction
  2. Pain/swelling/defortmity of distal thigh; popliteal injury if severe
  3. Posterior long leg splint; dont bear weight
  4. Consult with orthopedic while in ED; almsot always need surgery
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2
Q

Femoral shaft fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Fx at shaft of femur begins 5 cm distal to the lesser trochanter and end 6-8 cm proximal to the adductor tubercle MC due to MVC, peentrating trauma, falls
  2. AP/lateral XR; (Pelvis or knee XR to see if concurrent injury)
  3. Pain/swelling/tender thigh; short leg
  4. Traction splint, unless fracture or disclocation at pelvis, knee, ankle; dont bear weight
  5. Consult with orthopedic while in ED; almsot always need surgery
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3
Q

Hip dislocation =

  1. What is it?
  2. types
  3. Tests
  4. Exam
  5. Managment
  6. Disposition
A
  1. femoral head is displcaed from acetabulum; simple (w/o any assx fx) o complex (w fx)
  2. AP/lateral XR; CT for occult fc
  3. Exam
    1. Posterior = leg is ADDUCTED and IR (PADDIR)
    2. Anteiror = leg is ABducted and ER (AABER)
  4. Reduce within 6 hours and immobilize in knee immobilizer; protected weight-bearing
  5. Consult with orthopedic while in ED;
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4
Q

Hip Fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Any fracture of proximal femur; within 5 cm of lesser trochanter
  2. AP of hip/pelvis; MRI for occult fx
  3. Exam
    1. Pain with ROM, short leg, ER
  4. immobilize, no weight
  5. Consult with orthopedic while in ED; almsot always need surgery
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5
Q

Fibula Fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Fx due to direct trauma over lateral aspect of leg
  2. AP/lateral of lower leg
  3. Exam
    1. Pain worse with eversion
  4. Posterior short leg split for comfort.; weight w critches
  5. Discharge and follow up w orthopedic
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6
Q

Ottawa knee rule

A
  1. > 55 YO
  2. Isolated tenderness on patella
  3. Tenderness on fibular head
  4. Cant flex knee to 90 degress
  5. Cant bear weight immediately incident and in ED
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7
Q
  • Sensitivity is ___% for the Ottawa Ankle Rule with moderate specificity
A

100%

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8
Q

Ottawa ankle rule can be used in children ____, but exclusdes

A

children >6

NO: PG women, intoxicated patients, head injuries

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9
Q

Ottawa ankle rule

A
  1. any pain along malleolar region AND
    1. tenderness at tip of medial/lateral malleolus
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10
Q

a broad term that describes the movement of fracture fragments (distal relative to proximal)

A

displacement

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11
Q

extent of angulation relative to the long axis of the bone.

A

• Angulation/alignment

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12
Q

the amount of contact between the ends of the fracture fragments.

A

Apposition

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13
Q

used to describe when fracture fragments are line side-by-side.

A

Bayonet apposition

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14
Q
  • _______: describes when fragments are pulled apart
  • ______: describes when fragments are pushed together
A
  • Distraction: describes when fragments are pulled apart.
  • Impaction: describes when fragments are pushed together
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15
Q

what is rotation

A

extent of rotation of the distal fracture fragment relative to the proximal portion (often clinically apparent).

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16
Q

Management of Salter-Harris fractures

A
  1. Reduction
  2. Splint
  3. dont bear weight
  4. Ortho consult
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17
Q

Type ____ of Salter-Harris classification often require surgical management.

A

3-5

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18
Q
  • Involve transverse fracture through the growth plate (physis)
A

Type 1

19
Q

- Tenderness over the physis should be a presumed SH type-___

A

1

20
Q

Fracture through physis and metaphysis

A

Type 2 = MC type

21
Q
  • Fracture through physis + epiphysis + the articular surface
A

Type 3 SH

22
Q

Fracture through metaphysis + physis + epiphysis involving the articular surface.

A

Type 4

23
Q

Compression fracture of the growth plate (physis).

  • Often missed or thought to be a Salter-Harris I
  • Suspect if mechanism of injury involves a significant axial load.
  • Often diagnosed after arrest of growth has developed
A

Type 5

24
Q

Posterior knee splint

Causes

Procedure

Postioning

A
  1. Patella fracture/ injury/dislocation
  2. Quad tendon injury
  3. ST injury to knee
  4. Pt legs are too big for knee immobilizer

Distal to glutal fold => 6cm above malleoli

Flex knee 15-20 deg

25
Q

Posterior long leg splint

Inidications

Proecdure

Postionin

A
  1. Knee dislocation
  2. Tibial plateu/tibia fx
  3. Distal femur fx

Distal gluteal fold => base of toes

Ankle in neutral position (90 deg to leg); knee flexed 15 - 20

26
Q

Posterior short leg splint with stirrup

A
  1. Fracture, disolocation, sprain
    1. calcaneus
    2. talus
    3. ankle
    4. metasarsal
    5. Midfoot
  2. Injury to achilles tendon
27
Q

Short-Leg: With patient prone, start at plantar surface of metatarsal heads (base of the toes) and end at the level of the fibular head (just below the knee)

Stirrup: Place after short leg, start 3 to 4 cm below the level of the fibular head, extend under the plantar surface of the foot, and at the starting height on contralateral side of leg

A
28
Q

Collateral Ligament Injury

  1. XR
  2. How do you get injury to MCL and LCL
A
  1. AP/lateral
  2. MCL = valgus + ER stress to a flexed knee
  3. LCL = varus stress +/- IR
29
Q

MAnagement a MCL/LCL injury

Disposition

A
  1. Knee immobilizer if signif ligament laxity
  2. Discharge from ED and F/U with orthopedic
30
Q

Test of MCL/LCL injury

A
  1. MCL = joint laxity w/o stress test
  2. LCL = joint laxity WITH varus stress test
31
Q

ACL/PCL (anterior cruciate ligament)

XR

How do you get damage to each?

A
  1. AP/lateral
  2. ACL: valgus + ER to flexed knee + hyperextension
  3. PCL: posterior stress to flexed knee
32
Q

Exam for ACL injiry

A

+ anterior drawer and lachman test

33
Q

Exam for PCL injury

MAnagement and disposition

A

+ posterior drawer & sag sign

knee immbolizer

ED discharge and F/U with orthopedic

34
Q

ankle disolocation = ?

A

articular surface of talus dissociates from tibia** + **fibula, usually associated with a fracture

35
Q

imaging for ankle dislocaiton

A

AP/lateral/mortise

36
Q

4 main categories of dislocations

A
  1. Anterior
  2. lateral
  3. posterior
  4. superior
37
Q

how do you get a anterior ankle dislocation

A

foot dorsiflexed and displaced interiorly.

38
Q

Anterior Ankle Dislocation

associated injuries

A
  1. fracture of the anterior portion of the distal tibia,
  2. mechanical obstruction of dorsalis pedis artery
39
Q

Lateral Ankle Dislocation

A

foot displaced laterally

40
Q

Lateral Ankle Dislocation

Associated Injuries

A
  1. Medial/ lateral malleolus
  2. Distal fibula fractures
  3. Deltoid ligament injury
41
Q

Posterior Ankle Dislocation

  • how?
  • associated injuries
A

foot plantar flexed and displaced posteriorly

  1. Fracture of lateral malleolus
  2. Disruption of the tibiofibular syndesmosis
42
Q

Superior Ankle Dislocation

  • How is it dislocated?
  • Associated injury
A
  • Shortened lower leg with obvious deformity
  • assx injury
    • Articular damage
    • Fracture to thoracolumbar and/or calcaneus
43
Q

Management of ankle dislocation

A

1. reduce

2. Posterior short-leg splint w stirrup

3. dont bear weight

44
Q

Ankle Dislocation:

Disposition

A

Discuss with orthopedic specialist while patient is in the ED, almost always requires surgical management

PCM 4 Midterm (6 decks)

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