Lecture 5 - Lower Limb Injuries

Question 1

Hip dislocation

Answer 1

• axial load on flexed knee
• hip rests in flexion, adduction and internal rotation
• associated with acetabular rim fractures
• check for sciatic nerve injury

TREATMENT: reduction with traction at 90 degrees

Question 2

Slipped capital femoral epiphysis

Answer 2

• occurs in adolescence
• displacement occurs through physis
• common in overweight males
  TREATMENT: internal fixation, avascualr necrosis

Question 3

Fracture of femoral neck

Answer 3

• Intracapsular (subcapital or transcervical)
• Extracapsular: intertrochanteric

DIAGNOSIS: affected limb is shortened and externally rotated

Question 4

Subcapital fracture

Answer 4

• Risk of avascular necrosis

TREATMENT:

• internally fixed if undisplaced
• arthroplasty if displaced

Question 5

Intertrochanteric fracture treatment

Answer 5

• internal fixation

- elderly patient should be mobilised to prevent risk of recumbancy

Question 6

Femoral fracture in children: treatment option

Answer 6

• Gallows traction up to 3 yo
• thomas splint
• Hip Spica
• Flexible intramedullary nails

Question 7

Midshaft fracture treatment

Answer 7

Intramedullary nailing

Question 8

Supracondylar fracture treatment

Answer 8

• Nail or plate

Question 9

Patella fracture

Answer 9

• by direct force or sudden quadriceps contraction
• TREATMENT
• internally fixed if displaced, typically by wiring

Question 10

Osgood Schaltter’s disease

Answer 10

• in active adolescent: overuse injury
• treated with activity modification
• due to inflammation of tibial tubercule

Question 11

Patella dislocation

Answer 11

• teenage girls
• associated with patella maltracking and shallow sulcus
• TREATMENT: reconstructive surgery if recurrent

Question 12

Knee dislocation

Answer 12

• in major trauma

TREATMENT

• immediate closed reduction and splintage
• monitor vascular status
• surgical reconstruction of stabilising ligaments

Question 13

Medial collateral ligament injury

Answer 13

• common

TREATMENT
- rest, rehabilitation

Question 14

Psterolateral corner injury

Answer 14

• lateral collateral ligament, biceps femoris and fascia lata
• check fibular nerve function
  TREATMENT: surgical repair

Question 15

Posterior cruciate ligament injury

Answer 15

• due to tibia being forced backward with knee in flexion
• recognized by reduced stepoff, or “tibial sag”
• may require surgical reconstruction

Question 16

Anterior cruciate ligament injury

Answer 16

• twisting injury on fixed foot
• may be associated with meniscal injury
• surgical reconstruction

Question 17

Meniscal injury

Answer 17

• rotational stress on flexed, weight-bearing knee
• potentially causes ongoing pain, clicking, locking
• surgical repair or excision

Question 18

Tibial plateau fracture treatment

Answer 18

Internally fixed to restore joint congruity

Question 19

Tibial fracture

Answer 19

• Torsion, axial compression or direct force

TREATMENT: intramedullary nailing

• beware compartment syndrome: anterior compartment most commonly affected

Question 20

Tibial fracture in children

Answer 20

• treated with casting

- if need internal fixation: plating instead of nails to avoid growth plate damage with nailing

Question 21

Ankle fracture

Answer 21

• Sites of injury: medial malleolus, lateral malleolus, syndesmosis
• casting vs internal fixation

Question 22

Distal tibial physeal injury in children

Answer 22

• closed reduction and casting if extra articular

- internal fixation if articular displacement

Question 23

Talus fracture

Answer 23

• through talar neck

- risk of avascular necrosis

Question 24

Calcaneal fracture

Answer 24

• fixation depends on articular congruity and loss of height

Question 25

Tendo achilles rupture treatment

Answer 25

• plantar flexed cast or surgical repair

Question 26

Lisfranc fracture-dislocation treatment

Answer 26

• reduction and fixation if displaced

Question 27

Metatarsal and toe injuries

Answer 27

• reduction and fixation for: dislocation, displacement, instability