Lecture 5 - Lower Limb Injuries Flashcards
Hip dislocation
- 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
Slipped capital femoral epiphysis
- occurs in adolescence
- displacement occurs through physis
- common in overweight males
TREATMENT: internal fixation, avascualr necrosis
Fracture of femoral neck
- Intracapsular (subcapital or transcervical)
- Extracapsular: intertrochanteric
DIAGNOSIS: affected limb is shortened and externally rotated
Subcapital fracture
- Risk of avascular necrosis
TREATMENT:
- internally fixed if undisplaced
- arthroplasty if displaced
Intertrochanteric fracture treatment
- internal fixation
- elderly patient should be mobilised to prevent risk of recumbancy
Femoral fracture in children: treatment option
- Gallows traction up to 3 yo
- thomas splint
- Hip Spica
- Flexible intramedullary nails
Midshaft fracture treatment
Intramedullary nailing
Supracondylar fracture treatment
- Nail or plate
Patella fracture
- by direct force or sudden quadriceps contraction
- TREATMENT
- internally fixed if displaced, typically by wiring
Osgood Schaltter’s disease
- in active adolescent: overuse injury
- treated with activity modification
- due to inflammation of tibial tubercule
Patella dislocation
- teenage girls
- associated with patella maltracking and shallow sulcus
- TREATMENT: reconstructive surgery if recurrent
Knee dislocation
- in major trauma
TREATMENT
- immediate closed reduction and splintage
- monitor vascular status
- surgical reconstruction of stabilising ligaments
Medial collateral ligament injury
- common
TREATMENT
- rest, rehabilitation
Psterolateral corner injury
- lateral collateral ligament, biceps femoris and fascia lata
- check fibular nerve function
TREATMENT: surgical repair
Posterior cruciate ligament injury
- due to tibia being forced backward with knee in flexion
- recognized by reduced stepoff, or “tibial sag”
- may require surgical reconstruction
Anterior cruciate ligament injury
- twisting injury on fixed foot
- may be associated with meniscal injury
- surgical reconstruction
Meniscal injury
- rotational stress on flexed, weight-bearing knee
- potentially causes ongoing pain, clicking, locking
- surgical repair or excision
Tibial plateau fracture treatment
Internally fixed to restore joint congruity
Tibial fracture
- Torsion, axial compression or direct force
TREATMENT: intramedullary nailing
- beware compartment syndrome: anterior compartment most commonly affected
Tibial fracture in children
- treated with casting
- if need internal fixation: plating instead of nails to avoid growth plate damage with nailing
Ankle fracture
- Sites of injury: medial malleolus, lateral malleolus, syndesmosis
- casting vs internal fixation
Distal tibial physeal injury in children
- closed reduction and casting if extra articular
- internal fixation if articular displacement
Talus fracture
- through talar neck
- risk of avascular necrosis
Calcaneal fracture
- fixation depends on articular congruity and loss of height
Tendo achilles rupture treatment
- plantar flexed cast or surgical repair
Lisfranc fracture-dislocation treatment
- reduction and fixation if displaced
Metatarsal and toe injuries
- reduction and fixation for: dislocation, displacement, instability
