Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopaedics > Leg Injury > Flashcards

Leg Injury Flashcards

1
Q

Learning outcome:

A
  1. Fracture of tibia and fibular shaft
  2. Fracture of fibular alone
  3. Fracture of proximal tibia shaft
  4. Proximal tibiofibular joint dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Proximal third tibial shaft fracture pathology

A
  1. Epidemiology: 10% of tibial shaft fracture
  2. Mechanism of injury:
    - low energy: twisting injury, indirect
    - high energy: direct trauma
  3. Common complication:
    I. compartment syndrome
    II. malunion (20-60%)
    - procurvatum: patellar lig pull, gastrocnemius pull
    - valgus: anterior compartment muscle pull
  4. Fracture displacement
    - posterior more common than anterior, because anterior is limited by patella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Proximal third tibial shaft fracture diagnosis

A

Hx: as other fracture

Pe:

  1. check anterior compartment: passive ankle plantarflexion
  2. check posterior compartment: passive ankle dorsiflexion
  3. check lateral compartment: passive ankle inversion
  4. check 5 nerves:
    - deep peroneal nerve
    - superficial peroneal nerve
    - sural nerve
    - tibial nerve
    - saphenous nerve
  5. Vascular: PTA, DP

X-Ray
1. AP and lateral: angulation, displacement

CT-Scan
- if intraarticular extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fracture of tibia and fibular shaft pathology

A
  1. Epidemiology: most common long bone fracture
2. Mechanism of injury 
I. low energy
- diffrent fracture level
- less severe soft tissue injury
- spiral (twisting)*associated with posterior malleolar fracture, transverse (blow)
- long oblique 
II. high energy 
- same fracture level
- more severe soft tissue injury 
- comminuted, segmental 
- short oblique
  1. Complication
    I. Infection (Open fracture common)
    II. Compartment syndrome (10%), can occur in both open or closed fracture
  2. Classification
    I. Close: Oestern and Tscherne
    II. Open: Gustilo-Anderson
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fibular fracture alone pathology

A
  1. Mechanism of injury
    - spiral: rotational injury
    * may extend from ankle ligament injury “Maisonneuve fracture”
    - oblique/transverse: direct blow, valgus force
  2. Associated injury
    I. Peroneal nerve injury, entrapment (wrapped around head of fibula)
    II. LCL tear (attach to head of fibular)
    III. Ankle ligaments injury
    IV. Proximal tibiofibular joint dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fibular fracture alone diagnosis

A

Hx: as other fracture.
- pain tolerable (patient can still weightbear) tibia 82% load, fibular 12% load

Pe:

  • rule out compartment syndrome
  • rule out common peroneal nerve injury
  • rule out ankle ligament injury, tibial fracture
  • rule out LCL or other knee injury
  • rule out tibiofibular joint dislocation

X-Ray
1. AP and lateral: angulation, displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Proximal Tibiofibular joint dislocation pathology

A
  1. Mechanism of injury
    - fall onto flexed, adducted knee (eg. horseriding, parachuting)
  2. Associated injury:
    - posterior hip dislocation
    - fibular/tibia fracture
  3. Ogden classification
    I. anterolateral (most common)
    II. posterolateral
    III. superior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Proximal Tibiofibular joint dislocation diagnosis

A

Hx: as other dislocation, pain, deformity, swelling, joint instability (become varus if LCL tear)

Pe:

  • tenderness
  • fibular head prominence

X-Ray

  • AP: Widening of tibiofibular space
  • Lateral: Anterior/Posterior displacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of tibial bone?

A
  1. Prone to open fracture (subcutaneous)

2. Prone to non-union (if distal third) due to precarious blood supply. Major bs from medullary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

High energy vs low energy fracture of tibia and fibula?

A

Low energy

  • spiral
  • no comminution
  • long oblique fracture
  • less soft tissue injury
  • fibula fracture occurs at different level

High energy

  • transverse
  • comminution
  • short oblique
  • more soft tissue injury
  • fibula fracture occurs at same level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Choice of treatment factors?

A
  1. Soft tissue state
  2. Severity of bone injury
  3. Stability of fracture
  4. Degree of contamination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common complication of tibial or fibular fracture?

A
  1. Compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Principles of treatment of leg fracture?

A
  1. Limit soft tissue damage and restore/preserve soft tissue cover
  2. Prevent compartment syndrome
  3. Hold fracture alignment
  4. Early weight bearing
  5. Early joint movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of closed tibial fracture?

A
  1. Non-operative:
    - Closed Reduction
    - Long leg cast immobilization -> functional bracing after 4 weeks
  2. Operative:
    i. External fixation -> functional bracing
    ii. Intramedullary nailing
    iii. Percutaneous locking plate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Indication for closed reduction and long leg cast immobilization? (CRCI)

A
  1. Low energy fracture with acceptable alignment
    i.<5 degree varus
    /valgus angulation
    ii.<10 degree ant/post angulation
    iii.>50% cortical apposition
    iv.<1cm shortening
    v.<10 degree rotational malalignment
  2. Non-ambulator/paralyzed patient
  3. Patient unfit for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complication associated with CRCI?

A
  1. Shortening (if oblique fracture)
  2. Varus malunion of tibia (if fibular intact)
  3. Non-union (distal tibia have precarious blood supply)
16
Q

Indication for external fixation?

A
  1. Proximal metaphyseal fracture

2. Distal metaphyseal fracture

17
Q

Complication of Ex-Fix?

A
  1. Higher risk of malalignment compare to IM

2. Pin tract infection

17
Q

Indication for closed intramedullary nailing?

A
  1. soft tissue injury not tolerate casting
  2. segmental fracture
  3. comminuted fracture
  4. floating knee
  5. bilateral tibia fracture
  6. morbid obesity
19
Q

Advantage of closed intramedullary nailing?

A
  1. Decrease time to union (CRCI)
  2. Decrease weight bearing time (CRCI)
  3. Decrease risk of malalignment (ex-fix)
19
Q

Indication for percutaneous locking plate? (PLP)

A
  1. Inadequate proximal fixation with IM (metaphyseal)

2. Inadequate distal fixation with IM (metaphyseal)

20
Q

Complication of tibial shaft fracture?

A

Early:

  1. Compartment syndrome
  2. Nerve injury: superficial peroneal nerve
  3. Vascular: popliteal artery (prox tibia)

Late:

  1. Malunion: varus or valgus
  2. Non-union: more than 9mo
  3. Delayed union: union at 6-9mo
  4. Joint stiffness: prolonged cast

Orthopaedics (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions