Limbs Clinical Box Flashcards
fracture of hip bone
-pelvic fractures
-MC- fractures of femoral heads, neck, or trochanters
-avulsion fractures- small part of bone + ligament/tendon is avulsed (torn away)
-ex. ASIS
-avulsion fracture MC with sudden acceleration/deceleration
-older pts- at least 2 fractures** of the ring of bone formed by pubis, pubic rami, and acetabulum (think pretzel
-usually unilateral
-older pts- pubic rami fractures -> no tx, comfort
femoral fractures
-neck MC (especially osteoporosis females)*
-transcervical, intertrochanteric (between trochanters)
-violent direct injury -> spiral fracture (shaft)
-distal femur fractures -> may involve separates of condyles -> misalignment of knee joint
- neck fracture -> median circumflex femoral artery can damage -> avascular necrosis
-injured leg is shorter, and externally rotated
hip dislocation
-posterior hip dislocation- internal rotation
-anterior hip dislocation- external rotation
coxa vara and coxa valga
-decreased angle of inclination -> coxa vara
-increased angle -> coxa valga -> mild passive abduction of the hip
-rickets- weakens the neck
tibial and fibular fractures
-anterior tibia is subcutaneous -> compound fracture (open) or diagonal fracture
-fracture of tibia through nutrient canal -> predisposes to nonunion of bone fragments resulting from damage to nutrient artery
-fibular fracture associated with ankle joint dislocations (excessive inversion)
-ankle ligament tears -> tilts talus against lateral malleolus -> shears it off
-MC lateral malleolus avulsion fracture
-must check if the mortise is in tack -> surgical repair if not to prevent arthritis
-be mindful of interosseous membrane tears
bone grafts
-fibula is common site for bone grafting
-if segment is removed from fibula -> normal function remains
-fixes congenital bone defects, bone after trauma, malignant tumor
-periosteum and nutrient artery removed with it to keep tissue alive and grow when transplanted -> restores the blood supply to bone to which it has been attached
fractures involved epiphyseal plates
-primary ossification center for superior end of tibia appears after birth and joints shaft after puberty
-tibial fracture involved epiphyseal plates is serious in children -> jeopardizes normal growth
-tibial tuberosity appears at age 10 and another center for this appears at 12 -> disruption of epiphyseal plate at tibial tuberosity -> inflammation and pain during adolescence -> Osgood-Schlatter disease
-Salter-Harris classification- fractures in children
-Osgood-Schlatter disease- muscle and bone develop at different rates
-adductors of thigh and quad weakness -> knee pain
abnormalities of sensory function
-most cutaneous nerves in leg are multisegmental fibers from more than one segment of spinal cord
-use a sharp object to see if areas of numbness matches dermatome pattern
-indicates segmental (spinal nerve) lesion or multisegmental pattern of peripheral cutaneous nerve distribution
-area of numbness from lesion of single spinal nerve is small bc dermatomes overlap
compartment syndromes in leg and fasciotomy
-increased pressure in confined space -> poor circulation and threatens tissue and tissue distal
-generally closed ending at joints
-burns, sustained intense muscle use, blunt trauma -> hemorrhage, edema, inflammation of muscles
-septa and deep fascia are strong -> increases intracompartmental pressure
-ischemia, loss of distal pulse (from arterial compression)
-fasciotomy- incision of overlying fascia or septum- relieves pressure
saphenous nerve injury
-accompanies great saphenous vein
-pain, tingling or numbness along medial border of foot
varicose veins
-great saphenous vein
-dilated, tortuous, rotation
-valve cusps dont close
-reverse flow
-weight of long unbroken column of blood
-higher risk for DVT
thrombosis and thrombophlebitis
-DVT
-deep femoral vein*, popiteal, posterior and anterior tibial -> NOT THE SAPHENOUS VEIN (this is superificial)
-swelling, warmth, erythema, infection
-venous stasis (stagnation)- cause of thrombus formation
-caused by:
-incompetent, loose fascia that fails to resist muscle expansion -> no musculovenous pump
-external pressure on veins (cast, bandage, stockings, bedrest)
-muscular inactivity (flights)
-DVT + inflammation = thrombophlebitis
-DVT may travel to lung -> pulmonary thromboembolism -> large one can cause death by blocking main pulmonary artery
-skin irritation, wounds -> compression socks
enlarged inguinal lymph nodes
-abrasions with minor sepsis caused by microorganisms or toxins in blood or other tissues
-entire field of drainage (trunk inferior to umbilicus, perineum, entire lower limb) can enlarge
-females- consider metastasis of uterine cancer via round ligament
regional nerve blocks of lower limbs
-perineural injections
-femoral nerve (L2-L4)- blocked 2 cm inferior to inguinal ligament (finger breadths away from femoral artery)
hip and thighs contusions
-hip pointer injury- contusion of iliac crest MC
-bleeding from ruptured capillaries and infiltration of blood into muscles, tendons, and other soft tissue
-avulsion fracture- avulsion of bony site of muscle attachments
-ex. sarortius from ASIS or rectus femoris to ISIS
-charlie horse- acute cramping of individual thigh muscle bc of ischemia, nocturnal leg cramps, or contusion and rupture of blood vessels sufficient to form hematoma
