Lower Extremity Fractures Flashcards
MC MOI of pelvic fractures
- Fall
- High impact injury in younger people
In high impact pelvic fractures, what else needs to be checked?
Bladder injury (get a urine and see if there’s blood)
Hip fractures occur in what populations?
- 60 yo or older (90%)
- Females (75%)
MOI of hip fractures
- Usually a fall in the elderly
- High impact injury in younger people
- Can be pathologic from tumor, cyst, osteopenia
Clinical presentation of hip fractures
- Limb is shortened and ER
- Pain in groin and anterior thigh
- Unable to ambulate
Types of hip fractures
- Subcapital neck
- Transcervical neck
- Intertrochanteric
- Subtrochanteric
- Greater trochanter
- Lesser trochanter
Treatment of hip fracture
Surgery for either ORIF or hemi-arthroplasty almost always indicated ASAP because of high mortality rate
MOI of femur fractures
- High impact injury
- Can be pathologic
- May occur around prosthesis or ORIF components
Treatment of femur fracture
Usually includes external fixator, IM rod, gamma nail or ORIF w/plate and screws
MOI knee fracture
Direct blow, twisting, hyperextension
What is the “sunrise” view?
An x-ray view of the patella
What are the Ottawa knee rules?
Indications for knee x-ray
- 55+ yrs old
- Isolated patella tenderness
- Tenderness at fibular head
- Inability to flex 90 degrees
- Inability to bear weight (4 steps) immediately after injury
Describe tibial plateau fracture
- Intra-articular fx of proximal tibia
- Lateral tibial plateau (60-70%), medial tibial plateau (10-20%)
- Common in elderly
- High energy injury in young
How do people present with tibial plateau fracture?
- Acute hemarthrosis
- Unable to bear weight
- Joint line tenderness
What else should be assessed with tibial plateau fracture?
Popliteal artery and peroneal nerve injuries
Treatment of tibial plateau fractures
- Usually requires ORIF
- Some elderly or high risk pts can be treated non-wt bearing w/ a knee immobilizer
What is the largest sesamoid bone in the body?
Patella
What is the MC fracture of the patella?
Transverse
MOI patella fractures
Direct or indirect trauma or dislocation
Describe sunrise x-ray view
- Assesses alignment of patella for vertical/longitudinal fractures
- It does NOT evaluate transverse fractures (that may unnecessarily make a case surgical)
Treatment of patella fractures
- If not displaced, knee immobilizer and partial wt bearing
- If displaced, requires ORIF
Extensor mechanism injury MOI
- Patellar or quad tendon ruptures
- Sudden intense contraction of quads w/knee flexed
- Direct blow
- Laceration
What comorbidities increase risk for extensor mechanism injury?
RA, gout, SLE
Treatment of extensor tendon mechanism disruption
- Always requires repair of the tendon unless risks outweigh the benefits
- Initially, immobilization and non-wt bearing w/crutches or walker
Patella baja
Patella tendon rupture
*Can be normal in some people
Patella alta
Quadricep tendon tear
MOI tibia and fibula fractures
Trauma
MC type of tibia fracture
Shaft
Clinical presentation of tibia and fibula fractures
Fibula may be able to bear full wt as it is a non-wt bearing bone
Treatment of tibia and fibula fractures?
- Non displaced can be w/long leg cast or posterior splint w/knee flexed 20-30 degrees, ankle in neutral position, no wt bearing 4-6 wks
- Displaced need IM rods, ORIF w/plate and screws, or external fixator
Ottawa ankle rules
Indications for ankle x-ray
- Pain in malleolar zone and one of: bone tenderness at posterior edge lat malleolus or inability to bear wt immediately and in ED
- Pain in mid foot zone and bone tenderness at 5th MT base OR navicular OR inability to bear wt immediately and in ED
Ankle sprain MOI
Extreme inversion injury and plantar flex
MC injured ligament in ankle sprain
Anterior talofibular (ATF) ligament
What is a “high ankle sprain”?
- Damage to syndesmosis ligament
- Occurs w/dorsiflexion and ER
Damage to syndesmosis ligament is what kind of injury?
High ankle sprain
Ankle sprain grading system
1: stretch w/microscopic tearing of ligament (little swelling and functional loss, no joint instability)
2: partial tearing, mod-severe swelling, mod functional loss
3: complete rupture of ligament, severe swelling, mod-severe instability of joint
Types of ankle fractures
- Unimalleolar
- Bimalleolar
- Trimalleolar
- Maisonneuve
- Pilon
Treatment of ankle fracture
- Initially, splinting and non wt bearing
- Most will require ORIF
- If dislocation involved, reduction must be done prior to splinting
If a dislocation is involved with an ankle fracture, what must be done?
Reduction must be done prior to splinting
Maisonneuve ankle fracture MOI
Inversion injury that radiates up fibula and snaps off proximal fibula w/disruption of deltoid ligament (and many times a medial malleolus fracture)
Pilon fracture
Dome of distal tibial articular surface and extends into adjacent metaphysis
Pilon fracture MOI
Multiple mechanisms including a fall from height or MCV or skiing injuries
What are indications for surgery in a pilon fracture?
- Open
- Displaced (gap of more than 2 mm or step of more than 1 mm, rotational malalignment)
- Vascular compromise
- Compartment syndrome
Foot fracture MOI
Twisting or crushing
What x-rays do we get for foot fracture?
- If tender over metatarsals and cuneiforms, xray foot
- If tender over phalanges, xray toes
Avulsion fracture of 5th MT
- Sudden inversion of plantar flexed foot
- Usually extra-articular
- Symptoms can mimic ankle sprain
Jones fracture
- Transverse fx distal to MT-cuboid joint
- Usually occurs w/o inversion
Lisfranc joint
- Articulation between midfoot and forefoot
- Composed of 5 TMT joints
- Fracture location of TMT joint
Lisfranc fracture MOI
Crush injury or rotational force on a plantar flexed forefoot
Metatarsal fracture MOI
Multiple including inversion injury, direct blow, crush injuries
Treatment of toe fractures
- Buddy taping (MC)
- May use a fracture boot for multiple fractures
Where does an osteosarcoma originate?
Metaphyseal region of tubular long bone
Where do osteosarcomas MC occur?
Femur (42%)
What is the MC benign bone tumor?
Osteochondroma
Where does an osteochondroma MC occur?
Around knee and shoulder (but can occur in any bone)
Who is affected by osteochondroma?
- Males 3:1
- Diagnosed before age 20
How do osteochondromas grow?
- Near growth plates and grow away from physis
- Grow until skeletal maturity then stops when epiphyseal plates close
Describe fibrous cortical defects
- More than 2 cm in size
- Older children
- Solitary lesions (75%)
- Occur at sites of tendon/ligament insertion
Describe enchondroma
- Benign cartilaginous neoplasm
- Usually solitary lesion in medullary bone
- Small incidence of malignancies
- Described as “lytic lesions”
