Lower Extremity Fractures Lecture Powerpoint

Question 1

Pelvic ring fractures

Answer 1

Mechanism from high energy blunt force trauma, mortality rate for true pelvic ring injury up to 50%, hemorrhage leading cause of death in these injuries, rare in children and better prognosis because triradiate cartilage still open (hasn’t fused 3 bones of pelvis yet)

Question 2

One of highest predictors for increased mortality in pelvic ring injury is need for transfusion of >___ units of packed RBC**

Answer 2

4

Question 3

Physical exam for pelvic ring injuries (5)

Answer 3

• Pain and inability to bear weight
• palpate pelvis with gentle rotational force to feel (only once!!!)
• neurologic exam requires rectal exam for spincter tone and perianal sensation
• retrograde urethrogram prior to foley catheter insertion in case of bladder/urethral rupture
• gynecologic exam

Question 4

Strongest ligament in body

Answer 4

Posterior sacroiliac ligament

Question 5

Pelvic trauma series imaging (4)**

Answer 5

• AP pelvis
• CXR
• lateral C spine
• CT if hemodynamically stable

Question 6

Pelvic binder

Answer 6

Device that wraps around the pelvis and keeps a fabric sheet tight to preserve the broken ring, can help increase chance of survival

Question 7

Pelvic ring injury treatment options (3)**

Answer 7

• resuscitate ideally 1:1:1 RBC to FFP to platelets
• ORIF
• minor stable pelvic ring fractures can skip treatment

Question 8

Femoral neck fractures healing potential

Answer 8

Healing potential limited because femoral neck is intracapsular and bathed in synovial fluid lacking strong blood supply and periosteal layer, callus formation limited, which affects healing

Question 9

Femoral neck fractures treatment options (1)

Answer 9

-surgical always!!!

Question 10

Femoral neck fracture diagnostic studies (2)

Answer 10

• XR
• MRI
• NO CT scan

Question 11

Avascular necrosis causes*** (6)

Answer 11

• alcohol***
• systemic lupus or sickle cell
• exogenous steroid use
• pancreatitis
• trauma
• infection

Question 12

Avascular necrosis definition

Answer 12

Interference with blood supply to femoral head resulting in infarction, sees death of marrow elements and osteocytes, body tries to respond by revascularizing which then causes local hyperemia and osteoporosis of the living bone because of increased osteoclastic activity as parts of the bony remodeling process

Question 13

Garden classification of hip fractures and how are they treated (4)

Answer 13

Type I - incomplete, valgus impacted (crushing) - cannulated screws
Type II - complete fracture, nondisplaced - cannulated schools
Type III - complete fracture, partially displaced - hemi or total arthroplasty
Type IV - complete, fully displaced - hemi or total arthroplasty

Question 14

Physical exam findings for hip fractures (5)***

Answer 14

• discomfort with active or passive range of motion
• muscle spasm with motion
• small doses of valium
• leg may appear in external rotation and abduction, will appear shortened***
• pain described in groin and anterior medial thigh and knee

Question 15

What do all patients with hip fractures get? (7)

Answer 15

• foley catheter
• IV fluids
• pain control
• AP pelvis, full length femur xr, hip xr, CXR
• EKG
• Non weight bearing to affected extremity
• NPO for 8 hours

Question 16

General considerations for hip fractures** (2)

Answer 16

• elderly patients with hip fractures should be brought to surgery as soon as medically optimal to minimize morbidity and mortality, within 48 hours ideal
• mortality rate as high as 36% at one year in geriatric population

Question 17

Intertrochanteric hip fractures

Answer 17

Extracapsular hip fracture of proximal femur between greater and lesser trochanters, typically older age patients and have painful shortened lower extremity, mortality rates higher than for femoral neck fractures

Question 18

Femoral shaft fractures

Answer 18

High energy injury frequently associated with life threatening conditions, takes much force to fracture femur, do not miss associated neck fracture as often missed, bilateral femur fractures has high risk of mortality and pulmonary complications such as fat emboli

Question 19

3 potential spaces of tremedous blood loss in trauma patients***

Answer 19

• thorax
• pelvis
• thigh

Question 20

Bucks traction

Answer 20

Device for pain relief, maintanence of length in a fracture, and minimizes blood loss in a patient thru tying string and weight helping stretch out the bone

Question 21

Femoral shaft fractures treatment (3)

Answer 21

• long leg cast (rare)
• intramedullary nail
• ORIF

Question 22

Tibial plateau fractures

Answer 22

Periarticular injuries of the proximal tibia frequently associated with significant soft tissue injury, bimodal distribution with young and elderly patients, most often lateral least often medial (often associated with knee dislocation), strongly associated with meniscal tears, ACL injuries, and poses risk for compartment syndrome

Question 23

Why do we see more lateral sided tibial plateau fractures?

Answer 23

Because the lateral makes contact first during articulation despite at rest the medial side bearing the majority of the weight

Question 24

Tibial plateau fractures treatment options (2)

Answer 24

• hinged knee brace with partial weight bearing 8-12weeks with immediate ROM
• ORIF

Question 25

Tibial shaft fractures

Answer 25

Most common long bone fracture, low energy fracture pattern result often of torsional injury, associated fibular fracture occurs at different level, while high energy fracture often of direct force, associated fibula fracture at same level, more significant comminution, overall most common open fracture

Question 26

You can still have compartment syndrome with a ___ fracture

Answer 26

Open

Question 27

Tibial shaft fractures treatment options (3)

Answer 27

• closed reduction/cast immobilization
• external fixation
• intramedullary nailing (high incidence of pain for rest of life even if removed)

Question 28

Ankle fractures

Answer 28

Highest incidence in elderly women, most isolated malleolar, require urgent reduction in ED to prevent soft tissuecompromise, ice and elevate ASAP after reduction

Question 29

How to reduce ankle fractures

Answer 29

Flex hip up, bend knee, (take gastrocs out of equation), pick up by big toe (pronate and internally rotate in quigley’s traction)

Question 30

Ankle fractures treatments (2)

Answer 30

• walking boots or short leg cast

- ORIF

Question 31

Most frequent tarsal fracture

Answer 31

Calcaneus fractures