Lower Extremity Fractures Lecture Powerpoint Flashcards
Pelvic ring fractures
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)
One of highest predictors for increased mortality in pelvic ring injury is need for transfusion of >___ units of packed RBC**
4
Physical exam for pelvic ring injuries (5)
- 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
Strongest ligament in body
Posterior sacroiliac ligament
Pelvic trauma series imaging (4)**
- AP pelvis
- CXR
- lateral C spine
- CT if hemodynamically stable
Pelvic binder
Device that wraps around the pelvis and keeps a fabric sheet tight to preserve the broken ring, can help increase chance of survival
Pelvic ring injury treatment options (3)**
- resuscitate ideally 1:1:1 RBC to FFP to platelets
- ORIF
- minor stable pelvic ring fractures can skip treatment
Femoral neck fractures healing potential
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
Femoral neck fractures treatment options (1)
-surgical always!!!
Femoral neck fracture diagnostic studies (2)
- XR
- MRI
- NO CT scan
Avascular necrosis causes*** (6)
- alcohol***
- systemic lupus or sickle cell
- exogenous steroid use
- pancreatitis
- trauma
- infection
Avascular necrosis definition
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
Garden classification of hip fractures and how are they treated (4)
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
Physical exam findings for hip fractures (5)***
- 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
What do all patients with hip fractures get? (7)
- 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
General considerations for hip fractures** (2)
- 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
Intertrochanteric hip fractures
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
Femoral shaft fractures
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
3 potential spaces of tremedous blood loss in trauma patients***
- thorax
- pelvis
- thigh
Bucks traction
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
Femoral shaft fractures treatment (3)
- long leg cast (rare)
- intramedullary nail
- ORIF
Tibial plateau fractures
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
Why do we see more lateral sided tibial plateau fractures?
Because the lateral makes contact first during articulation despite at rest the medial side bearing the majority of the weight
Tibial plateau fractures treatment options (2)
- hinged knee brace with partial weight bearing 8-12weeks with immediate ROM
- ORIF
Tibial shaft fractures
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
You can still have compartment syndrome with a ___ fracture
Open
Tibial shaft fractures treatment options (3)
- closed reduction/cast immobilization
- external fixation
- intramedullary nailing (high incidence of pain for rest of life even if removed)
Ankle fractures
Highest incidence in elderly women, most isolated malleolar, require urgent reduction in ED to prevent soft tissuecompromise, ice and elevate ASAP after reduction
How to reduce ankle fractures
Flex hip up, bend knee, (take gastrocs out of equation), pick up by big toe (pronate and internally rotate in quigley’s traction)
Ankle fractures treatments (2)
- walking boots or short leg cast
- ORIF
Most frequent tarsal fracture
Calcaneus fractures
