Lower Extremity Trauma Flashcards
Femoral head fracture
is suspected. What imaging do you get?
Hip x-ray
abnormal trabecular pattern, cortical defects, shortening and angulation of the femoral neck
A patient following a MVA dashboard injury presents with a with groin (buttock, hip, thigh etc.) pain and local hip swelling and ecchymosis
Pelvis XR reveals a a posterior hip dislocation
and _____ fracture
femoral head fracture
Watch out for ___ injury in patients with femoral head fractures.
sciatic nerve
Clinical features of fracture:
Groin pain
Minimal bruising
Shortened and externally rotated leg
Femoral neck fracture
Femoral neck fracture treatment:
Conservative management for stable, nondisplaced fractures
3
Bed rest
physical therapy
VTE prophylaxis
Femoral neck fracture treatment:
Surgical therapy is indicated for
unstable fractures (typically adduction fractures)
and
fragment dislocation
Young pts → ___
Elderly pts → ___ or ___
Young pts → open reduction internal fixation (ORIF)
Elderly pts → total hip replacement (THR) or
hip hemiarthroplasty
Clinical features of fracture:
Hip pain and swelling
Significant ecchymosis +/- HD instability
Shortened and externally rotated leg
Intertrochanteric (hip) fracture
(extrascapular fracture can cause significant hemorrhage and HD instability)
- Dynamic hip screw (DHS) for stable fractures
- Intramedullary nail (Gamma nail) for stable or unstable fractures
- Arthroplasty for comminuted or pathological fractures
Intertrochanteric (hip) fracture treatment:
Nonsurgical approach for high risk patients
Surgery
___ for stable fractures
___ for stable or unstable fractures
___ for pathological fractures
Dynamic hip screw (DHS)
Intramedullary nail (Gamma nail)
Arthroplasty
Major complication for hip fractures
Avascular necrosis (AVN) of the femoral head
Painfully swollen, tense thigh
Signs of fracture (shortening, deformity)
+/- Crepitus and distal neurovascular deficits
Femoral shaft fracture
Femoral Shaft fractures:
Treatment →
Complications (2) →
Surgery
Vascular injury
Fat embolism
A minimally invasive surgical procedure in which the inside of a large joint is directly visualized using an endoscope.
Used to diagnose intra-articular pathologies that are not apparent on imaging.
Instruments can also be inserted for therapeutic procedures (removal of bony and/or cartilaginous fragments, ligament and/or meniscal reconstruction).
Arthroscopy
Complication of recurrent patellar dislocation →
osteoarthritis
Most commonly injured knee ligament
ACL
popping sound
Knee ligament injury preferred imaging
MRI (confirmatory test)
Knee ligament injury treatment
2 routes
- Conservative treatment
(for mild knee instability, less physically demanding occupations or sedentary) - Arthroscopic surgery
Mechanism of injury
Direct posterior blow to a flexed knee
Posterior cruciate ligament injury
Diagnostics
X-rays initially
MRI (confirmatory test)
for what injury?
Knee ligament injury
Valgus stress test:
Pt supine and the knee either in extension/flexion, gently abducts lower leg and pushes the knee medially by the lateral side (valgus force).
Widening of the medial joint space indicates __ injury.
MCL
Medial joint line tenderness
Varus stress test:
Pt supine and the knee either in extension/flexion, gently adducts lower leg and pushes the knee laterally by the medial side (varus force).
Widening of the lateral joint space indicates __ injury.
LCL
Lateral joint line tenderness
Knee pain exacerbated by weight‑bearing or activity
Palpable or audible pop/click with maneuvers
Joint line tenderness (medial or lateral)
Restricted knee extension
Intermittent joint effusions
diagnosis
Meniscus tear
Meniscus tear imaging/therapy:
imaging modality of choice ___
Both diagnostic and therapeutic ___
MRI
Arthroscopy
Meniscus tear complications
___ (Bone pathology)
___ (Vascular pathology)
Osteoarthritis
Baker cyst
__ treatment
Indication: open or displaced tibial shaft fractures
Surgical
Patients with tibial fractures should be monitored for 3 major complications:
Compartment syndrome
Fat embolism
______
Peroneal nerve injury (foot drop)
Patients with tibial fractures should be monitored for 3 major complications:
______
______
Peroneal nerve injury (foot drop)
Compartment syndrome
Fat embolism
3-view plain x-ray: anteroposterior (AP); and oblique view
for what structure fracture?
Ankle
Popping or snapping sound/sensation
(+) Thompson test: squeezing the calf in prone position with legs extended does not plantarflex foot
Absent passive plantar flexion
Achilles tendon rupture
*Both conservative and surgical approaches are recommended, but unclear
Club foot management
Manual repositioning & serial casting
Pes cavus (high-arch) management
orthotics & physiotherapy
Metatarsus adductus (in-toeing) management
Idiopathic but associated with hip dysplasia
Resolves spontaneously in > 95% of cases within the first 18 months of life
Splay (flat) foot can cause:
Metatarsalgia
Hallux valgus (Juanetes/bunion)
_____
Treatment→
Morton neuroma
(shooting pain between the 3rd and 4th metatarsal head)
Tx: Orthotics
A ____ fracture is suggested by local hip pain exacerbated by abduction
greater trochanter
A ____ fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip flexion and rotation.
lesser trochanter
A lesser trochanter fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip ___ and rotation.
flexion
A greater trochanter fracture is suggested by local hip pain exacerbated by [movement].
abduction
Most greater/lesser trochanter fractures heal with
conservative treatment (non-weightbearing)
Surgical repair for displaced fractures (> _cm)
> 1 cm
Dashboard injury in which a posteriorly directed force (ex: dashboard during a MVA) is directed towards an internally rotated, flexed, and adducted hip
results in _____ displacement.
Posterior hip displacement
cx: Sciatic or Peroneal n. dmg
Direct blow to the posterior hip or to an abducted leg
results in _____ displacement.
Anterior hip displacement
cx: Femoral n. dmg
Sensory deficit over anteromedial lower leg.
Motor deficits in hip flexion and knee extension.
What nerve is damaged?
Femoral nerve
(Saphenous nerve branches off)
*Commonly caused by anterior hip dislocation
Sensory deficit over the posterior leg and posterior lateral lower leg and foot.
Motor deficits in hip extension & knee flexion.
(hamstring muscle weakness)
What nerve is damaged?
Sciatic Nerve
(Sural, Fibular nerve branches off)
*Commonly caused by posterior hip dislocation
Sensory deficit over the anterolateral lower leg and dorsum of the medial foot & toes.
Motor deficit in foot pronation as well as causing foot drop and high-stepping gait .
What nerve is damaged?
Peroneal n. injury
*Commonly caused by fractures of the fibular head external compression (stirrups/casts) or posterior hip dislocation.
