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