Lower Extremity Trauma

Question 1

Femoral head fracture

is suspected. What imaging do you get?

Answer 1

Hip x-ray

abnormal trabecular pattern, cortical defects, shortening and angulation of the femoral neck

Question 2

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

Answer 2

femoral head fracture

Question 3

Watch out for ___ injury in patients with femoral head fractures.

Answer 3

sciatic nerve

Question 4

Clinical features of fracture:

Groin pain
Minimal bruising
Shortened and externally rotated leg

Answer 4

Femoral neck fracture

Question 5

Femoral neck fracture treatment:

Conservative management for stable, nondisplaced fractures
3

Answer 5

Bed rest
physical therapy
VTE prophylaxis

Question 6

Femoral neck fracture treatment:

Surgical therapy is indicated for
unstable fractures (typically adduction fractures)
and
fragment dislocation

Young pts → ___
Elderly pts → ___ or ___

Answer 6

Young pts → open reduction internal fixation (ORIF)

Elderly pts → total hip replacement (THR) or
hip hemiarthroplasty

Question 7

Clinical features of fracture:

Hip pain and swelling
Significant ecchymosis +/- HD instability
Shortened and externally rotated leg

Answer 7

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

Question 8

Intertrochanteric (hip) fracture treatment:

Nonsurgical approach for high risk patients

Surgery
___ for stable fractures
___ for stable or unstable fractures
___ for pathological fractures

Answer 8

Dynamic hip screw (DHS)
Intramedullary nail (Gamma nail)
Arthroplasty

Question 9

Major complication for hip fractures

Answer 9

Avascular necrosis (AVN) of the femoral head

Question 10

Painfully swollen, tense thigh
Signs of fracture (shortening, deformity)
+/- Crepitus and distal neurovascular deficits

Answer 10

Femoral shaft fracture

Question 11

Femoral Shaft fractures:

Treatment →
Complications (2) →

Answer 11

Surgery

Vascular injury
Fat embolism

Question 12

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).

Answer 12

Arthroscopy

Question 13

Complication of recurrent patellar dislocation →

Answer 13

osteoarthritis

Question 14

Most commonly injured knee ligament

Answer 14

ACL

popping sound

Question 15

Knee ligament injury preferred imaging

Answer 15

MRI (confirmatory test)

Question 16

Knee ligament injury treatment

2 routes

Answer 16

1. Conservative treatment
   (for mild knee instability, less physically demanding occupations or sedentary)
2. Arthroscopic surgery

Question 17

Mechanism of injury

Direct posterior blow to a flexed knee

Answer 17

Posterior cruciate ligament injury

Question 18

Diagnostics
X-rays initially
MRI (confirmatory test)
for what injury?

Answer 18

Knee ligament injury

Question 19

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.

Answer 19

MCL

Medial joint line tenderness

Question 20

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.

Answer 20

LCL

Lateral joint line tenderness

Question 21

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

Answer 21

Meniscus tear

Question 22

Meniscus tear imaging/therapy:

imaging modality of choice ___

Both diagnostic and therapeutic ___

Answer 22

MRI

Arthroscopy

Question 23

Meniscus tear complications
___ (Bone pathology)
___ (Vascular pathology)

Answer 23

Osteoarthritis

Baker cyst

Question 24

__ treatment

Indication: open or displaced tibial shaft fractures

Answer 24

Surgical

Question 25

Patients with tibial fractures should be monitored for 3 major complications:

Compartment syndrome
Fat embolism
______

Answer 25

Peroneal nerve injury (foot drop)

Question 26

Patients with tibial fractures should be monitored for 3 major complications:

______
______
Peroneal nerve injury (foot drop)

Answer 26

Compartment syndrome

Fat embolism

Question 27

3-view plain x-ray: anteroposterior (AP); and oblique view

for what structure fracture?

Answer 27

Ankle

Question 28

Popping or snapping sound/sensation

(+) Thompson test: squeezing the calf in prone position with legs extended does not plantarflex foot

Absent passive plantar flexion

Answer 28

Achilles tendon rupture

*Both conservative and surgical approaches are recommended, but unclear

Question 29

Club foot management

Answer 29

Manual repositioning & serial casting

Question 30

Pes cavus (high-arch) management

Answer 30

orthotics & physiotherapy

Question 31

Metatarsus adductus (in-toeing) management

Idiopathic but associated with hip dysplasia

Answer 31

Resolves spontaneously in > 95% of cases within the first 18 months of life

Question 32

Splay (flat) foot can cause:
Metatarsalgia
Hallux valgus (Juanetes/bunion)
_____

Treatment→

Answer 32

Morton neuroma
(shooting pain between the 3rd and 4th metatarsal head)

Tx: Orthotics

Question 33

A ____ fracture is suggested by local hip pain exacerbated by abduction

Answer 33

greater trochanter

Question 34

A ____ fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip flexion and rotation.

Answer 34

lesser trochanter

Question 35

A lesser trochanter fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip ___ and rotation.

Answer 35

flexion

Question 36

A greater trochanter fracture is suggested by local hip pain exacerbated by [movement].

Answer 36

abduction

Question 37

Most greater/lesser trochanter fractures heal with

conservative treatment (non-weightbearing)

Surgical repair for displaced fractures (> _cm)

Answer 37

> 1 cm

Question 38

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.

Answer 38

Posterior hip displacement

cx: Sciatic or Peroneal n. dmg

Question 39

Direct blow to the posterior hip or to an abducted leg

results in _____ displacement.

Answer 39

Anterior hip displacement

cx: Femoral n. dmg

Question 40

Sensory deficit over anteromedial lower leg.

Motor deficits in hip flexion and knee extension.

What nerve is damaged?

Answer 40

Femoral nerve

(Saphenous nerve branches off)

*Commonly caused by anterior hip dislocation

Question 41

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?

Answer 41

Sciatic Nerve

(Sural, Fibular nerve branches off)

*Commonly caused by posterior hip dislocation

Question 42

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?

Answer 42

Peroneal n. injury

*Commonly caused by fractures of the fibular head external compression (stirrups/casts) or posterior hip dislocation.