Lower Extremity Trauma Flashcards

1
Q

Femoral head fracture

is suspected. What imaging do you get?

A

Hip x-ray

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

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2
Q

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

A

femoral head fracture

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3
Q

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

A

sciatic nerve

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4
Q

Clinical features of fracture:

Groin pain
Minimal bruising
Shortened and externally rotated leg

A

Femoral neck fracture

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5
Q

Femoral neck fracture treatment:

Conservative management for stable, nondisplaced fractures
3

A

Bed rest
physical therapy
VTE prophylaxis

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6
Q

Femoral neck fracture treatment:

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

Young pts → ___
Elderly pts → ___ or ___

A

Young pts → open reduction internal fixation (ORIF)

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

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7
Q

Clinical features of fracture:

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

A

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
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8
Q

Intertrochanteric (hip) fracture treatment:

Nonsurgical approach for high risk patients

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

A

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

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9
Q

Major complication for hip fractures

A

Avascular necrosis (AVN) of the femoral head

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10
Q

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

A

Femoral shaft fracture

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11
Q

Femoral Shaft fractures:

Treatment →
Complications (2) →

A

Surgery

Vascular injury
Fat embolism

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12
Q

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).

A

Arthroscopy

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13
Q

Complication of recurrent patellar dislocation →

A

osteoarthritis

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14
Q

Most commonly injured knee ligament

A

ACL

popping sound

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15
Q

Knee ligament injury preferred imaging

A

MRI (confirmatory test)

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16
Q

Knee ligament injury treatment

2 routes

A
  1. Conservative treatment
    (for mild knee instability, less physically demanding occupations or sedentary)
  2. Arthroscopic surgery
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17
Q

Mechanism of injury

Direct posterior blow to a flexed knee

A

Posterior cruciate ligament injury

18
Q

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

A

Knee ligament injury

19
Q

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.

A

MCL

Medial joint line tenderness

20
Q

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.

A

LCL

Lateral joint line tenderness

21
Q

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

A

Meniscus tear

22
Q

Meniscus tear imaging/therapy:

imaging modality of choice ___

Both diagnostic and therapeutic ___

A

MRI

Arthroscopy

23
Q

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

A

Osteoarthritis

Baker cyst

24
Q

__ treatment

Indication: open or displaced tibial shaft fractures

25
Patients with tibial fractures should be monitored for 3 major complications: Compartment syndrome Fat embolism ______
Peroneal nerve injury (foot drop)
26
Patients with tibial fractures should be monitored for 3 major complications: ______ ______ Peroneal nerve injury (foot drop)
Compartment syndrome | Fat embolism
27
3-view plain x-ray: anteroposterior (AP); and oblique view | for what structure fracture?
Ankle
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
Achilles tendon rupture *Both conservative and surgical approaches are recommended, but unclear
29
Club foot management
Manual repositioning & serial casting
30
Pes cavus (high-arch) management
orthotics & physiotherapy
31
Metatarsus adductus (in-toeing) management Idiopathic but associated with hip dysplasia
Resolves spontaneously in > 95% of cases within the first 18 months of life
32
Splay (flat) foot can cause: Metatarsalgia Hallux valgus (Juanetes/bunion) _____ Treatment→
Morton neuroma (shooting pain between the 3rd and 4th metatarsal head) Tx: Orthotics
33
A ____ fracture is suggested by local hip pain exacerbated by abduction
greater trochanter
34
A ____ fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip flexion and rotation.
lesser trochanter
35
A lesser trochanter fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip ___ and rotation.
flexion
36
A greater trochanter fracture is suggested by local hip pain exacerbated by [movement].
abduction
37
Most greater/lesser trochanter fractures heal with conservative treatment (non-weightbearing) Surgical repair for displaced fractures (> _cm)
> 1 cm
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.
Posterior hip displacement cx: Sciatic or Peroneal n. dmg
39
Direct blow to the posterior hip or to an abducted leg | results in _____ displacement.
Anterior hip displacement cx: Femoral n. dmg
40
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
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?
Sciatic Nerve (Sural, Fibular nerve branches off) *Commonly caused by posterior hip dislocation
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?
Peroneal n. injury *Commonly caused by fractures of the fibular head external compression (stirrups/casts) or posterior hip dislocation.