Lower Leg Fractures Flashcards
distal femoral fracture
usually osteoperotic bone with fall onto flexed knee
can be extra articular (supracondylar) or intra articular (intercondylar)
usually fixed with a plate and screws as fracture position is difficult to maintain in cast
proximal tibial fracture
intra-articular
associated neurovascular injury and compartment syndrome
often due to valgus stress - lateral tibial plateau fracture
if they are high energy there is often substantial soft tissue damage
CT to determine fracture personality
ORIF (plates and screws)
disappointing surgery results - post-traumatic OA, and subsequent TKR
how is fracture with substantial soft tissue damage managed
external fixator spanning the joint for inital stability while swelling resolves
then definitive ORIF
tibial shaft fracture
Tibial shaft fractures usually occur with indirect force and either bending (transverse fracture) or rotational energy (spiral fracture), compressive force from deceleration (oblique fracture), a combination of these forces or from high energy injuries (comminuted fracture).
open fractures not uncommon due to tibial shaft being subcutaenous
what is the most common cause of compartment syndrome after trauma
tibial shaft fracture
non operative treatment of tibial shaft fractures
up to 50% displacement and 5 angulation can be tolerated with conservative management. any internal rotation is poorly tolerated
frequent cast changes and x rays
what happens to the position of the tibia if the fibula is not fractured after tibial shaft fractures
fibula not fractured - tibia drifts into varus
fibula fractured - tibia drifts into valgus
operative treatment of tibial shaft fractures
tibia is one of the slowest healing bones (16 weeks). several healing techniques - no single best.
internal fixation using IM nails - control fracture position and remove need for cast
what is not tolerated by the tibia
internal rotation
extra articular distal tibial fracture in acceptable position
treat conservatively
intra articular distal tibial fracture
Pilon fracture
usually high energy - check for other injuries
surgical emergency - ORIF
if there is significant soft tissue damage, externally fixate until soft tissue swelling settles
what investigation is best for Pilon fractures
CT
what does the Ottawa criteria describe
used to identify suspected ankle fracture and give guidance on use of x rays
basically if there is bony tenderness x ray or inability to bear weight - x ray
isolated distal fibular fracture treatment
stable - treat conservatively
walking cast/splint for around 6 weeks
distal tibial fracture/rupture of deltoid ligament
unstable
ORIF
what does talar shift/tilt imply
that deltoid ligament must be ruptured
risk of post traumatic OA
- anatomic reduction and rigid fixation reqired to minimise talar shift
bimalleolar fractures
- Pott’s
- unstable and can cause talar shift
- ORIF
midfoot fracture
Lisfranc fracture
fracture at base of 2nd metatarsal is associated with dislocation at base of it with/out dislocation of other metatarsals
typically a swollen, bruised foot which is unable to be weight born on
easily missed on x ray - if clinical suspicion get X ray
ORIF recommended
metatarsal fracture
5th commonly
- due to inversion with avulsion at insertion of fibularis brevis. heal well: cast, bandage or stout boot
1st uncommon, but important so fixture is recommended
2nd - common for stress fracture
- may not appear on x ray until callus formed, bone scan can aid diagnosis. Apply cast
toe fractures
usually do nothing - stout boot?
intra articular at base of proximal halanx of hallux may benefit from reduction and fixation
open - debride
dislocated - strap to neighbour
what movement are tibial shaft fractures assoicated with
twisting
what movement are distal tibial fractures associated with
sudden deceleration after fall from height
fall onto flexed knee
distal femoral fracture
calcaneal fractures
- fall from height onto heel
- can cause compartment syndrome
- manage with ORIF
