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Y5 - T+O > Lower limb anatomy / fractures > Flashcards

Lower limb anatomy / fractures Flashcards

1
Q

where does the femoral artery branch from

A

external iliac

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1
Q

where does the obturator artery branch from

A

internal iliac

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2
Q

what does the femoral nerve (L2-L4) supply

A

hip flexors and knee extensors

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3
Q

what does the obturator nerve (L2-L4) supply

A

medial muscles (the adductors)

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4
Q

nerve roots of sciatic nerve

A

L4-S3

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5
Q

where does the sciatic nerve supply

A

posterior thigh, and all muscles of lower leg and foot (splits into tibial and common perineal)

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6
Q

what is piriformis syndrome

A

where the piriformis muscle compress the sciatic nerve - get radicular pain, numbness and buttock tenderness

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7
Q

femoral shaft fracture damages which nerve / artery

A

femoral

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8
Q

what happens to the proximal segment in a femoral shaft fracture

A

gets pulled into external rotation by gluteus medius and minimus and then flexion by iliopsoas

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9
Q

complications of femoral shaft fracture

A

fat embolism, non union

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10
Q

how would a fat embolism present

A

resp signs (tachycardia, tachypnoea and hypoxia) and petechial rash and confusion

ABG - T1 resp failure
blood film - fat globules
CXR - diffuse bilateral pulmonary infiltrates
CTPA

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11
Q

how do you Tx fat embolism

A

supportive care but do prompt fixation to prevent it occurring

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12
Q

surgery for a femoral shaft fracture

A

IM nail

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13
Q

most common open fracture is

A

phalanx

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14
Q

Ix for tibial shaft fracture

A

full length AP and lateral Xray

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15
Q

MX of tibial shaft fracture

A

reduction and above knee backslab
IM nail

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16
Q

when might you have to do ORIF and plates in a tibial shaft fracture

A

if it is particularly proximal or distal

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17
Q

what causes a tibial plateau fracture (normally lateral)

A

high energy (jumping)

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18
Q

with any fracture what is is essential to assess for and SAY IN EXAM

A

assess for neurovascular problems

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19
Q

high risk of what in a tibial shaft fracture

A

compartment syndrome

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20
Q

if there is an associated fibula fracture with a tibia shaft fracture, what does the level of the fracture indicate

A

high energy will be at the same level and low energy will be at a different level

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21
Q

why would a tibial plateau fracture lead to rapid degenerative changes

A

as there is disruption of the articular surface

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22
Q

main complication of tibial plateau fracture

A

OA

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23
Q

in what direction does the hip normally dislocate

24
how is the hip held in a dislocation
adducted, internally rotated and shortened
25
timeframe to reduce the hip when it is dislocated in order to prevent avascular necrosis s
4 hours
26
what is a hip dislocation normally associated with and why
high energy force so normally has fractures too
27
pain in trochanteric bursitis exacerbated by what (pain typically over GT and will radiate down thigh)
external rotation
28
how to treat trochanteric bursitis
should resolve, advise avoid excessive adduction (crossing legs) and do some gluteal strengthening
29
most common site for a metatarsal stress fracture
2nd
30
damage to which peripheral nerve causes foot drop
common peroneal nerve (supplies anterior and lateral leg)
31
the deep peroneal nerve supplies muscles where
anterior leg
32
the superficial peroneal nerve supplies muscles
lateral leg
33
how is the superficial peroneal nerve normally injured
fracture of the head of the fibula
34
apart from common peroneal nerve injury, what else can cause foot drop
L5 radiculopathy (loss of ankle dorsiflexion)
35
which nerve supplies sensation to the sole of the foot
the tibial (medial plantar, lateral plantar and medial calcaneal)
36
what nerve supplies sensation to the top of the foot
the superficial peroneal, with the deep peroneal supplying the first webspace
37
which imaging modality is best for nerve injuries
MRI
38
what nerves makes up the sural nerve
the common fibular and the tibia nerve (no motor function but sensation to the lateral foot)
39
firstline pain Mx for peripheral nerve injury
NSAID (same as BNF guidance for back pain)
40
Mx of weber A
remain weight bearing in a CAM boot (controlled ankle movement) for 6 weeks
41
advise after hip fracture surgery
patient can immediately fully weight bear
42
compartment syndrome most commonly associated with
tibial shaft fractures and supracondylar fractures
43
what is a buckle fracture
in paeds - get a swelling of the cortex of a longbone due to incomplete fracture where the cortex is not breached, can be tx conservatively
44
what is an initial mx step in compartment syndrome
keep the limb at the level of the heart
45
firstline pain med for back pain
ORAL NSAID!!!
46
what is fat pad atrophy
we have a fat pad under our calcaneus. As we age/obesity/trauma this reduces which causes pain, especially when in bare foot
47
where is Mortons neuroma most likely to affect (pain and sensation of lump)
between third and fourth metatarsal
48
test of Mortons neuroma
pain elicited by deep pressure to intermetatarsal space of mulders click test (where the foot is manipulated)
49
Tx of Mortons neuroma
conservative --> good footwear, activity modification, NSAIDs, steroid injection May do surgery if above does not work
50
first sign of compartment syndrome
parasthesia (pulselessness is a late sign)
51
what is a greenstick fracture
unilateral cortex breach
52
what nerves are responsible for the knee reflex and what is the significance of this
L2/3/4 --> so when one of these nerve routes are compressed --> the knee reflex is affected L5 compression --> nerve root unaffected
53
when is VTE prophylaxis with LMWH started post surgery
after 6 hours
54
signs of avascular necrosis on Xray
flattening of the femoral head and crescent sign
55
pressure over what is diagnostic of compartment syndrome
40mmHg
56
Mx of compartment syndrome
1) fasciotomy 2) IV fluid resus as fasciotomy releases myoglobin --> AKI 3) if necrotic --> debride and amputate
57
for a flare of RA what is recommended
1) intraarticular steroids 2) IM or PO steroids

Y5 - T+O (11 decks)

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