Lower Limb Clinical Flashcards
Which way does the femoral head tend to dislocate?
Posterior - head of femur pushed back wars in something like an RTA.
The leg appears short and medially rotated
What happens in a congenital hip dislocation?
Femoral head does not locate fully in the acetabulum- the limb looks shorter and they cannot abduct the affected leg.
Where is a transcervical femoral fracture?
Shaft
What is an important feature that should be identified on Xray when looking at femoral fractures and why is it important?
Intra or extracapsular fracture
Intracapsular risks avascular necorsis as the medial circumflex artery may be damaged.
What is the most common site for a compound fracture?
Tibial shaft- superficial and has a poor blood supply
A fibula fracture is often linked with what other injury?
ankle dislocation
What causes fibula fractures?
Excessive inversion
If a patient falls from a height on to their feet- which bone in the foot could be fractured?
calcaneus
Extreme dorsiflexion may fracture which bone?
talus
Which muscle may avulse the tuberosity of the 5th metatarsal on sudden inversion?
Fibularis brevis
What is compartment syndrome and how is it treated?
Pressure building up with in the fascial compartment of a leg due to inflammation or haemorrhage. The pressure build up compresses neuromuscular structures making distal limb ischaemic- evidenced by temp drop or loss of pulse in the distal limb.
Fasciotomy
Which nerve block is performed 2cm inferior to the inaugural ligament and which spinal roots does it effect?
Femoral nerve L2-L4
Why does the proximal fragment of a patella fracture move cranially?
Action of quadriceps
How do you locate the femoral artery?
Midways between ASIS and the pubic symphysis
Outline the pathogenesis of a femoral hernia.
The femoral ring is a weakness in the absdominal wall which may permit a small protrusion of bowel. Its normally encased here between the femoral vein and lacunar ligament. But in advance cases it may pass through Saphenous opening of tensor fascialata
What is a trendelenburg sign?
If the superior gluteal nerve is injured when you stand on that leg the contralateral pelvis drops.
What would happen if an gluteal IM injection was given in the wrong place and damaged a nerve (the nerve we worry about in this procedure)?
Sciatic nerve damaged
- hip extension lost
- leg flexion lost
- ankle movements lost
How do we decide where is safe for IM intragluteal injection.
Index finger on ASIS spread fingers out along iliac crest. Middle finger will feel the tubercle then between first and middle finger is safe.
How might the tibial nerve be damaged and what would happen?
Deep populate fossa laceration- uncommon.
Muscles in the back of the leg lost.
flexion of the leg, plantar flexion and ankle inversion are all lost.
Sole of the foot loses sensation.
A pedestrian is hit on the side of the knee by a car and comes to A+E with a plantar flexed inverted foot- what is this and why has it happened?
Foot drop
Common fibular nerve damaged as it curves round the fibular neck.
Loss of dorsi-fexion and eversion of the ankle.
Sensation will be lost anterolateral leg and dorm of foot
What gaits may result from a common fibular nerve injury?
High stoppage gait
Waddling gait
Swing out gait
Which nerve supplies the web space between toe 1 and 2?
Deep fibular
A 40 year old man decides he would like to get fit and joins a rugby club. He runs in to make a tackle and there is an audible snap as he pushes off he is back foot. He then falls to the ground clenching his leg. What injury may he have suffered and how would you test for it?
Calcaneal tendon rupture
Squeeze calf when the knee is flexed on a chair and the foot should plantar flex if the tendon has good continuation
Which two foot pulses can we check?
Posterior tibial artery behind the medial malleolus Dosalis Pedis (a continuation of the anterior tibial artery) pulse between the tendon of extensor hellucis longs and extensor digitorum longus
