Lower Limb Fractures ☺️ Flashcards
Femoral neck fracture
- common in
- presentation
- Xray findings
- classification of femoral neck fractures = why is this important?
Common in - osteoporotic elderly female
Pain
Short, externally rotated leg
Can/cannot weight bear
Disrupted Shentons line
Garden system
-3 and 4 have the greatest risk of AVN
Femoral neck fracture Management of intracapsular fractures -undisplaced -displaced Management of extracapsular fractures -intertrochanteric -subtrochanteric
Displaced intracapsular
THR - independent, cognitively sound, surgically fit
Hemi - if not suitable for THR
Undisplaced intracapsular
DHS - young, fit
Hemi - if not suitable
Extracapsular intertrochanteric - DHS
Subtrochanteric - intramedullary nail
Hip dislocation
- presentation
- management
- complications
Posterior dislocation most common - short, internally rotated adducted leg
Initial - ABCDE, analgesia
Definitive - GA reduction
Supportive - physio
Sciatic nerve injury
AVN
OA
Femoral shaft fracture
- common in
- presentation
- key examinations
- management
- complications
High energy - young, RTAs
Low energy - elderly, osteoporotic falls
Severe pain, cannot weight bear
Short leg
CHECK NEUROVASCULAR STATUS BEFORE AND AFTER EVERY INTERVENTION
Initial - ABCDE, analgesia, fluids, G&S for blood loss
Definitive - traction splint and ortho referral
Neurovascular injury
Fat embolism => retinal hemorrhages
Major hemorrhage
Tibial/fibular shaft fracture
- key examinations
- management
- complications
Common peroneal nerve injury
Compartment syndrome
Closed, undisplaced - above knee cast => patella tendon bearing cast
Closed, displaced/comminuted => ORIF
Open => debride + ORIF
Compartment syndrome
Foot drop
Management of any open fracture
EMERGENCY
Debride within 6hrs of injury
IV ABx
Avoid internal fixation
Talar fracture
- cause
- presentation
- investigations
- management
- complications
High energy trauma
Pain, swelling, bruising
Can’t walk/weight bear
Xray
Stable - cast
Unstable - ORIF
High AVN risk
Ankle sprains
- cause
- presentation
- investigations
- management
Ligament damage often from inversion injury
MOST COMMON ATFL
-pain, swelling, tenderness, bruising
-weight bearing may be possible
Xray
PRICE
-if symptoms don’t settle/joint instability => surgery
Ottawa knee rules
-when would you Xray
Ottawa ankle rules
-when would you Xray?
Age 55+ Isolated tender patella Tender fibula head Can't flex knee to 90 Can't weight bear immediately and in RD
Malleolar pain +
- bony tenderrness in malleolar zone
- can’t weight bear immediately and in ED
Lisfranc fracture
- pathophysiology
- common cause
- presentation
- management
Lisfranc fracture - Lisfranc ligament torn => widened joint space between mid and forefoot on weight bearing Xray
Pain, swelling, bruising in midfoot
Weight bearing difficult hard
Non surgical - immobilisation
Surgical repair
Physio
Jones fracture
- location
- mechanism of injury
- presentation
- importance of recognising this fracture
- management
Transverse fracture at metaphysis diaphysis junction at base of 4th, 5th metatarsal
Acute - rolling over ankle
Stress - repetitive high impact on lateral foot from overuse
Lateral metatarsal pain and swelling
Difficulty walking
High non union risk
Management
- non surgical - non weightbearing cast
- surgical - if displaced or not healing well
General assessment for limb injuries
Mechanism of injury
Xray joint, above and below for bony injury
MRI joint for ligament, soft tissue injury
Assess neurovasculature Analgesia Fluids especially in femoral fractures WATCH OUT FOR COMPARTMENT SYNDROME Refer to ortho if in doubt
Meniscal and cruciate injuries
- MOI
- signs, investigations
- management
Twisting injury
Meniscal tears - knee locks, clicks, gives way, restricted range of mv
-positive McMurray
Cruciate - ACL most common => popping
-positive Lachman, anterior drawer
MRI - image soft tissues
Conservative - PRICE, physio
-if severe, surgical repair
Ankle fracture
-classification and management
Weber A, B - cast
-fibular break under/at the joint line
Weber C - ORIF
-fibular break above the joint line
