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C. Year 3 MLA Muscoskeletal Conditions > Lower Limb Fractures > Flashcards

Lower Limb Fractures Flashcards

1
Q

Are males or females more likely to suffer from a lower limb fracture?

A
  • males
  • 2:1 ratio
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2
Q

Which 2 bones makes up 80% of all lower limb fractures?

1 - femur
2 - patella
3 - fibula
4 - tibia

A

1 - femur
4 - tibia

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3
Q

What % of all lower limb fractures are of the hip?

1 - 4%
2 - 24%
3 - 40%
4 - 80%

A

3 - 40%

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4
Q

What is the most common cause of a lower limb fracture in younger groups?

RTC = road traffic accident

1 - RTC or high energy trauma
2 - falls
3 - pathological infection
4 - blunt trauma

A

1 - RTC or high energy trauma

  • for a pelvic open book fracture, this would require high velocity trauma
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5
Q

What is an acute major risk in a patient who experiences a high velocity accident and has a open book pelvic fracture or a severe fracture of the pelvis?

1 - increased risk of RA
2 - amputation
3 - infection
4 - haemorrhage

A

4 - haemorrhage

  • immediate treatment is to stop the bleeding and fix pelvis with external fixator
  • also cause multiple organ damage
  • in males 20% suffer urethral damage
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6
Q

In older patients, low energy falls are more common. All of the following are common EXCEPT which one?

1 - neck of femur
2 - pubic rami
3 - distal femur
4 - patella
5 - tibial plateau
6 - distal tibia

A

4 - patella

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7
Q

Which condition carries the highest risk of neck of femur fractures?

1 - hypertension
2 - dementia
3 - PE
4 - diabetes

A

2 - dementia

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8
Q

How many neck of femur fractures occur each year?

1 - 760
2 - 7600
3 - 76,000
4 - 760,000

A

3 - 76,000

  • indicator of frailty
  • 25% from care homes
  • 20% admitted from home are unable to return home
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9
Q

What is the 30 day mortality of a neck of femur fracture?

1 - 0.65%
2 - 6.5%
3 - 16.5%
4 - 36.5%

A

2 - 6.5%

  • 12 month mortality raises to 33%
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10
Q

If a patient presents with a neck of femur fracture, all of the following may be present, EXCEPT which one?

1 - severe pain
2 - able to weight bear
3 - unable to straight leg raise
4 - lower limb adopts an externally rotated and shortened position

A

2 - able to weight bear

  • not possible due to severe pain
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11
Q

When assessing a patient with a suspected neck of femur fracture, we normally perform a plain X-ray with 2 views. However, if the fracture is still unclear what can we do?

1 - ultrasound
2 - CT
3 - MRI
4 - PET scan

A

2 - CT

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12
Q

What is the definition of a intracapsular neck of femur fracture?

1 - between greater and lesser trochanter
2 - above the intertrochanteric line
3 - below the lesser trochanter

A

2 - above the intertrochanteric line

  • extracapsular are those that occur outside the capsule of the internal joint
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13
Q

Are intracapsular or extracapsular neck of femur fractures more likely to disrupt blood flow to the femoral head?

A
  • intracapsular
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14
Q

Which blood vessels provides that main blood flow to the head of the femur, and can be damaged during a intracapsular neck of femur fracture?

1 - femoral artery
2 - obturator artery
3 - lateral and medial circumflex arteries
4 - superficial iliac artery

A

3 - lateral and medial circumflex arteries

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15
Q

What are the 2 treatment options for a intracapsular neck of femur fracture?

1 - total hip arthroplasty
2 - extramedullary fixation
3 - hemiarthroplasty
4 - intramedullary fixation

A

1 - total hip arthroplasty
- acetabulum, head and neck of femur replaced

3 - hemiarthroplasty
- acetabulum remains
- head and neck of femur replaced

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16
Q

What are the 2 treatment options for a intercapsular neck of femur fracture?

1 - total hip arthroplasty
2 - extramedullary fixation
3 - hemiarthroplasty
4 - intramedullary fixation

A

2 - extramedullary fixation
4 - intramedullary fixation

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17
Q

Which of the following is NOT an immediate complication of neck of femur fractures?

1 - PE
2 - fat embolism
3 - cerebral vascular accident
4 - MI
5 - bleeding
6 - nerve injury
7 - amputation

A

7 - amputation

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18
Q

Which of the following is NOT an early complication of neck of femur fractures?

1 - PE
2 - DVT
3 -UTI
4 - sepsis
5 - wound infection
6 - dislocation
7 - haematoma

A

4 - sepsis

19
Q

Which of the following is NOT an late complication of neck of femur fractures?

1 - PE
2 - infection
3 - dislocation
4 - implant failure
5 - non-union pain
6 - physiological decline

A

1 - PE

20
Q

Patella fractures are most commonly caused by a direct blow to the knee, and can be displaced or undisplaced. What is a clinical sign often used to diagnose a patella fracture?

1 - pain in foot
2 - deferred pain in the hip
3 - cachexia
4 - inability to perform straight leg raise

A

4 - inability to perform straight leg raise

  • normally treated with splint or surgery depending on the severity
21
Q

What are the most common cause of a tibial shaft fracture?

1 - twisting injury
2 - pathological fracture
3 - direct impact
4 - heavy landing

A

1 - twisting injury
3 - direct impact

  • these are more common that femur shaft fractures
22
Q

Are tibial fractures likely to cause a compound fracture (break in the skin)?

A
  • yes
  • due to close proximity of the tibia and skin
23
Q

What is the most common conservative management for a patient with a tibial shaft fracture?

1 - analgesia only
2 - splint and analgesia
3 - plaster of Paris
4 - external fixation

A

3 - plaster of Paris

  • normally above the knee for a long period
  • no risk of infection as skin is not broken
24
Q

The most common surgical management for a patient with a tibial shaft fracture is external fixation or intramedullary nail. Which of the following is generally LEAST likely risk factor for this type of surgery?

1 - infection
2 - compartment syndrome
3 - DVT
4 - sepsis

A

4 - sepsis

25
Q

What type of movement normally causes an ankle fracture?

1 - twisting
2 - inversion
3 - eversion
4 - hyper-plantarflexion

A

1 - twisting

26
Q

The malleolus are the end of the bones that resemble a hammerhead, as per the image here. Ankle fractures are typically uni, bi or trimalleolar. The ankle mortise is what determines ankle stability. Which bones make up the ankle mortise?

1 - tibia and fibula
2 - tibia and calcaneus
3 - tibia, fibula and talus
4 - talus and tibia

A

3 - tibia, fibula and talus

  • LM = lateral malleolus
  • MM = medial malleolus
  • if ankle mortis intact and stable = conservative management in boot or cast
  • if ankle mortis not intact or unstable then use open reduction or internal fixation
27
Q

What type of movement normally causes an foot fracture?

1 - twisting
2 - inversion
3 - eversion
4 - hyper-plantarflexion

A

1 - twisting

28
Q

What is the most common place fracture in the foot?

1 - 1st metatarsal
2 - 5th metatarsal
3 - 5th distal phalange
4 - 1st distal phalange

A

2 - 5th metatarsal

  • caused by fibularis brevis pulling causing an avulsion fracture
29
Q

The most common place for a fracture in the foot is the 5th metatarsal. This is typically caused by twisting and where the fibularis brevis pulls the 5th metatarsal, causing an avulsion fracture. Most of these fractures can be managed conservatively, except which one of these:

1 - intra-articular disruption
2 - severe pain in the patient
3 - extensive inversion
4 - patient is >65 y/o

A

1 - intra-articular disruption

  • if this occurs, there is a risk of avascular necrosis and/or much slower healing time.
  • nutrient artery is impaired
  • also known as a Jones type fracture
30
Q

What is a lisfranc injury?

1 - disruption between base of 5th metatarsal and lateral cuneiform
2 - disruption between base of 1st metatarsal and medial cuneiform
3 - disruption between base of 3th metatarsal and lateral cuneiform
4 - disruption between base of 5th metatarsal and medial cuneiform

A

4 - disruption between base of 5th metatarsal and medial cuneiform

  • generally see a widening of the gap between the 1st and 2nd metatarsal
31
Q

A lisfranc injury is disruption between base of 5th metatarsal and medial cuneiform following trauma. We can generally see a widening of the gap between the 1st and 2nd metatarsal. Which 2 treatment options are generally performed on a lisfranc injury?

1 - analgesia only
2 - arthrodesis
3 - plaster of Paris
4 - open reduction/ internal fixation

A

2 - arthrodesis
- fixation of 2 bones

4 - open reduction/ internal fixation

32
Q

When considering a fracture, we have to be careful comparing adults with children. What extra part do we typically see in children that might look like a fracture, but is a growth plate?

1 - epiphysis
2 - metaphysis
3 - diaphysis
4 - physis

A

4 - physis

33
Q

When considering adult vs paediatric bones, which has the higher cartilaginous component?

A
  • paediatrics
  • cartilage is what goes on to form bone
  • cortical bone is also more porous than adults
34
Q

Why must we be careful in fractures where the left of injury does not match the description in children?

1 - patient may be more severely injured than expected
2 - internal bleeding
3 - unknown pathology
4 - safeguarding issue

A

4 - safeguarding issue

  • parents/carer may be to blame for injury
35
Q

Why are growth plate fractures in children more important than fractures in adults?

1 - higher risk of bleeding
2 - higher risk of neuro damage
3 - risk of abnormal fgrowth
4 - risk of amputation

A

3 - risk of abnormal growth

36
Q

What is the name the the categories used to identify the type of fracture at the growth plates in a child?

1 - modified glasgow scale
2 - salter-harris scale
3 - CURB scale
4 - WELLS scale

A

2 - salter-harris scale

37
Q

What is a torus fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

A

1 - involves only one cortex of bone

  • cortex refers to the hard outer layer of bones
38
Q

What is a greenstick fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

A

2 - involves both cortices but one is still intact

39
Q

What is a plastic deformation fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

A

3 - bone bends and is deformed like a plastic bone

40
Q

What % of fractures in children <1 y/o are due to non-accidental injury?

1 - 5%
2 - 25%
3 - 50%
4 - 75%

A

3 - 50%

  • 2nd most common cause of death in children
41
Q

90% of fractures are due to abuse in children under what age?

1 - <1 y/o
2 - <5 y/o
3 - <10 y/o
4 - <15 y/o

A

2 - <5 y/o

  • if underreported there is a 30-50% change of further abuse
  • 5-10% change of death from abuse
42
Q

All of the following fractures can occur through non-accidental injury, but which is the most common?

1 - humerus
2 - tibia
3 - femur
4 - ribs

A

1 - humerus

43
Q

If we suspect a safeguasrding issue, who should we get involved in the care and management of a child?

1 - senior nurse on department
2 - crash team
3 - pediatric and safeguarding team
4 - consultant on call

A

3 - pediatric and safeguarding team

C. Year 3 MLA Muscoskeletal Conditions (10 decks)

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