Lower Limb Fractures Flashcards
Two main types of fractures of the hip?
Intracapsular - Displaced (disruption to blood supple, often needs replaced.) and non-displaced (no disruption, can preserve bone).
extracapsular
Presentation of hip fractures?
Pain,
Shortened and externally rotated leg.
May be able to weight bear if non-displaced or incomplete neck fracture.
Classification of hip fractures?
Garden system:
Type I - stable fracture
Type II - Complete fracture but undisplaced.
Type III - Displaced fracture
Type IV - Complete boney disruption.
Blood supply disruption is most common in types III and IV.
Management of intracapsular hip fracture?
Undisplaced - internal fixation or hemiarthroplast if unfit.
Displaced fracture - All get arthroplasty!! Hemiarthroplasty if older patient. Total hip replacement if medically fit
Features of pelvic fractures?
Often high energy incidents however in the elderly population this can be caused by fall from standing.
Presentation - Obvious deformity or hypovolaemia,
Ix - AP, inlet and outlet view X-rays (often CT in trauma)
Classification - Young and Burgess classification or tile classification
Rx - pelvic binder and then fixation.
Complications - Urological injury, venous VTE and long standing pelvic pain
Features of Hip dislocations?
Types: Posterior (leg is shortened, adducted and internally rotated), anterior dislocation (abducted and externally rotated) or central dislocation.
Rx - reduction under GA within 4 hours.
Complications - Sciatic or femoral nerve injury. AVN, OA or recurrent dislocation.
Features of Knee dislocations?
Emergency which can be seen following RTA/sports injury.
High risk of damage to popliteal artery.
Needs urgent reduction and splinting, angiogram and potentially multiple ligament reconstruction.
Features of femur fractures?
Risk of haemorrhage into thigh and risk of fat embolus.
Emergency - reduce and splint (Thomas-type splint), reduces fracture movement, bleeding, damage to nerves and improves pain
Surgical management - Allows early weight bearing, often plates are used.
Features of tibial plateau fracture?
Presentation - Sudden onset pain, unable to weight-bear and swelling of knee.
Ix - plain radiographs
Classification - Schatzker classification.
Must reconstruct joint to reduce risk of OA
Features of tibial shaft fractures
Most common long bone to be fractures.
Often occurs after twisting injuries or direct blows.
Should be realigned asap.
If undisplaced then treat with cast.
If displaced then surgical fixation.
Risk of compartment syndrome
Indications for ankle X-ray for suspected fracture? (ottawa rules)
- Bony tenderness at lateral malleolar zone (Includes 6cm of lower fibula)
- Bony tenderness at medial malleolar zone (includes 6cm of lower tibia)
- Inability to walk 4 weight bearing steps immediately after injury and in A&E.
Features of hindfoot fractures?
Calcaneus fracture - Fall from height, involves subtalar joint and has significant swelling.
Talus fracture - Often RTA. Risk of AVN if displaced and may require fixation.
Features of forefoot fractures?
Most metatarsal fractures can be managed conservatively.
Pitfall is Lisfranc fracture - dislocation between tarsal bones and base of metatarsals.
