Lower Limb Fractures

Question 1

Femoral neck epidemiology

Answer 1

White elderly females
Low energy falls
Intra capsular -> head necrosis
25-30% 1 year mortality

Question 2

Femoral neck clinical features

Answer 2

Groin and hip pain
May be referred down the leg
Leg shorter, exert ally rotated and abducted

Question 3

Femoral neck investigations

Answer 3

X Ray

CT for displacement

Question 4

Femoral neck management

Answer 4

Conservative
-observation-> non wt bearing

Surgery

• ORIF-> displaced and young
• screw-> old

Question 5

Femoral neck complications

Answer 5

Femoral shaft #
Osteonecrosis
Non Union

Question 6

Intertrochanteric epidemiology

Answer 6

Females, older than femoral neck
Low energy
20-30% mortality in 1y
Extra capsular

Question 7

Intertrochanteric clinical features

Answer 7

Pain

Shorter and externally rotated

Question 8

Intertrochanteric investigations

Answer 8

X Ray

Ct if suspicious

Question 9

Intertrochanteric management

Answer 9

Conservative
-non wt bearing in to chair-> non ambulatory / old

Surgery

• compression screw-> stable
• intermediary -> unstable

Question 10

Intertrochanteric complications

Answer 10

Implant failure
Non Union
Malunion

Question 11

Patellar epidemiology

Answer 11

1% of skeletal injuries
Direct impact or eccentric contraction 
Males 20-50y
8% of pop have bipartate patellar 
Blood supply from inferior pole

Question 12

Patellar clinical features

Answer 12

Palpable defect
Haemarthrosis
Unable to perform straight leg raise

Question 13

Patellar investigations

Answer 13

X Ray
Avulsion
Fat pad signs

Question 14

Patellar management

Answer 14

Conservative

• knee immobilisation in extension, full wt bearing
• > intact extensor a
• > minimal displacement

Surgery

• ORIF with tension band
• > open
• > displaced

Question 15

Patellar complications

Answer 15

Weakness and ant knee pain
Symptomatic implant
Loss of reduction 
Non Union 
Proximal osteonecrosis 
Stiff
Infection

Question 16

Tibial shaft epidemiology

Answer 16

Most common long bone #
Low energy torsional
High energy direct force

Question 17

Tibial shaft clinical features

Answer 17

Pain
Can’t wt bear
Deformity

Question 18

Tibial shaft investigations

Answer 18

Full length AP

Knee and angle

Question 19

Tibial shaft management

Answer 19

Conservative
-reduction and cast-> closed and aligned

Surgery
-ORIF-> open

Question 20

Tibial shaft complications

Answer 20

Soft tissue injury 
Compartment syndrome
Bone loss
Multiple #
Knee pain with nailing
Malunion
Non Union
Malformation
Peroneal nerve injury

Question 21

Ankle classification

Answer 21

Uni/bi/tri maleolar

Weber for fibula

Question 22

Ankle investigations

Answer 22

X Ray

Stress radiograph for ligs

Question 23

Tibial shaft ankle management

Answer 23

Conservative
-short leg walking cast/boot-> isolated and minimal displacement

Surgery
-ORIF-> e/displaced

Question 24

Metatarsal epidemiology

Answer 24

5th metatarsal most common
2nd -5th decade
Fixed forefoot with hind foot rotation

Question 25

Metatarsal clinical features

Answer 25

Pain
Inability to bear wt
Localised tenderness

Question 26

Metatarsal investigations

Answer 26

X Ray

Question 27

Metatarsal management

Answer 27

Conservative
-Stiff soled shoe/boot wt bear as tolerated -> isolated and non displaced

Surgery
-ORIF

Question 28

Metatarsal complications

Answer 28

Malunion
Metatarsalgia
Plantar keratosis