Lower Limb Fractures Flashcards
Femoral neck epidemiology
White elderly females
Low energy falls
Intra capsular -> head necrosis
25-30% 1 year mortality
Femoral neck clinical features
Groin and hip pain
May be referred down the leg
Leg shorter, exert ally rotated and abducted
Femoral neck investigations
X Ray
CT for displacement
Femoral neck management
Conservative
-observation-> non wt bearing
Surgery
- ORIF-> displaced and young
- screw-> old
Femoral neck complications
Femoral shaft #
Osteonecrosis
Non Union
Intertrochanteric epidemiology
Females, older than femoral neck
Low energy
20-30% mortality in 1y
Extra capsular
Intertrochanteric clinical features
Pain
Shorter and externally rotated
Intertrochanteric investigations
X Ray
Ct if suspicious
Intertrochanteric management
Conservative
-non wt bearing in to chair-> non ambulatory / old
Surgery
- compression screw-> stable
- intermediary -> unstable
Intertrochanteric complications
Implant failure
Non Union
Malunion
Patellar epidemiology
1% of skeletal injuries Direct impact or eccentric contraction Males 20-50y 8% of pop have bipartate patellar Blood supply from inferior pole
Patellar clinical features
Palpable defect
Haemarthrosis
Unable to perform straight leg raise
Patellar investigations
X Ray
Avulsion
Fat pad signs
Patellar management
Conservative
- knee immobilisation in extension, full wt bearing
- > intact extensor a
- > minimal displacement
Surgery
- ORIF with tension band
- > open
- > displaced
Patellar complications
Weakness and ant knee pain Symptomatic implant Loss of reduction Non Union Proximal osteonecrosis Stiff Infection
Tibial shaft epidemiology
Most common long bone #
Low energy torsional
High energy direct force
Tibial shaft clinical features
Pain
Can’t wt bear
Deformity
Tibial shaft investigations
Full length AP
Knee and angle
Tibial shaft management
Conservative
-reduction and cast-> closed and aligned
Surgery
-ORIF-> open
Tibial shaft complications
Soft tissue injury Compartment syndrome Bone loss Multiple # Knee pain with nailing Malunion Non Union Malformation Peroneal nerve injury
Ankle classification
Uni/bi/tri maleolar
Weber for fibula
Ankle investigations
X Ray
Stress radiograph for ligs
Tibial shaft ankle management
Conservative
-short leg walking cast/boot-> isolated and minimal displacement
Surgery
-ORIF-> e/displaced
Metatarsal epidemiology
5th metatarsal most common
2nd -5th decade
Fixed forefoot with hind foot rotation
