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Orthopaedics > lower limb fractures and dislocations > Flashcards

lower limb fractures and dislocations Flashcards

1
Q

most common proximal femoral fracture

A

typically intracapsujlar neck of femur fracture

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2
Q

who is at risk of a NOF

A

can be caused by relatively minor trauma in elderly (osteoporosis)

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3
Q

features of NOF 3

A

pain

shortened and externally rotated leg

may be able to walk with difficulty

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4
Q

define intracapsula nof

A

occur just below femoral head to the insertion of the capsule of the hip joint

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5
Q

types of intracapsular nof 3

A

subcapital (commonest)

transcervical

basicervical

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6
Q

what is the risk with intracapsular nof

A

higher incidence of avasuclar necrosis

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7
Q

manageemtn of intracapsular nof 4

A

minimal displacement- internal fixation in situ
-if major illness-> hemiarthoplasty

displaced fracture
-if <70yo and fit-> reduction and internal fixation
-if older and reduced mobility- hemiartho or THR

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8
Q

what is the primary blood supply for the femoral head

A

retinacular arteries from the medial and lateral femoral circumflex arteries
-arises from profunda femoris artery

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9
Q

what increases risk of avascular necrosis in a nof

A

if intracapsular nof and sufe (slipped upper femoral epiphysis)

risk of AVN <10% if undisplaced
- >80% if displaced

SURGERY SHOULD BE PERFORMED ON DAY OR DAY AFTER ADMISSION

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10
Q

describe the gardner classification for intracapsular femoral neck fractures

A

Correlates with prognosis
-Key is to differentiate between undisplaced (I & II) & displaced (III & IV)

I = Stable fracture with inferior cortex intact
II = Complete undisplaced # through the neck
III = Complete neck # with partial displacement
IV = Fully displaced #

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11
Q

where is an extracapsular nof defined

A

between insertion of hip joint capsule and 5cm below the lesser trochanter

*-blood supply is not interrupted so risk of ANV is rarer

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12
Q

types of extracapsular nof 2

A

trochanteric

subtrochanteric

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13
Q

management of extracapsular nof

A

dynamic hip screw

subtrochanteric hip fracture
-intramedullary hip screw

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14
Q

overview of complications with femoral shaft fracture 4

A

requires considerable force so look for other injuries

500-1500ml of blood lost in a simple fracture

check distal pulses for possible femoraly artery damage

sciatic nerve injury may occur

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15
Q

treatment of femoral shaft fracture 3

A

stabilise patient in ED and traction with a thomas splint

fluid resuscitate if needed

definitive treatment is with a locked intramedullary nail
-allows early mobilisation

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16
Q

main cause of hip dislocation

A

mostly by direct trauma like RTA

-extremely painful

-may be associated with other fractures and life threatening injuries

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17
Q

diagnosis of hip dislocation

A

prompt diagnosis and approparte managemnt important to reduce morbidity

early MRI diagnosis may prevent later equinus foot defmoritiy

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18
Q

types of hip dislocation

A

posterior - most common 90%

anterior

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19
Q

presenation of posterior hip dislocation 2

A

affected leg is shortened, adducted and internally rotated

femoral head can be felt in buttock

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20
Q

presentation of anterior hip dislocation 2

A

usually abducted and externally rotated

NO leg shortening

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21
Q

managemnt of hip dislocation 5

A

ABCDE approach

analgesia

reduction under GA within 4hrs to reduce risk of AVN

traction for three weeks promotes joint capsule healing

physio long term

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22
Q

define distal femoral and proximal tibial fractures

A

divided into extra and intra articular fractures

23
Q

important point about distal femoral and proximal tibial fractures intracapsual

A

intracapsualar fractrues require fixation with an anatomically contoured locking plate

24
Q

overview of tibial plateau fracture

A

all intra-articular and difficult to treat

have a schaztzker classification system

non-operative treatment in the elderly

internal fixation to restore articular surface and minimise later OA

hinged cast braces locked in extension can reduce risk of chronic flexure contraction

25
Q

cause of patellar dislocation 1

A

most commonly a primary traumatic event
-direct trauma

26
Q

movement that causes patellar dislocation

A

severe contraction of quadriceps with knee strechted in valgus and external rotation

typically lateral dislocation
-flexed knee with lateral deformity

27
Q

risk factors for patellar dislocation 3

A

genu valgum

tibial torsion

high riding patella

28
Q

imaging in patellar dislocation 1

A

skyline XR of patella are needed
-can be clinically obvious

29
Q

treatment of patellar dislocation 4

A

reduction with firm medial pressure while extending the knee

post reduction XR to check for patellar fracture

period of immobilization in cast/ splint

rehab w quad strengthening exercise

30
Q

define stable and unstable ankle fractures

A

stable- only involve one side of the ankle
-Wever A/B

unstable-he ankle joint itself is displaced or can be displaced when it is subject to normal forces

31
Q

management of stable or minimally displaced ankle fracture

A

stable or minimally displaced fractures may be treated non-operatively in a cast

32
Q

management of unstable or displaced fractures

A

require surgery
-compression plate

33
Q

how does the weber classification for ankle fracture work

A

defines ankle fractures by the level of fibula fracture relative to the tibiofibular syndesmosis

34
Q

define weber type A

A

below the syndesmosis

35
Q

define weber type B

A

fractures start at level of the syndemosis

36
Q

define weber type C

A

above the syndesmosis

37
Q

when is an ankle XR only required in a suspected fracture 4

A

any pain in the malleolar zone & any of the following:
-bony tenderness at lateral malleolar zone
-bone tenderness at medial malleloar zone
-inability to weight-bear (immediately after injury & in ED)

38
Q

define a maisonneuve fracture 3

A

proximal spiral fibula fracture with syndesmosiss rupture
-medial malleous fracture or deltoid ligament rupture

always examine proximal fibula with ‘ankle sprains’

treatment is surgical as fractures are unstable and require fixation to restore ankle mortise

39
Q

define a lisfranc fracture dislocation at 1st tarsometatarsal joint

A

commonly missed fracture in multitrauma patients

can occur by stepping awkwardly off kerb

can cause compartment syndrome of medial foot
-later arthritis and perisitnet pain

On foot XR look for widening of the gap between medial cuneiform & base of 2nd metatarsal
-MRI gives better view
-Treat with precise anatomic reduction with screw fixation across 2nd metatarsal joint
-Lisfranc joint

40
Q

define fracture neck of talus

A

can occur after forced dorsiflexion

serious injury because interripton of vessels may lead to AVN of talus body

displaced fractures require ORIF

41
Q

define calcaneus fracture

A

often bilateral

known as lovers fracture (cheater jumping out the window)

frequently poor outcome

ALWAYS look for assoc spinal fracture

signs included sweling, bruising and inability to weight bear

42
Q

define 2nd metatarsal fracture

A

look for lisfranc dislocations

usually heals well with non-operative cast and weightbearing as pain allows

43
Q

define 5th metatarsal fracture

A

proximal avulsion fracture typically associated with ankle inversion
-treat conservatively

jones fracture
-transverse fracture near the base
-requires surgical intervention due to risk of non-union

44
Q

complications of hip fractures

A

fracture fixation can fail if poorly done
-ensure screws and plates secured and proper position

hemiarthoplasy may dislocate if ptx falls or if capsule gives way

mobile patient to avoid
-DVT
-chest infection
-pressure sores

45
Q

post-op hip fracture managemnt 5

A

require assistance to mobilise

physiotherapies

OT

care of elderly medicine team

home care
-ptx may not be able to return home

46
Q

define a DEXA scan

A

measurement taken at lumbar spin and hip

gives a t-score

assessed against health adult age 30

47
Q

how is a DEXA can result interpretted

A

higher T-score indicates lower bone density
-can calculate fracture risk

T score of -1.0 means bone mass of one standard deviation below that of young reference population

Z score is adjusted for age, gender and ehtnic factors

REMEMBER:
> -1= normal

-1 to -2.5 = osteopenia

<-2.5= osteoporosis

48
Q

what is the pelvis made of up

A

sacrum posteriorly

ilium

ischium

pubis

49
Q

differentiate between low and high energy pelvic fractures

A

high energy
-usually from RTA/ fall from height
-V dangerous high mortaillty rate
-high risk of bleeding and risk of damage to pelvic structures

low energy
elderly
-often osteoporotic
-low energy
-stable
-low blood loss

50
Q

managemnt of low energy pelvic fractures

A

non-operative

mobilisation with analgesia

normally heal spoppntaneously

51
Q

management of high energy pelvic fractures

A

stabilse to rpevent blood loss
-use pelvic binder until definitive stabilisation

-fractures can be fixed definitively with plates/bolts

52
Q

three types of pelvic fracture 3

A

AP compression

lateral compression

vertical shear

53
Q

what is important to note with high energy pelvic fractures

A

always nood for 2nd site of injury

pelvic ring usually breaks in 2 places

Orthopaedics (15 decks)

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