Lower limb fractures - BULLSHIT DONT LEARN JUST DO NOF Flashcards
Types of femur fractures
- Shaft
- Distal
Shaft fracture clinical features
- Extreme pain
- Deformity
Types of shaft fractures
- Transverse type
- Oblique type
- Spiral type
Shaft fracture mechanism of injury (MOI)
- MC Motorcycle accidents
- Extremely high energy trauma to the lower limb
Distal fracture location
Fracture that occurs between:
- Distal diaphyseal-metaphyseal junction
- Articular surface of femoral condyles
Distal fracture MOI
- High-energy falls in young patients with significant displacement
- Elderly patients with osteoporosis, sustaining low-energy injuries
Distal fracture clinical features
Knee effusions may be present with inter-articular involvement
Types of knee fractures
Patella fracture
Patella fracture clinical features
- Inability to straight leg raise
- Tenderness of the knee cap
Patella fracture MOI
- Direct blow to the knee, e.g. dashboard injury
- Rapid contraction of the quadriceps against a flexed knee
Patella fracture DDx
Anatomical variant = bipartite patella = where individuals have 2 patella components in their knee
Types of tibia fractures
- Secgond fracture
- Tibial plateau fracture
- Tibial shaft fracture
- Toddler’s fracture
- Tibial plafond fracture
Segond fracture location
A small avulsion fracture at the lateral tibia plateau
- Assosciated with ACL injury in 75% of cases
Segond fracture MOI
Caused by internal rotation and varus stress
- Typically occur from sporting injuries
Tibial plateau fracture locations
Periarticular injuries of the proximal tibia
Tibial plateau MOI
- Varus or valgus injuries causing medial or lateral involvement respectively
- High energy impact in young individuals
Low-energy trauma in osteoporotic bone
Tibial shaft fracture clinical features
- Open fractures and compartment syndromes are common features
- This is due to the lack of fascial compartment and subcutaneous tissues of the shin
Tibial shaft fracture MOI
Can arise from direct blows, falls or indirectly (through twisting motions)
Tibial shaft fracture epidemiology
Most common paediatric fracture of the lower limb
Toddler’s fracture location
A spiral fracture of the tibia without any injury to the fibula
Toddler’s fracture Epidemiology
- Predominantly affects children in their early years of walking
- Stable fracture: without displacement
Toddlers fracture MOI
- Twisting the leg whilst walking/running
- Getting leg caught whilst moving down a slide
Toddler’s fracture treatment
Requires no interventions other than monitoring
Tibial plafond fracture location
- Fracture of the distal tibia
- Often has intra-articular involvement
Tibial plafond fracture
- Severe ankle pain and inability to weight bear
Tibial plafond fracture MOI
- High energy axial load (e.g. fall from height or motor vehicle accident
- The talus is driven into the plafond, causing tibial fracture
Types of fibula fractures
- Maisonneuve fracture
- Lateral malleolar fracture
Maisonneuve fracture location
- Spiral fracture of the proximal fibula associated with ankle instability
- Ankle injuries include tibiofibular syndesmosis injury and posterior/medial malleolar fractures (tibial plafond)
Maisonneuve fracture MOI
- It arises due to the pronation-external rotation mechanism
- E.g. a foot inversion with rotation on the ankle caused by stepping off a curb awkwardly
Types of lateral malleolar fracture
- Weber A: fractures occur distal to the syndesmosis (fibrous connection between tibia and fibula)
- Weber B: fractures occur at the level of the syndesmosis
- Weber C: fractures occur proximal to the syndesmosis
Lateral malleolar fracture MOI
These injuries are typically sustained by “rolling the ankle”
Types of foot fractures
- Jones fracture
- Lisfranc injury
- Calcaneal fracture
- Talar neck fracture
Jones fracture location
- Fracture of the 5th metatarsal base
Jones fracture clinical features
Predisposed to poor healing and malunion to limited blood supply
Jones fracture
- Inversion injury to the foot
- May also occur from repetitive stress or overuse, meaning athletes are susceptible
Lisfranc injury location
- Tarsometatarsal fracture and dislocation of the Lisfranc region
- This is predominantly the region where the first and second metatarsals articulate with the tarsals
Lisfranc injury MOI
Axial load applied to a hyperplantarflexed foot, e.g. falling from a height
Calcaneal fracture location
Fracture of the heel bone, calcaneus
Calcaneal fracture MOI
Traumatic axial loading, e.g. falling from a height
Most common calcaneal fracture
Fractured tarsal bone
Talar neck fracture location
Fracture of the neck of the talus bone
Talar neck fracture MOI
Forced dorsiflexion with axial loading
Talar fracture complications
This fracture carries a high risk of avascular necrosis due to disruption of its retrograde blood flow
