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Trauma > Lower limb injuries > Flashcards

Lower limb injuries Flashcards

1
Q

Sign of femoral neck fracture?

A

Shortened, flexed and externally rotated limb

Shenton’s line interrupttion

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2
Q

Surgical emergency in the young:

A

Displaced intracapsular fractures of the femoral neck

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3
Q

What are the three types of intracapsular fractures of the femoral neck?

A

Subcapital
Transcervical
Basicervical

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4
Q

Which blood vessels are associated with the femoral neck?

A

Lateral and medial circumflex arteries from the femoral give branches to the neck
These include the lateral epiphyseal arteries and the posterior superior retinacular arteries

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5
Q

Three major types of femur neck fracture:

A

Intracapsular
Intertrochanteric
Subtrochanteric

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6
Q

Garden classification of fractured neck of femur:

A 
I = vagus impacted
II = non-displaced
III = complete: partially displaced
IV = complete: fully displaced
(III+IV are unstable)
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7
Q

What is trochanteric pain syndrome?

A

Inflammation/trauma in muscles, tendons, fascia or bursar

Women > Men; 40-60 y/o

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8
Q

What is trochanteric pain syndrome concurrent with?

A

Low back pain
OA of the knee
RA
Fibromyalgia

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9
Q

What is osteitis pubis?

A

Inflammation of the pubic symphysis and surrounding structures from repetitive trauma + opposing shearing forces in the symphysis

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10
Q

What is piriformis syndrome?

A

Neuropathy due to entrapment of the sciatic nerve

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11
Q

What causes entrapment of the sciatic nerve?

A

Trauma to buttocks
Scarring and fibrosis around nerve due to piriformis strain
Branches of nerve passing through a bifid piriformis

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12
Q

Sign of piriformis syndrome?

A

Wallet sign

Paraesthesia when sitting on wallet

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13
Q

What is athletic pubalgia?

A

Damage to soft tissue in groin area

aka sports hernia

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14
Q

What is femoacteabular impingement?

A

Abnormal contact between ant fem head and acet rim
Cam = non-spherical fem head causes abnormal forces in hip flexion
Pincer = over-coverage of the femoral head by the acetabulum

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15
Q

Management of fractured shaft of femur:

A

Assess neurovasculature
Blood loss of 0.75-1L = start IV fluids and send blood for G and S
IV analgesia and donway splint + ortho referral

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16
Q

What does the Drawer test test?

A

The stability of the anterior cruciate ligament

Must relax hamstrings at 80 degree angulation

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17
Q

What are Ottawa’s knee rules that warrant knee X-ray?

A 
Age > 55
Isolated tenderness of the patella
Tenderness at head of fibula
Inability to flex 90 degrees
Inability to bear weight immediately/ED (4 steps)
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18
Q

Which X-rays are ordered for a knee?

A

AP + Lateral views
Skyline view for patellar problems
Tunnel view for intercondylar area (e.g. loose bodies)
Sunrise view for vertical patellar fracture

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19
Q

Management of fractured patella?

A 
Elderly = bandage with ortho opinion
Young = POP cylinder/cricket splint + patient may walk
Displaced/comminuted = internal fixation/excision, admit
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20
Q

Management of dislocated patella:

A 
Reducible under N2O mostly
X-ray to exclude osteochondral fracture
Aspirate if large effusion
1st = POP cylinder/crickent splint and may walk
Recurrent = compression bandage
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21
Q

When is an apprehension test carried out?

A

If a dislocated patella is self re-located

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22
Q

What is a Segond fracture?

A

Avulsion fracture of the lateral aspect of the proximal tibia below the articular surface

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23
Q

What causes a Segond fracture?

A

Internal rotation and stress tensing the lateral capsular ligament

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24
Q

Associated injuries with the Segond fracture:

A

Tear of the anterior cruciate ligament (75-100%)
Injuries of medial and lateral menisci (66-70%)
Avulsion fracture of fibular head/Gerdy tubercle

25
Q

What is an avulsion fracture?

A

Small chunk of bone attached to a tendon/ligament gets pulled away from the main bone

26
Q

What is the protocol with identifying a second fracture with a Segond fracture?

A

MRI to assess ACL, menisci and other structures

27
Q

Fractured tibial condyle may require…

A

Internal fixation

28
Q

What should you order with an intercondylar tibial fracture?

A

Tunnel view X-ray

29
Q

What should you do in the case of a fracture to the tibial shaft +/- fibula?

A

Check the neurovascular status and the compartments

30
Q

If tibial fracture is due to direct blow what should you do?

A

Admit for 24 hours observation to make sure compartment syndrome does not occur

31
Q

When should you admit a tibial fracture?

A

If direct blow

If open or displaced

32
Q

Management of pre-tibial lacerations?

A

Avoid suturing unless very distracted wound edges

33
Q

Management of fractured fibula shaft from direct blow?

A

Crepe bandage
Exclude compartment syndrome
Exclude common peroneal nerve injury if at neck

34
Q

Where is compartment syndrome more common?

A

Gluteal and peroneal compartments

35
Q

Signs of compartment syndrome:

A

Pain out of proportion - active and passive

Paraesthesia, pallor, paralysis, pulseless (pulse presence does not exclude compartment syndrome)

36
Q

Diagnosis of compartment syndrome:

A

Pressure >20mmHg is abnormal and >40mmHg is diagnostic

37
Q

Treatment of compartment syndrome:

A

Fasciotomies

38
Q

Complications of compartment syndrome:

A

Myoglobinuria causing renal failure and requiring IV fluids

Necrosis - requiring debridement and possibly amputation

39
Q

Which fractures are most likely to cause compartment syndrome?

A

Supracondylar fractures

Tibial shaft fractures

40
Q

80-85% of inverted ankle sprains are due to what?

A

The anterior talofibular ligament

others include calcaneofibular ligament

41
Q

What are the Ottawa ankle rules for ordering a lateral view X-ray?

A

Pain in malleolar zone + either:
Bone tenderness at posterior tip of lateral malleolus
OR inability to bare weight immediately/ED

42
Q

What are the Ottawa ankle rules for ordering a medial view X-ray?

A

Pain in mid-foot zone + either:
Bone tenderness at base of 5th metatarsal
OR bone tenderness at the navicular
OR inability to bare weight immediately/ED

43
Q

What signs in the context of ankle fractures are considered abnormal?

A

Tibiofibular overlap <10mm (syndesmotic injury)
Tibiofibular clear space >5mm (syndesmotic injury)
Talor tilt >2mm

44
Q

What is a type A Weber fracture?

A

Tip of lateral malleolus fracture closest to ankle

45
Q

What is a type B Weber fracture?

A

Fracture of lateral malleolus further up, may be medial damage

46
Q

What is a type C Weber fracture?

A

Fracture of fibula higher up still with potential medial involvement

47
Q

Management of Weber A:

A

POP + walking if only tip
BKBS and non weight-bearing for 3 weeks if undisplayed oblique fracture
Displaced/gap between bone ends then referral

48
Q

Management of Weber B:

A

If stable then POP with walking
If undisplayed fracture of lateral malleolus + medial malleolus/swelling over deltoid ligament with no talar shift then refer
If displaced/lateral talar shift then internal fixation

49
Q

Management of Weber C:

A

Non-displaced = non-weight bearing BKBS for 3 weeks

Displaced/lateral talar shift = admission

50
Q

Management of ankle fracture if circulation in jeopardy?

A

Reduce immediately under Entonox + chocolate before X-ray

51
Q

What is Simmond’s test?

A

A test for tendoachilles tear
Normally supine squeeze of calf muscle will cause plantar flexion
This reflex will not be present in tear

52
Q

What should you consider with achilles tendon tear?

A 
RA
SLE
Renal failure
Hyperparathyroidism
Hyperlipoproteinuria
Gout
53
Q

Management of achilles tendon tear?

A

Operative

54
Q

Indications of calcaneus fracture?

A

Fall from height
Associated spinal and pelvic injuries
Bohler’s angle >20 degrees

55
Q

Risk with calcaneus fracture?

A

Compartment syndrome

56
Q

Which is the most common metatarsal fracture and what is the management?

A

5th metatarsal
Treatment is symptomatic - BKPOP for 3-4 weeks for pain
Double tubigrip for swelling

57
Q

Differential between Jones’ and pseudojones’ fracture:

A

Jones’ fracture occurs at the metaphyseal-diaphyseal junction and involves the 4th-5th metatarsal articulation
Pseudojones’ fracture involves the proximal tubercle
Jones is caused by a sudden change in direction whereas Pseudojones is caused by landing on the ankle awkwardly

58
Q

Important management step in femoral fractures?

A

Fluid repletion

Trauma (8 decks)

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