Lower Limb Injuries Flashcards
What is a tibial plateau fracture?
Intra-articular fracture of the proximal tibia, with either a split in the bone, a depression in the articular surface or both
Which types of injury cause tibial plateau fractures are which other structures may also be damaged?
Valgus stress injury –> lateral plateau fracture + MCL failure
Direct blow from care bumper –> may also cause proximal fibular injury + common peroneal nerve injury
How would damage to common peroneal nerve be visualised?
Foot drop
How is a tibial plateau fracture managed?
ORIF
- often substantial soft tissue swelling so temporary external fixation may be required before attempting ORIF
Which injury is the most common cause of compartment syndrome after trauma?
Tibial shaft fracture
How is a tibial shaft fracture managed?
Minimally displaced/angulated –> above knee plaster cast
- frequent cast changes + xray checks required
Surgery –> IM nail
- 25% suffer long term anterior knee pain so discuss this pre-op
How do you decide which ankle injuries require xray in A&E?
Ottawa criteria
- any severe localised bony tenderness or inability to weight bear for 4 steps –> xray
How is a stable ankle fracture managed?
Walking cast/splint
Which signs indicate rupture of deltoid ligament in an ankle fracture?
Medial bruising + tenderness
unstable
How is an unstable ankle fracture managed?
ORIF
How is a bimalleolar ankle fracture (both sides of ankle) managed?
ORIF
Which type of injury causes talar fractures?
Forced dorsiflexion from rapid deceleration e.g. RTA
What is the main risk with talar fractures and why?
High risk of AVN if displacement, subluxation or dislocation
–> gets blood supply distally
What is a Lisfranc fracture dislocation?
Fracture of base of 2nd metatarsal associated with dislocation elsewhere in the mid foot
How is a Lisfranc fracture investigated?
Intial xray but often missed –> CT if any doubt
