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MJM > Lower Limb Trauma > Flashcards

Lower Limb Trauma Flashcards

1
Q

Anatomical and physiological consequences of injury

A
  • Anatomical
    > Fracture
    > Dislocation
    > Soft tissue injury
  • Physiological
    > Bleeding + shock
    > Coagulopathy
    > Multiple organ failure
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2
Q

How many places does a rigid ring tend to fracture in?

A

At least 2

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3
Q

What are the rigid rings of the pelvis?

A
  • Main pelvic ring
  • 2x obturator rings
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4
Q

Main function of anterior ligaments of pelvis

A

Stabilise pubic symphysis

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5
Q

Anterior ligaments of the pelvis

A
  • Superior pubic ligament
  • Arcuate ligament
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6
Q

Relative strength of anterior ligaments of the pelvis and what this means

A
  • Relatively weak compared to rest of pelvis
  • Pubis symphysis disruption is common
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7
Q

Main function of secondary ligaments of the pelvis

A
  • Stop sacrum, and therefore spine, from tilting forward
  • Keep pelvic ring stable
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8
Q

Secondary ligaments of the pelvis

A
  • Sacrotuberous ligament
  • Sacrospinous ligament
  • Iliolumbar ligament
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9
Q

Main function of posterior ligaments of the pelvis

A

Stabilise sacroiliac joint (for weight bearing)

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10
Q

Posterior ligaments of the pelvis

A
  • Anterior sacroiliac ligament
  • Interosseus sacroiliac ligament
  • Posterior sacroiliac ligament
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11
Q

What is APC in pelvic injury?

A
  • Antero-posterior compression
  • Occurs when motor cyclist hits tree –> front of pelvis hits petrol tank
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12
Q

3 stages of APC injury

A
  • APC 1
  • APC 2
  • APC 3
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13
Q

What happens in an APC 1 injury?

A
  • Relatively low force applied to front of pelvis
  • Anterior ligaments damaged
  • This forces pelvis apart from the front
  • Secondary + posterior ligaments having elasticity results in small opening in front of pelvis
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14
Q

What happens in an APC 2 injury?

A
  • Greater force applied to front of pelvis
  • Damage to anterior + secondary ligaments
  • Results in sacroiliac joint being disrupted so pelvis hinges open
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15
Q

What happens in an APC 3 injury?

A
  • Even greater force applied
  • Causes pelvic ring injury which is vertically unstable
  • Whole of affected side of pelvis (+ lower limb) will move proximally (due to muscle pull)
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16
Q

Why are haemorrhages often associated with pelvic fractures?

A

Damage to pelvic floor

17
Q

Why are haemorrhages often associated with pelvic fractures?

A

Damage to pelvic floor which is covered by major vascular structures

18
Q

How is haemorrhage controlled?

A

Embolization (blockage of vessel)

19
Q

Why are hip fractures more common in elderly patients?

A

Weak bones

20
Q

3 types of hip fracture

A
  • Intracapsular
  • Trochanteric
  • Subtrochanteric
21
Q

Where are subtrochanteric fractures located?

A

Within 5cm below lesser trochanter

22
Q

Characteristic deformities of hip fracture

A
  • Shortening of leg
  • External rotation of leg
23
Q

Why does shortening of the leg occur in a hip fracture?

A
  • Action of muscles that cross the hip joint
    > Hip abductors (gluteus medius + minimus) + flexors (iliacus + psoas major)
24
Q

Why does external rotation of the leg occur in a hip fracture?

A
  • Normally rotation occurs around mechanical axis of femur (between centre of femoral head + centre of knee joint)
  • When fractured, it occurs around anatomical axis (shaft of femur)
25
Q

3 ligaments of hip joint

A
  • Iliofemoral ligament
  • Ischiofemoral ligament
  • Pubofemoral ligament
26
Q

What line needs to be assessed in an X-ray of a hip fracture?

A

Shenton’s line

27
Q

What is Shenton’s line?

A

Imaginary line drawn along inferior border of superior pubic ramus + along inferomedial border of neck of femur

28
Q

Where does anterior blood supply to the femoral head come from?

A

Lateral circumflex femoral artery (branch of profunda femoris)

29
Q

Where does posterior blood supply to the femoral head come from?

A

Medial circumflex femoral artery (branch of profunda femoris)

30
Q

When would the femoral head undergo avascular necrosis?

A
  • Intracapsular fracture
  • Cuts of retinacular vessels coming from medial/lateral circumflex arteries
31
Q

What procedure is used to treat a displaced femoral fracture?

A

Hemiarthroplasty (half hip joint replaced)

32
Q

What position is the proximal femur in after a subtrochanteric fracture and why?

A
  • Abducted (gluteus medius + minimus)
  • Flexed (iliacus + psoas major)
33
Q

Treatment of a subtrochanteric fracture

A
  • Line distal + proximal fragments by either:
    > Pushing from front to push fragment down
    > Placing spike in the bone and pulling it down to a ligament
  • Then do an intramedullary nailing (rod on inside of bone + fix with screws)
34
Q

Which ligaments make knee dislocation so uncommon?

A
  • Lateral + medial collaterals
  • Posterior + anterior cruciates
35
Q

What is the vascular danger of a knee dislocation?

A
  • Popliteal artery lies directly behind the joint
  • Can cut off blood supply to lower limb
36
Q

Causes of increased pressure in a muscle compartment

A
  • Increased pressure from inside (bleeding + oedema)
  • Increased pressure from outside (tight casts + dressings)
37
Q

Consequences of compartment syndrome

A
  • If decompression is late there is a severe risk of infection as dead muscle is ideal culture medium
  • Myoglobin can leak into circulation + cause renal damage –> renal failure
38
Q

Treatment of compartment syndrome

A
  • Remove bandages around area
  • Fasciotomy

MJM (32 decks)

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