Lower Limb Trauma Flashcards
how do femoral shaft fractures typically occur
high energy injuries
what things can cause stress fractures of the femoral shaft
osteoporosis
pagets
metastatic disease
long term bisphosphonates
what are the two main risks with displaced femoral shaft fractures
high blood loss
fat embolism
symptoms of a fat embolism
tachycardia, tachypnoea, hypoxia
pyrexia
confusion
petechial rash
initial management of a femoral shaft fracture
analgesia with femoral nerve block + stabilisation with Thomas splint
definitive management of a femoral shaft fracture
closed reduction with IM nail
which type of tibial shaft fracture will result from the following movements:
a) bending
b) rotational force
c) compressive force from deceleration
d) combination of forces/high energy
bending – transverse fracture
rotational force – spiral fracture
compressive force – oblique fracture
high energy – comminuted
conservative management of tibial shaft fracture
above knee casting
- can be used on fractures with up to 50% displacement
what is the healing of the tibia like?
very slow- slowest bone in the body to heal
takes roughly 16 weeks to union
how are tibial shaft fractures that require surgery managed
IM Nail
what are Pilon fractures
intra-articular fractures of the distal tibia
management of Pilon fractures
ORIF
how do Pilon fractures occur
fall from height
what is the risk associated with tibial fractures
compartment syndrome
ankle injuries are most commonly due to what
inversion / rotational force on planted foot
- damage to lateral ankle ligaments
presentation of ankle soft tissue sprain
pain, bruising, tenderness over affected ligaments
what criteria is used to assess suspected ankle fractures
Ottawa criteria
- gives guidance as to whether an Xray is needed
criteria for ankle Xray
severe localised tenderness
inability to weight bear for 4 steps
what makes an ankle fracture unstable
rupture of deltoid ligament
- medial bruising + tenderness
treatment of stable ankle fracture
walking cast/splint for 6 weeks
treatment of an unstable ankle fracture
ORIF
what is important to look at on ankle Xray
Talar shift
- causes post traumatic OA
management of ankle fracture with talar shift
anatomical reduction + internal fixation
how do calcaneal fractures occur
fall from height onto heal
how do fractures of the talar neck occur
forced dorsiflexion from rapid deceleration
a displaced talus fracture/ subluxation has a risk of what
AVN
What is a lisfranc fracture-dislocation
fracture + dislocation of base of 2nd metatarsal
presentation of lisfranc fracture-dislocation
grossly swollen + bruised foot, difficulty weight bearing
management of lisfranc fracture-dislocation
ORIF
