Lower Limb Trauma

Question 1

how do femoral shaft fractures typically occur

Answer 1

high energy injuries

Question 2

what things can cause stress fractures of the femoral shaft

Answer 2

osteoporosis
pagets
metastatic disease
long term bisphosphonates

Question 3

what are the two main risks with displaced femoral shaft fractures

Answer 3

high blood loss

fat embolism

Question 4

symptoms of a fat embolism

Answer 4

tachycardia, tachypnoea, hypoxia
pyrexia
confusion
petechial rash

Question 5

initial management of a femoral shaft fracture

Answer 5

analgesia with femoral nerve block + stabilisation with Thomas splint

Question 6

definitive management of a femoral shaft fracture

Answer 6

closed reduction with IM nail

Question 7

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

Answer 7

bending – transverse fracture
rotational force – spiral fracture
compressive force – oblique fracture
high energy – comminuted

Question 8

conservative management of tibial shaft fracture

Answer 8

above knee casting

- can be used on fractures with up to 50% displacement

Question 9

what is the healing of the tibia like?

Answer 9

very slow- slowest bone in the body to heal

takes roughly 16 weeks to union

Question 10

how are tibial shaft fractures that require surgery managed

Answer 10

IM Nail

Question 11

what are Pilon fractures

Answer 11

intra-articular fractures of the distal tibia

Question 12

management of Pilon fractures

Answer 12

ORIF

Question 13

how do Pilon fractures occur

Answer 13

fall from height

Question 14

what is the risk associated with tibial fractures

Answer 14

compartment syndrome

Question 15

ankle injuries are most commonly due to what

Answer 15

inversion / rotational force on planted foot

- damage to lateral ankle ligaments

Question 16

presentation of ankle soft tissue sprain

Answer 16

pain, bruising, tenderness over affected ligaments

Question 17

what criteria is used to assess suspected ankle fractures

Answer 17

Ottawa criteria

- gives guidance as to whether an Xray is needed

Question 18

criteria for ankle Xray

Answer 18

severe localised tenderness

inability to weight bear for 4 steps

Question 19

what makes an ankle fracture unstable

Answer 19

rupture of deltoid ligament

- medial bruising + tenderness

Question 20

treatment of stable ankle fracture

Answer 20

walking cast/splint for 6 weeks

Question 21

treatment of an unstable ankle fracture

Answer 21

ORIF

Question 22

what is important to look at on ankle Xray

Answer 22

Talar shift

- causes post traumatic OA

Question 23

management of ankle fracture with talar shift

Answer 23

anatomical reduction + internal fixation

Question 24

how do calcaneal fractures occur

Answer 24

fall from height onto heal

Question 25

how do fractures of the talar neck occur

Answer 25

forced dorsiflexion from rapid deceleration

Question 26

a displaced talus fracture/ subluxation has a risk of what

Answer 26

AVN

Question 27

What is a lisfranc fracture-dislocation

Answer 27

fracture + dislocation of base of 2nd metatarsal

Question 28

presentation of lisfranc fracture-dislocation

Answer 28

grossly swollen + bruised foot, difficulty weight bearing

Question 29

management of lisfranc fracture-dislocation

Answer 29

ORIF