Lower Limb Trauma

Question 1

To maximise the chance of restoration of function and to promote early mobilisation, almost all hip fractures undergo surgical management within what timeframe?

Answer 1

24 hours

Question 2

What typically happens to the affected limb in individuals with a hip fracture?

Answer 2

The limb is shortened and externally rotated

Question 3

Individuals with a hip fracture will have severe pain where?

Answer 3

The groin

Question 4

How can an intracapsular hip fracture be recognised on an x-ray?

Answer 4

A break in Shenton’s line

Question 5

Which subtype of hip fracture has a higher risk of disruption to the arterial supply of the femoral head, and hence a higher risk of AVN?

Answer 5

Intracapsular

Question 6

How should an undisplaced, intracapsular hip fracture be treated in a healthy individual with no or minimal co-morbidities?

Answer 6

Internal fixation

Question 7

How should an undisplaced, intracapsular hip fracture be treated in an individual with major illness or advanced organ specific disease?

Answer 7

Hemiarthroplasty

Question 8

How should a displaced, intracapsular hip fracture be treated in an individual with no or minimal co-morbidities aged < 70 years?

Answer 8

Internal fixation

Question 9

How should a displaced, intracapsular hip fracture be treated in an individual with no or minimal co-morbidities aged > 70 years?

Answer 9

Total hip replacement

Question 10

How should a displaced, intracapsular hip fracture be treated in an individual who has major comorbidities or or is immobile?

Answer 10

Hemiarthroplasty

Question 11

How should an extracapsular hip fracture (no special type) be treated?

Answer 11

Dynamic hip screw

Question 12

How should an extracapsular hip fracture (reverse oblique, transverse or subtrochanteric) be treated?

Answer 12

IM device

Question 13

What must be assessed after a patient has been treated for a hip fracture?

Answer 13

Calcium and vitamin D levels +/- DEXA scan

Question 14

What system can be used to classify hip fractures?

Answer 14

Garden system

Question 15

Following resuscitation and optimisation of analgesia, what can be used to stabilise a femoral shaft fracture before definitive treatment is initiated?

Answer 15

Thomas’ splint

Question 16

How is a femoral shaft fracture usually treated definitively?

Answer 16

Closed reduction and fixation with an IM nail

Question 17

In tibial shaft fractures with up to 50% displacement and 5 degrees of angulation, treatment can be conservative. What does this involve?

Answer 17

Above knee casting

Question 18

In tibial shaft fractures with more than 50% of displacement and 5 degrees of angulation, treatment is surgical. What does this involve?

Answer 18

Closed reduction and internal fixation with an IM nail

Question 19

Tibial shaft fractures can take up to how long to heal?

Answer 19

One year

Question 20

What are Pilon fractures and how are they treated?

Answer 20

Intra-articular fractures of the distal tibia- treat with ORIF

Question 21

What is the mechanism of injury for most ankle injuries?

Answer 21

Inversion injury

Question 22

According to the Ottawa rules, an x-ray is required for an ankle injury if there is pain in the malleolar zone, and one of what other findings?

Answer 22

Bony tenderness over the medial or lateral malleolus, or the inability to weight-bear for four steps

Question 23

How are isolated distal fibular fractures with no medial fracture or rupture of the deltoid ligament treated?

Answer 23

Walking cast or splint for 6 weeks

Question 24

How are distal fibular fractures with rupture of the deltoid ligament treated?

Answer 24

ORIF with plates and screws

Question 25

How is rupture of the deltoid ligament in the ankle suspected on clinical examination?

Answer 25

Medial bruising and tenderness

Question 26

How is rupture of the deltoid ligament in the ankle suspected on x-ray imaging?

Answer 26

Talar shift (asymmetric increased space around the talus)

Question 27

Virtually all patellar dislocations are in what direction?

Answer 27

Lateral

Question 28

Who are patellar dislocations most commonly seen in?

Answer 28

Adolescent females

Question 29

Why do patients with a patellar dislocation have pain over the medial retinaculum?

Answer 29

The medial patello-femoral ligament is torn

Question 30

A lipo-haemarthrosis is seen in which traumatic injury to the lower limb?

Answer 30

Patellar dislocation

Question 31

What is the risk of a second patellar dislocation?

Answer 31

10%

Question 32

What is the best x-ray view for assessing the ankle?

Answer 32

AP-mortise view

Question 33

What is the most common subtype of intracapsular hip fracture?

Answer 33

Subcapital

Question 34

Injury to what artery and nerve may occur in association with a femoral shaft fracture?

Answer 34

Femoral artery and sciatic nerve

Question 35

What is the usual mechanism of action for a posterior hip dislocation?

Answer 35

Front seat passenger, knee strikes dashboard

Question 36

How will the limb appear following a posterior hip dislocation?

Answer 36

The limb is shortened and internally rotated

Question 37

If a fracture is not seen on AP and lateral x-rays but the patient cannot weight bear, what investigation should be done next?

Answer 37

MRI

Question 38

Twisting of the lower leg with quadriceps contraction describes the mechanism of what injury?

Answer 38

Patellar dislocation

Question 39

Post-reduction of a patellar dislocation, what should be done?

Answer 39

Assessment of the extensor mechanism and x-ray to assess for a fracture

Question 40

What are the two main mechanisms of injury for a patellar fracture?

Answer 40

Fall onto a flexed knee or dashboard injury

Question 41

85% of ankle sprains are due to injury to what structure?

Answer 41

Anterior talo-fibular ligament

Question 42

What would make an ankle sprain be considered 'severe' and require below knee immobilisation for at least 10 days?

Answer 42

Inability to weight bear

Question 43

How should a mild ankle sprain be treated?

Answer 43

Rest, ice, compression, elevation

Question 44

If an individual has a calcaneal fracture following a fall from height, what other injury should be actively looked for?

Answer 44

Spinal fracture

Question 45

What is the primary imaging investigation in all polytrauma patients?

Answer 45

CT