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MB2 Rheumatology and Orthopaedics > lower limb trauma > Flashcards

lower limb trauma Flashcards

1
Q

what structures are at risk in pelvic fractures

A

internal iliac arterial system
pre-sacral venous plexus
lumbo-sacral plexus and nerve roots

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2
Q

3 patterns of pelvic injury

A

lateral compression
vertical shear
anteroposterior compression

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3
Q

what is a lateral compression injury

A

side impact where there is medial displacement of one hemipelvis
fracture through pubic ramus, ischium with sacral compression/SI disruption

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4
Q

what is an AP compression injury

A

wide disruption of pubic symphesis that may lead to open book pelvic fracture
manage bleed

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5
Q

what is a vertical shear pelvic fracture

A

axial force on a hemipelvis leading to superior displacement
leg length discrepancy, sacral nerve roots, lumbosacral plexus at risk and major haemorrhage

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6
Q

initial management of a pelvic fracture?

A

haemodynamic stabilisation with blood/fluids

pelvic binding or external fixation

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7
Q

ongoing haemodynamic instability, despite initial resus measure with pevic fracture warrants?

A

open pack pelvis
angio and embolisation
emergency laparotomy

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8
Q

what does a bleed on a PR exam for a pelvic injury indicate and what does this mean

A

rectal tear
makes the fracture open
urgent senior general surgery review

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9
Q

describe the most likely low energy pelvic fracture and how it is managed

A

minimal displaced lateral compression
sacral fracture or SI issue
conservative management
usually in elderly and low energy

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10
Q

what are the common causes of an acetabular fracture

A

posterior dislocation

high energy trauma

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11
Q

management of an acetabular fracture

A

small/undisplaced - conservative

unstable/displaced - ORIF to prevent OA or THR in older pt

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12
Q

what imaging modality may aid acetabular fracture pre surgery

A

CT

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13
Q

in who are hip fractures most common

A

older >80

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14
Q

mortality of hip replacement at 1 year

A

30%

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15
Q

when should operative hip repair be done in relation to fracture and exceptions?

A

<24 hours after fracture

exceptions are those with other more important conditions, unstable or likely to die

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16
Q

management of an intracapsular hip fracture

A

THR

hemiarthroplasty for restricted mobility or cognitive impairment

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17
Q

management of an extracapsular hip fracture

A

compression/DHS

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18
Q

causes of femoral shaft fracture

A 
high energy 
osteoporosis 
pagets disease 
metastatic bone disease 
long term bisphosphonates
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19
Q

initial femoral shaft fracture management

A

analgesia
femoral nerve block
thomas splint

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20
Q

definitive femoral shaft fracture management

A

IM nail or minimal invasive plate fixation

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21
Q

most common direction of patella dislocation?

A

lateral

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22
Q

risk factors for patella dislocation

A 
adolescence 
females 
generalised ligamentous laxity 
shallow trochlea 
rotational malalignment 
valgus knee
23
Q

how many first time patella dislocations have another

A

10%, half of these have many

24
Q

how would you manage a patella dislocation longer term

A

splint with physio to prevent another

bony procedure to correct malalignment

25
Q

classification system of prox tibial plateau

A

schatzker

26
Q

causes of a prox tibial plateau fracture and how may it appear

A

high energy in young or older osteoporosis

split bone, depression in articular surface

27
Q

management of a prox tibial plateau fracture?

A 
ORIF to prevent OA and stiffness 
CT scan 
bone graft if depression 
external fix in high swell
TKR in severe case
28
Q

what injuries can follow car bumper injury

A

common peroneal nerve injury

prox tibial plateau fracture

29
Q

true/false - tibial fractures are commonly open fractres

A

true

30
Q

most common cause compartment syndrome?

A

tibial fracture

31
Q

non-op manageent of tibial fracture? tolerance of rotation/displacement/angulation?

A

upper knee cast
5% angulation
50% displacement
no rotation

32
Q

if the fibula is fractured with the tibia the tibia drifts to varus/valgus

A

valgus

33
Q

if the fibula isnt fractured with the tibia the tibia drifts to varus/valgus

A

varus

34
Q

operative management of tibial fracture

A

ORIF can be used but IM nail favoured
external fixation may be needed
non-union needs bone graft or circle frame

35
Q

how long does tibial union take to occur

A

16 weeks, and a year to heal

36
Q

soft tissue sprains to lateral ligaments ankle present as?

A

pain
bruising
moderate/mild tenderness over ligaments

37
Q

what criteria are used to determine imaging of ankle in A&E

A

ottowa

severe localised tenderness over distal tibia/fibula or no weight bear at all

38
Q

what ankle fractures can be managed conservatively

A

no medial fracture or ruptured deltoid ligament

39
Q

management of an ankle fracture with ruptured deltoid ligament?

A

ORIF

40
Q

how do you know if there is a rupture of the deltoid ligament

A

bruising medially with tenderness

talar shift on XR

41
Q

management of a bimalleolar ankle fracture

A

ORIF

42
Q

true/false - ORIF for an ankle fracture can be delayed by a week or two to allow soft tissues to heal

A

true - this helps to prevent healing issues and infection

43
Q

presentation of a midfoot fracture/dislocation

A

grossly swollen and bruised foot
cannot weight bear
normal x ray

44
Q

what is a midfoot fracture/dislocation

A

fracture of base of 2nd metatarsal with/without dislocation of other metatarsals at TMJ
ligament from medial cuneiform no longer holds in place

45
Q

if an X ray is normal in a suspicious midfoot fracture/dislocation what do you do

A

get a CT scan

46
Q

true/false - the 1st metatarsal is commonly fractured

A

false - its a strong bone

47
Q

what is a common location for stress fracture and how is this managed and investigated

A

2nd metatarsal
cannot be visible on XR until there is a callus so get a bone scan
treat with cast

48
Q

management of the lesser metatarsal fractures

A

casting

K wires if multiple

49
Q

what metatarsal fracture is most common and describe mechanism

A

5th

inversion with avulsion fracture at insertion of fibularis brevis

50
Q

management of a 5th metatarsal fraxcture?

A

stout boot 4-6 weeks

51
Q

true/false - if there is non-union of a 5th metatarsal fracture it needs operative management

A

false - theres probably fibrous healing so just leave it

52
Q

management of a toe fracture

A

stout boot

53
Q

how would you manage a toe dislocation

A

manually reduce closed and strap or wire in place

54
Q

what toe fractures may need surgical stabilisation

A

intra articular - if a big fragment

all open fractures need debrided and then wires

MB2 Rheumatology and Orthopaedics (22 decks)

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