lower limb trauma

Question 1

what structures are at risk in pelvic fractures

Answer 1

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

Question 2

3 patterns of pelvic injury

Answer 2

lateral compression
vertical shear
anteroposterior compression

Question 3

what is a lateral compression injury

Answer 3

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

Question 4

what is an AP compression injury

Answer 4

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

Question 5

what is a vertical shear pelvic fracture

Answer 5

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

Question 6

initial management of a pelvic fracture?

Answer 6

haemodynamic stabilisation with blood/fluids

pelvic binding or external fixation

Question 7

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

Answer 7

open pack pelvis
angio and embolisation
emergency laparotomy

Question 8

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

Answer 8

rectal tear
makes the fracture open
urgent senior general surgery review

Question 9

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

Answer 9

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

Question 10

what are the common causes of an acetabular fracture

Answer 10

posterior dislocation

high energy trauma

Question 11

management of an acetabular fracture

Answer 11

small/undisplaced - conservative

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

Question 12

what imaging modality may aid acetabular fracture pre surgery

Answer 12

CT

Question 13

in who are hip fractures most common

Answer 13

older >80

Question 14

mortality of hip replacement at 1 year

Answer 14

30%

Question 15

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

Answer 15

<24 hours after fracture

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

Question 16

management of an intracapsular hip fracture

Answer 16

THR

hemiarthroplasty for restricted mobility or cognitive impairment

Question 17

management of an extracapsular hip fracture

Answer 17

compression/DHS

Question 18

causes of femoral shaft fracture

Answer 18

high energy 
osteoporosis 
pagets disease 
metastatic bone disease 
long term bisphosphonates

Question 19

initial femoral shaft fracture management

Answer 19

analgesia
femoral nerve block
thomas splint

Question 20

definitive femoral shaft fracture management

Answer 20

IM nail or minimal invasive plate fixation

Question 21

most common direction of patella dislocation?

Answer 21

lateral

Question 22

risk factors for patella dislocation

Answer 22

adolescence 
females 
generalised ligamentous laxity 
shallow trochlea 
rotational malalignment 
valgus knee

Question 23

how many first time patella dislocations have another

Answer 23

10%, half of these have many

Question 24

how would you manage a patella dislocation longer term

Answer 24

splint with physio to prevent another

bony procedure to correct malalignment

Question 25

classification system of prox tibial plateau

Answer 25

schatzker

Question 26

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

Answer 26

high energy in young or older osteoporosis | split bone, depression in articular surface

Question 27

management of a prox tibial plateau fracture?

Answer 27

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

Question 28

what injuries can follow car bumper injury

Answer 28

common peroneal nerve injury | prox tibial plateau fracture

Question 29

true/false - tibial fractures are commonly open fractres

Answer 29

true

Question 30

most common cause compartment syndrome?

Answer 30

tibial fracture

Question 31

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

Answer 31

upper knee cast 5% angulation 50% displacement no rotation

Question 32

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

Answer 32

valgus

Question 33

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

Answer 33

varus

Question 34

operative management of tibial fracture

Answer 34

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

Question 35

how long does tibial union take to occur

Answer 35

16 weeks, and a year to heal

Question 36

soft tissue sprains to lateral ligaments ankle present as?

Answer 36

pain bruising moderate/mild tenderness over ligaments

Question 37

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

Answer 37

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

Question 38

what ankle fractures can be managed conservatively

Answer 38

no medial fracture or ruptured deltoid ligament

Question 39

management of an ankle fracture with ruptured deltoid ligament?

Answer 39

ORIF

Question 40

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

Answer 40

bruising medially with tenderness | talar shift on XR

Question 41

management of a bimalleolar ankle fracture

Answer 41

ORIF

Question 42

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

Answer 42

true - this helps to prevent healing issues and infection

Question 43

presentation of a midfoot fracture/dislocation

Answer 43

grossly swollen and bruised foot cannot weight bear normal x ray

Question 44

what is a midfoot fracture/dislocation

Answer 44

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

Question 45

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

Answer 45

get a CT scan

Question 46

true/false - the 1st metatarsal is commonly fractured

Answer 46

false - its a strong bone

Question 47

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

Answer 47

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

Question 48

management of the lesser metatarsal fractures

Answer 48

casting | K wires if multiple

Question 49

what metatarsal fracture is most common and describe mechanism

Answer 49

5th | inversion with avulsion fracture at insertion of fibularis brevis

Question 50

management of a 5th metatarsal fraxcture?

Answer 50

stout boot 4-6 weeks

Question 51

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

Answer 51

false - theres probably fibrous healing so just leave it

Question 52

management of a toe fracture

Answer 52

stout boot

Question 53

how would you manage a toe dislocation

Answer 53

manually reduce closed and strap or wire in place

Question 54

what toe fractures may need surgical stabilisation

Answer 54

intra articular - if a big fragment | all open fractures need debrided and then wires