lower limb trauma Flashcards
what structures are at risk in pelvic fractures
internal iliac arterial system
pre-sacral venous plexus
lumbo-sacral plexus and nerve roots
3 patterns of pelvic injury
lateral compression
vertical shear
anteroposterior compression
what is a lateral compression injury
side impact where there is medial displacement of one hemipelvis
fracture through pubic ramus, ischium with sacral compression/SI disruption
what is an AP compression injury
wide disruption of pubic symphesis that may lead to open book pelvic fracture
manage bleed
what is a vertical shear pelvic fracture
axial force on a hemipelvis leading to superior displacement
leg length discrepancy, sacral nerve roots, lumbosacral plexus at risk and major haemorrhage
initial management of a pelvic fracture?
haemodynamic stabilisation with blood/fluids
pelvic binding or external fixation
ongoing haemodynamic instability, despite initial resus measure with pevic fracture warrants?
open pack pelvis
angio and embolisation
emergency laparotomy
what does a bleed on a PR exam for a pelvic injury indicate and what does this mean
rectal tear
makes the fracture open
urgent senior general surgery review
describe the most likely low energy pelvic fracture and how it is managed
minimal displaced lateral compression
sacral fracture or SI issue
conservative management
usually in elderly and low energy
what are the common causes of an acetabular fracture
posterior dislocation
high energy trauma
management of an acetabular fracture
small/undisplaced - conservative
unstable/displaced - ORIF to prevent OA or THR in older pt
what imaging modality may aid acetabular fracture pre surgery
CT
in who are hip fractures most common
older >80
mortality of hip replacement at 1 year
30%
when should operative hip repair be done in relation to fracture and exceptions?
<24 hours after fracture
exceptions are those with other more important conditions, unstable or likely to die
management of an intracapsular hip fracture
THR
hemiarthroplasty for restricted mobility or cognitive impairment
management of an extracapsular hip fracture
compression/DHS
causes of femoral shaft fracture
high energy osteoporosis pagets disease metastatic bone disease long term bisphosphonates
initial femoral shaft fracture management
analgesia
femoral nerve block
thomas splint
definitive femoral shaft fracture management
IM nail or minimal invasive plate fixation
most common direction of patella dislocation?
lateral
risk factors for patella dislocation
adolescence females generalised ligamentous laxity shallow trochlea rotational malalignment valgus knee
how many first time patella dislocations have another
10%, half of these have many
how would you manage a patella dislocation longer term
splint with physio to prevent another
bony procedure to correct malalignment
classification system of prox tibial plateau
schatzker
causes of a prox tibial plateau fracture and how may it appear
high energy in young or older osteoporosis
split bone, depression in articular surface
management of a prox tibial plateau fracture?
ORIF to prevent OA and stiffness CT scan bone graft if depression external fix in high swell TKR in severe case
what injuries can follow car bumper injury
common peroneal nerve injury
prox tibial plateau fracture
true/false - tibial fractures are commonly open fractres
true
most common cause compartment syndrome?
tibial fracture
non-op manageent of tibial fracture? tolerance of rotation/displacement/angulation?
upper knee cast
5% angulation
50% displacement
no rotation
if the fibula is fractured with the tibia the tibia drifts to varus/valgus
valgus
if the fibula isnt fractured with the tibia the tibia drifts to varus/valgus
varus
operative management of tibial fracture
ORIF can be used but IM nail favoured
external fixation may be needed
non-union needs bone graft or circle frame
how long does tibial union take to occur
16 weeks, and a year to heal
soft tissue sprains to lateral ligaments ankle present as?
pain
bruising
moderate/mild tenderness over ligaments
what criteria are used to determine imaging of ankle in A&E
ottowa
severe localised tenderness over distal tibia/fibula or no weight bear at all
what ankle fractures can be managed conservatively
no medial fracture or ruptured deltoid ligament
management of an ankle fracture with ruptured deltoid ligament?
ORIF
how do you know if there is a rupture of the deltoid ligament
bruising medially with tenderness
talar shift on XR
management of a bimalleolar ankle fracture
ORIF
true/false - ORIF for an ankle fracture can be delayed by a week or two to allow soft tissues to heal
true - this helps to prevent healing issues and infection
presentation of a midfoot fracture/dislocation
grossly swollen and bruised foot
cannot weight bear
normal x ray
what is a midfoot fracture/dislocation
fracture of base of 2nd metatarsal with/without dislocation of other metatarsals at TMJ
ligament from medial cuneiform no longer holds in place
if an X ray is normal in a suspicious midfoot fracture/dislocation what do you do
get a CT scan
true/false - the 1st metatarsal is commonly fractured
false - its a strong bone
what is a common location for stress fracture and how is this managed and investigated
2nd metatarsal
cannot be visible on XR until there is a callus so get a bone scan
treat with cast
management of the lesser metatarsal fractures
casting
K wires if multiple
what metatarsal fracture is most common and describe mechanism
5th
inversion with avulsion fracture at insertion of fibularis brevis
management of a 5th metatarsal fraxcture?
stout boot 4-6 weeks
true/false - if there is non-union of a 5th metatarsal fracture it needs operative management
false - theres probably fibrous healing so just leave it
management of a toe fracture
stout boot
how would you manage a toe dislocation
manually reduce closed and strap or wire in place
what toe fractures may need surgical stabilisation
intra articular - if a big fragment
all open fractures need debrided and then wires
