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MSK > Lower Limb Trauma > Flashcards

Lower Limb Trauma Flashcards

1
Q

What mechanism causes pelvic injury?

A

Young patients - high energy injury

Older patients - osteoporosis

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2
Q

Name the bones of the pelvis

A

Sacrum
Ilium
Ischium
Pubic bones

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3
Q

What neuromuscular structures can be damaged in pelvic trauma?

A

Internal iliac arterial system
Pre-sacral venous plexus
Roots and branches of lumbo-sacral plexus

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4
Q

Name four types of pelvic fracture

A
  • lateral compression fracture
  • anteroposterior compression fracture
  • vertical shear
  • acetabular fracture
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5
Q

How does a lateral compression fracture occur?

A

Side impact - one half of the pelvis is displaced medially

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6
Q

Describe the three types of lateral compression fracture

A

I - ramus fracture and ipsilateral anterior sacral compression fracture
II - ramus fracture and ipsilateral posterior ilium fracture
III - ipsilateral lateral compression and contralateral APCF

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7
Q

How does an anteroposterior compression fracture occur?

A

Open book fracture due to widespread disruption of the pubic symphysis

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8
Q

Describe the three types of anteroposterior compression fracture

A

I - symphysis widening <2.5cm
II - symphysis widening >2.5cm, anterior SI d’astasies and disruption of sacrspinous/tuberous ligaments
III - SI dislocation, disruption to sacrospinous and sacrouberous ligaments

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9
Q

Describe a vertical shear fracture

A

Posterior and superior hemipelvis displacement, high risk of nerve injury and haemorrhage. Shorter leg on affected side

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10
Q

How are pelvic fractures managed?

A

Pelvic binder to temporarily hold reduction
PR exam
Angiogram
Embolisation or packing of the pelvis

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11
Q

How are acetabular fractures managed?

A

X-ray/CT
Small/undisplaced - conservative
Displaced/unstable - reduction and fixation or replacement

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12
Q

State the risk factors for hip fractures

A
  • osteoporosis
  • smoking
  • malnutrition
  • excess alcohol
  • neurological impairment
  • impaired vision
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13
Q

What type of fractures are at risk of non-union?

A

Intracapsular fractures

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14
Q

How are intracapsular fractures treated?

A

Fixation, hemiarthroplasty or total hip replacement

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15
Q

Describe garden grading

A

I - impaction/incomplete
II - non-displaced complete
III - partially displaced
IV - displaced and complete

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16
Q

How will an intracapsular fracture present?

A

History of fall, painful and unable to weight bear, shortened and externally rotated due to abductors and iliopsoas

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17
Q

Name three types of extra capsular fracture

A
  • basicervical
  • intertrochanteric
  • subtrochanteric
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18
Q

How are extracapsular fractures investigated?

A

X-ray

MRI

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19
Q

If an intracapsular fracture is displaced how is it treated?

A

Poor function - hemi-arthroplasty
Young patient - fixation
Good function - THR

20
Q

How is an intracapsular non-displaced fracture treated?

A

Poor function - hemi-arthroplasty
Good function - THR
Good function and good blood supply - fixation

21
Q

How are extra capsular fractures treated?

A

Inter-trochanteric - DHS
Sub-trochanteric - Intramedullary nail
Reverse oblique - intramedullary nail

22
Q

What factors predispose to femoral shaft fractures?

A

Osteoporosis
Metastatic disease
Paget’s
Long term bisphosphonates

23
Q

What is the significant complication of femoral shaft fracture?

A

Substantial blood loss up to 1.5 litres can occur and fat can enter the damaged venous system causing a fat embolism

24
Q

How is a femoral shaft fracture managed?

A

Thomas splint
Analgesia
Femoral nerve block
Reduction and stabilisation with nail/plate

25
Q

How do distal femoral fractures occur?

A

Osteoporotic bone with a fall onto the flexed knee

26
Q

Describe a distal femoral fracture

A

Adopts a flexed position - gastro pull and unless contraindicated fixed with plate, screws and cast

27
Q

Describe a proximal tibial fracture with valgus stress

A

Lateral plateau fracture with failure of the MCL and sometimes ACL

28
Q

Describe a proximal tibial fracture as a result of a blow from car

A

Proximal fibular fracture and injury to common perineal nerve with foot drop

29
Q

Describe a proximal tibial fracture due to varus stress

A

Medial plateau fracture with LCL rupture and stretch injury to common perineal nerve

30
Q

How are proximal tibial fractures managed?

A

Total Knee Replacement

Plate and Screws for fixation

31
Q

What is the most common cause of compartment syndrome?

A

Tibial Shaft Fracture

32
Q

How are tibial shaft fractures managed?

A

Non-operative - above knee cast

Operative - internal fixation controls the position

33
Q

What is the slowest healing bone in the body?

A

Tibia

34
Q

What is a common method of tibial stabilisation?

A

Intra-medullary nailing

35
Q

State another name for distal tibial fractures

A

Pilon fractures

36
Q

What merits an ankle x-ray?

A

Tenderness on medial/lateral malleolus if unable to weight bear

37
Q

Describe a stable ankle fracture

A

Isolated distal fibular fracture with no other damage is common and treated with a cast/splint for 6 weeks

38
Q

Describe an unstable ankle fracture

A

Distal fibular fractures with deltoid ligament rupture - bruising and tenderness

39
Q

What is talar shift?

A

Asymmetric increased space around the talus within the ankle mortise

40
Q

What is talar tilt?

A

Talus and tibial plafond non-parallel

41
Q

What bone is commonly fractures on a fall from height onto the heel?

A

Calcaneal

42
Q

How does a talar fracture occur?

A

Forced dorsiflexion from rapid deceleration - risk of AVN if displaced
Reduce and fixation

43
Q

What is the name for a mid foot fracture?

A

Lisfranc

44
Q

What imaging is required for a lisfranc fracture?

A

CT scan

45
Q

How will a mid foot fracture present?

A

Grossly swollen bruised foot upon which they are unable to bear weight

MSK (22 decks)

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