Lower Limb Trauma: Fractures and Dislocations Flashcards
What are the common causes of lower limb fractures and dislocations?
Common injuries include:
* Industrialisation: High energy injuries
* Locomotives: Motor vehicle collisions and pedestrian accidents
* Risky lifestyles: substance use and abuse, adventure and leisure activities
These factors contribute to the prevalence of lower limb injuries.
What is a common fracture affecting the elderly?
Neck of femur fractures
These fractures are indicators of bone weakness and often result from low-energy injuries.
What mechanism of injury commonly causes neck of femur fractures in the elderly?
Low energy fall
In younger individuals, high energy injuries such as motor vehicle accidents are more common.
What are the associated injuries in neck of femur fractures for elderly patients?
Uncommon due to comorbidities hindering treatment
In younger patients, high energy injuries may include concomitant limb fractures and head injuries.
What is the immediate management approach for neck of femur fractures?
ATLS approach to trauma patient
This includes rehydration, especially in the elderly due to delayed presentation.
What are the common complications after neck of femur fractures?
- Malunion of the hip
- Avascular necrosis (AVN) of the hip
- Osteoarthritis of the hip
AVN may require later total hip replacement.
What mechanism of injury leads to tibial plateau fractures?
Fall onto extended knees (axial loading)
This type of fracture is peri-articular, affecting the knee area.
What are the soft tissue complications associated with tibial plateau fractures?
- Severe soft tissue injuries
- Popliteal artery injuries
- Peroneal nerve injury (foot drop)
Compartment syndrome is a significant concern with these injuries.
What are the immediate complications of tibial plateau fractures?
Compartment syndrome
Delayed complications can include osteoarthritis of the knee.
What are common mechanisms of injury for ankle fractures?
Twisting mechanism, variable foot position
These injuries often involve fractures of the malleoli and syndesmosis.
What is the management approach for ankle fractures?
- Nonoperative: closed manipulation and immobilisation (below knee POP)
- Operative: for failed nonoperative treatment, all open fractures
Assessment includes surveying for insufficiency fractures.
What is the most common type of hip dislocation?
Posterior hip dislocation
This type typically occurs from dashboard injuries.
What is the clinical limb attitude for posterior hip dislocation?
Adducted, shortened and externally rotated
This presentation helps in diagnosing the injury.
What should be done for anterior hip dislocation treatment?
Immediate reduction
Operative reduction may be necessary for failed closed reduction or certain associated fractures.
What is a common characteristic of knee dislocations?
Commoner in obese females
Knee dislocations are described according to direction: anterior, posterior, medial, lateral, and combinations.
What are the associated injuries with knee dislocations?
- Tibial plateau fractures
- Knee ligament injuries
- Meniscus injuries
- Popliteal artery injuries (intimal tears on CT angio)
These associated injuries highlight the complexity of knee dislocation cases.
What is the treatment for knee dislocations?
- Immediate reduction
- Vascular assessment
- Referral for orthopaedic evaluation and further management
Prompt assessment and management are critical to prevent complications.
Features of anterior hip dislocation.
Abducted, shortened, and externally rotated.
