MSPA: Orthopaedics: Lower limb fractures Flashcards
What determines the stability, severity and need for emergent management in pelvic fractures ?
Mechanism of fracture. That is high energy or low energy trauma.
What is the percentage of mortality in pelvic fractures?
15-25% for closed fractures
Up to 50% for open fractures
What are stable pelvic fractures ?
These are fractures with only 1 break point in the pelvic ring. There should only be limited bleeding and the bone should stay in place.
What is the management of stable pelvic fractures?
- If the fracture doesn’t extend to acetabulum
early mobilisation, bed rest and analgesia
usually suffice - If extends into acetabulum may require
operative management
What are unstable pelvic fractures ?
These are fractures with 2+ breaks in pelvic ring and risk of massive haemorrhage. Early stabilisation with pelvic binder is essential.
What are pubic rami fractures ?
This is a significant issue in older patients and more common in woman than in men. It present with pain on walking or the inability to mobilise/reduce mobility. It is diagnosed on x-Ray.
What is the management of pubic rami fracture?
Weight bear as tolerated (WBAT vs NWB or
FWB)
* Mobilising is better!
– Analgesia
– Physiotherapy
What are the complications of pelvic fractures?
– Death from haemorrhage
– Osteoarthritis
– Urogenital Injury
– DVT/PE
– LRTIs
What are neck of femur fractures ?
It is the most common fracture in elderly. 80% occur in woman. It has a bimodal distribution as majority occur in elderly and minority in young patients.
What are the risk factors for NOF fractures ?
female sex, Caucasian, osteoporosis/paenia, recurrent falls,
diabetes mellitus, tobacco and alcohol use
What is the presentation of NOF fracture ?
Pain and non weight bearing on affected limb
– Shortened & externally rotated limb
– If high clinical suspicion but xray unequivocal, CT or MRI (gold
standard)
What are intra-capsular NOF fractures ?
Fracture line within capsule of hip joint. It has High risk of disruption of blood supply to head of femur causing avascular necrosis of femoral head.
What are extra-capsular NOF fractures ?
Fracture line distal to hip joint capsule. Inter-trochanteric (between greater and lesser trochanter fractures.
What are subtroacateric fractures?
These are pathological fractures or high energy fractures in elderly. May need Thomas splint.
What is the blood supply of the NOF ?
Via intraosseous nutrient vessels of the trochanteric anastomosis formed by the medial and lateral femoral
circumflex arteries which originates from the deep femoral artery.
What is Shenton’s line ?
It is an imaginary line formed by the medial edge of NOF and the inferior edge of the superior pubic ramus. Loss of contours of the Shenton’s line is a sign of fractured NOF.
What is the Garden’s classification of the intracapsular NOF fractures ?
Type 1: Incomplete/valgus impacted
* Type 2: Complete fracture line and non-displaced on AP
and lateral views of X-ray
* Type 3: Complete with partial displacement
* Type 4: Complete displacement of fragments
What is the management of intracapsular NOF fractures ?
-Risk of blood supply disruption high. therefore it is Usually treated with hip hemiarthroplasty, Total hip arthroplasty and ORIF for young patients even for undisplaced fractures. Also undisplaced factures can be treated with cannulated screw fixation.
What is the management of extra-capsular NOF fractures ?
Dynamic Hip Screw +/ -cephalomedullary/intramedullary nail for more distal fractures .
What are the complications of NOF fractures ?
- Avascular necrosis (AVN) of femoral head
- PE/DVT
- Non-union or Mal-union
- Osteoarthritis
- Fracture
- Limb-length discrepancy
- Mortality: Pre-injury morbidity is the most significant determinant
of post-operative survival.
What is hip a dislocation ?
It usually occurs from RTA or falls from heights. In 90% of the case dislocation is in the posterior direction and in 10 % in the anterior direction. There may be swelling and discolouration at the hip with inability to weight bear.