[Ortho] Lower Limb Fracture

Question 1

what are the bones that make up the ankle?

Answer 1

tibia, fibula and talus

Question 2

what are lateral malleolar fractures classified by?

Answer 2

Weber system

Question 3

what does any sign of NV compromise require?

Answer 3

immediate surgical review

Question 4

what are the initial mx of an ankle fracture?

Answer 4

• analgesia (pain ladder)
• AP / lateral / oblique X-rays
• if joint is clinically deformed / there is a fracture-dislocation on X-ray, closed reduction should be performed

Question 5

what can be done for stable ankle fractures?

Answer 5

sent home with repeat X-rays in fracture clinic

Question 6

pt comes in with an ankle injury. what can be used to assess the likelihood of a fracture?

Answer 6

Ottawa rules

Question 7

what are the Ottawa rules?

Answer 7

if yes to any of these, a fracture cannot be rule out:

1. inability to weight bear immediately after injury and in A+E
2. pain on palpation of lateral malleolus
3. pain on palpation of medial malleolus

Question 8

if pt does not have any of the 3 criteria for Ottawa rules, how do you manage it?

Answer 8

safe discharge with R.I.C.E.

Question 9

pt meets criteria for Ottawa rules, what ix should be done now?

Answer 9

X-ray AP, lateral and oblique

Question 10

X-ray shows a unimalleolar fracture with no evidence of ligamentous injury. what is the next step in mx?

Answer 10

discharge with cast and fracture clinic to follow up X-rays

Question 11

X-ray shows a unimalleolar fracture with evidence of ligamentous injury. what does this mean?

Answer 11

unstable fracture

Question 12

X-ray shows a bi/tri-malleolar fracture with evidence of ligamentous injury. what does this mean?

Answer 12

unstable fracture

Question 13

pt has an unstable ankle fracture. how do you manage this?

Answer 13

• closed reduction (if joint is dislocated on X-ray)

- refer for surgical fixation

Question 14

what is the mx of open fractures based off on?

Answer 14

Gustilo-Anderson classification system

Question 15

what should all open fractures be treated with?

Answer 15

empirical IV abx +/- tetanus booster

and gross debris removed

Question 16

what is not advised in open fractures?

Answer 16

washing wounds out with saline

Question 17

what is type 1 in the Gustilo-Anderson classification system?

Answer 17

<1cm wide, typically clean

Question 18

what is type 2 in the Gustilo-Anderson classification system?

Answer 18

1-10cm wide, typically some soiling

Question 19

what is type 3a in the Gustilo-Anderson classification system?

Answer 19

> 10cm wide, adequate tissue coverage for closure

Question 20

what is type 3b in the Gustilo-Anderson classification system?

Answer 20

> 10cm wide, inadequate tissue coverage for closure; requires tissue flap

Question 21

what is type 3c in the Gustilo-Anderson classification system?

Answer 21

any wound with major vascular injury

Question 22

Segond fracture (lateral tibial plateau) is associated with?

Answer 22

75% associated with ACL rupture

Question 23

strong, lateral blow to the knee. dx?

Answer 23

suspect the ‘unhappy triad’ (ACL, MCL and medial meniscus tears)

Question 24

anterior drawer test for the ankle tests for?

Answer 24

talofibular ligament stability

Question 25

“lightbulb sign” on shoulder X-ray?

Answer 25

posterior dislocation of the shoulder

Question 26

pain on palpation of the anatomical snuffbox. dx?

Answer 26

scaphoid fracture (high risk of AVN)

Question 27

paradoxical breathing after trauma to the chest. dx?

Answer 27

flail segment