Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Charis & Ellie vs MSK part 2 > Pelvis and Lower Limb trauma > Flashcards

Pelvis and Lower Limb trauma Flashcards

1
Q

who gets pelvic fractures?

A

young people - usually dur to high energy
older people - usually due to osteoporosis - can get pubic rain fractures from low energy injuries, usually minimally displaced lateral compression injuries and settle with conservative management over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what forms the pelvic ring?

A

sacrum
ilium
ischium
pubic bines with strong supporting ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

vessels of the pelvic ring

A

branches of the internal iliac arterial system and the pre0sacral venous plexus are prone to injury
risk of serious hypovolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

nerves of the pelvic ring

A

nerve roots and branches of the lumbosacral plexus are prone to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

lateral compression fracture in the pelvic ring?

A

due to side impact (RTA) where 1 half of the pelvis (hemipelvis) is displaced medially
fractures through the pubic rami/ischium involve a sacral compression fracture of SI joint disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

vertical shear fracture in the pelvic ring?

A

due to axial force on one hemipelvis (e.g. fall from height, rapid, deceleration)
affected hemipelvis is displaced superiorly
risk of injury to the sacral nerve roots and lumbosacral plexus
risk of major haemorrhage
leg on the affected side will appear shorter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

anteroposterior compression injury in the pelvic ring?

A

can cause wide disruption of the pubic symphysis
resulting in an ‘open-book pelvic fracture’
causes substantial bleeding from torn vessels
also from the pelvic volume increasing exponentially due to the degree of displacement - with widely displaced injuries the pelvis can hold several litres of blood before tamponade and clotting occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

management of pelvic ring fractures

A

prompt assessment and resuscitation

treat the blood loss - fluids/blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

management of open book pelvic fractures

A

promptly reduce the displacement to minimise the pelvic volume to allow tamponade of bleeding to occur
apply tied sheet/special pelvic binder around the outside of the pelvis to hold the reduction temporarily and allow slotting of the vessels
an external fixator will provide more secure initial stablisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the management if after initial pelvic fracture management haemodynamic instability continues

A

angiogram and
embolisation,
or open packing of the pelvis if laparotomy is required for co-existing intra-abdominal injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the other structures which can be injured in a pelvic fracture?

A

potential for bladder and urethral injuries, blood at the urethral meatus and urinary catheterisation can cause further injury
urological assessment and intervention is needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what exam is mandatory when there is pelvic fracture?

A

PR exam to assess sacral nerve root function and to look for blood
presence of blood indicates a rectal tear injury - the injury is an open fracture with a higher mortality risk
general surgical review as may need defunctioning colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the acetabulum?

A

intra-articular section of the pelvis which forms the ‘cup’ of the hip joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

who gets acetabulum fractures?

A

younger patients with high energy injuries

older patients with low energy injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the significance of posterior wall acetabulum fractures/

A

may be associated with hip dislocation - head of femur pushed out the back of the joint - RTA where the car driver’s knees collide with the dashboard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is a acetabulum fracture investigated?

A

x-ray (difficult to see - try oblique view)

CT scans - determine fracture pattern for surgical planning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how are undisplaced/small wall acetabulum fractures managed?

A

conservative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how are intra-articular/unstable/displaced acetabulum fractures managed?

A

young people
- anatomic reduction and rigid fixation to decrease risk of post traumatic OA
older patients - THR, either early (with an uncemented cup and screws) or delayed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

who gets hip fractures?

A

older people with osteoporosis
numbers of hip fractures are increasing with ageing population
majority are over 80 and 75% are female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what co-morbidities are associated with hip fractures?

A 
they tend to increase the risk of falls 
cerebrovascular insufficiency 
cardiac arrhythmias 
postural hypertension etc. 
comorbidities such as renal failure cardiopulmonary disease and chest infections can cause complications post-surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how are hip fractures managed?

A

nearly all have surgery usually within 24 hours
risks of non-operative management just as high
exceptions - high risk patients expected to die very soon after injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the prognosis of hip fractures

A

20% don’t regain full independence and need long-term care, 30% fail to return to their pre-injury function
many need a stick/walking frame
some patients fail to recover and so need a wheelchair and may need assistance/ hoist to transfer from bed to chair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

risk factors for a proximal femoral fracture?

A

Risk doubles every 10 yrs after 50 yrs old
• Osteoporosis (3 times more common in females)
• Smoking
• Malnutrition
• Excess alcohol
• Impaired vision
• Neurological impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how does proximal femoral fracture (hip fracture) present?

A

usually externally rotated and shortened leg
pain in groin
pain on pin roll

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the blood supply to the femoral head?

A
  • Intramedullary artery of shaft of femur (travels up the femoral neck and into the femoral head)
  • Medial and lateral circumflex branches of profunda femoris
  • Artery of ligamentum teres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is an intra-capsular proximal femoral fracture?

A 
fracture is above the trochanter lines, 
undisplaced, displaced (young, old and active, old), garden 
fractures 
I - valgus impacted displaced, 
II - undisplaced, 
III - 
displaced, 
VI - displaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

complications of a intra-capsular proximal femoral fracture?

A

Complications: non-union, AVN (as the arterial supply of the
femoral head can be disrupted)

28
Q

what is a extra-capsular proximal femoral fracture?

A

basicervical, intertrochanteric, subtrochanteric

29
Q

what are the potential complications of a proximal femoral fracture?

A

malunion

non-union (but much less than intra-capsular

30
Q

how is a proximal femoral fracture diagnosed?

A

history - fall, pain, unable to weight bear
shortening
external rotation - due to pull of the tendon
investigations
- X ray - shenton’s line
- MRI

31
Q

how is a proximal hip fracture treated?

A

return the patient to pre-fracture level of function

usually by operation followed by early mobilisation to avoid complications of recumbency

32
Q

management of undisplaced intra-capsular hip fracture?

A 
Good function (young adult, high energy injury) = fixation (reduction using DHS, screws, can do 
multiple pinning)
Risks: AVN/non-union as blood supply is probably damaged 
• Poor function = hemiarthroplasty (hip replacement - replacing femoral head alone
33
Q

management of displaced intra-capsular fracture?

A

Hemiarthroplasty or total hip replacement (THR is replacing the acetabulum as well as the
femoral head)
Risks: THR has higher risk of infection and displacement (esp. in the cognitively impaired) but can
give better function so is given for higher functioning hip fracture patients

34
Q

how is a extra-capsular hip fracture managed?

A

Generally fixed with internal fixation, keeping the patient’s own natural hip joint
blood supply in extra-capsular injuries is usually intact so tend to do fixation instead of replacement
An IMN can be short or long
CHS/DHS = large screw is inserted into the femoral head across the fracture line, and a plate
which has a barrel attached to the lateral end of the screw and is fixed to the femoral shaft - as
the patient weight bears, the screw slides into the barrel of the plate which results in
compression at the fracture site promoting fracture healing

35
Q

extra-capsular Intertrochanteric fracture management

A

CHS/DHS [compression/dynamic hip screw]

36
Q

extra-capsular basicervical fracture management

A

CHS/DHS [compression/dynamic hip screw]

37
Q

extra-capsular Subtrochanteric fracture management

A

(usually in elderly patients with osteoporosis who fall onto the side,
area has poor blood supply, non-union is quite common) = IMN [intramedullary nail], pre-operatively can use pain-relief and Thomas splint
fracture from the greater to lesser trachanter

38
Q

summary of hip fracture management?

A

early mobility is important
If both sides are vascularised = fix
If one side is avascular = replace

39
Q

extra-capsular reverse oblique fracture management?

A

IMN

sort of the opposite of a subtrochanteric fracture

40
Q

how is an infection post hip fracture managed?

A

sometimes metal work is removed but not routinely
if infected after fracture healing - take it out, give antibiotics etc.
if infected before fracture is fully healed, might give antibiotics and then take it out but treatment is more variable

41
Q

where are the common sites of fragility fractures?

A

neck of femur (NOF)
neck of humerus
wrist
vertebral and pelvic fractures

42
Q

what are some fraility syndromes

A

falls immobility
delirium
incontinence
susceptibility to the side effects of medication
(if patient is very frail get in a better operative state for better post-operative recovery)

43
Q

who gets femoral shaft fractures?

A

usually a result of high energy
substantial risk of concomitant fracture elsewhere
Can get stress fractures of the femoral shaft due to:
osteoporotic bone,
metastatic disease,
patients with Paget’s disease,
long-term bisphosphonate use (for osteoporosis - so paradoxical)

44
Q

what are the risks of a femoral shaft fracture?

A

Fat embolism, fat from medullary canal entering the damaged venous system (causes
confusion, hypoxia, risk of ARDS)
IF displaced, can get substantial blood loss (up to 1.5L)

45
Q

what is the management of a femoral shaft fracture?

A

Resuscitation
Initial - optimise analgesia with a femoral nerve block, Thomas splint (stabilises fracture minimising further blood loss and fat embolism)
Definitive - usually closed reduction and stabilisation with IMN, but can use minimally invasive
plate fixation (with minimal disruption to the fracture site blood supply)

46
Q

what is the knee?

A

the articulation between the distal end of the femur and proximal tibia
hinge joint
mainly does flexion and extension, has small degree of rotation
not as stable as the hip joint

47
Q

who gets a distal femoral fracture?

A

usually in osteoporotic bone fall on the flexed knee

48
Q

what are the types of distal femoral fracture?

A

can be extra-articular - supracondylar or intra-articular - intercondylar

49
Q

how does a distal femoral fracture present?

A

usually adopts a flexed position due to the pull of the gastrocnemii muscles

50
Q

how is a distal femoral fracture managed?

A

usually fixed with plates and screws

51
Q

who gets knee dislocation?

A

uncommon

either due to high energy injuries ow with severe hypertension and/or rotational forces with a sporting injury

52
Q

how is a knee dislocation treated?

A 
surgical emergency 
- high incidence of vascular injury 
nerve injury and compartment syndrome 
should be urgently reduced 
need thorough neurovascular assessment 
knee is unstable - external fixator
53
Q

who gets patellar dislocation?

A 
pretty common 
more common in female adolescents 
general ligament laxity 
valgus knee
rotational malalignment 
shallow trochlear groove
54
Q

what is the most common patellar dislocation?

A

lateral dislocations
due to either a direct blow or a contraction of the quadriceps with a
rotational force with the patella not engaged in the trochlea (less than 30° flexed)

55
Q

how does a patellar dislocation present?

A

tenderness over the medial retinaculum (as medial patellofemoral ligament is torn
may have haemoathrosis
may get osteochondral fractures (which occasionally need retrieval fixation depending on size)

56
Q

how is a patellar dislocation managed?

A

may spontaneously reduce when knee is straightened
if remains dislocated - manipulation for reduction
may get subluxation
sometimes needs surgical stabilisation (bony procedure for malalignment/soft tissue (MPFL) reconstruction)

57
Q

what is the prognosis of patellar dislocation?

A

10% will get another dislocation with 50% getting multiple recurrent dislocations
most adolescents stabilise as they get older

58
Q

who gets a proximal tibia (plateau) fracture?

A

either high energy in young patients - might be associated with neurovascular injury to compartment syndrome
or
low energy in osteoporotic bone

59
Q

what is the effect of a lateral plateau fracture in the proximal tibia?

A

caused by valgus stress injury to knee, can cause failure of
MCL and ACL

60
Q

what is an intra-articular fracture in the proximal tibia (plateau) fracture?

A

either split in the bone

depression of the articular surface or both

61
Q

what is the effect of a medial plateau fracture in the proximal tibia?

A

caused by varus stress, this is less common, can cause LCL

rupture

62
Q

what is the presentation of damage to the common peroneal (femoral) nerve in plateau fracture?

A

common accompanying injury

causes foot-drop due to loss of power to tibialis injury

63
Q

what is the management of a proximal tibia (plateau) fracture?

A

reduction and fixation (plates and screws, CT can help),
with early motion to prevent stiffness and post-traumatic OA,
may need bone graft
Can use external fixator before surgery, sometimes this is used as definitive management
If this all fails (which happens often) then need total knee replacement

64
Q

what causes tibial shaft fractures?

A

usually due to indirect force and either bending (transverse) fracture
rotational energy (spiral fracture)
or
compressive force from deceleration (oblique fracture)
can be a combo of these or from high energy injuries (comminuted fractures)
can be open fractures - tibial shaft is subcutaneous

65
Q

what is something to be aware of with tibial shaft fractures?

A

it is the commonest cause of compartment syndrome after trauma esp in ant. compartment of leg

66
Q

what is the treatment of tibial shaft fracture?

A

up to 50% displacement and 5 degrees of angulation can be treated conservatively (cast, check X-rays)
if fibula is not fractured then tibia often drifts varus
if fibula is also fractured then the tibia drifts valgus
Surgical stabilisation: esp. if comminuted fractures (highly unstable), open fractures or
compartment syndrome
- IMN is most commonly used (25% have anterior knee pain afterwards - need to discuss this
with patients esp. those who have an occupation that involves kneeling)
- ORIF with plates and screws (risk of affecting blood supply, non-union)
Can do external fixation (can cause pin site infection/loosening)
Non-union - may need bone grafting/special circular frames
Compression at fracture site to promote healing
Form new bone from distraction osteogenesis (making a longer bone out of a shorter one)

67
Q

healing of the tibia

A

one of the slowest healing bones in the body

union around 16 weeks and heals in 1 year

Charis & Ellie vs MSK part 2 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions