trauma: lower limb Flashcards
what forms the pelvis
sacrum, ilium, ischium, pubic bones
what causes lateral compression pelvic hip fracture and what is damaged
one half pelvis crushed medially (RTA)
fractured ischium, pubic and sacral compression
what causes vertical compression pelvic hip fracture and what is damaged
fall and displaced superiorly, sacral nerve root and lumbosacral plexus at risk, one leg shorter
in anterioposterior compression pelvic hip fracture what is damaged
disrupts pubic symphysis –> opne book fracture, bleeding and tamponade
what is mainly at risk in pelvic fractures
usually high energy to resus, hypovolaemia, internal iliac and sacral venous plexus, bladder and urethra, lumbosacral plexus
who commonly gets hip fractures
elderly, osteoporosis, demal, co-morbidities –> increased falls
what co-morbidities can increase chances of falling
arrhythmias, postural hypotension
what is usually better treatment for hip surgery or conservative and why
surgery better as non-surgical longer recovery (pressure sores, atrophy, cant walk)
what can cause acetabulum fractures
posterior wall fractures (from femur eg knees on dashboard) and hip dislocation
what is best investigations for acetabulum intra articular fractures
CT > x ray
how do you manage acetabulum fractures
undisplaced (conservative), unstable (reduction and fixation), older (THR)
in an intra capsular hip fracture on head of femur what is often done
risk of AVN hemi-arthoplasty or THR
what is done for extracapsular head of femur hip fracture
should not cause AVN, compression/ dynamic hip screw
what can cause femoral shaft stress fractures
osteoporosis, metastatic disease, paget’s
what are risks of displaced femoral shaft fractures
blood loss, fat from medullar canal blocks venous system (embolism –> hypoxia or ARDS)
what is the initial management for a femoral shaft fractures
analgesia, femoral nerve block, THOMAS SPLINT
what is the definitive management for a femoral shaft fractures
closed reduction and intramedullary nails
how do you manage true knee dislocations
urgent reduced and revascularisation, unstable –> external fixator, multi-ligament reconstruction
what might you consider in a grossly unstable knee joint
true knee dislocation with spontaneous reduction
what are risks in high energy intra-articular proximal tibial fractures
neurvasculature and compartment synrome
what imaging is useful in intra-articular proximal tibial fractures
CT
how do you manage intra-articular proximal tibial fractures
ORIF, often need TKR in later life
what is the most common cause of compartment syndrome from trauma
tibial shaft fracture
how do you treat tibial shaft fractures non-operatively
knee cast if <50% displaced with frequent changes and X rays
how do you treat tibial shaft fractures operatively
internal fixation
how do you treat comminuted tibial shaft fractures
ORIF + plates and screws, intramedullary nailing, surgical grafts
what symptom would warrant an ankle x ray
unable to bear weight
what is commonly ruptured in ankle fractures
medial deltoid ligaments
what are symptoms of medial deltoid ligaments rupture in ankle fracture
medial bruising and tenderness, talar shift (internally rotated)
how do you treat stable ankle fractures
with no deltoid rupture - cast or splint
how do you treat unstable ankle fractures
ruptured deltoid, ORIF
what is a midfoot (lisfranc) fracture/ dislocation
uncommon fracture and dislocation at base of 2nd metatarsal
what is gold standard for midfoot (lisfranc) fracture/ dislocation
CT
what are symptoms of midfoot (lisfranc) fracture/ dislocation
grossly swollen, bruised, cant bear weight
how is the base of the 5th metatarsal commonly fractured
inversion injury
how do you manage 5th metatarsal fracture
walking cast/ boot
how do you manage 1st metatarsal fracture
(uncommon), fixation
how do you identify 2nd metatarsal fracture and how do you get it
stress fracture and bone scan
