Week 10 - Fractures And Anterior/medial Leg Flashcards
What are types of fractures can children have?
- Incomplete fracture
- – Buckle fractures = compression
- – Greenstick fractures = tension
- Rapid healing
- Growth plate (epiphyseal) fractures
- – These can stunt growth
What are stress fractures?
Fractures caused by repetitive, non-violent stresses
- More common in females than males
- Predispositions = osteoporosis, sports, eating disorders
What are some early fracture complications?
Local: - Nerve injury - Vascular injury - Compartment syndrome - Avascular necrosis - Infection - Surgical Systemic: - Hypervolaemia/shock - Fat embolism - Thromboembolism - Acute respiratory distress syndrome - Disseminated intravascular coagulation
What are some late fracture complications?
Local: - Delayed union - Non union - Malunion - Myositis ossificans - Re-fracture Regional: - Osteoporosis - Joint stiffness - Chronic regional pain syndrome - Abnormal biomechanics - Osteoarthritis
What are the signs and symptoms of fracture?
- Pain
- Loss of function
- Swelling
- Deformity
- Bony tenderness
- Crepitus
- Abnormal movement
What are the factors that influence bone healing?
Local: - Injury (configuration/soft tissue injury) - Bone (cancellous/cortical) - Treatment (reduction/stability/infection) Regional: - Blood supply - Muscle cover Systemic: - Age - Co-morbidity - Bone pathology - Head injury
How can bone healing go wrong?
- Malunion (when the bones don’t heal in the right place)
- Non-union (hypertrophic, atrophic)
- Infection
Which muscles are fiund in the anterior compartment of the leg?
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
- Fibularis tertius
What are the actions of the tibialis anterior?
- Dorsiflexion (main dorsiflexor of the foot)
- Inversion of the foot
What innervates the tibialis anterior?
Deep fibular nerve
What are the actions of the extensor digitorum longus?
- Extension of the 4 lateral toes
- Dorsiflexion of the foot
What innervated the extensor digitorum longus?
Deep fibular nerve
What are the actions of extensor hallucis longus?
- Extension of the great toe
- Dorsiflexion of the foot
What innervates the extensor hallucis longus?
Deep fibular nerve
What are the actions of the fibularis tertius?
- Eversion of the foot
- Dorsiflexion of the foot
What innervates the fibularis tertius?
Deep fibular nerve
Which muscles are found in the lateral compartment of the leg?
- Fibularis longus
- Fibularis brevis
What are the actions of the fibularis longus?
- Eversion of the foot
- Plantarflexion
- Supports the lateral and transverse arches of the foot
What innervates the fibularis longus?
Superficial fibular nerve
What are the actions of the fibularis brevis?
Eversion of the foot
What innervates the fibularis brevis?
Superficial fibular nerve
What are the motor functions of the common fibular nerve?
- Innervates the short head of the biceps femoris directly
- Also supplies the muscles in the lateral (via superficial fibular nerve) and anterior compartments (via deep fibular nerve) of the leg
What are the sensory functions of the common fibular nerve?
- Innervates the skin over the upper lateral (via lateral sural cutaneous nerve) and lower posterolateral leg (via sural communicating nerve)
- Supplies cutaneous innervation to the skin of the anterolateral leg (via superficial fibular nerve) and the dorsum of the foot (deep fibular nerve)
How can the common fibular nerve be damaged?
- Most commonly, by a fracture of the fibula
- – It wraps around the fibular neck, so a fracture of the fibular neck can cause nerve palsy
- Use of a tight plaster cast
What is the effect of damage to the common fibular nerve?
Lose the ability to dorsiflex the foot at the ankle joint
- Foot appears permanently plantarflexed (known as foot drop)
- Present with a characteristic gait
Loss of sensation over the dorsum of the foot and lateral side of the leg
What is the effect of superficial fibular nerve entrapment?
Can cause pain and paraesthesia over the lower leg and dorsum of the foot
How can superficial nerve entrapment occur?
- Usually results from ankle sprains or twisting of the ankle
- – This causes the nerve to stretch in the lower leg
- Can also be compressed by the deep fascia of the leg
How can the superficial fibular nerve be directly damaged?
- Fracture of the fibula
- Perforating wound to the lateral side of the leg
What is the effect of direct damage to the superficial fibular nerve?
- May result in loss of eversion
- Loss of sensation over the majority of the dorsum of the foot and the anterolateral aspect of the leg
How can the deep fibular nerve be compressed?
- Excessive use of anterior leg muscles
- Tight-fitting shoes (compresses the nerve beneath the extensor retinaculum)
What is the effect of compression of the deep fibular nerve?
Foot drop
What is the arterial supply to the leg?
- At the lower border of the popliteus, the popliteal artery terminates by dividing into anterior and posterior tibial arteries
- Posterior tibial artery continues inferiorly
- – The fibular artery branches off from it
- The anterior tibial artery passes anteriorly between the tibia and fibula
- – It then moves inferiorly down the leg
- – It runs down into the foot, where it becomes the dorsalis pedis artery
- – It moves down the leg close to the deep fibular nerve
What are open fractures?
- Fractures that have an open wound
- They are more likely to become infected
- Used to be called compound fractures
