X-ray/LE/UE

Question 1

Distal Femur Fx

Answer 1

AP & Lateral views
exam: pain/swelling/deformity at distal thigh
posterior leg splint, non-weight bearing

Question 2

Femoral shaft fx

Answer 2

AP & Lateral Views
fx begin 5cm distal to lesser trochanter and 6-8cm proximal to adductor tubercle
Mechanism: MVC or penetrating trauma, falls elderly, nonaccidental children
-immediate reduction, traction splint unless concurrent fx/dislocation of ipsilateral hip, knee, or ankle

Question 3

Hip Dislocation Posterior

Answer 3

AP & lateral x-ray views, CT for occult fx
Displacement of femoral head from acetabulum
Simple: w/o associated proximal femur or acetabular fx
complex: with associated proximal femur or acetabular x
exam: leg held in AD-duction, IR
reduction w/in 6 hours and immobilization knee, protected weight bearing

Question 4

Hip Dislocation Anterior

Answer 4

AP & lateral x-ray views, CT for occult fx
Displacement of femoral head from acetabulum
Simple: w/o associated proximal femur or acetabular fx
complex: with associated proximal femur or acetabular x
exam: leg held in AB-duction and ER
reduction w/in 6 hours and immobilization knee, protected weight bearing

Question 5

Hip Fracture

Answer 5

AP view of hip/pelvis 
MRI occult fx (more sensitive than CT)
-Any fx proximal within 5cm of lesser trochanter 
mechanism: fall or direct trauma 
-immobilization, non-weight bearing

Question 6

Fibula Fx

Answer 6

AP & Lateral views of lower leg
Mechanism: direct trauma over lateral aspect of leg
Pain worsens with eversion
immobilization in posterior short leg splint (for comfort)
-weight bearing as tolerated with crutches

Question 7

Collateral Ligmament Injury: MCL

Answer 7

AP and lateral views to evaluate bony injury
-MCL - valgus and external rotation stress to flexed knee
MCL: joint laxity without stress test
immobilization in knee immobilizer if significant ligamentous laxity

Question 8

LCL

Answer 8

AP and lateral views to evaluate bony injury
-LCL - varus and internal rotation
LCL: joint laxity with varus stress test
immobilization in knee immobilizer if significant ligamentous laxity

Question 9

Cruciate Ligament Injury

Answer 9

AP and Lateral views
ACL: positive anterior draw sign
PCL: positive posterior draw sign
knee immobilizer

Question 10

Meniscus injury

Answer 10

AP and Lateral Views
injury medial/lateral meniscus
mechanism: rotational of flexed knee on planted foot
+ McMurrays, Apley’s compression/distraction test
knee immobilization

Question 11

Patella Dislocation

Answer 11

AP and Lateral Views; consider sunrise view
displacment of patella from patellofemoral groove
-forceful contraction of quads with flexed and rotated knee or direct trauma to flexed knee
pain worse with knee movement, deformity
immobilization of knee or posterior leg spint

Question 12

Patella Fracture

Answer 12

AP and lateral views; sunrise
Direct trauma to anterior kneee
hemarthrosis, palpable deformity, inability to straighten leg
immobilization of knee or posterior leg splint

Question 13

Tibial Plateau Fx

Answer 13

AP and lateral views
CT for occult fx, especially if unexplained knee effusion
mechanism: valgus/varus forced combined with axial loading
associated injury of popliteal a, and ligaments (Lateral> medial) compartment syndrome
Pain worse with varus/valgus testing
-immobilization posterior leg splint, non-weight bearing

Question 14

Anterior Ankle dislocation

Answer 14

AP, lateral, mortise view
foot dorsiflexe and displaced anteriorly
mechanical obstruction of dorsalis pedis artery
reduction and immobilization in posterior short leg with sitrrup splint, non-weight bearing

Question 15

Lateral Ankle Dislocation

Answer 15

Foot displaced laterally
associated: malleolar (medial/and or lateral) and distal fibula fx, deltoid ligament injury
reduction and immobilization in posterior short leg with sitrrup splint, non-weight bearing

Question 16

Posterior Ankle Dislocation

Answer 16

Foot plantar flexed and displaced posteriorly
Associated: lateral malleolus fx, disruption of tibifibular syndesmosis
reduction and immobilization in posterior short leg with sitrrup splint, non-weight bearing

Question 17

Superior Ankle Dislocation

Answer 17

shortened lower leg with obvious deformity
Associated: articular damage, thoracolumbar and or calcaneal fx
reduction and immobilization in posterior short leg with sitrrup splint, non-weight bearing

Question 18

Lateral Malleolus Fx

Answer 18

AP, lateral, mortise
associated: deltioid ligament or tibiofibular syndesmosis injury
posterior short leg with stirrup splint, non-weight bearing

Question 19

Medial Malleolus Fx

Answer 19

AP, lateral, mortise
associated: delotid, tibiofibular sydesmotic ligament injury, fibular neck fx (maisooneuve fx), lateral or posterior malleolus, tibial nerve, posterior tibial artery
reduction and immobilization in posterior short leg with stirrup splint, non-weight bearing

Question 20

Bimalleolar Fx

Answer 20

unstable: both lateral and medial
equivalent: lateral malleolus fx with widened mortise concerning for deltoid ligament injury
Assoc: deltoid, tibiofibular syndesmotic ligament injury
reduction and immobilization in posterior short leg with stirrup splint, non-weight bearing

Question 21

Trimalleolar Fx

Answer 21

unstable fx of lateral, medial, and posterior malleoli
Associated: deltoid ligament rupture, fibular neck fractures, injury to tibial n, posterior tibia a, peroneal a
Reduction and immobilization in posterior short leg with stirrup, non-weight bearing

Question 22

Maisonneuve Fx

Answer 22

AP, Lateral, mortise view
widened mortise = deltoid ligament injury
Full length tibia or proximal tibia view
unstable fx will have proximal tibial fx, distal tibiofibular syndesmosis injury, and deltoid ligament rupture or medial malleolus fx
mechanism: IR of leg and ER of talus with planted foot
reduction if displaced and immobilization posgterior lon