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Clin Med II MHM - FINAL > Lower Extremity Fractures > Flashcards

Lower Extremity Fractures Flashcards

1
Q

MC MOI of pelvic fractures

A
  • Fall

- High impact injury in younger people

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2
Q

In high impact pelvic fractures, what else needs to be checked?

A

Bladder injury (get a urine and see if there’s blood)

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3
Q

Hip fractures occur in what populations?

A
  • 60 yo or older (90%)

- Females (75%)

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4
Q

MOI of hip fractures

A
  • Usually a fall in the elderly
  • High impact injury in younger people
  • Can be pathologic from tumor, cyst, osteopenia
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5
Q

Clinical presentation of hip fractures

A
  • Limb is shortened and ER
  • Pain in groin and anterior thigh
  • Unable to ambulate
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6
Q

Types of hip fractures

A
  • Subcapital neck
  • Transcervical neck
  • Intertrochanteric
  • Subtrochanteric
  • Greater trochanter
  • Lesser trochanter
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7
Q

Treatment of hip fracture

A

Surgery for either ORIF or hemi-arthroplasty almost always indicated ASAP because of high mortality rate

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8
Q

MOI of femur fractures

A
  • High impact injury
  • Can be pathologic
  • May occur around prosthesis or ORIF components
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9
Q

Treatment of femur fracture

A

Usually includes external fixator, IM rod, gamma nail or ORIF w/plate and screws

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10
Q

MOI knee fracture

A

Direct blow, twisting, hyperextension

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11
Q

What is the “sunrise” view?

A

An x-ray view of the patella

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12
Q

What are the Ottawa knee rules?

A

Indications for knee x-ray

  • 55+ yrs old
  • Isolated patella tenderness
  • Tenderness at fibular head
  • Inability to flex 90 degrees
  • Inability to bear weight (4 steps) immediately after injury
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13
Q

Describe tibial plateau fracture

A
  • Intra-articular fx of proximal tibia
  • Lateral tibial plateau (60-70%), medial tibial plateau (10-20%)
  • Common in elderly
  • High energy injury in young
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14
Q

How do people present with tibial plateau fracture?

A
  • Acute hemarthrosis
  • Unable to bear weight
  • Joint line tenderness
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15
Q

What else should be assessed with tibial plateau fracture?

A

Popliteal artery and peroneal nerve injuries

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16
Q

Treatment of tibial plateau fractures

A
  • Usually requires ORIF

- Some elderly or high risk pts can be treated non-wt bearing w/ a knee immobilizer

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17
Q

What is the largest sesamoid bone in the body?

A

Patella

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18
Q

What is the MC fracture of the patella?

A

Transverse

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19
Q

MOI patella fractures

A

Direct or indirect trauma or dislocation

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20
Q

Describe sunrise x-ray view

A
  • Assesses alignment of patella for vertical/longitudinal fractures
  • It does NOT evaluate transverse fractures (that may unnecessarily make a case surgical)
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21
Q

Treatment of patella fractures

A
  • If not displaced, knee immobilizer and partial wt bearing

- If displaced, requires ORIF

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22
Q

Extensor mechanism injury MOI

A
  • Patellar or quad tendon ruptures
  • Sudden intense contraction of quads w/knee flexed
  • Direct blow
  • Laceration
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23
Q

What comorbidities increase risk for extensor mechanism injury?

A

RA, gout, SLE

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24
Q

Treatment of extensor tendon mechanism disruption

A
  • Always requires repair of the tendon unless risks outweigh the benefits
  • Initially, immobilization and non-wt bearing w/crutches or walker
25
Q

Patella baja

A

Patella tendon rupture

*Can be normal in some people

26
Q

Patella alta

A

Quadricep tendon tear

27
Q

MOI tibia and fibula fractures

A

Trauma

28
Q

MC type of tibia fracture

A

Shaft

29
Q

Clinical presentation of tibia and fibula fractures

A

Fibula may be able to bear full wt as it is a non-wt bearing bone

30
Q

Treatment of tibia and fibula fractures?

A
  • Non displaced can be w/long leg cast or posterior splint w/knee flexed 20-30 degrees, ankle in neutral position, no wt bearing 4-6 wks
  • Displaced need IM rods, ORIF w/plate and screws, or external fixator
31
Q

Ottawa ankle rules

A

Indications for ankle x-ray

  • Pain in malleolar zone and one of: bone tenderness at posterior edge lat malleolus or inability to bear wt immediately and in ED
  • Pain in mid foot zone and bone tenderness at 5th MT base OR navicular OR inability to bear wt immediately and in ED
32
Q

Ankle sprain MOI

A

Extreme inversion injury and plantar flex

33
Q

MC injured ligament in ankle sprain

A

Anterior talofibular (ATF) ligament

34
Q

What is a “high ankle sprain”?

A
  • Damage to syndesmosis ligament

- Occurs w/dorsiflexion and ER

35
Q

Damage to syndesmosis ligament is what kind of injury?

A

High ankle sprain

36
Q

Ankle sprain grading system

A

1: stretch w/microscopic tearing of ligament (little swelling and functional loss, no joint instability)
2: partial tearing, mod-severe swelling, mod functional loss
3: complete rupture of ligament, severe swelling, mod-severe instability of joint

37
Q

Types of ankle fractures

A
  • Unimalleolar
  • Bimalleolar
  • Trimalleolar
  • Maisonneuve
  • Pilon
38
Q

Treatment of ankle fracture

A
  • Initially, splinting and non wt bearing
  • Most will require ORIF
  • If dislocation involved, reduction must be done prior to splinting
39
Q

If a dislocation is involved with an ankle fracture, what must be done?

A

Reduction must be done prior to splinting

40
Q

Maisonneuve ankle fracture MOI

A

Inversion injury that radiates up fibula and snaps off proximal fibula w/disruption of deltoid ligament (and many times a medial malleolus fracture)

41
Q

Pilon fracture

A

Dome of distal tibial articular surface and extends into adjacent metaphysis

42
Q

Pilon fracture MOI

A

Multiple mechanisms including a fall from height or MCV or skiing injuries

43
Q

What are indications for surgery in a pilon fracture?

A
  • Open
  • Displaced (gap of more than 2 mm or step of more than 1 mm, rotational malalignment)
  • Vascular compromise
  • Compartment syndrome
44
Q

Foot fracture MOI

A

Twisting or crushing

45
Q

What x-rays do we get for foot fracture?

A
  • If tender over metatarsals and cuneiforms, xray foot

- If tender over phalanges, xray toes

46
Q

Avulsion fracture of 5th MT

A
  • Sudden inversion of plantar flexed foot
  • Usually extra-articular
  • Symptoms can mimic ankle sprain
47
Q

Jones fracture

A
  • Transverse fx distal to MT-cuboid joint

- Usually occurs w/o inversion

48
Q

Lisfranc joint

A
  • Articulation between midfoot and forefoot
  • Composed of 5 TMT joints
  • Fracture location of TMT joint
49
Q

Lisfranc fracture MOI

A

Crush injury or rotational force on a plantar flexed forefoot

50
Q

Metatarsal fracture MOI

A

Multiple including inversion injury, direct blow, crush injuries

51
Q

Treatment of toe fractures

A
  • Buddy taping (MC)

- May use a fracture boot for multiple fractures

52
Q

Where does an osteosarcoma originate?

A

Metaphyseal region of tubular long bone

53
Q

Where do osteosarcomas MC occur?

A

Femur (42%)

54
Q

What is the MC benign bone tumor?

A

Osteochondroma

55
Q

Where does an osteochondroma MC occur?

A

Around knee and shoulder (but can occur in any bone)

56
Q

Who is affected by osteochondroma?

A
  • Males 3:1

- Diagnosed before age 20

57
Q

How do osteochondromas grow?

A
  • Near growth plates and grow away from physis

- Grow until skeletal maturity then stops when epiphyseal plates close

58
Q

Describe fibrous cortical defects

A
  • More than 2 cm in size
  • Older children
  • Solitary lesions (75%)
  • Occur at sites of tendon/ligament insertion
59
Q

Describe enchondroma

A
  • Benign cartilaginous neoplasm
  • Usually solitary lesion in medullary bone
  • Small incidence of malignancies
  • Described as “lytic lesions”

Clin Med II MHM - FINAL (16 decks)

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