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Block 4 > Lower Limb Injuries > Flashcards

Lower Limb Injuries Flashcards

1
Q

Define fracture.

A

A breach of integrity of part or the whole of a bone

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2
Q

Define subluxation.

A

Partial separation of the articular surfaces of the joint

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3
Q

Define dislocation.

A

Complete separation of the articular surfaces of a joint

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4
Q

Define fracture dislocation.

A

A dislocation where there is also a fracture involving one or more of the articular surfaces of a joint

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5
Q

Define sprain.

A

Stretching of the joint capsule and ligaments of a joint, insufficient to produce subluxation or dislocation

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6
Q

What are the mechanisms of fracture formation?

A
  1. Bone strength

2. Force/energy

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7
Q

What are some causes of weak bones?

A

Osteoporosis (e.g. post-menopausal)
Osteogenesis imperfecta (brittle bone disease)
Secondary bone cancer

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8
Q

What are the clinical signs and symptoms of a fracture?

A 
Pain
Swelling
Tenderness
Bruising
Deformity
Crepitus
Abnormal movement
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9
Q

Why do fractures cause pain?

A

Bones do not have nerves themselves but fractures hurt either due to the surrounding nerves becoming impinged or bleeding as this will increase pressure on soft tissues e.g. muscles

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10
Q

What are the 2 different types of compound fracture?

A
  1. From within: bone has come out of the skin
  2. From without: something has hit a limb with such force that it has gone through the skin and fractured the bone leaving an open wound
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11
Q

What are compound fractures at high risk of?

A

Infection as they are open wounds

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12
Q

What other structures can be affected by fractures causing complications?

A 
Blood vessels
Brain
Spinal cord
Nerves
Contents of chest
Abdomen
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13
Q

What are the different types of fracture union?

A
  1. Normal: 6 weeks - 3 months
  2. Delayed: takes longer than expected
  3. Malunion: joins in wrong alignment (e.g. in clavicle as it is impossible to immobilise it)
  4. Non-union: does not unite (e.g. if it not immobilised and fixed in the correct position)
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14
Q

How can you diagnose a fracture?

A 
History & examination
X-ray
Computerised Axial Tomography (CAT) scan
MRI
US
Bone scan
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15
Q

What different X-ray views can be used to look at a fracture?

A
  1. Antero-posterior in sagittal plane

2. Lateral in coronal plane

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16
Q

What can a Magnetic Resonance Image (MRI) tell you about a fracture?

A

Bone density

If fluid is present (by adding contrast)

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17
Q

What type of fractures will most likely need a ultrasound (US) to detect?

A

Greenstick fractures as they are so fine, you cannot see them on other forms of scan but US waves will go down through the crack and be more obvious

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18
Q

Who are ultrasounds (US) most commonly used on?

A

Children

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19
Q

What are the main structural bony features of the pelvis?

A

Ilium
Ischium
Pubis
Acetabulum

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20
Q

What are patients with pelvic fracture at risk of?

A 
Blood loss (can be fatal)
Abdominal injury e.g. bladder or male urethra 
Nerve injury
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21
Q

What vessels do you bleed most from? Why?

A

Veins as they cannot constrict like arteries can

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22
Q

How is the ilium usually injured?

A

Lateral blow

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23
Q

When will patients with pubic fractures get the most pain?

A

When weight bearing on 1 leg

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24
Q

It is important to get fracture patients ____ as quickly as possible.

A

Moving

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25
Q

What is another term for a pubic symphysis separation?

A

Open book fracture

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26
Q

How do most fractures need to be fixed?

A

With metal pins fixating the fracture so the bones are immobilised

27
Q

How do intra-articular acetabular fractures occur most commonly?

A

Hit to femur from side OR if patient lands on leg hitting the roof of acetabulum with force (force travels up leg) esp. when weight bearing (force travels down leg)

28
Q

How can neck of femur (intracapsular/transcervical) fractures occur?

A

Osteoporosis
Fall
Stress fracture
Spontaneously

29
Q

What is a common complication of neck of femur (intracapsular/transcervical) fractures?

A

Avascular necrosis as intra-capsular retinacular arteries (branches of circumflex femoral arteries) are damaged and there is no compensatory blood supply to the femoral head

30
Q

If a patient has a neck of femur (intracapsular/transcervical) fracture, what will their lower limb look like?

A

Short

Externally rotated

31
Q

What might you do instead of using metal fixation in a young, fit and healthy fracture patient?

A

Hip replacement as metal will erode the bone over time

32
Q

What type of femur fracture requires the most mechanical fixation?

A

Head of femur/extra-capsular/subcapital

33
Q

What type of patients are more at risk of blood supply damage and avascular necrosis with neck of femur (intracapsular/transcervical) fractures? Why?

A

The younger the patient the higher the risk as the amount of force it takes to fracture a young person’s neck of femur is much greater than in an elderly person

34
Q

What is the mortality statistics of neck of femur (intracapsular/transcervical) fractures?

A

40% of patients die within 2 years after

35
Q

How is the hip likely to become dislocated?

A

Requires high impact frontal force (e.g. if in a head on car crash) when you are sitting down as this is when the ligaments are laxed allowing the hip to posteriorly dislocate

36
Q

If a dislocation at a synovial joint (e.g. hip) is not reduced within 6 hours, what can occur?

A

Chrondrolysis
Avascular necrosis
Degenerative arthritis

37
Q

What nerve is at risk of damage with a posterior hip dislocation?

A

Sciatic n.

38
Q

What options are there to treat a femoral shaft fracture? What one is better?

A

External fixation allowing bone to heal but requires 3 months in hospital or an internal fixation where a intramedullary nail through the piriform fossa and piriformis so patient can get up and walk around

39
Q

What are the consequences of a patellar intra-articular fracture?

A

Haemarthrosis

Loss of knee extension

40
Q

How can you treat a patella fracture?

A

Internal fixation

Patellectomy (if patella shattered)

41
Q

Why are tibial plateau fractures high risk?

A

They are usually intra-articular so nerves are damaged along with soft tissue and major blood vessels such as the popliteal vessels

42
Q

Why can meniscal injuries not repair themselves?

A

As menisci of the knee do not have a blood supply (except round their edge)

43
Q

What is the main mechanism of meniscal injury?

A

Rotation of the femur on a fixed tibia (i.e. tibia fixed on ground)

44
Q

If a meniscal injury becomes more extensive, what can happen?

A

Cruciate ligament injury

45
Q

How can you test the cruciate ligaments of the knee?

A

Anterior or posterior draw test

46
Q

What is a triad knee injury?

A

An injury that damages the meniscus, cruciate ligaments AND medial ligaments

47
Q

How can you fix ligaments of the knee? Whats the problem with this?

A

Semitendonosus OR patella tendon can be used but artificial tendons require fixation and getting tension right is crucial but difficult

48
Q

How can a patient get a tibial shaft fracture?

A

Direct trauma

Rotational strain

49
Q

How do you treat tibial shaft fractures?

A

External immobilisation

Internal immobilisation

50
Q

What is compartment syndrome?

A

When pressure in the muscle compartment is greater than the systolic pressure

51
Q

What is a complication of a tibial shaft fracture?

A

Compartment syndrome

52
Q

What is a give away sign of compartment syndrome?

A

Increasing pain even if analgesia is given, the pain goes away for a bit then comes back and continues to get worst

53
Q

What is the function of the anterior compartment of the leg?

A

Dorsiflexion of the foot and ankle - important in swing phase of walking

54
Q

What part of the ankle can be fractured?

A 
Ankle mortice
Medial malleolus
Lateral malleolus
Intra-articular
Calcaneus (Os Calcis)
55
Q

If the ankle is fractured, how must you treat it?

A

Restore ankle anatomy with surgery

56
Q

What are ankle fractures commonly associated with? How can this be reduced?

A

Soft tissue injury so RICE leg straight away to reduce effects of this

57
Q

What joint can be damaged by a calcaneal fracture?

A

Subtalar (responsible for inversion/eversion movements of ankle and foot)

58
Q

What types of soft tissue injury of the lower limb exist?

A

Skin lesions
Vascular compromise
Diabetes
Vascular insufficiency

59
Q

How does the Achilles/calcaneal tendon rupture?

A

Tendon is degenerated due to overuse and then a forceful contraction of the gastrocnemius and soleus ruptures the tendon completely

60
Q

What is Simmonds test?

A

Where the patient lies on front and you squeeze their calves to test for Achilles/calcaneal tendon rupture - if it is not ruptured, the foot should move

61
Q

What is the treatment of Achilles/calcaneal tendon rupture?

A

Conservative (external immobilisation)

Operative (internal fixation)

62
Q

What is Lisfranc’s injury?

A

An injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus at the tarso-metatarsal joint (Lisfranc’s joint) that can cause gangrene and subsequent amputation if not restored quickly

63
Q

What can Lisfranc’s injury cause?

A

Soft tissue injury

Vascular damage -> gangrene -> amputation

Block 4 (33 decks)

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