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NMSK1 - physio 1 > distal femur, patellar and proximal tibial fractures > Flashcards

distal femur, patellar and proximal tibial fractures Flashcards

1
Q

where in the distal femur can fractures occur?

A
  • supracondylar
  • condylar - unicondylar or bicondylar
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2
Q

what is a tibial plateau fracture?

A

the break of the upper part of the tibia

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3
Q

what can cause a supracondylar fracture?

A
  • forced flex and hyperextension injury
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4
Q

what is recommended with a supracondylar fracture?

A

ORIF is usually recommended

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5
Q

what causes a condylar fracture?

A
  • high energy trauma eg fall from height or RTA
  • older people - lower energy trauma eg osteoporosis
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6
Q

what types of fractures can be seen with a condylar fracture?

A
  • open
  • minimally displaced
  • displaced
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7
Q

how is an** undisplaced **condylar fracture managed/treated?

undisplaced - bone is broken but not out of alignment

A
  • hinged knee brace
  • NWB for 6 weeks
  • joint aspiration
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8
Q

how is a displaced condylar fracture managed?

A
  • ORIF with plates and screws
  • continous passive motion CPM machine to prevent stiffness
  • NWB gait
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9
Q

how is an open condylar fracture treated?

A
  • external fixation
  • NWB
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10
Q

what are complications with distal femoral fracture?

A
  • shock
  • fat emolus
  • non union
  • mal union
  • limb shortening- eg if it heals in a shortened position
  • muscle weakness eg quad lag
  • loss of ROM - eg limited knee flexion
  • infection
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11
Q

what MOI’s could cause a patella fracture?

A
  • direct impact injury
  • indirect eccentric contraction/ indirect lengthening of muscle (injury caused by internal force in body)
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12
Q

Describe the management of a non displaced patellar fracture

A
  • aspirate the joint - suck out synovial fluid - if there is excess swelling or bleeding
  • apply long leg cast for 4-6 weeks - knee is in extension
  • NWB or PWB
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13
Q

what is a transverse fracture of the patella?

A
  • this occurs when the patella fractures into 2 parts in the transverse plane , dividing the bone into an upper and lower portion
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14
Q

what is a big risk with transverse patella fractures?

A
  • there is a risk of further separation of the fracture
  • we dont want the quadricep to contract too much as it might pull the quadricep tendon apart further and make the fracture worse
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15
Q

how is a transverse patella fracture treated?

A
  • ORIF
  • long leg cylinder cast for 6 weeks
  • NWB / PWB on gait
  • NO ISOMETRIC QUAD exercises as it may destabilise the fracture site
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16
Q

what is a comminuted fracture of the patella?

A

a comminuted fracture of the patella is when it shatters into 3 or more pieces

17
Q

what is the MOI for a comminuted patella fracture?

A
  • a blow to flexed knee - eg fall or RTA
18
Q

describe the management of a comminuted fracture of the patella

A
  • ORIF - to reassemble the fragments
  • patellectomy - reserved for severe and excessive comminution (surgical removal of knee cap)
  • full cast for 6 weeks with knee in extension
19
Q

what is the MOI of a tibial plateau fracture?

A
  • caused by a strong force on the lower leg with the leg in valgus or varus position
  • falls, RTAS and sports - only 5-10%
20
Q

what other conditions / injuries may be seen with a tibial plateau fracture?

A
  • injury to ACL
  • injury to MCL
  • injury to the menisci of the knee
21
Q

what system classifies tibial plateau fractures?

A
  • the schatzker system - classifies these fractures into 6 types
  • 1-3 = lower energy trauma and 4-6 = higher energy trauma
22
Q

what does the conservative management of a tibial plateau fracture involve?

A
  • hinged brace
  • NWB for 8-12 weeks
  • early ROM especially knee flexion
23
Q

what does the surgical management of a tibial plateau fracture involve?

A
  • ORIF
  • may or may not need bone grafting - replacing damaged bone
  • early ROM - esp knee flexion
  • may or may not have - continous passive movement machine
24
Q

what are the complications of a tibial plateau fracture?

A
  • knee joint instability, especially if there is also ligament damage
  • long term risk of post traumatic OA

NMSK1 - physio 1 (36 decks)

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