LE Trauma Flashcards
(160 cards)
1
Q
Powerful musculature of the thigh usually is the cause of frequent
displacement
A
femoral shaft injury
2
Q
Femoral shaft injury can cause fatty marrow escape into circulation which may lead to
A
fat pulmonary embolism
3
Q
3 types of femoral shaft fractures:
A
Type I - Spiral or transverse (most common)
Type II - Comminuted
Type III - Open
4
Q
m/c type of femoral shaft fracture
A
Type I - Spiral or transverse
5
Q
After signifiant trauma or as a pathological fracture due to metastatic bone
disease or primary bone neoplasms or other osseous pathology
A
Diaphysis fracture
6
Q
Increased use of Bisphosphanates medications in treatment of osteoporosis
may result in
A
femoral shaft fractures
7
Q
Clinical manifestations of femoral shaft fracture
A
- severe pain
- inability to stand or ambulate
- regional and systemic
complications such as neurological and vascular injury
8
Q
m/c type of femoral shaft fracture
A
spiral or transverse-oblique fracture
may involve bayonet deformity
9
Q
Often intra-articular and frequently comminuted
A
Supracondylar and Condylar distal femur fracture
10
Q
Supracondylar and Condylar distal femur fractures usually occur as a result of?
A
1) low-energy trauma in osteoporotic bone in the elderly
2) high-energy trauma in young patients
11
Q
clinical signs of supracondylar and condylar distal femur fracture?
A
Pain, deformity, weakness, and inability to ambulate/stand
12
Q
complications for supracondylar and condylar distal femur fracture?
A
- compartment syndrome
- vascular and nerve injury
13
Q
key mechanism of
injury leading to fracture in osteoporotic
patients
A
Low force or even trivial trauma
14
Q
may develop following total knee arthroplasty
A
Supracondylar fractures
15
Q
two configurations types for femoral condyle fractures
A
“T” or “Y”
always intraarticular
16
Q
Femoral condyle fractures can be complicated by
A
delayed healing and comminuted fragments.
17
Q
Femoral condyle fractures may co-exist with
A
Tibial plateau fracture
18
Q
were originally termed a bumper or fender fracture
A
Tibial plateau fractures
19
Q
what % of tibial plateau fractures result from impact with automobile
bumpers
A
25%
20
Q
most common
mechanism of tibial plateau fractures
A
Axial loading I.e. fall from a height
21
Q
In younger patients the tibial plateau fracture often involves
A
splitting
22
Q
In older, osteoporotic patients, what type of fractures are typically are seen?
(difficult to detect radiographically)
A
depression fractures
23
Q
occur in
approximately 10% of patients with tibial plateau fracture
A
Soft tissue injuries (e.g. to cruciate and collateral ligaments)
24
Q
Fractures of the lateral or medial tibial plateau or more common?
A
lateral plateau from lateral femoral condyle
25
Type 1 Shatzker tibial plateau fracture
wedge (low force)
26
Type 2 Shatzker tibial plateau fracture
wedge with depression
27
Type 3 Shatzker tibial plateau fracture
depression with no wedge
28
Type 4 Shatzker tibial plateau fracture
Like type 1 but invovles medial plateau
29
Type 5 Shatzker tibial plateau fracture
both plateaus
30
Type 6 Shatzker tibial plateau fracture
both plateaus + part of proximal metaphysis/diaphysis
31
results from an intra-articular fracture with escape of
| fat and blood from the bone marrow into the knee joint
Lipohemarthrosis
32
Lipohemarthrosis is most frequently associated with what fracture?
tibial plateau fracture or distal femoral
| fracture
33
Patella fractures may also result in
lipohemarthrosis
34
sign of lipohemarthrosis
FBI sign or fat-blood-interphase
35
Fat-fluid level is seen on any horizontal beam radiograph, but best achieved with what view?
cross-table horizontal lateral view
36
Indication of intra-articular/intra-capsular fracture about the knee,
typically tibial plateau fractures
FBI sign
37
may occur especially in young or adolescent
| patients as a result of pull and tear by the ACL
Tibial spine avulsion
38
avulsion likely from pull of lateral capsular knee ligaments and
possibly IT band
Segond fractures
39
Important radiographic clue to ACL tear
Segond fracture-avulsion
40
occur in children
| while jumping on a trampoline
Transverse fractures of the proximal tibial metaphysis (trampoline fracture)
41
most often seen in children 2
| to 5 years of age.
trampoline fracture
42
Most occur in adolescents
| with immature bone and active growth apophysis
Tibial tuberosity avulsion fractures (uncommon)
43
Associated with sports and jumping
Tibial tuberosity avulsion fractures
44
Tibial tuberosity avulsion fractures occurs with
violent contraction
of quadriceps or passive flexion
against contracted quadriceps
45
Osgood-Schlatter disease is associated with what fracture?
Tibial tuberosity avulsion fractures
46
swelling and pain over the patella with point tenderness and
reduction in extension strength
(Large joint effusion or hemarthrosis)
Patella fracture
47
most common type of patella fracture?
“split” or transverse fracture in mid patella
| >60%
48
comminuted patella fracture, also called?
“stellate” type - 25%
49
vertical patella fracture occurs what percent of the time?
15%
50
usually from medial facet due to lateral patella
osteochondral defect
51
Transverse (most common) patella fracture exerted by?
sudden forceful quad
| contraction
52
Stellate fracture, usually from
direct impact and burst
53
best view for Lateral patella dislocation and osteochondral defect?
Sunrise view
54
Patella fractures need to be differentiated from
multipartite patella
55
important to recognize because coexistent vascular
| (popliteal artery) injury complications
Knee Joint or Femoral-Tibial dislocation
56
Knee dislocation are classified in relation of
Tibial displacement compared to
| the Femur
57
5 types of Knee dislocations
1. anterior (40%) often hyperextension injury
2. posterior (30%) may be due to direct falls or MVA “dashboard” injury
3. lateral (20%)
4. rotatory (5%)
5. medial (5%)
58
most commonly torn ligament of the knee
ACL
59
imaging required for diagnosis and management of ACL tear?
MR
60
potential radiographic signs of ACL tear
- anterior tibial translocation sign
- Segond fracture
- arcuate fracture
- joint effusion
61
indicates avulsion of fibular attachment of biceps femoris and
lateral collateral ligament.
Arcuate sign
62
High suspicion for ACL tear and potential posterolateral
| instability and failed ACL reconstruction
Arcuate sign
63
Acute ACL tears typically occur in the what portion of the ligament?
middle portion
64
Normal ACL angle should be aligned along femoral condyles known as the
Blumensaat's line
65
O'Donogheu's triad is typically due to
pivot shift and srong valgus
| force
66
O'Donogheu's triad
1) ACL tear
2) MCL tears and
3) tear of the medial meniscus (can be bucket handle tear)
67
m/c type of meniscal tear
horizontal or cleavage tear
68
Meniscal tears are best evaluated with
MRI
69
the meniscus that is torn much more frequently due to its
| fixed attachment to corresponding tibial plateau
Posterior horn of medial meniscus
70
Acute meniscal tears that only involve the ______ of the outer fibres can be
managed conservatively or heal on their own
red zone
71
inversion stress is the most common cause of ankle injuries for 2
anatomic reasons
1) medial malleolus is shorter than the lateral malleolus
| 2) deltoid ligament is stronger than the lateral ligaments.
72
commonly associated with distal fibular fractures and are unstable
posterior malleolar fractures
73
classification of lateral malleolar fractures
Weber ankle fracture classification
74
Clinical diagnosis of suspected ankle fractures and the need for radiographic
examination can be successfully determined by applying the Ottawa Ankle
Rule
Ottawa Ankle
| Rule
75
Weber __ : below syndesmosis
A
76
Weber __ at the level of
| syndesmosis
B
77
Weber __ above syndesmosis
C
78
Lateral malleolus/distal fibula
| fracture above syndesmosis is stable or unstable?
unstable
79
Lateral malleolus/distal fibula
| fracture above syndesmosis is also referred to as?
Pott's fracture
| 6cm above lateral malleolus
80
is combination of oblique or spiral fracture of the
| proximal fibula and unstable ankle injury
Maisonneuve fracture (high ankle sprain)
81
Manifests by widening of the ankle joint due to distal tibiofibular syndesmosis
and/or deltoid ligament disruption
(sometimes fracture of the medial
malleolus)
Maisonneuve fracture (high ankle sprain)
82
Maisonneuve fracture is considered Weber __
C
83
positive squeeze test can indicate fracture or
high ankle sprain
84
Fracture of both lateral (fibula) and medial (tibial) malleolus and considered to
be unstable due to frequent disruption of distal tibiofibular syndesmosis and
sometimes deltoid ligament
Bimalleolar ankle fractures
85
transverse fracture through tibial
| malleolus and oblique or spiral fracture through distal fibular
Bimalleolar ankle fractures
86
Bimalleolar fractures of this type may be described by some as
Dupuytren
| fracture
87
Associated deltoid ligament
disruption and lateral dislocation
of the talus may exist
Bimalleolar fractures
88
Three-part (Trimalleolar) fracture of the ankle
| involves what three structures?
1. medial malleolus
2. posterior aspect of the tibial plafond
(referred to as the posterior malleolus)
3. lateral malleolus
89
Triplanar fractures primarily
| occur in ______ patients
younger
90
Results from an abduction-external rotation mechanism when anterior tibiofibular
ligament avulses the anterolateral corner of the distal tibial epiphysis
Tillaux fracture
91
Tillaux fracture requires an open physis and considered a Salter-Harris __
injury of ______
3, distal tibia
92
represents an anterolateral distal tibial epiphysis avulsion
Tillaux fracture
93
Tillaux avulsion fracture is rarely seen in adults because
the ligament gives out before avulsion
94
undisplaced spiral fractures usually of the tibia in toddlers either due to fall or when the leg is stuck in between the wooden spacing of the crib/cot
Toddler fractures
| usually spiral and undisplaced
95
Occasionally in toddler fractures both tibia and fibula are fractured, referred by some as
Both Bones
| fracture
96
Occasionally spiral or comminuted oblique tib & fib fractures occur as
Ski-boot or
| Boot-top fractures
97
most frequently fractured foot
| bones
calcaneus and talus
98
Most commonly fractured tarsal bone
calcaneus (60%)
99
Calcaneal fractures can be classified as...
- Extra-articular:
25-30%
- Intra-articular:
70-75%
100
calcaneal tuberosity avulsion fracture, calcaneal w/o
| talocalcaneonavicular (subtalar) extension
Extra-articular
101
Lover's/Don Juan/Casanova fracture of which 10% can be associated with the TL fracture
Intra-articular
102
If bilateral calcaneal fractures are seen, then
the spine should be evaluated (xrays
| and CT scanning)
103
Angle between two tangent lines drawn across the anterior and posterior
borders of calcaneus on the lateral view
Bohler's angle
is less than 20- degrees it indicates a calcaneal fracture
104
Bohler's angle less than ___ degrees it indicates a calcaneal fracture
20
105
a significant finding that should prompt active search for
| fracture.
marked opacification of Kagar’s fat pad
106
Overuse injury seen in athletes, especially with running and aerobics, and
military recruits
Calcaneal Stress Fracture
107
Stress fractures in general may take how long to appear on conventional radiographs?
7-14 days
108
key radiographic feature of calcaneal stress fracture?
vertically oriented zone of increased density on lateral radiograph
that is perpendicular to the trabecular lines
109
considered most sensitive and specific imaging of stress fractures of the
lower extremity
MRI
110
Radiographic evaluation of a talur fracture must include what views?
DP, Oblique and lateral ankle/foot
| views
111
Fractures of the talus can be divided into 3 main regions:
Body, neck, and head
112
extend through the thinnest portion of the talus, just
| proximal to the talar head
Talar neck fractures
113
Common types of talus fracture are
avulsion fractures or vertical fractures
114
talur avulsions are typically due to
twisting foot injuries
115
Hawkins talus fracture classification
| type I
non displaced fracture
116
Hawkins talus fracture classification
| type II:
displaced fracture with subluxation or dislocation of the subtalar joint and
a normal ankle joint
117
Hawkins talus fracture classification
| type IIl
displaced fracture with body of talus dislocated from both subtalar and
ankle joint
118
Talar neck fractures may be complicated with the risk of
avascular
| necrosis (AVN)
119
AVN risk increases with increase in complexity
type I fractures has 0%–15% risk
type II fractures have 20%–50% risk
type III fractures approach 100% risk
120
The most common mechanism of potentially significant talar neck fractures is a
dorsally directed force on a braced foot
(such as in head-on motor vehicle
accidents when foot is pressing on the breaks)
121
Talar neck and to some degree talar body fractures were once known as
“Aviator's astragalus fractures or Aviator’s fractures"
122
describes subchondral lucency/osteopenia line of the talar dome
that occurs secondary to subchondral atrophy 6-8 weeks after a talar neck fracture
Hawkins sign
123
Hawkins sign indicates that there is sufficient _______ in the talus
vascularity
124
Osteochondral injuries may be complicated by
early/secondary advanced DJD
125
can mimic a lateral ankle sprain
Lateral talar process fractures aka "snowboarder" fractures
126
Lateral talar process ("snowboarder") fractures occur when the foot is
dorsiflexed and inverted
127
As many as ____ of lateral talar process fractures are missed on radiographs
40-50%
128
Posterior talar process fractures may involve
medial or lateral tubercle of the
| posterior process of talus
129
Posterior talar process fractures are caused by
inversion
130
Unfused ossification center of the lateral tubercle forms the
os trigonum
131
Shepherd fracture is Injury of the
lateral tubercle
132
Cedell fracture is injury to the
is uncommon and is
caused by forced dorsiflexion and pronation
medial tubercle
133
Injury to the medial tubercle (Cedell fracture) is caused by
forced dorsiflexion and pronation
134
Injury to the medial tubercle (Cedell fracture) is treated using a
Short leg cast or ankle brace until signs of union appear
135
main DDx of posterolateral talar process fracture
Os trigonum
136
most common type
| of dislocation involving the foot
Lisfranc fracture/dislocations
137
mechanism of Lisfranc fracture/dislocations include
direct crush injury, or an indirect load
| onto a plantar flexed foot
138
the two types of Lisfranc fracture-dislocation are?
Homolateral and
| Divergent
139
lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains aligned
Homolateral
140
lateral dislocation of the 2nd to 5th metatarsals with medial
dislocation of the 1st metatarsal
Divergent
141
fracture/dislocation of the mid-tarsal joint of the foot, i.e. talonavicular and calcaneocuboid joints
Chopart injury
142
Chopart injury the commonly fractured bones are the
calcaneus cuboid and navicular
143
In chopart injury the foot is usually dislocated
medially and superiorly
144
most common stress fractures
2nd and 3rd metatarsal (march fracture)
145
occur at the base of the fifth metatarsal
Jones fractures
| Dance Fx
146
Jones fractures occur at the metadiaphyseal
| junction with OUT
distal or intra-articular extension
147
Jones fractures occur as a result of significant ______ force to the forefoot with
the ankle in __________
adduction, plantar flexion
148
fracture located approximately 2 cm (1.5-3 cm)
| from the tip of the 5th metatarsal
Jones fracture
149
Jones fractures are prone to
non-union
| with rates as high as 30-50%
150
non-union Jones fractures usually take ___ months heal
2
151
distal horizontal fracture line w/o
| intra-articular extension
Jones Fx
152
one of the more common
| foot avulsion injuries
pseudo-Jones fracture
153
Over 90 % of fractures of the base of the 5th metatarsal are?
pseudo-Jones fracture
154
pseudo-Jones fracture is occasionally
| referred to as a
"tennis fracture“
155
pseudo-Jones fracture is caused by insertion of peroneus brevis and forcible
inversion of the foot in plantar flexion
156
tip of the proximal 5th metatarsal, oriented mostly transversely
pseudo-Jones fracture
157
Toe fractures most frequently are caused by a
crushing injury or axial force such
| as stubbing a toe (Bedroom fracture)
158
Most children with fractures of the physis should be referred, but children with
selected nondisplaced Salter-Harris types I and II fractures may be treated by
family physicians
159
considered an open fracture and may carry
| risk of osteomyelitis
Toe fractures involving the nail
160
Stable toe fractures can be treated with
Buddy taping
