Lecture 3 - fractures of the lower limb

Question 1

what are the mechanisms in femoral hip fractures ?

Answer 1

mostly in elderly women
direct in car accidents in young

Question 2

what is the clinical pictures of hip fracture ?

Answer 2

external rotation and adduction

Question 3

explain the elevation of the greater trochanter

Answer 3

happens in:
* Fractures of the femoral neck
* Hip dislocations
* Certain congenital deformities
Coxa vara or hip dysplasia

Question 4

peters line

Answer 4

• Definition: A line drawn across the pelvis through the tops of both acetabula.
  * Interpretation: The greater trochanter should lie at or below this line.
  * Ascension finding: If the trochanter lies above Peter’s line, ascension is present.
  Use: Detecting superior displacement of the femur head or trochanter.

Question 5

explain the Ogston-Bryant triangle

Answer 5

formed by:
ASIS
ischial tuberosity
tip of the greater trochanter
Significance: Changes in triangle dimensions suggest displacement of the greater trochanter

Question 6

explain Nelaton roser line

Answer 6

• Drawn from the ASIS to the ischial tuberosity.
  * Normal: Greater trochanter lies on or just below the line.
  Ascension finding: Trochanter seen above the line.

Question 7

explain the schoemakers line

Answer 7

• Method: Line drawn from the ASIS through the tip of the greater trochanter.
  * Normal: Both lines meet above the umbilicus.
  Ascension finding: If the lines meet below or away from the umbilicus, indicates displacement.

Question 8

what does the delbet classification tells us about the femoral neck fracture?

Answer 8

it classifies the anatomical position of the fracture:
I. Subcapital or transepiphyseal
II. transcervical
III. basicervical

Question 9

explain what adduction in femoral neck suggest ?

Answer 9

non imacted
unstable
negative prognosis

Question 10

explain what abduction in femoral neck fracture means ?

Answer 10

valgus impacted
stable
positive prognosis

Question 11

what is pauwels biochemical classification ?

Answer 11

it describes the femoral neck fracture based on the inclincation angle of the fracture line to the horizontal

Question 12

why is pauwels classification useful ?

Answer 12

it can predict:
fracture stability
risk of dispalcement
healing potentiel
treatment approach

Question 13

explain now the three types of pauwels classifications

Answer 13

Type 1 - less than 30 degress
Type 2 - between 30-50 degress
type 3 - greater than 50 degress

Question 14

what is the soeur class?

Question 15

garden regiological class type I

Answer 15

incomplete
stable
abduction, coxa valga
clinical signs are minimal

Question 16

garden class type II?

Answer 16

complete but not displaced

Question 17

Garden Type III

Answer 17

complete and dispalced
angulated
varus dispalcement
fracture still has connection

Question 18

Garde type IV

Answer 18

complete
displaced
no contact
reduction is unstable and difficult

Question 19

treatment of neck fracture in orthopedic?

Answer 19

deambulation - analgetics
weight bearing
bed immobilization

Question 20

surgical treatment of femural neck fractures ?

Answer 20

first choice
DHS
hip arthoplasty
K wires

Question 21

what are the indications of osteosynthesis ?

Answer 21

G1 and G2

Question 22

what are arthroplasty indications ?

Answer 22

G3 and G4

Question 23

what are the early complications seen in hip fractures ?

Answer 23

thrombosis
must give heparin

Question 24

what are the late complications of hip fractures ?

Answer 24

avascular necrosis
non-union
hip osteoarthritis

Question 25

explain the anatomical classification of trochanteric fractures, they are 6 types

Answer 25

cervicotrochanteric pertrochanteric intertrochanteric subtrochanteric trochantero-diaphysis isolated greater or lesser trochanter

Question 26

explain the Kyle classification types

Answer 26

Type I - undisplaced, stable, noncommunuted Type II - displaced, stable, minimal communuted Type III - unstable, significant postero-medial communuted Type IV - unstable, postero-medial comminuted, subtrochanteric component

Question 26

clinical presentation of trochanteric fractures ?

Answer 26

pain etc shortening of limb limb in adduction and external rotation

Question 27

explain how the imaging is performed in trochanteric fractures

Answer 27

AP and L CT and MRI in inconclusive and pain

Question 28

treatments

Answer 28

first choice is surgery except in case of contraindications gammanail DHS elastic nails

Question 28

complications ?

Answer 28

thrombosis embolism malunion nonunion osteoarthritis

Question 29

explain the indirect trauma of femoral diaphysis

Answer 29

flexion for the normal femural curve torsion

Question 30

what is the positon of the leg oupon proximal frature of the diaphysis ?

Answer 30

abduction and external rotation

Question 31

what is the psotion of the leg in distal fragments of the femural diaphysis ?

Answer 31

adduction

Question 32

othropedics in femrual diaphysis fractrues ?

Answer 32

pully system to keep the leg straight throguh the tipial tuberosity with Braun splint

Question 33

surgical treatment of femural diaphysis fractrue

Answer 33

centromedullary nail elastic nail in children palte external fixation for open fractures

Question 34

classify the anatomical parts of the femural epiphysis ?

Answer 34

supracondylar - extraarticular supra and intercondular - intraarticular unicodyular - interarticular

Question 35

what is the indirct mechanism of femural epiphysis ?

Answer 35

falling on the feet wit hknee in valgus or varus

Question 36

explain how osteoarthritis can spread to the contralateral or epsilatal limbs in femrual epiphysis fracture?

Answer 36

if the femur remains too short or too curved the hip and knee of the same limb or fo the other limb and the vertebra will be abnormalliy solicited knee sitffness

Question 37

surgical treatment of the epiphysis of the femur

Answer 37

plate and screws blade plate DCS centromedullary retrogade nail

Question 38

where is the ncentromedullary retrograde nail used in epiphysis femural fracture ?

Answer 38

at the supracpndular fractures

Question 39

explain the indirect fracture of the patella

Answer 39

violent contraction of the quadriceps

Question 40

clinical signs of patella fractue

Answer 40

crepitus pen signs no active extension of the knee

Question 41

differential diagnosis of patella fracture

Answer 41

patella bipartita lesions of the ectensor apparatus of the knee

Question 42

surgical treatment of the patella

Answer 42

§ Osteosynthesis with figure of 8 configuration tension band § Cerclage § Partial patelectomy with transosseous reinsertion of the tendon § Screws Or combination

Question 43

what is the most frequent tibial fracture mechanims ?

Answer 43

forced falgus

Question 44

give the anatomical classification of tibial fractures

Answer 44

I fracture of tibial spines II fractures of the tibial plateaus III dia-epiphyseal fracture of the tibia IV fractures of anterior tuberosity V fractures epiphyseal decollation

Question 45

explain the Schatzker classification

Answer 45

fracture of the external tuberosity fra I-III fracture of the internal tuberocity IV bicondylar V fracture through the metadiaphysis of the tibia VI

Question 46

clinical diagnosis of tibial fracture

Answer 46

* Detection of pulse in a.dorsalis pedis and a. tibialis posterior Determine sensibility in the territories of peroneal and tibial nerve

Question 47

orthopedic treatment of the tibia

Answer 47

○ Fractures without displacement ○ Femuropodal (long leg) cast 6 - 10 weeks Thrompoprophylaxy for the whole period

Question 48

Type I - split of the external plateau treatment

Answer 48

* Orthopedic treatment Osteosynthesis with screws +/- wires

Question 49

Type III - pure depression without split of the lateral tibial plateau treatment

Answer 49

* If instability in frontal plane or depression greater than 3 mm Surgical treatment with lift of the articular surface, spongious structural graft and osteosynthesis

Question 49

Type II - Split depression of the lateral plateau treatment

Answer 49

Open reduction - lift of the depression, spongious structural graft + osteosynthesis with plate and screws

Question 50

Type IV - fracture of the medial condyle treatment

Answer 50

Reduction with or without graft + osteosynthesis with plate and screws on the medial side

Question 51

Type V - bicondylar fractures

Answer 51

Open reduction with or without grafts + osteosynthesis with plates and screws

Question 52

Types VI - fracture with dissociation between metaphysis and diaphysis treatment

Answer 52

* Open reduction with or without grafts + osteosynthesis with plates and screws

Question 53

Associated capsulo-ligamentar lesions

Answer 53

* Tibial plateau fractures ○ Instability from the fracture Instability from associated capsulo-ligamentar lesions

Question 54

indriect mechanism of the diaphysis of tibia and fibula

Answer 54

Through exaggerated flexion - transversal or oblique fracture Through torsion - spiroid fracture

Question 55

clinical diagnosis of tibial and fibula diaphysis fracture

Answer 55

as usual Detection of pulse in a.dorsalis pedis and a. tibialis posterior Determine sensibility in the territories of peroneal and tibial nerves