LL Trauma Flashcards

Question

Femoral fracture management (proximal)

Answer 1

Surgical management depends on location and type of fracture, patients age, health and function. • Intramedullary Nailing (IMN) • Plate and screws (ORIF) • Hemiarthroplasty • Total Hip Arthroplasty (THA/THR) • Dynamic Hip Screw • External fixation; Open #

Answer 2

Type 1: Split # of lateral tibial plateau • Type 2: Central depression of lateral tibial plateau • Type 3: split of the medial tibial plateau • Type 4: bicondylar tibial plateau • Type 5: dissociation between the metaphysis and diaphysis • Type 6: articular, multi- fragmental

Answer 3

• Nondisplaced closed injuries heal readily with protected weight bearing • Complex fracture patterns that extend into diaphysis = soft tissue or neurovascular injuries that can threaten the limb • Split-depression # are associated with Lateral meniscus and MCL injuries (type 2 & 3) • 18% of patient with Type 6 had compartment syndrome

Answer 4

• Goals: Stable knee, restore joint surface, preserve functional ROM

Answer 5

• High energy axial compression events: RTA, Fall from height • Bone is often crushed or split (shattered) into several pieces (comminuted #) • Severity of Injury depends on: >Number of fractures >Amount & size of broken bone fragments >Amount of bone displacement >Surrounding STI; muscles, tendons, skin • Open/ compound # risk of infection to wound & bone

Answer 6

Type 1 – Cleavage # with no major articular disruption Type 2 – Fracture dislocation with major articular surface disruption, without comminution Type 3 – Major articular disruption with impacted and comminuted #

Answer 7

Surgical intervention required for unstable # – unable to perform until swelling/blisters are managed • Ex-fix often used primarily: helps restore bone alignment, limb length & provides stability. • Extensive STI need EX-fix surgery until injuries settle • Internal fixation using screws and metal plates: ORIF

Answer 8

The Lisfranc midfoot joint complex has very little movement • Critical in stabilizing the arch for push off during gait cycle • It transfers forces generated by the calf muscles to the forefoot • If injury occurs but left untreated instability of the arch can cause it to collapse • Low energy trauma seen in football players when one player lands on the back of another player’s foot whilst foot is plantarflexed and in the push off position • High energy trauma: RTA’s, fall from height

Answer 9

Surgery is recommended with displaced fractures or malalignment of the bones to restore stability to the midfoot • ORIF: Screws and plates (may need removing later date) Multiples screws Combination of plates and screws Plates that span the joints • Midfoot fusion; cartilage from bones removed and metal plates, screws or staples are used to compress the bones together

Answer 10

Posterior (90%) > Anterior • Anterior iliofemoral ligament stronger than posterior ischiofemoral ligaments • Displaced femoral head can interrupt the blood supply = AVN • Branches from the external iliac artery form a ring around the neck of femur • Medial femoral circumflex artery flows posterior direction, often disrupted with posterior displacement • Lateral femoral circumflex artery flows anterior direction, often disrupted with anterior displacement • Management: Traction techniques

Answer 11

Pressure within a muscle compartment rises to dangerous levels (> venous pressure) = restricts blood flow to tissues = tissue damage & necrosis if left untreated Key areas: lower leg, forearm or thigh Key symptoms: Severe pain that doesn’t improve with rest Swelling and tightness in the affected area Reduced sensation or motorfunction Muscle weakness Management: Emergency surgical fasciotomy required

Answer 12

Blood clot formation in a deep vein (LL’s) post surgery & prolonged immobility • Early mobilisation, circulation ex’s, body position awareness, compression therapy • Key symptoms: swelling, pain, redness, warmth, swollen veins, leg heaviness, reduced mobility/leg stiffness, PE (Pulmonary Embolism) • Key symptoms: Sudden SOB, Chest pain, Coughing up blood, Rapid heartbeat, Fainting/dizziness

Answer 13

occur if direct impact, compression or stretching to the nerve. Depends on location of trauma and forces involved • Common perineal nerve injury; drop foot • Fractures to pelvis, hip or thigh, post hip and knee replacement, pelvis surgery, childbirth prolonged labour Key symptoms: muscle weakness (foot & ankle), reduced AROM, sensory disturbances: numbness, tingling, pain, burning sensations, Functional Issues: drop foot, high stepping gait, dragging of the foot, high falls risk on uneven surfaces DN4 Questionnaire English DN4 Questionnaire French Management: Neuropathic pain relief, orthotics, strengthening/stretching ex’s, sensory stimulation

Answer 14

promote healing, restore function, reduce pain, improve quality of life Gradual return to normal activities, long rehabilitation journey 1. Pain Mx 2. Early mobilization; circulation ex’s, PROM ex’s 3. Protection of injured area: braces, splinting, casting, activity modifications, avoid high risk activities 4. Gradual weight bearing and strengthening – always led by the orthopaedic consultant 5. Restore ROM: passive, active-assisted, active 6. Functional training 7. Progressive load and activity progression

LL Trauma Flashcards

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