Lower Extremity Fractures Flashcards Preview

Clin Med II MHM - FINAL > Lower Extremity Fractures > Flashcards

Flashcards in Lower Extremity Fractures Deck (59):
1

MC MOI of pelvic fractures

-Fall
-High impact injury in younger people

2

In high impact pelvic fractures, what else needs to be checked?

Bladder injury (get a urine and see if there's blood)

3

Hip fractures occur in what populations?

-60 yo or older (90%)
-Females (75%)

4

MOI of hip fractures

-Usually a fall in the elderly
-High impact injury in younger people
-Can be pathologic from tumor, cyst, osteopenia

5

Clinical presentation of hip fractures

-Limb is shortened and ER
-Pain in groin and anterior thigh
-Unable to ambulate

6

Types of hip fractures

-Subcapital neck
-Transcervical neck
-Intertrochanteric
-Subtrochanteric
-Greater trochanter
-Lesser trochanter

7

Treatment of hip fracture

Surgery for either ORIF or hemi-arthroplasty almost always indicated ASAP because of high mortality rate

8

MOI of femur fractures

-High impact injury
-Can be pathologic
-May occur around prosthesis or ORIF components

9

Treatment of femur fracture

Usually includes external fixator, IM rod, gamma nail or ORIF w/plate and screws

10

MOI knee fracture

Direct blow, twisting, hyperextension

11

What is the "sunrise" view?

An x-ray view of the patella

12

What are the Ottawa knee rules?

Indications for knee x-ray
-55+ yrs old
-Isolated patella tenderness
-Tenderness at fibular head
-Inability to flex 90 degrees
-Inability to bear weight (4 steps) immediately after injury

13

Describe tibial plateau fracture

-Intra-articular fx of proximal tibia
-Lateral tibial plateau (60-70%), medial tibial plateau (10-20%)
-Common in elderly
-High energy injury in young

14

How do people present with tibial plateau fracture?

-Acute hemarthrosis
-Unable to bear weight
-Joint line tenderness

15

What else should be assessed with tibial plateau fracture?

Popliteal artery and peroneal nerve injuries

16

Treatment of tibial plateau fractures

-Usually requires ORIF
-Some elderly or high risk pts can be treated non-wt bearing w/ a knee immobilizer

17

What is the largest sesamoid bone in the body?

Patella

18

What is the MC fracture of the patella?

Transverse

19

MOI patella fractures

Direct or indirect trauma or dislocation

20

Describe sunrise x-ray view

-Assesses alignment of patella for vertical/longitudinal fractures
-It does NOT evaluate transverse fractures (that may unnecessarily make a case surgical)

21

Treatment of patella fractures

-If not displaced, knee immobilizer and partial wt bearing
-If displaced, requires ORIF

22

Extensor mechanism injury MOI

-Patellar or quad tendon ruptures
-Sudden intense contraction of quads w/knee flexed
-Direct blow
-Laceration

23

What comorbidities increase risk for extensor mechanism injury?

RA, gout, SLE

24

Treatment of extensor tendon mechanism disruption

-Always requires repair of the tendon unless risks outweigh the benefits
-Initially, immobilization and non-wt bearing w/crutches or walker

25

Patella baja

Patella tendon rupture
*Can be normal in some people

26

Patella alta

Quadricep tendon tear

27

MOI tibia and fibula fractures

Trauma

28

MC type of tibia fracture

Shaft

29

Clinical presentation of tibia and fibula fractures

Fibula may be able to bear full wt as it is a non-wt bearing bone

30

Treatment of tibia and fibula fractures?

-Non displaced can be w/long leg cast or posterior splint w/knee flexed 20-30 degrees, ankle in neutral position, no wt bearing 4-6 wks
-Displaced need IM rods, ORIF w/plate and screws, or external fixator

31

Ottawa ankle rules

Indications for ankle x-ray
-Pain in malleolar zone and one of: bone tenderness at posterior edge lat malleolus or inability to bear wt immediately and in ED
-Pain in mid foot zone and bone tenderness at 5th MT base OR navicular OR inability to bear wt immediately and in ED

32

Ankle sprain MOI

Extreme inversion injury and plantar flex

33

MC injured ligament in ankle sprain

Anterior talofibular (ATF) ligament

34

What is a "high ankle sprain"?

-Damage to syndesmosis ligament
-Occurs w/dorsiflexion and ER

35

Damage to syndesmosis ligament is what kind of injury?

High ankle sprain

36

Ankle sprain grading system

1: stretch w/microscopic tearing of ligament (little swelling and functional loss, no joint instability)
2: partial tearing, mod-severe swelling, mod functional loss
3: complete rupture of ligament, severe swelling, mod-severe instability of joint

37

Types of ankle fractures

-Unimalleolar
-Bimalleolar
-Trimalleolar
-Maisonneuve
-Pilon

38

Treatment of ankle fracture

-Initially, splinting and non wt bearing
-Most will require ORIF
-If dislocation involved, reduction must be done prior to splinting

39

If a dislocation is involved with an ankle fracture, what must be done?

Reduction must be done prior to splinting

40

Maisonneuve ankle fracture MOI

Inversion injury that radiates up fibula and snaps off proximal fibula w/disruption of deltoid ligament (and many times a medial malleolus fracture)

41

Pilon fracture

Dome of distal tibial articular surface and extends into adjacent metaphysis

42

Pilon fracture MOI

Multiple mechanisms including a fall from height or MCV or skiing injuries

43

What are indications for surgery in a pilon fracture?

-Open
-Displaced (gap of more than 2 mm or step of more than 1 mm, rotational malalignment)
-Vascular compromise
-Compartment syndrome

44

Foot fracture MOI

Twisting or crushing

45

What x-rays do we get for foot fracture?

-If tender over metatarsals and cuneiforms, xray foot
-If tender over phalanges, xray toes

46

Avulsion fracture of 5th MT

-Sudden inversion of plantar flexed foot
-Usually extra-articular
-Symptoms can mimic ankle sprain

47

Jones fracture

-Transverse fx distal to MT-cuboid joint
-Usually occurs w/o inversion

48

Lisfranc joint

-Articulation between midfoot and forefoot
-Composed of 5 TMT joints
-Fracture location of TMT joint

49

Lisfranc fracture MOI

Crush injury or rotational force on a plantar flexed forefoot

50

Metatarsal fracture MOI

Multiple including inversion injury, direct blow, crush injuries

51

Treatment of toe fractures

-Buddy taping (MC)
-May use a fracture boot for multiple fractures

52

Where does an osteosarcoma originate?

Metaphyseal region of tubular long bone

53

Where do osteosarcomas MC occur?

Femur (42%)

54

What is the MC benign bone tumor?

Osteochondroma

55

Where does an osteochondroma MC occur?

Around knee and shoulder (but can occur in any bone)

56

Who is affected by osteochondroma?

-Males 3:1
-Diagnosed before age 20

57

How do osteochondromas grow?

-Near growth plates and grow away from physis
-Grow until skeletal maturity then stops when epiphyseal plates close

58

Describe fibrous cortical defects

-More than 2 cm in size
-Older children
-Solitary lesions (75%)
-Occur at sites of tendon/ligament insertion

59

Describe enchondroma

-Benign cartilaginous neoplasm
-Usually solitary lesion in medullary bone
-Small incidence of malignancies
-Described as "lytic lesions"