Lower Extremity Trauma

Question 1

what is the cause of frequent femoral shaft displacement or fracture

Answer 1

powerful musculature of thigh

Question 2

femoral shaft injury can lead to what

Answer 2

fat pulmonary embolism

Question 3

what are 3 types of femoral shaft fractures

which is most common

Answer 3

type 1 - spiral or transverse oblique MC**
type 2 - comminuted
type 3 - open

Question 4

increase use of what medicine in treatment of osteoporosis may result in femoral shaft fractures

Answer 4

bisphosphanates

Question 5

what deformity usually occurs after femoral shaft fracture

Answer 5

bayonet deformity

Question 6

bayonet deformity and oblique fractures are due to what

Answer 6

due to opposing actions of muscles

Question 7

incomplete bisphosphanate fracture typically occur on the __ aspect of the femoral shaft cortex

Answer 7

lateral aspect near upper femur

Question 8

what fractures of the distal femur are intra-articular and often comminuted

Answer 8

supracondylar and condylar distal femur fractures

Question 9

supracondylar and condylar fractures of distal femurs occur due to what 2 things in what patients

Answer 9

low energy trauma in elderly

high energy in young patients

Question 10

supracondylar and condylar fracture patients have history of what

Answer 10

elderly patients - history of minor falls

younger patients - compression and impaction injury

Question 11

supracondylar and condylar complications

Answer 11

compartment syndrome
vascular injury
nerve injury

Question 12

femoral condylar fractures occur as a __ and __ and are always ___

Answer 12

T or Y

intracapsular

Question 13

tibial plateau fractures are termed as ___ or ___

Answer 13

bumper and fender fractures

Question 14

how do proximal tibial fractures occur

Answer 14

axial loading

falling from height

Question 15

proximal tibial fractures usually involve what in younger patients

Answer 15

splitting

or split fracture of tibial plateau

Question 16

proximal tibial fractures usually involve what in elderly patients

Answer 16

depression or impaction fractures

Question 17

fractures of the __ tibial plateau is more common than the other side due to impact by the prominent __ femoral condyle

Answer 17

lateral

lateral

Question 18

how do we classify tibial plateau fractures

Answer 18

shatzker types

type 1 - lateral tp wedge - low force
type 2 - lateral tp wedge with depression
type 3 - no wedge but lateral tp depression
type 4 - medial/lateral plateau wedge - high force
type 5 - both tibial plateaus with 2 wedges
type 6 - both tibial plateaus and part of proximal metaphysis or diaphysis

Question 19

what results from intra-artiular fractures with eascape of fat and blood from the bone marrow into the knee joint

Answer 19

lipohemarthrosis

Question 20

what is lipohemarthrosis most commonly associated with

Answer 20

tibial plateau fracture

distal femoral fracture

Question 21

what is the typical sign of lipohemarthrosis in the knee

Answer 21

FBI sign
fat blood interphase sign

long horizontal line seen in suprapatellar pouch - but only seen if patient lays supine for 5 min to let blood and fat accumulate in suprapatellar pouch

Question 22

FBI sign or fat blood interphase sign can be seen on what xray view

Answer 22

cross table horizontal lateral beam radiograph

beam is tangential to fat blood interphase

Question 23

FBI sign indicates what

Answer 23

intra-articular or intracapsular fracture in the knee

Question 24

where is FBI sign crucial for diagnosis

Answer 24

undisplaced impaction fracture of the lateral tibial plateau in an elderly patient

Question 25

what are two ways to diagnose an impaction fracture of the lateral tibial plateau

Answer 25

FBI sign check height of tibial plateaus on each side and see if they are equal

Question 26

what may occur in younger or adolescent patients as a result of a ACL tear

Answer 26

avulsion of the tibial spine

Question 27

what is the fracture called where there is an avulsion caused by pulling of the lateral capsular knee ligaments and possibly IT band

Answer 27

segond fracture/avulsion associated with ACL tears

Question 28

what is an important radiographic clue that the ACL has been torn

Answer 28

segond fracture/avulsion

Question 29

what are transverse fractures of the proximal tibial metaphysis that occur from children bouncing

Answer 29

trampoline fractures

Question 30

trampoline fractures are common in kids how old

Answer 30

2 to 5 years old

Question 31

where do trampoline fractures occur in the tibia

Answer 31

proximal tibial metaphysis transverse fracture across

Question 32

what fracture occurs in adolescents with immature bone and active growth plates that occur from sports or jumping

Answer 32

tibial tuberosity avulsion fractures

Question 33

avulsion of the tibial tuberosity occurs how

Answer 33

violent quad contraction or passive flexion against contracted quads

Question 34

tibial tuberosity avulsion commonly occur in teens with this condition

Answer 34

osgood schlatter disease

Question 35

what does patella fracture occur

Answer 35

direct trauma or forceful contraction of quads

Question 36

what is clinical presentation of patella fracture

Answer 36

patella tenderness marked reduction in leg extension strength joint effusion hemarthrosis

Question 37

what is the most common patella fracture what are others that can occur but less common

Answer 37

transverse fracture in mid patella also called split others - comminuted (stellate) and vertical

Question 38

in a patella fracture, osteochondral defect is located on the ___ facet due to ____ patella dislocation and stress against lateral femoral condyle seen on what view

Answer 38

medial facet lateral dislocation sunrise view

Question 39

knee or femoral tibial dislocation can result in what

Answer 39

compromised popliteal artery leads to limb loss possibly

Question 40

what other injuries occur with knee dislocation

Answer 40

bi cruciate ligament rapture

Question 41

can knee dislocations be reduced

Answer 41

yes 50% of them can be reduced after injury

Question 42

knee dislocation is classified in relation to ___ displacement

Answer 42

tibia

Question 43

what are the 5 types of knee dislocations

Answer 43

anterior MC - with hyperextension injury posterior - due to direct falls, MVA, dashboard injury lateral rotatory medial

Question 44

what is the MC ligament torn in the knee

Answer 44

ACL

Question 45

what are potential radiographic signs of ACL tear

Answer 45

anterior tibial translocation sign segond fracture* arcuate fracture joint effusion

Question 46

what indicates avulsion of the fibular detachment of biceps femoris and lateral collateral lig

Answer 46

arcuate sign

Question 47

arcuate sign indicates what

Answer 47

``` ACL tear and posterolateral instability and failed ACL reconstruction if not detected early ```

Question 48

acute ACL tears occur in the ___ portion of the ligament and appear discontinuous

Answer 48

middle

Question 49

what signal on MRI is used for ACL tear

Answer 49

T2

Question 50

normal ACL angle may indicate what

Answer 50

partial rupture

Question 51

normal ACL angle should be aligned with femoral condyles known as what line

Answer 51

blummensaats line

Question 52

what is O donogheus triad

Answer 52

ACL. MCL. MM

Question 53

meniscal tears of the knee occur why

Answer 53

due to trauma or chronic degenerative failure of menisci in the knee

Question 54

what is the most common types of meniscal tears

Answer 54

horizontal and cleavage tear

Question 55

what horn of the medial meniscus is torn more frequently why

Answer 55

posterior fixed attachment to tibial plateau

Question 56

acute meniscal tears that only involve the __ zone of the outer fibers can be managed conservatively why

Answer 56

red there is red, red white, and white zones in meniscus red is highly vascularized so will heal on its own white lacks blood supply so healing is unlikely