Lower limb fracture

Question 1

Ankle fracture

Answer 1

Ottawa rules for ankle xrays

Pain in lateral malleolar zone and any one of
- bony tenderness at the lateral malleolar zone
- bony tenderness at the medial malleolar zone
- inability to walk four weight bearing steps immediately after the injury and in the emergency department

Question 2

Patella fracture- direct

Answer 2

Following direct blow or trauma to the front of the knee

Usually undisplaced crack or comminuted fracture but with intact extensor mechanism

Question 3

Indirect injury

Answer 3

Quadriceps forcefully contracts against a block to knee extension

Results in transverse patella fracture with possible disruption of extensor mechanism

Question 4

Clinical features of patella fracture

Answer 4

Swelling and bruising

Pain and tenderness around the knee

May be a palpable gap

Question 5

Investigations for patella fracture

Answer 5

Plain films usually sufficient to diagnose patella fractures

AP and lateral view

Question 6

Management of patella fracture

Answer 6

Undiscplaced: hinged knee brace for 6 weeks and patients allowed to fully weight bear

Displaced: consider tension band wire, inter-fragmentary screws or cerclage wires (still hinged knee brace for 4-6 weeks and allowed to fully weight bear)

Question 7

Metatarsal fractures

Answer 7

5th metatarsal most common

Pain, bony tenderness, swelling, antalgic gait

Xrays distinguish between displaced and non-displaced fractures