Lower limb fractures - BULLSHIT DONT LEARN JUST DO NOF

Question 1

Types of femur fractures

Answer 1

• Shaft
• Distal

Question 2

Shaft fracture clinical features

Answer 2

• Extreme pain
• Deformity

Question 3

Types of shaft fractures

Answer 3

• Transverse type
• Oblique type
• Spiral type

Question 4

Shaft fracture mechanism of injury (MOI)

Answer 4

• MC Motorcycle accidents
• Extremely high energy trauma to the lower limb

Question 5

Distal fracture location

Answer 5

Fracture that occurs between:
- Distal diaphyseal-metaphyseal junction
- Articular surface of femoral condyles

Question 6

Distal fracture MOI

Answer 6

• High-energy falls in young patients with significant displacement
• Elderly patients with osteoporosis, sustaining low-energy injuries

Question 7

Distal fracture clinical features

Answer 7

Knee effusions may be present with inter-articular involvement

Question 8

Types of knee fractures

Answer 8

Patella fracture

Question 9

Patella fracture clinical features

Answer 9

• Inability to straight leg raise
• Tenderness of the knee cap

Question 10

Patella fracture MOI

Answer 10

• Direct blow to the knee, e.g. dashboard injury
• Rapid contraction of the quadriceps against a flexed knee

Question 11

Patella fracture DDx

Answer 11

Anatomical variant = bipartite patella = where individuals have 2 patella components in their knee

Question 12

Types of tibia fractures

Answer 12

• Secgond fracture
• Tibial plateau fracture
• Tibial shaft fracture
• Toddler’s fracture
• Tibial plafond fracture

Question 13

Segond fracture location

Answer 13

A small avulsion fracture at the lateral tibia plateau
- Assosciated with ACL injury in 75% of cases

Question 14

Segond fracture MOI

Answer 14

Caused by internal rotation and varus stress
- Typically occur from sporting injuries

Question 15

Tibial plateau fracture locations

Answer 15

Periarticular injuries of the proximal tibia

Question 16

Tibial plateau MOI

Answer 16

• Varus or valgus injuries causing medial or lateral involvement respectively
• High energy impact in young individuals
  Low-energy trauma in osteoporotic bone

Question 17

Tibial shaft fracture clinical features

Answer 17

• Open fractures and compartment syndromes are common features
• This is due to the lack of fascial compartment and subcutaneous tissues of the shin

Question 18

Tibial shaft fracture MOI

Answer 18

Can arise from direct blows, falls or indirectly (through twisting motions)

Question 19

Tibial shaft fracture epidemiology

Answer 19

Most common paediatric fracture of the lower limb

Question 20

Toddler’s fracture location

Answer 20

A spiral fracture of the tibia without any injury to the fibula

Question 21

Toddler’s fracture Epidemiology

Answer 21

• Predominantly affects children in their early years of walking
• Stable fracture: without displacement

Question 22

Toddlers fracture MOI

Answer 22

• Twisting the leg whilst walking/running
• Getting leg caught whilst moving down a slide

Question 23

Toddler’s fracture treatment

Answer 23

Requires no interventions other than monitoring

Question 24

Tibial plafond fracture location

Answer 24

• Fracture of the distal tibia
• Often has intra-articular involvement

Question 25

Tibial plafond fracture

Answer 25

- Severe ankle pain and inability to weight bear

Question 26

Tibial plafond fracture MOI

Answer 26

- High energy axial load (e.g. fall from height or motor vehicle accident - The talus is driven into the plafond, causing tibial fracture

Question 27

Types of fibula fractures

Answer 27

- Maisonneuve fracture - Lateral malleolar fracture

Question 28

Maisonneuve fracture location

Answer 28

- Spiral fracture of the proximal fibula associated with ankle instability - Ankle injuries include tibiofibular syndesmosis injury and posterior/medial malleolar fractures (tibial plafond)

Question 29

Maisonneuve fracture MOI

Answer 29

- It arises due to the pronation-external rotation mechanism - E.g. a foot inversion with rotation on the ankle caused by stepping off a curb awkwardly

Question 30

Types of lateral malleolar fracture

Answer 30

- Weber A: fractures occur distal to the syndesmosis (fibrous connection between tibia and fibula) - Weber B: fractures occur at the level of the syndesmosis - Weber C: fractures occur proximal to the syndesmosis

Question 31

Lateral malleolar fracture MOI

Answer 31

These injuries are typically sustained by “rolling the ankle”

Question 32

Types of foot fractures

Answer 32

- Jones fracture - Lisfranc injury - Calcaneal fracture - Talar neck fracture

Question 33

Jones fracture location

Answer 33

- Fracture of the 5th metatarsal base

Question 34

Jones fracture clinical features

Answer 34

Predisposed to poor healing and malunion to limited blood supply

Question 35

Jones fracture

Answer 35

- Inversion injury to the foot - May also occur from repetitive stress or overuse, meaning athletes are susceptible

Question 36

Lisfranc injury location

Answer 36

- Tarsometatarsal fracture and dislocation of the Lisfranc region - This is predominantly the region where the first and second metatarsals articulate with the tarsals

Question 37

Lisfranc injury MOI

Answer 37

Axial load applied to a hyperplantarflexed foot, e.g. falling from a height

Question 38

Calcaneal fracture location

Answer 38

Fracture of the heel bone, calcaneus

Question 39

Calcaneal fracture MOI

Answer 39

Traumatic axial loading, e.g. falling from a height

Question 40

Most common calcaneal fracture

Answer 40

Fractured tarsal bone

Question 41

Talar neck fracture location

Answer 41

Fracture of the neck of the talus bone

Question 42

Talar neck fracture MOI

Answer 42

Forced dorsiflexion with axial loading

Question 43

Talar fracture complications

Answer 43

This fracture carries a high risk of avascular necrosis due to disruption of its retrograde blood flow