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Lower limb injuries Flashcards

(58 cards)

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1
Q

Sign of femoral neck fracture?

A

Shortened, flexed and externally rotated limb

Shenton’s line interrupttion

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2
Q

Surgical emergency in the young:

A

Displaced intracapsular fractures of the femoral neck

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3
Q

What are the three types of intracapsular fractures of the femoral neck?

A

Subcapital
Transcervical
Basicervical

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4
Q

Which blood vessels are associated with the femoral neck?

A

Lateral and medial circumflex arteries from the femoral give branches to the neck
These include the lateral epiphyseal arteries and the posterior superior retinacular arteries

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5
Q

Three major types of femur neck fracture:

A

Intracapsular
Intertrochanteric
Subtrochanteric

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6
Q

Garden classification of fractured neck of femur:

A 
I = vagus impacted
II = non-displaced
III = complete: partially displaced
IV = complete: fully displaced
(III+IV are unstable)
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7
Q

What is trochanteric pain syndrome?

A

Inflammation/trauma in muscles, tendons, fascia or bursar

Women > Men; 40-60 y/o

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8
Q

What is trochanteric pain syndrome concurrent with?

A

Low back pain
OA of the knee
RA
Fibromyalgia

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9
Q

What is osteitis pubis?

A

Inflammation of the pubic symphysis and surrounding structures from repetitive trauma + opposing shearing forces in the symphysis

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10
Q

What is piriformis syndrome?

A

Neuropathy due to entrapment of the sciatic nerve

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11
Q

What causes entrapment of the sciatic nerve?

A

Trauma to buttocks
Scarring and fibrosis around nerve due to piriformis strain
Branches of nerve passing through a bifid piriformis

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12
Q

Sign of piriformis syndrome?

A

Wallet sign

Paraesthesia when sitting on wallet

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13
Q

What is athletic pubalgia?

A

Damage to soft tissue in groin area

aka sports hernia

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14
Q

What is femoacteabular impingement?

A

Abnormal contact between ant fem head and acet rim
Cam = non-spherical fem head causes abnormal forces in hip flexion
Pincer = over-coverage of the femoral head by the acetabulum

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15
Q

Management of fractured shaft of femur:

A

Assess neurovasculature
Blood loss of 0.75-1L = start IV fluids and send blood for G and S
IV analgesia and donway splint + ortho referral

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16
Q

What does the Drawer test test?

A

The stability of the anterior cruciate ligament

Must relax hamstrings at 80 degree angulation

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17
Q

What are Ottawa’s knee rules that warrant knee X-ray?

A 
Age > 55
Isolated tenderness of the patella
Tenderness at head of fibula
Inability to flex 90 degrees
Inability to bear weight immediately/ED (4 steps)
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18
Q

Which X-rays are ordered for a knee?

A

AP + Lateral views
Skyline view for patellar problems
Tunnel view for intercondylar area (e.g. loose bodies)
Sunrise view for vertical patellar fracture

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19
Q

Management of fractured patella?

A 
Elderly = bandage with ortho opinion
Young = POP cylinder/cricket splint + patient may walk
Displaced/comminuted = internal fixation/excision, admit
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20
Q

Management of dislocated patella:

A 
Reducible under N2O mostly
X-ray to exclude osteochondral fracture
Aspirate if large effusion
1st = POP cylinder/crickent splint and may walk
Recurrent = compression bandage
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21
Q

When is an apprehension test carried out?

A

If a dislocated patella is self re-located

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22
Q

What is a Segond fracture?

A

Avulsion fracture of the lateral aspect of the proximal tibia below the articular surface

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23
Q

What causes a Segond fracture?

A

Internal rotation and stress tensing the lateral capsular ligament

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24
Q

Associated injuries with the Segond fracture:

Study These Flashcards
A

Tear of the anterior cruciate ligament (75-100%)
Injuries of medial and lateral menisci (66-70%)
Avulsion fracture of fibular head/Gerdy tubercle

25
What is an avulsion fracture?
Small chunk of bone attached to a tendon/ligament gets pulled away from the main bone
26
What is the protocol with identifying a second fracture with a Segond fracture?
MRI to assess ACL, menisci and other structures
27
Fractured tibial condyle may require...
Internal fixation
28
What should you order with an intercondylar tibial fracture?
Tunnel view X-ray
29
What should you do in the case of a fracture to the tibial shaft +/- fibula?
Check the neurovascular status and the compartments
30
If tibial fracture is due to direct blow what should you do?
Admit for 24 hours observation to make sure compartment syndrome does not occur
31
When should you admit a tibial fracture?
If direct blow | If open or displaced
32
Management of pre-tibial lacerations?
Avoid suturing unless very distracted wound edges
33
Management of fractured fibula shaft from direct blow?
Crepe bandage Exclude compartment syndrome Exclude common peroneal nerve injury if at neck
34
Where is compartment syndrome more common?
Gluteal and peroneal compartments
35
Signs of compartment syndrome:
Pain out of proportion - active and passive | Paraesthesia, pallor, paralysis, pulseless (pulse presence does not exclude compartment syndrome)
36
Diagnosis of compartment syndrome:
Pressure >20mmHg is abnormal and >40mmHg is diagnostic
37
Treatment of compartment syndrome:
Fasciotomies
38
Complications of compartment syndrome:
Myoglobinuria causing renal failure and requiring IV fluids | Necrosis - requiring debridement and possibly amputation
39
Which fractures are most likely to cause compartment syndrome?
Supracondylar fractures | Tibial shaft fractures
40
80-85% of inverted ankle sprains are due to what?
The anterior talofibular ligament | others include calcaneofibular ligament
41
What are the Ottawa ankle rules for ordering a lateral view X-ray?
Pain in malleolar zone + either: Bone tenderness at posterior tip of lateral malleolus OR inability to bare weight immediately/ED
42
What are the Ottawa ankle rules for ordering a medial view X-ray?
Pain in mid-foot zone + either: Bone tenderness at base of 5th metatarsal OR bone tenderness at the navicular OR inability to bare weight immediately/ED
43
What signs in the context of ankle fractures are considered abnormal?
Tibiofibular overlap <10mm (syndesmotic injury) Tibiofibular clear space >5mm (syndesmotic injury) Talor tilt >2mm
44
What is a type A Weber fracture?
Tip of lateral malleolus fracture closest to ankle
45
What is a type B Weber fracture?
Fracture of lateral malleolus further up, may be medial damage
46
What is a type C Weber fracture?
Fracture of fibula higher up still with potential medial involvement
47
Management of Weber A:
POP + walking if only tip BKBS and non weight-bearing for 3 weeks if undisplayed oblique fracture Displaced/gap between bone ends then referral
48
Management of Weber B:
If stable then POP with walking If undisplayed fracture of lateral malleolus + medial malleolus/swelling over deltoid ligament with no talar shift then refer If displaced/lateral talar shift then internal fixation
49
Management of Weber C:
Non-displaced = non-weight bearing BKBS for 3 weeks | Displaced/lateral talar shift = admission
50
Management of ankle fracture if circulation in jeopardy?
Reduce immediately under Entonox + chocolate before X-ray
51
What is Simmond's test?
A test for tendoachilles tear Normally supine squeeze of calf muscle will cause plantar flexion This reflex will not be present in tear
52
What should you consider with achilles tendon tear?
``` RA SLE Renal failure Hyperparathyroidism Hyperlipoproteinuria Gout ```
53
Management of achilles tendon tear?
Operative
54
Indications of calcaneus fracture?
Fall from height Associated spinal and pelvic injuries Bohler's angle >20 degrees
55
Risk with calcaneus fracture?
Compartment syndrome
56
Which is the most common metatarsal fracture and what is the management?
5th metatarsal Treatment is symptomatic - BKPOP for 3-4 weeks for pain Double tubigrip for swelling
57
Differential between Jones' and pseudojones' fracture:
Jones' fracture occurs at the metaphyseal-diaphyseal junction and involves the 4th-5th metatarsal articulation Pseudojones' fracture involves the proximal tubercle Jones is caused by a sudden change in direction whereas Pseudojones is caused by landing on the ankle awkwardly
58
Important management step in femoral fractures?
Fluid repletion

Trauma (8 decks)

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