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Orthopaedics > Lower Limb Trauma > Flashcards

Lower Limb Trauma Flashcards

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1
Q

Different neck shaft angles

A
  1. Coxa vara: <120 deg
  2. Normal: 120-135 deg
  3. Coxa valga: >135 deg
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2
Q

What is Shenton’s line?

A

Continuous line from lower border of superior pubic ramus, laterally towards head and neck of femur
Disturbed in any pathology of hip

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3
Q

Special tests for Hip

A
  1. Trendelenburg test
  2. Thomas test
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4
Q

What is Trendelenburg test?

A

Test to assess abductor mechanism of hip

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5
Q

Principle abductors of Hip

A
  1. Gluteus medius
  2. Gluteus minimus
    Supplied by sup gluteal nerve
    Help maintain gait: I/L abductors help C/L limb
    Helps moving the limb when other limb is in stance phase
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6
Q

Causes of Abductor failure

A
  1. Gluteus medius weakness
  2. Gluteus minimus weakness
  3. Sup gluteal nerve palsy
  4. Coxa vara
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7
Q

Mechanism of Trendelenburg gait

A

Paralysis of gluteus medius and minimus -> No pelvic stabilisation on affected limb

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8
Q

Test procedure of Trendelenburg test

A

Ask patient to stand on each limb (30 secs)
Observe ASIS
When patient stands on pathological side, sound side sinks
Positive test: ASIS/PSIS of other (normal) side goes down

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9
Q

B/L abductor failure causes

A

Waddling gait

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10
Q

What is Thomas test?

A

AKA Hugh Owen Thomas well leg raise test
Used to assess flexion contracture/flexion deformity of hip

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11
Q

Types of Hip dislocation

A
  1. Post dislocation
  2. Ant dislocation
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12
Q

Mechanism of injury of Post hip dislocation

A

Dashboard injury

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13
Q

Mechanism of injury of Ant hip dislocation

A

Deceleration injury, fall from injury

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14
Q

Attitude of limb in Post hip dislocation

A
  1. Flexion at hip
  2. Adduction at thigh
  3. Internal rotation
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15
Q

Attitude of limb in Ant hip dislocation

A
  1. Flexion at hip
  2. Abduction at thigh
  3. Externally rotated limb
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16
Q

Length of limb in Hip dislocation

A

Post D: Shortened
Ant D: Lengthened

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17
Q

X ray features of Ant hip dislocation

A
  1. Shenton’s line is broken
  2. Head lies outside acetabulum
  3. Abduction and ext rotation of limb
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18
Q

X ray features of Post hip dislocation

A
  1. Shenton’s line is broken
  2. Adduction and int rotation of limb
  3. Lesser trochanter is not visible
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19
Q

Head palpable in Hip dislocation

A

Post D: Gluteal region
Ant D: Femoral triangle

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20
Q

Management of Hip dislocation

A

Closed reduction
If not reducing d/t muscle spasm: Closed reduction under anaesthesia
If no reduction: Open reduction + Apply skeletal traction

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21
Q

Complications of Hip dislocation

A
  1. Avascular necrosis: M/C (If not reduced within 6-12 hrs post injury)
  2. Sciatic nerve injury: In post dislocation
    Presents with foot drop/high stepping gait d/t common peroneal nerve injury
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22
Q

Types of Proximal femur #

A
  1. Neck of femur/Intracapsular fracture
  2. Intertrochanteric/Extracapsular fracture
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23
Q

Trauma leading to Proximal femur #

A

Neck of femur #: Trivial fall
Intertrochanteric #: Moderate to severe fall

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24
Q

Pain in Proximal femur #

A

Neck of femur #: Mild
Intertrochanteric #: Moderate to severe

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25
Location of pain in Proximal femur fracture
Neck of femur #: Scarpa’s triangle Intertrochanteric #: Trochanteric region
26
Shortening of limb in Proximal femur #
Neck of femur #: <1 inch Intertrochanteric #: >1 inch
27
Deformity/attitude of Proximal femur #
Neck of femur #: Ext rotation <45 deg (Capsule limits it) Intertrochanteric #: Ext rotation >45 deg (Lat part of foot touches the bed)
28
Complications of Neck of femur #
AVN>Non union D/t disruption of blood supply)
29
Complications of Intertrochanteric #
Malunion/Coxa vara/Dec in neck-shaft angle No disruption of blood supply
30
Classification of Neck of femur #
1. Anatomical 2. Pauwel’s 3. Garden’s
31
If patient is >65 years old, management of Neck of femur #
Replacement: 1. Hemiarthroplasty (In previously normal hip): Implant: Austin Moore, Thompson, Bipolar (Best) 2. Total (In previously abnormal hip): In osteoarthritis
32
If patient is <65 years old, management of Neck of femur #
1. Age of fracture checked: > If >3 weeks: MRI is done > If <3 weeks: Closed reduction IF + Cannulated cancellous screws 2. MRI done: > Non viable HOF: Fix + vascularisation procedures > Viable HOF: Fix + osteotomy If both fails: Total hip replacement
33
Fix + vascularisation procedures
1. Meters 2. Bakshi 3. Fibular vascular graft
34
What is Hemiarthroplasty?
Replacement of only head and neck of femur
35
What is Total arthroplasty?
Replacement of head and neck of femur + Acetabular cup
36
Management of Intertrochanteric #
1. Surgical: Maintain neck shaft angle (125-130 deg) with devices and prevent coxa vara 2. Conservative: In inoperable cases (age, comorbidities) > Derotation boot
37
What is Derotation boot?
Allows healing in Malunited position Prevents external rotation
38
Devices used to treat Intertrochanteric #
1. Proximal femoral nail with locking and stabilisation screws 2. Dynamic hip screw: Sliding compression mechanism
39
What is Fat embolism syndrome?
Leaking of Intramedullary fat into circulation
40
Clinical features of Fat embolism syndrome
Mnemonic: 3C 1. Cutaneous: Petechial rash 2. Cardiorespiratory: Dyspnea/tachypnea 3. CNS: Depression, coma, anxiety All 24-48 hours after poly trauma
41
Diagnostic criteria for Fat embolism syndrome
GURDS criteria 1 major + 4 minor = Fat embolism
42
Major criteria of GURDS criteria
1. Axillary/Subconjunctival petechia 2. PaO2 below 60 mmHg 3. CNS depression 4. Pulmonary edema
43
Minor criteria of GURDS criteria
1. Tachycardia 2. Fever 3. Anemia (MOST IMP) 4. Thrombocytopenia (MOST IMP) 5. Fat globules in sputum 6. Fat globules in urine (Lipiduria): Gurd test (MOST IMP) 7. Inc in ESR 8. Retinal emboli
44
Management of Fat embolism syndrome
Prevention: Immobilsation + Early fixation of fracture Treatment: Supportive O2 + IPPV
45
Treatment of Femur shaft fracture
ACC to age: <6 months: Pavlik harness 6 months-5 years: Hip spica cast (If <2 years/<12 kg: Gallows traction) 5-10 years: Flexible nails (Ender’s nail, TENS)/Plates if unstable >10 years: Intramedullary interlocking nails
46
Patella # is caused by
H/o direct trauma to knee
47
Treatment of Patella fracture
Tension band wiring with K wire
48
What is Bipartite patella?
Congenital anomaly: Accessory ossification centre Small separated fragment d/t incompletely fused patella at superolateral pole Incidental finding on X ray Rarely painful Management: Conservative
49
Management of Tibial shaft fracture
1. Patellar tendon bearing cast (Conservative) 2. Definitive treatment: CRIF with Intramedullary rod/nail with interlocking screws
50
What is Runner’s fracture?
Stress fracture of fibula seen in marathon runners
51
Types of Ankle fractures
1. Isolated lat malleolus # 2. Bimalleolar/Pott’s # 3. Trimalleolar/Cotton’s #
52
Management of Ankle fractures
Closed reduction (Neurovascular assessment before and after) -> Slab application -> Definitive surgery (Once swelling dec)
53
Mechanism of injury of Calcaneal #
Fall from height landing on feet
54
Angles to assess reduction of Calcaneal fracture
Dec in Bohler’s angle Inc in Gissane’s angle (Way to remember: After break {fracture} up, boys goes down, girl goes up)
55
What is Aviator’s fracture?
Fracture talar neck Inc risk of avascular necrosis of body of talus Hawkins classification of talar neck # Blood supply of talus: Dorsalis pedis -> Sinus tarsi A
56
What is Chopart’s fracture?
Fracture of intertarsal joint
57
What is Lisfranc’s fracture?
Fracture of Tarso-metatarsal joint
58
What is Robert Jones fracture?
Fracture of base of 5th metatarsal
59
Zones of Robert Jones fracture
Zone 1 (Pseudo jones fracture): D/t avulsion of peroneus tendon Zone 2 (True Jones fracture): In watershed area (Dec in vascularity) -> Non union Zone 3 (Stress fracture)
60
Treatment of Robert Jones fracture
Non weight bearing short leg cast for 6-8 weeks Intramedullary screw fixation if displacement + (Ideal Rx)

Orthopaedics (12 decks)

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