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Lower limb fractures (Foot (Talus (Diagnosis (Examination
Ankle/foot exam…
Lower limb fractures
Foot
Talus
Diagnosis
Examination
Ankle/foot exam
Knee, pelvis, spine
Neurovascular
X-radiograph
Management
Analgesia, immobilise
May need MUA/ORIF
Pathophysiology
Fall onto feet or violent dorsiflexion (car pedal RTA)
Displacement/doslocation can cause avascular necrosis
Metatarsals
-
Diagnosis
-
X-radiograph
Check for Lisfranc (tarso-metatarsal)
dislocation, as often missed
Management
Analgesia, POP backslab
MUA/fixation/ORIF
Calcaneus
Diagnosis
Examination
Ankle/foot (swelling, bruising, tender)
Knee, hips, spine exam
Neurovascular exam
X-radiograph
Calcaneal X-rays
Management
Analgesia, elevation
May need ORIF
-
Phalanges
Diagnosis
-
X-radiograph
Only if grossly deformed, compound fracture,
tenderness, suspected FB
Management
Analgesia, elevation, padded buddy strapping
If displaced, MUA
Amputation if unsalvageable
Patella
Diagnosis
Examination
Knee exam - pain, swelling, crepitus, difficult extension
Hip exam
Neurovascular exam
X-radiograph
Management
If undisplaced, conservative (analgesia, plaster of paris)
If displaced, surgical fixation (ORIF)
-
Ankle
-
Avulsion fractures
-
Management
Rest, analgesia, elevation, mobilize
If large displacement, Immobilise in POP
-
Femur
Shaft
Pathophysiology
Requires massive force (crush injury, RTA, falls)
Often associated with multisystem trauma
Other injuries e.g. hip, pelvis, knee
May occur at any point e.g. subtrochanteric,
supracondylar, mid shaft
Management
Iniitial ABCDE
Analgesia (femoral nerve block)
Traction immobilisation (e.g. Thomas splint)
with intramedullary nail fixation
-
Diagnosis
Examination
Hip exam - deformity, leg shortening,
external rotation and abduction
Spine and knee exam
Neurovascular exam
X-radiograph
Neck
Intracapsular
Clinical presentation
Hip pain, radiating to knee
Shortened and externally rotated leg
Cannot weight bear
Diagnosis
-
X-radiograph
Disrupted Shenton's line
Classification (Garden)
Grade 1 - Incomplete fracture, undisplaced, intact cortex
Grade 2 - Complete fracture, undisplaced
Grade 3 - Complete fracture, slight displacement
Grade 4 - Complete fracture, full displacement
Pathophysiology
Elderly patients, often minor trauma
Can disrupt blood supply to femoral head (avascular necrosis)
Management
Initial (ABCDE)
IV fluids
Bloods (crossmatch, FBC, U+E, LFTs)
Analgesia (IV morphine + antiemetic;
femoral nerve block may be needed)
Definitive
If no/minimal displacement, screw fixation
If displaced, head excision with prosthesis
-
Tibia
Plateau
Management
Analgesia
Immobilisation long leg POP backslab
Elevation, ORIF, bone grafts
Diagnosis
Examination
Knee exam - tenderness, swelling
Hip and ankle exam
Neurovascular status
X-radiograph
Pathophysiology
Valgus stress (falls onto extended leg, pedestrians hit by cars)
Compression of proximal tibia, often
associated haemarthrosis or ligament injury
Shaft
Diagnosis
-
X-radiograph
Management
Conservative
If undisplaced, analgesia and long leg POP backslab
Surgical
If displaced, refer for MUA, intramedullary nails, ORIF
-
Fibula
Shaft
Diagnosis
-
X-radiograph
Management
If undisplaced, analgesia, elevation
and support in POP or padded bandage
If displaced, may need surgery
Pathophysiology
Direct blow or twisting injury
Often combo with a tibial fracture
May damage common peroneal nerve