4.5

Questions and Answers

What is caused by a sudden, severe contraction of the quadriceps muscle while the knee is in a stretched valgus and external rotation position?

Lateral dislocation of the patella (correct)

Osteochondral injury

Medial dislocation of the knee

Distal fibula fracture

What percentage chance do patients have of experiencing recurrent patellar dislocation after non-operative treatment for a first-time dislocation?

35-40%

5-10%

25-30%

15-20% (correct)

Which of the following complications is most likely from a patellar dislocation?

Tibial spine fracture

Osteochondral fracture (correct)

Fractured femur

Complete knee dislocation

What is the immediate treatment approach for a dislocated knee under anesthesia?

Reduction and back-slab with knee flexion Signup and view all the answers

Which condition can predispose an individual to recurrent dislocation of the patella?

Generalized joint laxity Signup and view all the answers

What type of fracture may result from a twisting force applied to the leg?

Spiral fracture of both tibia and fibula Signup and view all the answers

What is a key clinical feature to examine when assessing a dislocated knee?

Condition of the feet and circulation in the popliteal artery Signup and view all the answers

What type of fracture is characterized by a separate triangular ‘butterfly’ fragment?

Short oblique fracture Signup and view all the answers

Which treatment is typically indicated for subtrochanteric fractures?

Open reduction and internal fixation Signup and view all the answers

What is a common complication following femoral shaft fractures?

Thromboembolism Signup and view all the answers

What defines a malunion in the context of femoral fractures?

No more than 15 degrees of angulation accepted Signup and view all the answers

In which scenario are intertrochanteric fractures likely to occur?

From trivial injuries in elderly patients Signup and view all the answers

What is a characteristic feature of supracondylar fractures of the femur?

Fracture line just above the femoral condyles Signup and view all the answers

What complication is associated with the treatment of open femoral fractures?

Infection Signup and view all the answers

Which of the following is a key characteristic of condylar fractures?

The knee typically shows swelling and haemarthrosis Signup and view all the answers

What is the most significant concern when treating femoral shaft fractures?

Displacement of the fracture due to muscle pull Signup and view all the answers

What is the most common mechanism of injury leading to a posterior dislocation of the hip?

Striking the knee against the dashboard in a road accident Signup and view all the answers

Which position characterizes the lower limb in a posterior hip dislocation?

Short, adducted, internally rotated, and slightly flexed Signup and view all the answers

What complication occurs in 10-20% of cases after a posterior hip dislocation?

Sciatic nerve injury Signup and view all the answers

Which complication of traumatic hip dislocation has an increased risk if reduction is delayed beyond a few hours?

Avascular necrosis Signup and view all the answers

What is a common cause of fracture of the femoral neck in younger individuals?

A fall directly onto the greater trochanter Signup and view all the answers

During treatment, what is typically done after reduction of a posterior hip dislocation?

Traction is applied and maintained for 3 weeks Signup and view all the answers

What are the initial steps in management of a hip dislocation?

Reduction under general anesthesia, followed by traction Signup and view all the answers

Which of the following is NOT a factor contributing to the development of osteoarthritis after a hip dislocation?

Delays in joint mobility exercises Signup and view all the answers

What is the recommended treatment for markedly displaced and/or comminuted fractures of the lateral condyle?

Open reduction and internal fixation Signup and view all the answers

Which method is typically employed for treating fractures of the medial condyle?

Open reduction and fixation with a buttress plate and screws Signup and view all the answers

What can be a consequence of severe tibial plateau fractures?

Compartment syndrome Signup and view all the answers

What is a common mechanism that leads to tibial plateau fractures?

Direct impact from a vehicle Signup and view all the answers

When treating undisplaced and minimally displaced fractures of the lateral condyle, what is the preferred approach?

Conservative management Signup and view all the answers

What surgical technique might be required for bicondylar fractures due to their complexity?

Combination of screw fixation and circular external fixation Signup and view all the answers

What is a potential complication of tibial plateau fractures that can affect treatment outcomes?

Vascular injury Signup and view all the answers

What describes the term used for tibial plateau fractures resulting from a fall where the knee is forced into valgus or varus?

Bumper fracture Signup and view all the answers

Which of the following is not a type of patellar fracture?

Segmentation fracture Signup and view all the answers

What is the main approach for treating an undisplaced patellar fracture?

Plaster cylinder for stabilization Signup and view all the answers

In the management of a comminuted (stellate) fracture of the patella, which statement is true?

The undersurface of the patella is irregular. Signup and view all the answers

What mechanism is commonly associated with a displaced transverse fracture of the patella?

Forced passive flexion while the quadriceps are contracted Signup and view all the answers

Which of the following complications should be closely monitored after a patellar fracture?

Compartment syndrome Signup and view all the answers

When treating a displaced transverse fracture, what is typically done to the extensor mechanism?

It is repaired with internal fixation. Signup and view all the answers

What daily activities are encouraged during the initial treatment of an undisplaced fracture?

Quadriceps exercises Signup and view all the answers

Which of the following is a characteristic feature of a comminuted patellar fracture?

Irregularity in bone undersurface Signup and view all the answers

What type of patellar fracture is characterized by fragments resulting from high-energy trauma, often needing surgical intervention?

Comminuted fracture Signup and view all the answers

When managing an undisplaced patellar fracture, which treatment approach is typically recommended?

Application of a back-slab Signup and view all the answers

Which clinical feature is most commonly associated with patellar dislocation?

Visible deformity of the patella Signup and view all the answers

What is a common complication that may arise after a first-time patellar dislocation?

Recurrent dislocation Signup and view all the answers

In the context of a patellar dislocation, which mechanism primarily causes the patella to dislocate laterally?

Severe quadriceps contraction in valgus position Signup and view all the answers

What type of management is crucial for a patient with a dislocated knee to identify possible circulatory issues?

Careful monitoring of the popliteal artery Signup and view all the answers

In which scenario is a comminuted fracture likely to occur in relation to the patella?

Direct impact during contact sports Signup and view all the answers

What primary factor increases the risk of recurrent patellar dislocation?

Generalized joint laxity Signup and view all the answers

Which type of patellar fracture is most likely to be caused by a direct blow?

Undisplaced fracture Signup and view all the answers

What daily activity is emphasized during the treatment of an undisplaced patellar fracture?

Quadriceps strengthening exercises Signup and view all the answers

In the management of a comminuted (stellate) patellar fracture, which procedure might be necessary if the undersurface is irregular?

Partial patellectomy Signup and view all the answers

What occurs when the extensor mechanism is disrupted in a displaced transverse fracture of the patella?

Requirement for internal fixation Signup and view all the answers

What type of fracture typically occurs in elderly patients due to trivial injuries?

Subtrochanteric fractures Signup and view all the answers

What treatment is generally recommended for supracondylar fractures of the femur?

Skeletal traction Signup and view all the answers

What key sign should be examined to monitor for complications following a patellar fracture?

Signs of compartment syndrome in the leg and foot Signup and view all the answers

In treating a comminuted fracture of the femur, what is a common complication to consider?

Infection from open injuries Signup and view all the answers

Which of the following best describes the mechanism leading to a transverse fracture of the patella?

Forced, passive flexion of the knee while the quadriceps is contracted Signup and view all the answers

What is a common complication that should be monitored after a patellar dislocation?

Chronic knee instability Signup and view all the answers

Which mechanism of injury is most commonly associated with femoral shaft fractures?

High-energy injury Signup and view all the answers

What complication is commonly linked to patellar dislocation?

Recurrent instability Signup and view all the answers

Which type of patellar fracture would be least likely to allow the patient to lift their leg due to extensor mechanism involvement?

Transverse fracture Signup and view all the answers

What is a characteristic feature indicating a condylar fracture?

Swelling and doughy feel of haemarthrosis Signup and view all the answers

What is one potential complication from a delayed reduction of a traumatic dislocation?

Osteoarthritis Signup and view all the answers

What defines a delayed union in the context of a fractured femur?

Fracture healing takes more than 3–6 months Signup and view all the answers

What is the treatment approach for undisplaced fractures of the lateral condyle?

Conservative management Signup and view all the answers

Which type of fracture typically requires treatment with a buttress plate and screws?

Medial condyle fractures Signup and view all the answers

What is the most likely complication associated with severe tibial plateau fractures?

Compartment syndrome Signup and view all the answers

Which statement accurately describes a common mechanism of injury leading to tibial plateau fractures?

Strong impact from a lateral direction combined with axial load Signup and view all the answers

What is typically required for managing a bicondylar fracture due to its complexity?

Combination of screw fixation and circular external fixation Signup and view all the answers

Which surgical treatment is recommended for markedly displaced fractures of the lateral condyle?

Open reduction and internal fixation Signup and view all the answers

What is a potential consequence of untreated severe tibial plateau fractures?

Chronic arthritis development Signup and view all the answers

What is commonly observed in patients with tibial plateau fractures associated with major vascular injury?

Rapid loss of limb function Signup and view all the answers

Which of the following best describes the mechanism of injury leading to a posterior dislocation of the hip?

A collision with the dashboard during a car accident Signup and view all the answers

What is a key characteristic of the position of the limb in a posterior hip dislocation?

Internally rotated and adducted Signup and view all the answers

After a posterior hip dislocation is successfully reduced, what is the typical next step in treatment?

Begin movement and exercises as pain allows Signup and view all the answers

What complication is most commonly associated with posterior hip dislocations involving sciatic nerve injury?

Foot drop due to nerve damage Signup and view all the answers

Which of the following factors increases the risk of avascular necrosis after a hip dislocation?

Delay in reduction beyond a few hours Signup and view all the answers

In evaluating the complications of dislocation of the hip, which of the following is NOT typically a consequence of cartilage injury?

Fracture of the acetabulum Signup and view all the answers

What is the most appropriate treatment for a fracture of the femoral neck resulting from a fall onto the greater trochanter in a younger individual?

Immediate surgical fixation with screws Signup and view all the answers

During the evaluation of a comminuted fracture of the femoral neck, which of the following characteristics would likely be assessed?

Degree of displacement and number of fracture fragments Signup and view all the answers

A comminuted patellar fracture is often caused by low-energy trauma and typically requires non-surgical management.

False Signup and view all the answers

The management of an undisplaced patellar fracture generally favors prompt surgical repair to ensure proper healing.

False Signup and view all the answers

A direct blow to the knee can cause an avulsion fracture of the patella due to the impact on the extensor mechanism.

True Signup and view all the answers

Patellar dislocations predominantly occur medially due to the physiological alignment of the knee joint.

False Signup and view all the answers

One potential complication of a patellar dislocation is the tearing of the medial patellofemoral ligament (MPFL).

True Signup and view all the answers

Recurrent dislocation after a first episode is primarily influenced by lower proprioceptive awareness and muscle strength.

False Signup and view all the answers

In patients treated for a first-time dislocation without surgery, the chance of experiencing another dislocation is approximately 30-40%.

False Signup and view all the answers

The primary mechanism for patellar dislocation involves the quadriceps muscle contracting while the knee is in a straight position.

False Signup and view all the answers

A comminuted or ‘stellate’ fracture of the patella is characterized by a direct blow to the knee.

False Signup and view all the answers

Treatment for an undisplaced patellar fracture primarily involves maintaining knee flexibility while healing.

False Signup and view all the answers

In a displaced transverse fracture of the patella, the entire extensor mechanism remains intact.

False Signup and view all the answers

A transverse fracture with a gap between fragments indicates an indirect traction injury due to passive flexion of the knee during quadriceps contraction.

True Signup and view all the answers

Compartment syndrome is a common complication that arises from improper treatment of patellar fractures.

True Signup and view all the answers

A congenital bipartite patella can be easily confused with a fracture due to its smooth line extending across the bone.

True Signup and view all the answers

Dislocated patellas can often lead to osteoarthritis if not addressed properly during initial treatment.

True Signup and view all the answers

Quadriceps exercises are not necessary during the recovery of a displaced patellar fracture.

False Signup and view all the answers

A comminuted patellar fracture is rarely associated with high-energy trauma and generally requires minimal intervention.

False Signup and view all the answers

The treatment approach for an undisplaced patellar fracture usually involves surgery and immediate weight bearing.

False Signup and view all the answers

Direct trauma is a common mechanism for patellar dislocation, often occurring when the knee is in a flexed position.

False Signup and view all the answers

Joint stiffness, non-union, and vascular injury are common complications associated with patellar fractures.

True Signup and view all the answers

Patellar fractures most frequently occur from indirect injuries rather than direct blows to the knee.

False Signup and view all the answers

A common complication following non-surgical treatment for a patellar dislocation is recurrent patellar dislocation.

True Signup and view all the answers

The management of a displaced transverse fracture typically emphasizes preserving the extensor mechanism.

True Signup and view all the answers

A patellar fracture characterized by a high-energy mechanism often leads to a need for comprehensive rehabilitation post-surgery.

True Signup and view all the answers

A patellar fracture can occur from a direct blow to the knee.

True Signup and view all the answers

The recommended treatment for an undisplaced patellar fracture is immediate surgical intervention.

False Signup and view all the answers

Comminuted fractures of the patella are often managed with non-weight bearing activities only.

False Signup and view all the answers

A fall directly onto the knee can lead to a lateral patellar dislocation.

False Signup and view all the answers

One common complication following a first-time patellar dislocation is the risk of recurrence.

True Signup and view all the answers

Immediate treatment of a dislocated knee requires focusing on stabilizing the joint and checking for vascular status.

True Signup and view all the answers

Osteoarthritis is more likely to develop in patients with retained fragments from a patellar fracture.

True Signup and view all the answers

The mechanism of injury for a patellar fracture primarily involves pulling of the quadriceps muscle.

False Signup and view all the answers

Comminuted patellar fractures are characterized by multiple bone fragments resulting from low-energy trauma.

False Signup and view all the answers

Open reduction and internal fixation is rarely required for managing undisplaced fractures of the patellar region.

True Signup and view all the answers

The primary mechanism causing a patellar dislocation involves the quadriceps muscle contracting excessively while the knee is in varus alignment.

False Signup and view all the answers

All types of tibial plateau fractures require surgical intervention for effective treatment.

False Signup and view all the answers

Risk of wound complications increases significantly when treating bicondylar fractures with external fixation alone.

True Signup and view all the answers

Bumper fractures often occur as a result of car accidents where a pedestrian is struck on the knee.

True Signup and view all the answers

In cases of patellar dislocation, monitoring for signs of compartment syndrome is not essential.

False Signup and view all the answers

Management of comminuted patellar fractures often involves substantial fixation techniques to stabilize the injury.

True Signup and view all the answers

Comminuted fractures of the tibial plafond can occur from severe axial compression, such as falling from a height.

True Signup and view all the answers

All Salter–Harris fracture types involve a vertical split of the epiphysis.

False Signup and view all the answers

Avascular necrosis is a common complication of fractures of the neck of the femur.

False Signup and view all the answers

Fractures of the calcaneum commonly occur from falls onto one or both heels.

True Signup and view all the answers

Fractures of the head of the talus are among the most common injuries following a car accident.

False Signup and view all the answers

Extra-articular fractures of the calcaneum specifically affect the bony processes or the anterior part of the bone.

False Signup and view all the answers

Severe comminution in ankle fractures may extend up the shaft of the tibia.

True Signup and view all the answers

The degree of fracture displacement does not influence the risk of avascular necrosis in talar fractures.

False Signup and view all the answers

Patients with calcaneum fractures often suffer from associated injuries to the spine, pelvis, or hip.

True Signup and view all the answers

Fractures in the talus are considered common due to their low mobility.

False Signup and view all the answers

Intra-articular fractures cleave the bone accurately and run into the inferior articular surface.

False Signup and view all the answers

Broadening of the heel is a common complication that can lead to issues with shoe fitting.

True Signup and view all the answers

Talocalcaneal stiffness is an immediate consequence of minor midtarsal injuries.

False Signup and view all the answers

Medial midtarsal dislocation appears similar to an 'acute clubfoot.'

True Signup and view all the answers

Fractures isolated to the navicular, cuneiform, or cuboid bones are commonly seen.

False Signup and view all the answers

The Lisfranc fracture-dislocation is associated with sprains of the foot.

False Signup and view all the answers

Stress fractures primarily occur in athletes and can manifest as a tender lump distal to the mid-shaft of the second metatarsal.

True Signup and view all the answers

Dislocations of the tarsometatarsal region are frequently associated with twisting and crushing injuries.

True Signup and view all the answers

Acute clubfoot is a condition generally linked to lateral midtarsal dislocations.

False Signup and view all the answers

Joint stiffness and osteoarthritis are not typical complications of severe intra-articular fractures.

False Signup and view all the answers

What is the primary complication associated with fractures of the neck of the talus?

Avascular necrosis (AVN) of the body Signup and view all the answers

Which type of Salter-Harris fracture indicates that the epiphysis is split vertically and may become displaced?

Type 3 Signup and view all the answers

What is a common mechanism of injury for talar fractures?

High-energy events such as car accidents Signup and view all the answers

In the context of calcaneum fractures, what is the primary cause of injury?

Falling from a height onto the heels Signup and view all the answers

Which fracture type involves shattering of the tibial plafond due to severe axial compression?

Comminuted fractures Signup and view all the answers

What is a possible consequence of untreated Type 3 or Type 4 Salter-Harris fractures?

Abnormal bone growth and ankle deformity Signup and view all the answers

What percentage of patients with calcaneum fractures also suffer from associated injuries?

More than 20% Signup and view all the answers

What kind of fractures can result from fractures of the talus?

Various types including osteochondral fractures Signup and view all the answers

After a fall from a height, which injury to the ankle is most often observed?

Fractures of the tibial plafond Signup and view all the answers

What type of fracture is characterized by splitting or crushing of the calcaneum?

Comminuted fracture Signup and view all the answers

What complication is commonly associated with intra-articular fractures?

Joint stiffness and osteoarthritis Signup and view all the answers

Which type of midtarsal dislocation produces a valgus deformity?

Lateral midtarsal dislocation Signup and view all the answers

What is a common mechanism leading to metatarsal fractures?

Direct blow Signup and view all the answers

What is the most typical presentation of a stress (march) fracture in the foot?

Tender lump distal to mid-shaft of a metatarsal Signup and view all the answers

Which of the following best describes extra-articular fractures?

Fractures that do not involve the articular surface Signup and view all the answers

Which injury is characterized by combination fractures or fracture-dislocations in the midtarsal area?

Major midtarsal injury Signup and view all the answers

In cases of tarsometatarsal injuries, what is the usual cause of dislocation?

Twisting and crushing injuries Signup and view all the answers

What common issue can result from a broadening of the heel following an intra-articular fracture?

Shoe fitting problems Signup and view all the answers

How should fractures in the midtarsal region be approached in terms of injury classification?

Assumed to be combination fractures Signup and view all the answers

What is a potential consequence of isolated injuries of the navicular, cuneiform, or cuboid bones?

Increased likelihood of osteoarthritis Signup and view all the answers

What complication commonly arises from broadening of the heel due to intra-articular fractures?

Impingement affecting tendons Signup and view all the answers

What is a potential outcome of displaced intra-articular fractures?

Joint stiffness Signup and view all the answers

What appearance does a medial midtarsal dislocation resemble?

An acute clubfoot Signup and view all the answers

In midtarsal injuries, which type of injury is rare compared to others?

Navicular fractures Signup and view all the answers

What type of fracture can commonly be expected from a twisting force applied to the leg?

Intra-articular fracture Signup and view all the answers

What should be suspected if a patient experiences pain, swelling, and bruising of the foot after an accident?

Fracture-dislocation Signup and view all the answers

Which injury is characterized by the presence of a tender lump distal to the mid-shaft of a metatarsal bone?

Stress (march) fracture Signup and view all the answers

What type of injuries are typical causes of tarsometatarsal injuries?

Twisting and crushing injuries Signup and view all the answers

What complication is commonly associated with severe fracture-dislocations in the foot?

Compartment syndrome Signup and view all the answers

What is a common cause of metatarsal fractures?

Direct blow Signup and view all the answers

What is a potential outcome if a Type 3 or Type 4 Salter-Harris fracture is not accurately reduced?

Abnormal growth and ankle deformity Signup and view all the answers

What is a common cause of talar injuries?

Car accidents or falls from a height Signup and view all the answers

Which of the following fragments is at risk of avascular necrosis (AVN) due to neck fractures of the talus?

Posterior fragment Signup and view all the answers

When a patient falls from a height onto one or both heels, which type of fracture is commonly sustained?

Calcaneal fracture Signup and view all the answers

What type of injury does a comminuted fracture of the tibial plafond typically involve?

Shattering of the tibial plafond due to axial compression Signup and view all the answers

What is a significant risk associated with fractures of the neck of the talus?

Delayed healing due to blood supply issues Signup and view all the answers

Which of the following is true regarding extra-articular fractures of the calcaneum?

They involve processes or the posterior part of the bone. Signup and view all the answers

In which scenario is a calcaneal fracture most likely to occur?

Jumping off a height and landing on one's feet Signup and view all the answers

Which statement is correct regarding the Salter-Harris classification of fractures?

Type 3 fractures involve vertical splitting of the epiphysis. Signup and view all the answers

Which type of fracture is most likely to happen in patients with severe axial trauma?

Comminuted fracture of the tibial plafond Signup and view all the answers

What type of fracture is caused by severe axial compression of the ankle joint?

Comminuted fracture Signup and view all the answers

In the Salter-Harris classification, what does a Type 3 fracture indicate?

The epiphysis is split vertically with possible displacement Signup and view all the answers

What is a common complication following a fracture of the neck of the talus?

Avascular necrosis Signup and view all the answers

What mechanism commonly causes fractures of the calcaneum?

Fall from a height Signup and view all the answers

What type of injury may occur due to considerable violence and is characterized by the fracture of multiple areas of the talus?

Comminuted fracture Signup and view all the answers

What can happen if Type 4 fractures in the Salter-Harris classification are not accurately reduced?

Abnormal ankle growth and deformity Signup and view all the answers

Which of the following correctly describes a common consequence of fractures to the calcaneum?

Associated injuries to the spine or pelvis Signup and view all the answers

What term describes the fragmentation of bone often seen in severe ankle injuries?

Comminution Signup and view all the answers

What is a significant risk factor for avascular necrosis following talar neck fractures?

Degree of fracture displacement Signup and view all the answers

Which type of talar injury involves fractures of the bony processes or dislocations of the talus?

Osteochondral fractures Signup and view all the answers

What is a common complication that may arise due to intra-articular fractures?

Joint stiffness and osteoarthritis Signup and view all the answers

What can be a significant consequence of a medial midtarsal dislocation?

Acute clubfoot appearance Signup and view all the answers

Which injuries are common in the midtarsal region?

Minor sprains to severe fracture-dislocations Signup and view all the answers

Which factor is commonly associated with stress fractures in the foot?

Repetitive high-impact activities Signup and view all the answers

What is a notable feature of the broadening of the heel due to complications from fractures?

Causes impingement affecting peroneal tendons Signup and view all the answers

What is a usual cause of tarsometatarsal injuries?

Twisting and crushing injuries Signup and view all the answers

An isolated injury to which bone is considered rare?

Metatarsal Signup and view all the answers

What visual indication might suggest a lateral midtarsal dislocation?

Valgus deformity Signup and view all the answers

What condition may result from chronic overuse, particularly in young adults active in sports?

Metatarsal stress fracture Signup and view all the answers

Which type of fracture often requires surgery due to complications like dislocation?

Fracture-dislocations Signup and view all the answers

What type of fracture is best treated with locked intramedullary nailing?

Diaphyseal fractures Signup and view all the answers

What is a common management strategy for stable fractures?

Full-length cast application Signup and view all the answers

Which of the following is considered a late sign of compartment syndrome?

Numbness in the leg or foot Signup and view all the answers

What is a primary objective in managing compartment syndrome?

Decompress the compartment as soon as possible Signup and view all the answers

What condition is commonly associated with a feeling of tightness or 'bursting' in the leg?

Compartment syndrome Signup and view all the answers

Which of the following best describes malunion in long bone fractures?

Improper alignment that may lead to complications Signup and view all the answers

Which treatment method is typically indicated for unstable fractures at the outset?

Skeletal fixation Signup and view all the answers

What is a critical factor in the management of lower limb injuries to reduce soft tissue damage?

Early weight bearing and joint movements Signup and view all the answers

What is the recommended treatment for subtrochanteric fractures?

Open reduction and internal fixation Signup and view all the answers

What is a common complication associated with femoral shaft fractures?

Delayed union and non-union Signup and view all the answers

What characterizes intertrochanteric fractures?

Lying in external rotation after injury Signup and view all the answers

Which complication is a concern following open injuries of the femur?

Infection Signup and view all the answers

What is a primary mechanism for supracondylar fractures of the femur?

Direct trauma Signup and view all the answers

What deformity may occur with malunion of a femoral fracture?

Varus and external rotation deformities Signup and view all the answers

What is a critical consideration in the management of femoral shaft fractures?

Minimizing muscle pull Signup and view all the answers

What type of fracture is characterized by a gap between the fragments due to forced flexion of the knee?

Transverse fracture Signup and view all the answers

Which type of fracture involves a pull by the gastrocnemius muscle?

Supracondylar fracture Signup and view all the answers

Which treatment approach is recommended for managing a comminuted patellar fracture?

Internal fixation and extensor expansion repair Signup and view all the answers

What is a common outcome of knee dislocation not addressed promptly?

Vascular injury Signup and view all the answers

What complication should be closely monitored after a patellar fracture?

Patellofemoral joint damage Signup and view all the answers

What should be palpated in a patient with a supracondylar fracture of the femur?

Tibial pulses Signup and view all the answers

What is often the mechanism of injury associated with a patellar fracture?

Direct blow to the leg Signup and view all the answers

Which complication is specifically linked to compartment syndrome in the lower limb?

Nerve damage Signup and view all the answers

What is the typical cause of a fracture of the femoral neck in younger individuals?

A fall from a height Signup and view all the answers

What complication occurs in approximately 10-20% of cases following a posterior hip dislocation?

Sciatic nerve injury Signup and view all the answers

Which step is typically taken immediately after the reduction of a posterior hip dislocation?

Traction for 3 weeks Signup and view all the answers

What increases the risk of avascular necrosis following a traumatic hip dislocation?

Delayed reduction beyond a few hours Signup and view all the answers

What typically characterizes the position of the lower limb in a posterior dislocation of the hip?

Shortened and adducted Signup and view all the answers

What factor contributes to the development of osteoarthritis after a hip dislocation?

Retained fragments in the joint Signup and view all the answers

What is a common mechanism for a central dislocation of the hip?

Fall on the side Signup and view all the answers

What should be protected to prevent injury during recovery from a sciatic nerve injury?

The ankle and foot Signup and view all the answers

What is an essential management step for a dislocated knee?

Close monitoring for circulatory issues Signup and view all the answers

What is a common consequence of failure to promptly treat a traumatic hip dislocation?

Development of osteoarthritis Signup and view all the answers

What mechanism primarily leads to a spiral fracture of both the tibia and fibula?

A twisting force Signup and view all the answers

What is a vital clinical feature to observe when assessing a dislocated knee?

Foot circulation and sensation Signup and view all the answers

Which of the following best describes a short oblique fracture?

A fracture occurring at an angle and lacking a separate fragment Signup and view all the answers

What is typically included in the urgent treatment for a dislocated knee?

Reduction under anaesthesia Signup and view all the answers

What complication arises from non-operative treatment of a first-time patellar dislocation?

15–20% chance of recurrent dislocation Signup and view all the answers

Which factor does NOT predispose to recurrent dislocation of the patella?

Excessively low body weight Signup and view all the answers

Which injury mechanism is most likely to cause a dislocated knee?

Significant impact from a motor vehicle accident Signup and view all the answers

What is commonly revealed in X-rays when assessing a dislocated knee?

Fracture of the tibial spine Signup and view all the answers

What should be checked repetitively in the treatment of a dislocated knee?

Circulation in the leg Signup and view all the answers

Which of the following statements is true regarding the management of knee dislocations?

An external fixator may be used if the joint is unstable Signup and view all the answers

A full-length cast is applied for stable fractures that are undisplaced or minimally displaced.

True Signup and view all the answers

Plate fixation is preferred for treating diaphyseal fractures.

False Signup and view all the answers

Compartment syndrome is characterized by the absence of pulses as a late sign.

True Signup and view all the answers

Skeletal fixation treatment is not recommended for low-energy unstable fractures.

False Signup and view all the answers

Tenting of the skin and diminished sensation can indicate a closed fracture.

False Signup and view all the answers

Numbness and increasing pain are early warning symptoms of compartment syndrome.

False Signup and view all the answers

Early weightbearing is encouraged in fracture management to promote healing.

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A valgus deformity is more easily compensated for by the normal ankle than a varus deformity.

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Intertrochanteric fractures are most commonly associated with trivial injuries in elderly patients.

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Subtrochanteric fractures are characterized by their occurrence only in young adults.

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The treatment of choice for femoral shaft fractures is usually open reduction and internal fixation.

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Complications from Achilles tendon injuries include joint stiffness and non-union.

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Vascular injury is a common complication associated with femoral shaft fractures.

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An undisplaced fracture of the patella results from direct trauma.

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Malunion in the context of femoral fractures is defined as having no more than 20 degrees of angulation.

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In supracondylar fractures of the femur, direct trauma is the typical cause.

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Comminuted fractures of the patella involve the extensor mechanism being torn completely.

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The management of a displaced transverse fracture involves repairing the extensor mechanism.

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One or both femoral condyles may be fractured in condylar fractures.

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Injuries that result in knee dislocations are always a result of high-energy impacts.

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Joint stiffness is a complication associated with patellar dislocations.

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A transverse fracture of the patella is classified as a direct trauma injury.

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Locking intramedullary nails can be used for treating supracondylar fractures of the femur.

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A posterior dislocation of the hip commonly occurs when the leg is short and lies adducted.

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Avascular necrosis occurs in 20% of traumatic hip dislocations if reduction is delayed for several hours.

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The sciatic nerve is typically damaged in 30-40% of cases of hip dislocation.

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In the management of hip dislocation, movement and exercises should begin immediately after the injury.

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A fracture of the femoral neck in younger individuals is often due to a fall from a height.

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Complications such as osteoarthritis can occur due to cartilage damage at the time of hip dislocation.

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A central dislocation of the hip is typically treated with immediate surgical intervention only.

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The presence of retained fragments in the joint is a contributing factor to the development of osteoarthritis post-dislocation.

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Traction is maintained for up to two weeks following a hip dislocation reduction.

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The lower limb is examined for signs of injury to the femoral nerve following a hip dislocation.

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A twisting force can cause a spiral fracture of the tibia and fibula.

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Recurrent dislocation of the patella has a 10-15% chance after non-operative treatment.

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The medial patellofemoral ligament is often torn in a lateral dislocation of the patella.

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A dislocated knee typically occurs without significant violence.

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A back-slab with the knee in 30 degrees of flexion is used for urgent reduction of a dislocated knee.

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The popliteal artery must be examined to ensure it is not torn or obstructed in the setting of a knee dislocation.

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Short oblique fractures can result from an angulatory force on the leg.

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After a knee dislocation, distal sensation and movement should be tested for potential nerve injury.

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Marked genu varum is a predisposing factor for recurrent patellar dislocation.

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Clinical features of knee dislocation include severe bruising and gross deformity.

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Intra-articular fractures cleave the bone vertically and run into the inferior articular surface.

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Broadening of the heel can cause issues with shoe fitting.

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Isolated injuries of the navicular, cuneiform, or cuboid bones are very common.

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A medial midtarsal dislocation produces a varus deformity.

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Metatarsal fractures can be caused by severe twisting injuries.

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A tender lump distal to the mid-shaft of a metatarsal bone is common in stress fractures.

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Talocalcaneal stiffness can lead to osteoarthritis following displaced intra-articular fractures.

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Twisting and crushing injuries are rare causes of tarsometatarsal injuries.

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Compartment syndrome should always be excluded in suspected midtarsal dislocations.

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Mid-tarsal injuries may vary from minor sprains to severe fracture–dislocations.

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Severe axial compression of the ankle joint can shatter the tibial plafond.

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Fractures of the talus are common injuries.

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Comminuted fractures of the tibial plafond often lead to damage of the articular cartilage.

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Avascular necrosis is unlikely to occur in fractures of the neck of the talus.

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Type 1 Salter–Harris fractures involve the epiphysis being split vertically.

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Fractures of the calcaneum can occur from falls from heights.

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Comminuted tibial plafond fractures can extend up the shaft of the bone.

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The calcaneus is always uninjured in falls from height.

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Failure to accurately reduce Type 3 or 4 Salter-Harris fractures can lead to abnormal growth.

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What is a common complication of intra-articular fractures?

Osteoarthritis and joint stiffness Signup and view all the answers

Which injury is characterized by significant pain, swelling, and bruising of the foot after an accident?

Fracture-dislocation Signup and view all the answers

What is the characteristic appearance of a medial midtarsal dislocation?

Acute clubfoot appearance Signup and view all the answers

What can lead to broadening of the heel as a complication?

Intra-articular fractures Signup and view all the answers

Which type of injury in the midtarsal area poses a threat to the survival of the foot?

Severe fracture–dislocations Signup and view all the answers

What type of fracture is primarily caused by direct blows or severe twisting injuries?

Metatarsal fractures Signup and view all the answers

What is a common location for a stress fracture in a young adult engaged in strenuous activity?

Mid-shaft of a metatarsal bone Signup and view all the answers

Which type of dislocation results in a valgus deformity?

Lateral midtarsal dislocation Signup and view all the answers

What is the presumed nature of fractures in the midtarsal area?

Combination fractures Signup and view all the answers

What is a potential complication that may arise after intra-articular fractures?

Talocalcaneal stiffness Signup and view all the answers

What is a significant consequence of a comminuted fracture of the tibial plafond?

Severe damage to articular cartilage Signup and view all the answers

What characterizes a Type 3 Salter-Harris fracture?

The epiphysis is split vertically and displaced Signup and view all the answers

What increase the risk of avascular necrosis (AVN) in talar fractures?

Degree of displacement of the fracture Signup and view all the answers

Which type of injury commonly occurs due to falls from height impacting the heel?

Fractures of the calcaneum Signup and view all the answers

What commonly accompanies calcaneal fractures in over 20% of cases?

Injuries to the spine, pelvis, or hip Signup and view all the answers

What is a notable characteristic of talar injuries?

They are commonly due to significant violence Signup and view all the answers

What happens if a Type 4 Salter-Harris fracture is not accurately reduced?

It results in abnormal growth and deformity Signup and view all the answers

What type of fractures are classified as extra-articular fractures of the calcaneum?

Fractures of calcanear processes or the posterior part Signup and view all the answers

Which type of fracture is most at risk of failing to unite in talar neck fractures?

Comminuted fractures Signup and view all the answers

What is often seen in patients with significant ankle injuries such as those involving the tibial plafond?

Considerable damage to the cartilage and bone Signup and view all the answers

Study Notes

Dislocation of the Patella

The knee's natural valgus angle encourages lateral pull on the patella during quadriceps contraction.
Traumatic dislocation often results from sudden quadriceps contraction while the knee is externally rotated and in valgus, commonly occurring in field sports.
Lateral dislocation may tear medial retinacular fibers and the medial patellofemoral ligament (MPFL).
Non-operative treatment for first-time dislocation carries a 15-20% chance of recurrent dislocations.
Risk factors for recurrence include generalized joint laxity, genu valgum, and high patella.

Dislocation of the Knee

Knee dislocation requires significant trauma, like in a road accident.
Cruciate ligaments are typically torn, and there may be collateral ligament injuries.
Clinical signs include severe bruising, swelling, and visible deformity.
Popliteal artery injury must be ruled out through circulation checks, and nerve function should be assessed.
X-rays may reveal tibial spine fractures due to ligament avulsion; arteriography may be necessary if circulation is in doubt.
Urgent reduction under anesthesia is required, often supported by a back-slab in 15 degrees of flexion.

Fractures of the Tibia and Fibula

Spiral fractures stem from twisting forces, while angular forces lead to oblique fractures with potential butterfly fragments.
Common clinical symptoms include bruising, severe swelling, and limb shortening with external rotation.

Intertrochanteric Fractures

Typically caused by direct trauma, these fractures occur in the proximal femur.
Complications include fixation failure, where screws may cut out of osteoporotic bone, and potential malunion with varus or external rotation deformities.

Subtrochanteric Fractures

Often present in the elderly, these fractures go through or below the lesser trochanter and are frequently comminuted.
Open reduction and internal fixation are the standard treatment approaches.

Femoral Shaft Fractures

Common in young adults and usually result from high-energy injuries.
High muscle padding can protect but may cause severe displacement, complicating reduction.
Complications include vascular injuries, thromboembolism, infections, delayed or non-union, and joint stiffness.

Supracondylar Fractures of the Femur

Direct trauma above the femoral condyles may result in these fractures.
Gastrocnemius muscle pull may cause the distal fragment to tilt backward.
Tibial pulses should be palpated to assess vascular integrity.

Condylar Fractures

Fractures can occur in one or both femoral condyles, often characterized by knee swelling and a feel of hemorrhagic effusion.

Tibial Plateau Fractures

Result from bending forces and axial loads, often termed "bumper fractures" due to vehicle impacts.
Fractures can crush or split the tibial condyles, and associated ligament injuries may occur.

Treatment of Tibial Plateau Fractures

Undisplaced fractures may be treated conservatively, while marked displacement often requires open reduction and internal fixation.
Medial condyle fractures are complex and best managed using buttress plates and screws.
Bicondylar fractures require internal fixation and care for potential compartment syndrome.

Fracture of the Patella

Three main types of patellar fractures:
- Undisplaced fractures from direct blows.
- Comminuted (stellate) fractures.
- Transverse fractures due to forced knee flexion with a contracted quadriceps.
Treatment varies by fracture type, focusing on the integrity of the extensor mechanism.
Undisplaced fractures receive protective treatment; comminuted forms may require partial patellectomy; displaced transverse fractures need internal fixation and extensor expansion repair.### Complications of Fractures
Compartment syndrome requires repeated examination of the leg and foot for signs.
Possible complications include joint stiffness, deformity, and osteoarthritis.

Fracture of the Patella

Types of fractures include:
- Undisplaced fracture from a direct blow.
- Comminuted or ‘stellate’ fracture.
- Transverse fracture due to forced passive flexion of the knee; extensor mechanism disrupted.
Importance of distinguishing patellar fractures from congenital bipartite patella.

Treatment of Patellar Fractures

Undisplaced fractures require protective treatment and knee immobilization for 4-6 weeks, with daily quadriceps exercises.
Comminuted fractures pose a risk to the patellofemoral joint; may require partial patellectomy.
Displaced transverse fractures necessitate internal fixation and repair of the extensor mechanism; braces used until knee extension is regained.

Intertrochanteric and Subtrochanteric Fractures

Intertrochanteric fractures can lead to fixation failure and malunion with varus or external rotation deformities.
Subtrochanteric fractures often occur in the elderly from trivial injuries; treatment is usually open reduction and internal fixation.

Femoral Shaft Fractures

Common in young adults, usually from high-energy impacts; muscle pull can cause severe displacement complicating reduction.
Potential complications include vascular injury, thromboembolism, infection, delayed union, non-union, and joint stiffness.

Supracondylar and Condylar Femur Fractures

Supracondylar fractures result from direct trauma; treatment includes skeletal traction or open reduction with internal fixation.
Condylar fractures may present with knee swelling due to hemarthrosis and require careful assessment for treatment.

Dislocation of the Hip

Posterior dislocation is common after road accidents; presents with a short, adducted, internally rotated limb.
Complications include sciatic nerve injury (10-20% occurrence) and avascular necrosis, especially if reduction is delayed.

Fracture of the Femoral Neck

Typically results from falls on the greater trochanter; younger individuals may suffer from high-impact trauma.
Open reduction and internal fixation are the standard treatment.

Tibial Plateau Fractures

Often result from bending forces and axial loads, commonly seen in accidents involving pedestrians or in falls.
Treatment varies; undisplaced fractures may be managed conservatively, while displaced fractures require surgical intervention.

Comminuted Fractures of the Tibial Plafond (Pilon Fractures)

Caused by severe axial compression, notably from falls; these fractures result in extensive damage to articular cartilage.
Treatment focuses on stabilization and addressing associated complications.

Ankle Fractures in Children

Utilize Salter-Harris classification; Type 3 and 4 fractures involve vertically split epiphyses, risking poor growth if not reduced accurately.

Fracture of the Talus

Rare but serious injuries resulting from significant trauma; include fractures of various parts of the talus.
Avascular necrosis is a major concern with neck of the talus fractures.

Fractures of the Calcaneum

Often occur from falls, causing split or crush injuries; can be associated with other significant injuries.
Common complications include broadening of the heel, leading to fitting issues and potential osteoarthritis.

MID-TARSAL Injuries

Range from minor sprains to severe fractures that may threaten foot viability; isolated navicular or cuneiform fractures are rare.
Mid-tarsal dislocations may present as acute clubfoot or valgus deformity, requiring assessment for ischemia or compartment syndrome.

Tarsometatarsal and Metatarsal Fractures

Fractures may result from direct blows, twisting injuries, or repetitive stress.
Stress fractures commonly occur in active individuals, presenting as localized pain and tenderness along the mid-shaft of a metatarsal.### Comminuted Fractures of the Tibial Plafond (Pilon Fractures)
Occurs due to severe axial compression, such as falls from a height.
Results in shattering of the tibial plafond, causing significant articular cartilage and subchondral bone damage.
Severe cases may involve fracture extension up the shaft of the tibia.

Ankle Fractures in Children

Classified using Salter-Harris system (Types 1 to 4).
Types 3 and 4 involve vertical splitting of the epiphysis, which, if unreduced, leads to abnormal growth and deformity.

Fracture of the Talus

Rare injuries typically from high-force events like car accidents or falls.
Types include fractures of the head, neck, body, bony processes, dislocations, and osteochondral fractures.
Complications include avascular necrosis (AVN) of the talus, especially from neck fractures, depending on displacement severity.

Fractures of the Calcaneum

Often arise from falls from heights, leading to compression against the talus.
Commonly associated with injuries to the spine, pelvis, or hip.
Differentiate between extra-articular (involving calcaneal processes) and intra-articular fractures (cleaving into the superior articular surface).

Complications of Calcaneal Fractures

Broadening of the heel can cause shoe-fitting issues and affect peroneal tendons/sural nerve.
Intra-articular fractures can lead to talocalcaneal stiffness and osteoarthritis.

Midtarsal Injuries

Present from minor sprains to severe fracture-dislocations threatening foot viability.
Isolated fractures of navicular, cuneiform, or cuboid bones are rare; combination fractures are more common.

Tarsometatarsal Injuries

Commonly result from twisting/crushing injuries, with sprains being frequent but dislocations rare.
Suspect fracture-dislocation in patients with post-accident foot pain, swelling, and bruising, even without obvious deformity.

Lisfranc Fracture Dislocation

Result from direct trauma or stress mechanisms impacting the tarsometatarsal region.

Metatarsal Stress (March) Fractures

Common in physically active individuals, particularly new recruits or athletes experiencing overuse.
Symptoms include localized tenderness and possible skin tenting or open wounds.

Management Objectives for Fractures

Limit soft tissue damage and maintain skin integrity.
Achieve and maintain fracture alignment.
Monitor for compartment syndrome with early recognition.
Initiate early weight-bearing and joint movement.

Treatment Approaches

Stable fractures: Full-length casts are applied; knee slightly flexed, and ankle at right angle.
Unstable fractures: Utilize skeletal fixation; locked intramedullary nailing preferred for diaphyseal fractures; plate fixation for metaphyseal fractures.

Open and High-Grade Injury Complications

Includes vascular injuries, compartment syndrome (characterized by tightness, pain, and late numbness), and infections.
Timely identification and fasciotomy for compartment syndrome critical.

Dislocations of the Patella

Often occur due to intense quadriceps contraction with valgus knee position.
Typically dislocate laterally, risking medial retinacular and MPFL injuries.
Recurrent dislocation risk in conservatively treated patients.

Knee Dislocation

Often results from severe trauma (e.g., road accidents), necessitating examination for vascular and nerve injuries.
Requires urgent reduction under anesthesia; stability maintained via external fixators if necessary.

Tibia and Fibula Fractures

Caused by twisting or angulatory forces; common complications include compartment syndrome and joint stiffness.

Patella Fractures

Types include undisplaced, comminuted, and displaced transverse fractures.
Treatment varies with fracture type; stabilization of extensor mechanism is crucial for recovery.

Intertrochanteric and Subtrochanteric Fractures

Common in elderly due to trivial injuries; often require open reduction and fixation.
Generally associated with complications such as malunion and fixation failure.

Femoral Shaft Fractures

Common in young adults due to high-energy trauma; complicated by significant muscle pull leading to displacement.
Watch for joint stiffness, malunion, and infection.

Femoral Neck Fractures

Often due to falls; have risks of compartment syndrome and long-term joint issues like osteoarthritis.

Hip Dislocations

Posterior dislocations from road accidents; leg typically short, adducted, and internally rotated.
Immediate reduction is crucial to prevent complications like sciatic nerve injury and avascular necrosis.

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Description

This quiz covers the crucial aspects of patella dislocation and knee dislocation. It addresses causes, risk factors, and clinical features associated with these injuries, particularly in sports contexts. Understanding these concepts is vital for anyone studying sports medicine or orthopedics.