Lower limb injuries - PowerPoint PPT Presentation

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Lower limb injuries

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Lower limb injuries Richard Hardern Anterior draw test Emergency problems Dislocation (not patellar) Compartment syndrome Skin medially is at risk. – PowerPoint PPT presentation

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Title: Lower limb injuries


1
Lower limb injuries
  • Richard Hardern

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Content
  • Knee, ankle, foot
  • Anatomy
  • History and examination
  • Treatment of limb threatening problems

3
Not a case for the Emergency Nurse Practitioner!
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Knee anatomy
  • Bones
  • Ligaments cruciate and collateral
  • Menisci

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Ankle anatomy
  • Bones
  • Ligaments medial lateral
  • Tendons

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Peroneus brevis
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Gastrocnemius
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Foot anatomy
  • Bones

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History examination
  • Mechanism of injury
  • Mechanism of injury
  • Mechanism of injury

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General Considerations
  • Always inquire about the mechanism of injury.
  • Always inquire about the effect on function.
  • Always do the following in this order
  • Inspection
  • Palpation
  • Range of Motion (active before passive)

20
Knee look
  • Skin- scars, redness
  • Muscle- wasting of quads (compare diameter of
    thigh if quads wasted)
  • Bone/joint- Effusion, Varus Valgus deformity(
    measure intermalleolar distance if valgus),
  • Watch them walking too at some point (even if
    only from WR into examination cubicle)

21
Knee feel
  • Skin - Temperature, back of hand
  • Muscle- Ask patient to contract quads
  • Bone/joint- Effusion fluid displacement test,
    patellar tap test (may be negative if tense
    effusion)
  • Joint line tenderness (with knee bent)
  • Patellar tendon
  • MCL,LCL
  • Popliteal swellings

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Knee move
  • Active then passive-
  • Flexion (135 degrees normal)
  • Extension (put hand behind knee)
  • Feel for crepitus

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Knee special tests - collaterals
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Knee special tests - cruciates
ACL
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PCL
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Knee special tests - menisci
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Knees active resisted extension
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Ankle/foot examination
  • Look
  • Knee distally
  • Walking too (at some point)

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Ankle/foot examination
  • Feel
  • Knee distally
  • Medial lateral (include base 5th MT)
  • Leave tender area until last

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Ankle / foot examination
  • Move
  • Ankle
  • Midtarsal
  • Stability test anterior drawer

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Anterior draw test
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Emergency problems
  • Dislocation (not patellar)
  • Compartment syndrome

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  • Skin medially is at risk.
  • If skin becomes broken/necrotic, becomes an
    open one.
  • Risks of complications much greater (especially
    infection).
  • Needs emergent reduction (with analgesia).
  • Damage to popliteal artery if dislocated knee

45
Compartment syndrome
  • The pain may be intensely out of proportion to
    the injury, especially if no bone is broken.
  • There may also be a tingling or burning sensation
    (paresthesias) in the muscle.
  • The muscle may feel tight or full.
  • If the area becomes numb or paralysis sets in,
    cell death has begun and efforts to lower the
    pressure in the compartment may not be successful
    in restoring function.
  • Pain worse if affected muscle passively
    stretched.
  • Pulses not lost (until very late).

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