Lower Extremity Injuries

All You Need to Know

Asses CSMAsses CSM

Immobilize InjuryImmobilize Injury

TransportTransport

Introduction

Epidemiology of Ski InjuriesEpidemiology of Ski Injuries Types of Knee InjuriesTypes of Knee Injuries

Sprains/ligament tearsSprains/ligament tears FracturesFractures DislocationsDislocations

Other Lower Extremity InjuriesOther Lower Extremity Injuries Prehospital CarePrehospital Care QuestionsQuestions

Epidemiology of Ski Injuries

1970s: 5 to 8 per 1000 skier days1970s: 5 to 8 per 1000 skier days 1990s: 2 to 3 per 1000 skier days1990s: 2 to 3 per 1000 skier days Lower Ext. Injury:Upper Ext. InjuryLower Ext. Injury:Upper Ext. Injury

4:1 in 19804:1 in 1980 2:1 in 19902:1 in 1990

Epidemiology of Lower Extremity Injuries

in Ankle Injuriesin Ankle Injuries

in ACL Injuriesin ACL Injuries Knee sprains most common (30% of all Knee sprains most common (30% of all

injuries in adults)injuries in adults)

Knee Anatomy

Knee Anatomy

Types of Knee Injury

SprainsSprains DislocationsDislocations FracturesFractures

Sprains

Injury to ligaments supporting a jointInjury to ligaments supporting a joint Secondary to abnormal motion of the jointSecondary to abnormal motion of the joint Range from minor tearing to complete Range from minor tearing to complete

disruptiondisruption

Anterior Cruciate Ligament

Prevents tibia from Prevents tibia from

moving forward on the moving forward on the

femurfemur

Involved in 40% of sprainsInvolved in 40% of sprains

Usually injured by Usually injured by

deceleration, flexion and rotationdeceleration, flexion and rotation

Medial Collateral Ligament

Patellar Tendon/Quad. Ligament

Dislocations

Loss of continuity between articular Loss of continuity between articular surfacessurfaces

Patellar dislocationPatellar dislocation Knee dislocationKnee dislocation

Patella Dislocation

Secondary to twisting Secondary to twisting

injury on an extended injury on an extended

kneeknee Patella is displacedPatella is displaced

laterallylaterally Usually easily reduced Usually easily reduced

by hyperextending knee by hyperextending knee

and flexing hipand flexing hip

Knee Dislocation

Secondary to Secondary to hyperextension, and hyperextension, and rotary or direct forcerotary or direct force

Associated ligamentous Associated ligamentous and possibly artery and and possibly artery and nerve injurynerve injury

May reduce May reduce spontaneously but will spontaneously but will be grossly unstablebe grossly unstable

Fracture

Can occur secondary to direct trauma or Can occur secondary to direct trauma or forceful twisting.forceful twisting.

Incidence has been declining Incidence has been declining between 1972 and 1994 there was an between 1972 and 1994 there was an

89% decrease in adult tibial fractures89% decrease in adult tibial fractures

Other Lower Extremity Injuries

PelvisPelvis HipHip FemurFemur Tibia/FibulaTibia/Fibula AnkleAnkle FootFoot

Pelvis Fracture

Pelvis Fracture

Direct Blow - Skier vs TreeDirect Blow - Skier vs Tree Many TypesMany Types Potential for Significant InjuryPotential for Significant Injury

Laceration of blood vesselsLaceration of blood vessels Proximity of other organsProximity of other organs

Examination Examination TreatmentTreatment

Hip Injuries

Relatively UncommonRelatively Uncommon FractureFracture

Shortened and externally rotatedShortened and externally rotated DislocationDislocation

Hip and knee flexed, thigh internally Hip and knee flexed, thigh internally rotatedrotated

Femur Fracture

Direct Blow or Violent TwistingDirect Blow or Violent Twisting Possibility of Significant Blood LossPossibility of Significant Blood Loss CSM assessmentCSM assessment Traction SplintTraction Splint ReassessReassess TransportTransport

Tibia/Fibula Fracture

““Boot-Top Fracture”Boot-Top Fracture” Frequently Angulated and/or RotatedFrequently Angulated and/or Rotated Re-alignmentRe-alignment

PainfulPainful Reduce bleeding and preserve functionReduce bleeding and preserve function Allows splint placementAllows splint placement

Ankle Injuries

Snowboarders and TelemarkersSnowboarders and Telemarkers SprainsSprains FracturesFractures DislocationsDislocations CSM AssessmentCSM Assessment Splint Splint

RealignmentRealignment

Foot

Uncommon in SnowsportsUncommon in Snowsports Falls From HeightsFalls From Heights Heel Fx Associated with Back InjuryHeel Fx Associated with Back Injury

Prehospital Care

Assess neuro-vascular statusAssess neuro-vascular status Realignment Realignment

especially if greater than 1 hour from helpespecially if greater than 1 hour from help Immobilize Immobilize TransportTransport