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Rosen's Orthopedics > 50. Knee and lower leg > Flashcards

50. Knee and lower leg Flashcards

1
Q

3 compartments of the knee

A
  1. patellofemoral
  2. medial tibiofemoral
  3. lateral tibiofemoral
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2
Q

2 rules for knee #

A

Ottawa
Pittsburgh
- higher sense

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3
Q

What is most urgent concern in knee dislocation

A

popliteal artery injury

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4
Q

5 directions of knee dislocation and most common one

A 
In order
o	anterior
o	posterior
o	medial
o	lateral 
o	rotary
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5
Q

2 nerves to assess in knee dislocation and how to test

A 
peroneal most common
	dorsum of foot sense
	dorsiflexion
posterior tibial nerve
	plantar sense
	plantar flexion
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6
Q

3 methods to assess popliteal injury

A

Pulses NOT enough

  • ABI
  • CTA
  • duplex US
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7
Q

MGMT of knee dislocation

A 
-	reduce ASAP
o	before imaging
o	simple traction-countertraction
-	immobilize in long splint
-	assess artery
-	open joint – ancef
-	watch for compartment syndrome
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8
Q

MGMT of distal femoral #

A
  • femoral blocks very effective
  • splint
  • emergency ortho
    o ORIF
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9
Q

What is secondary sign of tibial plateau #

A

Segond

- avulsion at lateral capsular ligament

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10
Q

4 xray signs of plateau #

A

o look for fat-fluid level
o also fat globules on joint tap
o look for bone avulsions
o joint space widening

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11
Q

MGMT of plateau

A

splint and no WB until ortho

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12
Q

What is # of tibial spine

A

of intercondylar eminence

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13
Q

MGMT of # of tibial spine

A
  • immobilize knee
  • non-weight bearing
  • ortho in 3-7 days
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14
Q

What is Osteochondritis dissecans

A
  • partial or total separation of articular cartilage from underlying bone
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15
Q

MGMT of osteochonditis dissecans

A

NWB until ortho

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16
Q

5 possible locations of extensor mechanism injury

A
  1. quad muscles
  2. tendon
  3. medial and lateral retinaculae
  4. patella
  5. patellear tendon and tibia tubercle
17
Q

4 signs of extensor injury on xray

A

o Obliteration of quads tendon
o Poorly defined supra-patellar mass
o Soft tissue calcific densities
o Displaced patella

18
Q

MGMT of extensor injury

A
  • any partial or complete tear should get ortho referral

- if only partial, probably immobilize in extension for 4-6wks

19
Q

5 types of patella #

A 
o	transverse
o	stellate
o	comminuted
o	longitudinal
o	proximal or distal pole
20
Q

MGMT of patellar #

A
  • initially knee immobilizer
  • crutches with initial WBAT
  • ortho in 1 week
21
Q

MGMT of patella dislocation

A
  • reduce
  • post-reduction xray
  • immobilize in full extension
22
Q

3 xray findings to suggest ligament tear

A

 Losse bodies
 Segond
 Lateral capsular sign

23
Q

MGMT of ligament tear

A
  • RICE and NSAIDS
  • Minimal WBAT
  • Fu othro 1 week
24
Q

test for patellofemoral syndrome

A
  • compression of patella against femur elicits pain
25
Q

MGMT for patellofemoral syndrome

A

o strengthen quads
o brace support
o limit flexion actives
o NSAIDS

26
Q

What is plica syndrome

A
  • redundant folds of synovium

- repeated synovitis

27
Q

MGMT of plica

A

rest

NSAIDS

28
Q

What is Popliteus tendinitis

A
  • small flat muscle passes beneath lateral head of gastroc
  • usually in athletes
  • running and walking down hill makes it worse
  • tenderness to medial insertion point of gastroc
29
Q

MGMT of Popliteus tendinitis

A

rest,

nsaids

30
Q

2 main locations of bursitis

A 
1. prepatellar
o	repetitive kneeling on hard surface
o	also common site of septic bursitis
2. anserine bursitis
o	pain at proximal medial tibia
o	obese women with OA
31
Q

MGMT of subcondylar #s

A

o Long leg posterior splint

o Comminuted or intraarticular need ortho

32
Q

Watson classification for tibial tubercle #

A

Proximal anterior border
• Type 1 – hinged up without displacement
• 2 – small portion avulsed but no articular surface involved
• 3 – extend into articular surface

33
Q

MGMT of tibial tubercle #

A

o 1 – immobilize in extension
o 2 – same if can be reduced by external maneuvers
o 3- ORIF

34
Q

Nerve injured in tibial shaft #

A

peroneal

35
Q

MGMT of tibial shaft #

A
  1. immobilize in long leg posterior splint in 10-20 deg flexion
  2. if pain persists, think about compartment syndrome
36
Q

What is only really important proximal fibula #

A

Maissoneuve
o medial ankle disruption with tearing of ligament
o fibula floats free relative to the tibia
 unstable ankle mortise

37
Q

MGMT of most proximal fib #

A
  • ice, rest, analgesia
  • non-weight bearing
  • don’t need long leg cast, but may help with comfort
  • progress WBAT with no pain
  • if severely displaced, then ortho
38
Q

3 types of tib/fib dislocations

A 
1. Anterolateral
	Most common
	Fall on flexed leg
2. Posterior
	Direct blow to flexed knee
	Peroneal injury
3. Superior
	Ankle #s common
39
Q

MGMT of of tib/fib dislocations

A
  • closed reduction
    o flex knee to 90, evert ankle, apply direct pressure to fib
  • immobilize knee and ortho

Rosen's Orthopedics (8 decks)

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