Assessment and management of the knee and lower limb

Question 1

ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB

Overview

History

Examination

X-rays

Fractures and Dislocations.

Soft Tissue Injuries

Other Knee/Lower limb Problems

Answer 1

Question 2

History

Mechanism of injury is vitally important.

Flexed/Twisting

Forced flexion/Hyperextension

Falls/Direct Blow

Swelling Rapid/Gradual

Previous Knee Problems

No Injury or Previous Problems?

Answer 2

Ottawa Knee Rules

Xrays are only required if the following are present:

• Isolated bony tenderness of the patella.
• Bony tenderness of the fibula head.
• Patient cannot flex knee to 90°
• Patient cannot weight bear (4 steps) after injury or in A&E

Exceptions

Question 3

Answer 3

Question 4

Patella fracture

Answer 4

Question 5

Patella

Answer 5

Dislocation of the Knee

Question 6

Tibia Plateau Fracture

Answer 6

Haemarthrosis

Question 7

Cruciate ligament rupture

Answer 7

ACL rupture

Lachman Test

Question 8

PCL rupture

(tibial sag)

Answer 8

Avulsion fracture of the ACL insertion

Question 9

Meniscul injury

Answer 9

Collateral ligament injury

Question 10

Soft tissue injuries

Answer 10

Soft tissue injury

Question 11

Bursitis

Typically from kneeling

Prepatellar

In front of patella

Infrapatellar

Below patella

Treatment

Rest, NSAIDS, stop kneeling Pyrexia and/or Cellulitis

Fluid aspiration. Cultures. Antibiotics

Answer 11

Knee problems not to be missed