Blue Boxes

Question 1

Trochanteric bursitis

Answer 1

Inflammation of the trochanteric bursa that can be Caused by repetitive actions such as climbing stairs while carrying heavy objects or running on a steeply elevated treadmill.
Causes diffuse pain in the lateral thigh region and point tenderness over the great trochanter
Pain elicited by manually resisting abduction and lateral rotation of thigh while lying on unaffected side

Question 2

Ischial bursitis

Answer 2

Caused by repeated stress from activities using hip extension while seated such as cycling or rowing
Pain increases with movement of gluteus maximus

Question 3

Fracture of distal femur may have what affect on what artery

Answer 3

Could rupture the popliteal artery resulting in a hemorrhage
If femoral artery must be ligated, blood can bypass the occlusion through genicular anastomosis and reach popliteal artery distal to the ligation

Question 4

Injury to common fibular nerve

Answer 4

It is located superficially so it is the most common nerve injured in lower limb. It wraps around fibular neck so fracture of that area can injure the nerve. Results in paralysis of all muscles of anterior and lateral compartments, resulting in foot drop.
Toes do not clear the ground during the swing phase of walking
Waddling gait, swing out gait and high stepping gait are all possible

Question 5

Venous return from leg

Answer 5

When a person is standing, the venous return from the leg depends largely on the muscular activity of the triceps surae. Contraction of the calf muscle pumps blood superiorly in the deep veins

Question 6

Calcaneal tendon rupture

Answer 6

Probably most severe acute muscular problem of the leg
Individuals cannot plantarflex against resistance, cant balance on the affected side
Walking is possible only when the limb is laterally/externally rotated
Bruising in the malleolar region, lump in the calf appears

Question 7

Superficial fibular nerve entrapment

Answer 7

Chronic ankle sprains may produce recurrent stretching of the superficial fibular nerve, which may cause pain along the lateral side of the leg and the dorsum of the foot

Question 8

Avulsion fractures of hip

Answer 8

Fracture of hip refers to femoral head/neck/trochanter
Avulsion fractures occur at apophyses- areas where muscles are attached such as ASIS, AIIS, ischial tuberosity and ischiopubic rami

Question 9

Cox vara vs valga

Answer 9

Cox vara is a decrease in the angle of inclination of the hip, cox valga is an increase
Cox vara causes mild shortening of the lower limb and limits passive abduction of the hip

Question 10

Dislocated epiphyses of femoral head

Answer 10

Happens in older children and adolescents 10-17 years old
Acute trauma or repetitive microtraumas place increasing shearing stress on the epiphysis, especially with abduction and lateral rotation of thigh. Epiphysis can dislocate causing a progressive cox vara deformation. Common initial symptom is pain in the hip that may be referred to the knee

Question 11

Tibial fractures

Answer 11

Usually occurs at the junction of its middle and inferior thirds, where it is narrowest.
This area also has the poorest blood supply, and is a common site for a compound fracture (bone through skin)
Fracture of tibia through nutrient canal predisposes the patient to non-union of the bone fragments b/c of damage to the nutrient artery

Question 12

Transverse march fracture

Answer 12

Stress fracture of inferior third of the tibia

Common in people who take long hikes before they are conditioned for the activity

Question 13

Boot top fracture

Answer 13

Frequently occurs during skiing when you fall forward and the leg comes over the top of the boot.

Question 14

Bone grafts

Answer 14

Bone from the fibula is frequently used because walking, running and jumping can still be normal afterwards.

Question 15

Fracture of the talar neck

Answer 15

May occur during severe dorsiflexion of the ankle

Question 16

Os trigonum

Answer 16

When the secondary ossification center of the talus fails to unite with the talus, it is referred to as os trigonum. Usually occurs bilaterally

Question 17

DVT

Answer 17

Deep venous thrombosis
Can be caused by venous stasis which can be caused by loose fascia that fails to resist muscle stress, external pressure on the veins from bedding during prolonged hospital stay or tight cast, muscular inactivity
Swelling, warmth, erythema
Thrombus may develop which can break free and travel to lung and obstruct pulmonary artery

Question 18

Saphenous vein graft

Answer 18

Great saphenous vein is commonly used for arterial bypass because it is readily accessible, has sufficient space between tributaries and perforating veins and has higher percentage of muscular and elastic fibers than other superficial veins
Vein must be inverted so valves do not obstruct

Question 19

Hip and thigh contusions

Answer 19

Often referred to as hip pointer
Refers to a contusion of the iliac crest that usually occurs at its anterior portion
Causes bleeding from ruptured capillaries and can lead to a hematoma
Thigh hematoma is usually caused by tearing of fibers of the rectus femoris

Question 20

Psoas abscess

Answer 20

Retroperitoneal infection in abdomen or greater pelvis, characteristically occurring in association with TB of the vertebral column or secondary to Crohn disease, may result in formation of a psoas abscess
Psoas abscess should always be considered when edema occurs in the proximal part of the thigh
Severe pain may be referred to the hip, thigh or knee joint

Question 21

Paralysis of quadriceps

Answer 21

Unable to extend leg against resistance

Patient will press on the distal thigh during walking to prevent inadvertent flexion of the knee joint

Question 22

Patellar fracture

Answer 22

Can occur from direct blow to the knee or sudden contraction of the quadriceps (when one slips and attempts to prevent a backward fall)

Question 23

Replaced or accessory femoral artery

Answer 23

Enlarged pubic branch of the inferior epigastric artery either takes the place of the obturator artery or joins it as an accessory obturator artery.
This artery runs close to or across the femoral ring and can be closely related to the neck of a femoral hernia. Therefore, this artery could be involved in a strangulated femoral hernia