Clinical Correlations

Question 1

Avulsion fx

Answer 1

fragments of bone that are pulled off due to rapid contraction of muscle
Pelvis, tibial tuberosity, ankle(lateral and medial malleolar), foot (5th MT)

Question 2

Osgood Shlatter( tibial tubercle apophyseal traction injury)

Answer 2

quads pull off the tibial tuberosity

can damage the growth plate

Question 3

malleolar avulsion fx

Answer 3

eversion tearing of the deltoid ligament fx off a chunk of lateral malleolus

Question 4

transverse patellar fx

Answer 4

quads can pull patella apart longitudinally

or can be from direct trauma

Question 5

bipartite and tripartite patella

Answer 5

non-union of ossification centers of patella into several components (NORMAL lack of fusion of pieces) NO hx of trauma

But may increase risk for fx

Question 6

tibial fx

Answer 6

several places for injury, mostly near middle and distal 1/3 (narrowest portion and least vascularized)

prone to compound fx

Question 7

lateral malleolar fx

Answer 7

due to its length, during exs extension the talus can break it off

Question 8

CCD angle

Answer 8

Normal 120 degrees (adults)
changes during development

head, neck, shaft of femur

Question 9

Coxa Vara

Answer 9

CCD< 120deg
decrease in length of affected limb with increase in Q angle –>genu valgum–>
knock knee

causes wearing of lateral condyle

Question 10

Coxa Valga

Answer 10

CCD>120deg
moves femur outward and makes it longer
decreased Q angle–>ride on medial condyle–>pushes knee out–>Genum varum–>bow leg (which is slightly longer)

causes wearing of medial condyle

Question 11

Q angle

Answer 11

angle b/w vertical line from mid patella to middle of the hip and another line from patella to ASIS

spread of hips in females is wider, so Q angle is wider (17 in W, 14 in M)

Question 12

Slipped capital femora epiphysis

Answer 12

trauma in femoral epiphysis
occurs in children
causes shorter limb–>coxa vara

Question 13

Avascular necrosis of femoral head

Answer 13

due to fx of the femoral head that disrupts the arteries surrounding the head–> will need a total hip

mostly from medial femoral circumflex a that are disrupted

Question 14

Hip dislocation

Answer 14

hip loosest in flexion (i.e. tightest in standing)

pops out posteriorly- think sitting in a car

Question 15

Hip drop

Answer 15

g medius and minimus help maintain the sacral base
–>paralysis (from superior gluteal n) of these cause dropping of hip to the unsupported side (i.e. the side that is in swing phase)

Question 16

Menisci

Answer 16

Can tear when full weight on the during flexion
Medial torn more often from pinching (less stable due to attachment to MCL)

removal of meniscus–> erosion of the cartilage of over time

bucket handle tear: longitudinal tear of meniscus that must be removed

Question 17

MCL tear

Answer 17

from hits laterally that opens angle medially

attached to the MM and ACL, so you could hurt all three of these (unholy triad)
–>think getting hit by a puck or football injury

Question 18

LCL tear

Answer 18

from hits medially that opens angle laterally

Question 19

ACL tear

Answer 19

torn more often from hyperextension
or when tibia moves forward when foot was fixed
or when femur is in MR and leg is flexed such as running and then cutting one foot to opposite side

can rarely cause avulsion fx of tibial plateau if injury is slow

Question 20

Patellar dislocation

Answer 20

most likely to occur laterally

Question 21

Patellofemoral syndrom

Answer 21

improper tracking of patella
causes chrondromalacia of patella (softening of articular cartilage)
causes quad imbalance

Question 22

Baker’s Cysts

Answer 22

from chronic knee effusion
synovial fluid leaks into bursa (forms cyst most often posteriorly)
impeded flexion

Question 23

Os trigonum

Answer 23

extra little bone on the talus

during exs plantar flexion can irratate and be pinched–> pain (think ballet, or high heels etc)

Question 24

Inversion sprain

Answer 24

over elevation of medial border of the foot
injury to Lateral collateral ligament of ankle
anterior talofibular ligament most often injured

Question 25

Eversion sprain

Answer 25

over elevation of lateral border of the foot causing eversion
injury to medial collateral ligament (more rare)
can cause Pott’s fx (bimaleolar ankle fx)
total disruption of the mortise

Question 26

Femoral pulse

Answer 26

pulse located in the supine pt by.w. ASIs and pubic tubercle ( lack of pulse indicates external iliac disruption)

Question 27

varicosities

Answer 27

valves cannot maintain backflow of blood causing dilation

from degeneration of fascia which reduces ability of muscular pump

Question 28

Sapenous varix

Answer 28

saphenous vein dilation w/in femoral triangle

misdiagnosed as femoral hernia or psoas abscess

Question 29

superficial inguinal nodes

Answer 29

receive drainage from superficial thigh

Question 30

Femoral n. lesion

Answer 30

L 2,3,4 
loose al anterior musculature 
no paltellar reflex 
loss of hip flexion and leg extension 
loss of cutaneous feeling int he L4 dermatome (anterior thigh, medial leg, medial foot)

Question 31

Obturator nerve lesion

Answer 31

L 2,3,4
loose medial compartment
decrease adduction, flexion, and rotation
anesthesia in obturator skin patch on medial thigh

Question 32

Piriformis syndrome

Answer 32

L45- S1,2,3

in some individuals the tibial and common fibular go thru the piriformis
puts pressure on the nerve
impingement of common in athletic individuals
loss of eversion and dorsiflexion and numbness on lateral anterior leg and dorsum of foot

Question 33

Sciatic n. lesion

Answer 33

loose all posterior thigh, and leg muscles (can only have flexion of thigh and extension of leg) No achilles reflex, no inversion/eversion

paresthesia down posterior leg

Question 34

Inferior gluteal N damage

Answer 34

S5, S1,2

loose G max–> wasting, trouble going up stairs (lack of extension)
think going form sitting to standing

Question 35

Tibial n. damage

Answer 35

L4,5 S1-3
Loss of plantar flexion, flexion and adduction and abduction of the toes and anesthesia to large portion of the sole, wasting of posterior leg muscles

foot is held in dorsiflexion and eversion

Question 36

Common fibular damage

Answer 36

L4-5 S1-2
usually occurs when is goes around the neck of the fibula
loose all anterior and lateral muscles –> no dorsiflexion and eversion and SOME plantar flexion and inversion

foot held in plantar flexion and inversion

numbness of anterior leg and dorsum of foot

Question 37

Superficial fibular damage

Answer 37

loose eversion and some plantar flexion

foot held in inversion and dorsiflexion
loose nearly all cut sensation in dorsum of foot (except b/w 1st and 2nd toe)

Question 38

Deep fibular n

Answer 38

loose dorsiflexion and inversion

foot held in plantar flexion and slight everted

just lose feeling b/w 1st and 2nd toe

Question 39

L4/5 neuopathy

Answer 39

causes foot drop in which foot flaps against floor

loss of TA (L4)
loss of EHL (L5)

Question 40

Meralgia paresthetica

Answer 40

damage to the lateral femoral cutaneous n. (L2,3)
w/in the abdomen (tumor, pregnancy) or as it passes to the inguinal ligament near ASIS (overly tightened belt)

causes paresthesias down the leg

Question 41

Medial plantar nerve compression

Answer 41

as it passes deep to flexor retinaculum from exs eversion or running–>paresthesias on medial sole of foot w/ weakness of intrinsic toe muscles

Question 42

Plantar Fasciitis

Answer 42

inflammation of plantar aponeurosis caused by overuse
tender with pain from dorsiflexion or extension of great toe
accompanied by bone spurs in apo and triceps surae

Question 43

Femoral hernia

Answer 43

protrusion of viscera thru the femora ring
more often in females
can impede on great saphenous v.

Question 44

Compartment syndrome

Answer 44

infection w/in one fascial compartment of the leg that can produce pressure increases that:

1) decrease blood to the compartment or distal to it
3) impinge nerves–> paresthesias distal, paralysis to the muscles of the compartment
tx: fasciotomy to prevent necrosis

Question 45

Psoas abscess

Answer 45

retroperitoneal pelvic infection that descends within the fascial sheath
can descend to the psoas resulting in pain within the femoral triangle
can be confused with hernia, saphenous varix etc