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MBChB YR2 MSK > Disease Profiles: Lower Limb Conditions > Flashcards

Disease Profiles: Lower Limb Conditions Flashcards

1
Q

Describe the usual mechanism of injury of a hip fracture in a younger patient

A

High energy trauma

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2
Q

Describe the surgery available for patients with recurrent patella dislocation

A

Lateral release, MPFL reconstruction

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3
Q

Describe the management of ankle instability due to ligament injury

A

Physiotherapy, consider arthroscopy for pain

Reconstruction if needed (75% will not need reconstruction)

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4
Q

Why is a CT useful in a calcaneus fracture?

A

Calcaneal fractures are often comminuted, anatomy can be clarified by CT

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5
Q

Rupture of which ligament may lead to rotatory instability?

A

ACL

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6
Q

Name two potential complications of an LCL rupture

A

Common fibular nerve palsy, early OA of the knee

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7
Q

What is the usual mechanism of injury for an ankle fracture?

A

Inversion injury with a rotational force applied to the foot

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8
Q

Name the surgical procedure used to treat a displaced intracapsular fracture in a patient who was previously high functioning

A

Total hip replacement

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9
Q

Which patient group is most likely to develop hallux valgus?

A

Higher incidence in females, familial tendency, incidence increases in age

Commoner in rheumatoid arthritis and other inflammatory arthropathies as well as some neuromuscular diseases (multiple sclerosis, cerebral palsy)

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10
Q

What can causes a metatarsal stress fracture?

A

Repeated injury or stress e.g. runners, soldiers on long marches, dancers

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11
Q

What is type II tibialis posterior tendon dysfunction?

A

Planovalgus, midfoot abduction, passively correctable

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12
Q

Which investigations would you perform in suspected Morton’s neuroma?

A

X-ray (AP/LAT/oblique WB) to rule out MSK pathology

Diagnostic US - swollen nerve

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13
Q

Describe the clinical presentation of an ACL injury

A

Audible pop followed by deep knee pain and swelling (haemarthrosis) within an hour of the injury

Pain settles but leaves rotatory instability

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14
Q

What does joint pain in hallux valgus indicate?

A

OA

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15
Q

Which patient group is most likely to fracture their hip?

A

60+ years, association with osteoporosis, majority are female

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16
Q

Which type of extracapsular hip fracture is represented by the red line in the diagram?

A

Basicervical

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17
Q

What causes a loose body in a joint?

A

Trauma, osteochondritis dissecans and joint degeneration can cause a fragment of cartilage +/- bone to detach

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18
Q

Which patient group is most likely to rupture their Achilles tendon?

A

>40 years, associated with diabetes, RA and steroid use

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19
Q

Describe the management of a ruptured LCL diagnosed early (within 2-3 weeks)

A

Urgent repair

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20
Q

Describe the usual management of a knee extensor mechanism rupture

A

Urgent surgical repair with follow up physio to gradually increase ROM

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21
Q

Which tendon can cause an avulsion fracture of the 5th metatarsal?

A

Peroneus brevis tendon

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22
Q

Describe the x-ray findings of a tibial plateau fracture

A

Variable - from obvious fracture line to subtle subchondral sclerosis

Horizontal beam lateral shows lipohaemarthrosis

Small avulsed bone fragments can indicate significant soft tissue injury

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23
Q

How would you manage a PCL injury which is part of a multilligament knee injury?

A

Usually requires reconstruction

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24
Q

Which patient group is most likely to dislocate their patella?

A

Most common in teenagers, higher incidence in females

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25
Q

Describe the clinical presentation of a PCL injury

A

Popliteal knee pain and bruising

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26
Q

How would you diagnose an LCL injury?

A

Isolated LCL tear is a clinical diagnosis but x-rays and MRI can be used to rule out associated injuries

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27
Q

Describe the management of a bucket handle meniscal tear

A

If picked up early - can be repaired If irreparable - partial meniscectomy

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28
Q

When might a theatre reduction be indicated for a complete knee dislocation?

A

If medial femoral condyle button-holed through the medial capsule

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29
Q

How can a patella dislocation cause an osteochondral fracture?

A

Medial patellofemoral ligament will tear and the medial facet of the patella strikes the lateral femoral condyle

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30
Q

What does a loss of contour of Shenton’s line in pelvic x-ray indicate?

A

Hip fracture

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31
Q

Describe the management of patellofemoral dysfunction

A

Physio to strengthen quadriceps (particularly vastus medialis obliqus)

Taping may help alleviate symptoms

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32
Q

Which investigation would you perform in suspected bone marrow oedema (bone bruising)?

A

MRI

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33
Q

Which classification system is used to categorise intracapsular hip fractures?

A

Garden classification - predicts union and risk of AVN, which influences treatment

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34
Q

What is type I tibialis posterior tendon dysfunction?

A

Swelling, tenderness, slightly weak muscle power

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35
Q

Which type of antibiotics can cause tendonitis?

A

Quinolone antibiotics (ciprofloxin)

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36
Q

Which part of the knee extensor mechanism tends to rupture in the younger age group (<40 years)?

A

Patellar tendon

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37
Q

Name the classification mechanism for tibial plateau fractures

A

Schatzer

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38
Q

When might an arthroscopic meniscectomy be indicated in a meniscal tear?

A

Irreparable tears with recurrent pain, effusion or mechanical symptoms (catching, clicking, locking) which fails to settle within 3 months

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39
Q

Describe the management of a Lisfranc injury

A

Requires fixation - ORIF

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40
Q

Describe the examination findings in ACL injury

A

Excessive anterior translation of the tibia on the anterior drawer test and Lachman test

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41
Q

What is the usual mechanism of injury for a calcaneus fracture?

A

Axial compression e.g. falling from height onto the heel

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42
Q

Describe the clinical presentation of a Baker’s cyst

A

Can appear as general fullness of the popliteal fossa

Soft and non-tender

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43
Q

Describe the clinical presentation of hallux valgus

A

Usually bilateral, joint incongruence can cause pain

May be unable to wear closed shoes due to bursa (bunion) and/or nerve damage

The great toe and second toe may rub causing ulceration and skin breakdown

Transfer metatarsalgia or poor balance indicates defunctioned 1st ray

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44
Q

How would you manage an isolated PCL injury?

A

Conservative - generally don’t require reconstruction

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45
Q

What is trochanteric bursitis?

A

Repetitive trauma caused by iliotibial band tracking over trochanteric bursa which causes inflammation of the bursa

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46
Q

Describe the surgical management of Achilles tendonitis

A

Tendon decompression and resection of paratenon (rarely used as condition is usually self-limiting)

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47
Q

Describe the clinical presentation of a loose body in a joint

A

History of mobile lump or sharp occasional pain and locking/catching suggestive of loose body

They should not cause constant, generalised or severe pain

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48
Q

Describe the management of a patella dislocation

A

Manually reduce if not already spontaneously reduced, brace, physio

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49
Q

Rupture of which ligament may lead to valgus instability?

A

MCL

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50
Q

When would surgical management of hallux valgus be indicated?

A

Failure of conservative management, lesser toe deformities, lifestyle limitation, overlapping, functional limitation (NOT cosmetic reasons alone)

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51
Q

What is plantar fasciitis?

A

Degenerative condition of the plantar fascia that causes sharp pain on the bottom of the foot pain

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52
Q

Why is there a risk of AVN in a talus fracture?

A

Talus has a reversed blood supply

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53
Q

Describe the examination findings in Morton’s neuroma

A

Loss of sensation in the affected webspace, Mulder’s click test

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54
Q

Which investigations would you perform if you suspect a loose body?

A

X-ray (commonly overdiagnosed), MRI can confirm

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55
Q

Describe the pathophysiology of Achilles tendon rupture

A

May follow a single high energy event, but is often the culmination of recurrent minor tears or following recent tendonitis

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56
Q

Describe the x-ray findings of a calcaneus fracture

A

Calcaneal compression causes loss of the central peak seen in a normal calcaneaus (measured using Bohler’s angle), and bone density will increase

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57
Q

Describe the clinical presentation of a hip fracture

A

Hip/groin pain, may be swelling, unable to weightbear

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58
Q

Which patient groups are most likely to develop trochanteric bursitis?

A

Females, young runners and older patients

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59
Q

Which other fracture clinically resembles a 5th metatarsal fracture?

A

Lateral malleolar fracture

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60
Q

Describe the usual mechanism of injury for a complete knee dislocation

A

Serious high energy injury (usually - can be low energy in elderly)

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61
Q

How would you investigate a low energy pelvic fracture?

A

MRI most sensitive, CT more sensitive than x-ray especially once fractures start to heal

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62
Q

Describe the clinical presentation of tibialis posterior tendon dysfunction

A

Pain and/or swelling posterior to medial malleolus, change in foot shape, diminished walking ability/balance, mid foot and ankle pain

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63
Q

Describe the examination findings in hallux rigidus

A

Dorsal exostosis (bone spur), IPJ hyperextension

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64
Q

Describe the examination findings of a patella dislocation

A

Pain medially, haemarthrosis (effusion), positive patella apprehension test

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65
Q

When might an arthroscopic meniscal repair be indicated in a meniscal tear?

A

Acute traumatic peripheral meniscal tears in younger patients

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66
Q

Which investigation would you perform in a suspected tibial shaft fracture?

A

X-ray - AP and lateral

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67
Q

What is lipohaemarthrosis?

A

Escape of fat and blood from the bone marrow into the joint due to an intra-articular fracture, most commonly seen in the knee

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68
Q

Describe the mechanism of injury of a ‘bumper injury’

A

Tibial plateau fracture affecting the lateral condyle which is caused by valgus force with foot planted

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69
Q

Which investigations would you perform in a suspected ankle fracture?

A

X-ray - AP and lateral views

CT can help clarify fracture anatomy, especially complex fractures

US and MRI may be needed to define soft tissue injury

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70
Q

What is gluteal cuff syndrome?

A

The broad tendinous insertion of the abductor muscles (predominantly the gluteus medius) is under considerable strain and is subject to tendonitis and degeneration leading to tendon tears

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71
Q

A stress fracture most commonly occurs in which metatarsals?

A

Most commonly 2nd metatarsal, followed by 3rd

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72
Q

Describe the management of a metatarsal stress fracture

A

Rest for 6‐12 weeks in a rigid soled boot

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73
Q

What are hammer toes?

A

PIPJ flexion, DIPJ extension and neutral MTPJ

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74
Q

Which nerve is at risk of damage in an LCL rupture?

A

Common fibular nerve

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75
Q

Which nerve is at risk of damage due to a hip dislocation?

A

Sciatic nerve

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76
Q

What is the usual mechanism of injury for a meniscal tear in an older patient?

A

Atraumatic spontaneous degenerate tears, probably represents 1st stage of knee OA

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77
Q

Describe the management of bone marrow oedema (bone bruising)

A

Will settle with time - no treatment know to speed up resolution (3 months-over a year)

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78
Q

Name the components of the extensor mechanism of the knee

A

Tibial tuberosity, the patellar tendon, the patellar, the quadriceps tendon and the quadriceps muscles

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79
Q

Describe the management of a degenerative meniscal tear

A

Corticosteriod injection may help with symptoms in the early period, pain and inflammation may settle but healing rates decrease with age

Arthroscopic menisectomy not indicated as only suitable for unstable tears and not pain only

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80
Q

What is the usual mechanism of injury for LCL injury?

A

Varus stress and hyperextension

Often occurs in combination with PCL or ACL injury

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81
Q

Which classification system is used to categorise pelvic ring fractures?

A

Young-Burgess classification

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82
Q

What is the usual mechanism of injury for a meniscal tear in a younger patient?

A

Usually a sporting injury, classically a twisting force on a loaded knee

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83
Q

What is the primary investigation for a pelvic fracture?

A

X-ray - pelvis and lateral hip

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84
Q

Describe the surgical management of an ankle fracture

A

ORIF

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85
Q

Which patient factor is inversely proportional to the risk of recurrent patella instability?

A

Age

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86
Q

Which investigation would you perform in suspected PCL injury?

A

X-ray, MRI

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87
Q

What is the mechanism of injury for a 5th metatarsal fracture?

A

Inversion injury

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88
Q

Why are knees with degenerative changes on imaging unlikely to benefit from an arthroscopic menisectomy to treat a meniscal tear?

A

Removal of meniscal tissue may increase the stress on already worn/damaged surfaces

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89
Q

Describe the management of tibialis posterior tendon rupture

A

If no secondary OA present - tendon transfer

If secondary OA present - arthrodesis

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90
Q

Describe the mechanism of injury of a tibial plateau fracture in a older patient

A

Low energy injury

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91
Q

What is the usual mechanism of injury for an MCL injury?

A

Valgus stress with possible external rotation (e.g. rugby tackling from the side)

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92
Q

What is the gold standard investigation for pelvic soft tissue injury?

A

MRI - provides a more complete assessment of all soft tissues and bones

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93
Q

What is the usual mechanism of injury for a PCL injury?

A

Tend to occur following a direct blow to anterior tibia (e.g. dashboard, motorbike)

Isolated PCL rupture rare (usually occurs with other injury)

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94
Q

Why is a Jones fracture of the 5th metatarsal at risk of non-union?

A

Poor blood supply

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95
Q

Describe the clinical presentation of a patella dislocation

A

Clear history of patella dislocating laterally, often self-relocating

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96
Q

Describe the conservative management of a tibial plateau fracture

A

Above knee cast

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97
Q

Why are intracapsular hip fractures prone to femoral head AVN and non-union?

A

Can damage the medial femoral circumflex artery

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98
Q

What is a bucket handle meniscal tear?

A

Large meniscal fragment is able to flip out of its normal position and displace anteriorly or into the intercondylar notch where the knee locks and is unable to fully extend due to mechanical obstruction from the trapped meniscal fragment

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99
Q

Which deformity can develop following a bucket handle meniscal tear which remains locked?

A

Fixed flexion deformity

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100
Q

Which type of hip fracture occurs distal to the intertrochanteric line?

A

Extracapsular fracture

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101
Q

Why would a repeat x-ray or MRI be indicated in a patient with suspected hip fracture?

A

Some undisplaced fractures are subtle/invisible on x-ray, so if clinical suspicion persists further investigation is needed

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102
Q

What is a Lisfranc injury?

A

Fracture and/or dislocation of the midfoot that disrupts one or more tarsometatarsal joints

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103
Q

Describe the clinical presentation of a meniscal tear

A

Pain and tenderness localised to joint line, patient may feel knee is about to give way if a loose meniscal fragment is caught in the knee when walking, catching or locking sensation

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104
Q

Name the two categories of intracapsular hip fracture

A

Subcapital and transcervical

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105
Q

Which artery is at risk in a complete knee dislocation?

A

Popliteal artery

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106
Q

Describe the management of plantar fasciitis

A

Rest, NSAIDs, physiotherapy

Night splinting, taping, heel cups or medial arch supports

Corticosteriod injections may alleviate symptoms

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107
Q

Describe the prognosis of a ruptured LCL

A

Tends not to heal and can cause varus and rotatory instability

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108
Q

Which investigations would you perform in a calcaneus fracture?

A

X-ray, CT

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109
Q

Describe the mechanism of injury of a tibial plateau fracture in a younger patient

A

High energy injury

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110
Q

Which classification system is used to categorise ankle fractures?

A

Weber classification

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111
Q

Which investigations would you perform in suspected ACL injury?

A

Joint aspiration - haemarthrosis

MRI to confirm

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112
Q

Describe the clinical presentation of pes cavus

A

Pain in the arch of the foot, often accompanied by claw toes

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113
Q

Describe the definitive management of a complete knee dislocation

A

Sequential ligamentous repair

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114
Q

Name two possible complications of a femoral shaft fracture

A

Significant blood loss, risk of fat embolus

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115
Q

Why are tibia/fibula fractures commonly found with a talus fracture?

A

The fibia and fibula are paired bones forming an elongated ring with the talus - bony ring injuries usually involve disruption at >1 site

116
Q

When would vascular stenting or by‐pass be indicated in a complete knee dislocation?

A

If there is associated neurovascular injury

117
Q

Describe the management of an acute MCL injury

A

Hinged knee brace

118
Q

Which investigation would you perform in suspected hallux rigidus?

A

WB X-ray - AP/LAT and oblique

119
Q

What is Mulder’s click test?

A

Medio‐lateral compression of the metatarsal heads (exerted by squeezing the forefoot with your hand) may reproduce symptoms or produce a characteristic ‘click’

Used to examine causes of metatarsalgia associated with Morton’s neuroma

120
Q

What is hallux rigidus?

A

OA of the first MTP joint

121
Q

Describe the pathophysiology of tibialis posterior tendon dysfunction

A

The tendon is under repeated stress and particularly with degeneration can develop tendonitis, elongation and eventually rupture

122
Q

Describe the x-ray findings in a quadriceps tendon rupture

A

Effusion, patella sitting low

123
Q

Describe the management of chronic MCL instability

A

MCL tightening (advancement) or reconstruction with tendon graft (rare)

124
Q

Which investigation would you perform in a suspected patella fracture?

A

X-ray - AP and lateral

125
Q

Which investigations would you perform for a complete knee dislocation where there is no concern over neurovascular status?

A

X-ray, MRI

126
Q

Which part of the knee extensor mechanism tends to rupture in the older age group (>40 years)?

A

Quadriceps tendon

127
Q

Which type of hip fracture occurs proximal to the intertrochanteric line and involves the femoral head and neck?

A

Intracapsular fracture

128
Q

Describe the clinical presentation of Morton’s neuroma

A

Burning pain and a tingling that radiates to the affected toes

Pain exacerbated by footwear, and relieved by removal of shoe, massaging foot and changing footwear

129
Q

What typically causes acute pelvic soft tissue injury?

A

Muscle tear or tendon avulsion

130
Q

What is pes cavus?

A

Abnormally high arch of the foot

131
Q

What is a Baker’s cyst?

A

Inflammation and swelling of the semimembranosus bursa that usually arises in conjunction with OA of the knee

132
Q

Name the surgical procedure used to treat an subtrochanteric extracapsular fracture

A

IM nail

133
Q

Describe the examination findings of a patient with a hip fracture

A

Lower limb on affected side may be shortened and externally rotated

134
Q

Which investigations can be used to distinguish between complete and partial tears of the Achilles tendon?

A

US or MRI

135
Q

What typically causes chronic pelvic soft tissue injury?

A

Chronic overuse which causes bone or soft tissue pain at the site of tendon/ligament attachment

136
Q

Describe the surgical management of a ruptured Achilles tendon

A

Suture repair of tendon

137
Q

Describe the clinical presentation of an LCL injury

A

Knee swelling with ecchymosis, pain, deformity and instability

138
Q

What is Morton’s neuroma?

A

Benign fibrotic thickening of a plantar digital nerve due to repeated trauma (irritation)

139
Q

What might a small opacification suggest in a patella dislocation?

A

Osteochondral fracture

140
Q

Describe the management of a calcaneus fracture

A

Cast immobilisation with nonweightbearing for 6-12 weeks

141
Q

Describe the conservative management of a pelvic fracture

A

Analgesia, weight bearing as tolerated

142
Q

Which nerve is at risk in a complete knee dislocation?

A

Common fibular nerve

143
Q

Describe the definitive management of a hip dislocation

A

Fixation of associated pelvic fractures, fixation of other injuries in poly-trauma patients

144
Q

What is the usual mechanism of injury of a femoral shaft fracture?

A

High energy injuries, occur in major trauma patients and is often associated with other injuries

145
Q

Describe the conservative management of hallux valgus

A

Wearing wider and deeper shoes to prevent bunions, the use of a spacer in the first web space to stop rubbing between the great and second toes

146
Q

Why should steroid injections for tendonitis of the extensor mechanism of the knee be avoided?

A

High risk of tendon rupture

147
Q

Describe the clinical presentation of patellofemoral dysfunction

A

Anterior knee pain, worse going downhill

Grinding or clicking sensation at the front of the knee and stiffness after prolonged sitting causing ‘pseudolocking’ where the knee acutely stiffens in a flexed position

148
Q

How would you manage an isolated PCL injury in which the patient has recurrent instability?

A

Consider reconstruction

149
Q

Describe the clinical presentation of plantar fasciitis

A

Start up pain after rest on the instep of the foot (at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity)

Pain can be worse after exercise

150
Q

Which investigation would you perform in a suspected metatarsal stress fracture?

A

X-ray - AP and oblique views

Bone scan may be needed to confirm as fracture may not be visible for 3 weeks on x-ray

151
Q

How can a loose body grow over time?

A

Gets nutrition from the synovial fluid

152
Q

Describe the indications for surgical excision of Morton’s neuromas

A

Symptoms persist after 2-3 months of footwear modification and metatarsal pads/metatarsal dome, inadequate response to corticosteriod injection

153
Q

What is bone marrow oedema (bone bruising)?

A

Impaction to articular surface leads to microscopic fracture of trabecular bone with bleeding and inflammation

154
Q

What is the most commonly injured knee ligament?

A

ACL

155
Q

Describe the examination findings of a meniscal tear

A

May be inflammatory effusion present, positive meniscal provocation tests e.g. Steinman’s

Acute locked knee signifies displaced bucket handle meniscal tear

156
Q

Describe the operative management of a patella fracture

A

ORIF, partial/total patellectomy

157
Q

How does tibialis posterior tendon dysfunction lead to flat feet?

A

Elongation or rupture leads to loss of the medial arch with resulting valgus of the heel and flattening of the medial arch of the foot

158
Q

Name a complication of bone marrow oedema (bone bruising)

A

Hyaline cartilage over area may deteriorate over time leaving a full thickness chondral defect

159
Q

What is hallux valgus?

A

Deformity of the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

160
Q

Describe the clinical presentation of a calcaneus fracture

A

Pain, inability to bear weight, significant swelling

Look for other injuries especially spinal

161
Q

Name the surgical procedure used to treat an intertrochanteric extracapsular fracture

A

Dynamic hip screw

162
Q

Describe the conservative management of a tibial shaft fracture

A

Above knee cast

Patient may need closed reduction in theatre before cast is fitted

163
Q

A meniscal tear occurs in 50% of injuries to which other knee ligament?

A

ACL

164
Q

Which ankle ligament is most commonly injured?

A

AFTL - weakest ligament

165
Q

Describe the examination findings of a patella fracture

A

Palpable patella defect, significant haemarthrosis, unable to perform straight leg raise

166
Q

How can you distinguish between a 5th MT base fracture in an adolescent and the normal adolescent ossification centre?

A

5th MT base fracture will be transverse, ossification centre is longitudinal

167
Q

When might an US be indicated in a pelvic soft tissue injury?

A

Can show acute injuries affecting superficial structures

168
Q

Describe the clinical presentation of a patella fracture

A

Severe pain in/around kneecap

169
Q

What is the usual mechanism of injury for an ACL injury?

A

Usually twisting sports injury - higher rotational force, turning the upper body laterally on a planted foot (football, rugby, skiing)

170
Q

Why is the risk of AVN and non-union low in extracapsular hip fractures?

A

Blood supply to the head of femur is intact

171
Q

Name two fractures associated with a hip dislocation

A

Posterior acetabular wall, femoral

172
Q

What is a Thomas splint used for?

A

Initial management of a femoral shaft fracture for temporary stabilisation

173
Q

Why is it unusual to have a single pelvic fracture?

A

Bony disruption usually affects more than one site

174
Q

Describe the conservative management of a patella fracture

A

Knee immobilised in extension, full weight bearing

175
Q

Describe the management of a femoral shaft fracture

A

Nearly always operative - IM nail, plate fixation (ORIF/MIPPO)

176
Q

What causes pes cavus?

A

Can be idiopathic but is often related to neuromuscular conditions

177
Q

Describe the conservative management of claw and hammer toes

A

Toe ‘sleeves’ and corn plasters to prevent toes rubbing on footwear

178
Q

Describe the USS/MRI findings in a knee extensor mechanism rupture

A

May show partial/complete tear

179
Q

Which type of extracapsular hip fracture represented by the green line in the diagram?

A

Reverse oblique

180
Q

What is a grade 3 ligament injury?

A

Complete tear

181
Q

Why should steroid injection not be administered around the Achilles tendon?

A

Risk of rupture

182
Q

Which type of extracapsular hip fracture is represented by the blue line in the diagram?

A

Subtrochanteric

183
Q

What causes the medial patella pain in a patella dislocation?

A

Torn medial patella retinaculum tendon

184
Q

Which patient group is most likely to develop Morton’s neuroma?

A

Mean age 45-50, obese, female (possible link to high heels)

185
Q

Describe the prognosis of plantar fasciitis

A

Symptoms can take up to two years to resolve

186
Q

Which meniscus tears most commonly?

A

Medial meniscus

187
Q

Describe the surgical management of claw and hammer toes

A

Tenotomy, tendon transfer, arthrodesis (PIPJ) or toe amputation

188
Q

Describe the clinical presentation of an knee extensor mechanism rupture

A

Knee pain and weakness

189
Q

Describe the management of trochanteric bursitis

A

Analgesia (NSAIDs), physio, steroid injection

190
Q

What is the usual mechanism of injury for a talar dome margin fracture?

A

Excessive inversion/eversion

191
Q

Define a chronic ankle sprain

A

Recurrent sprains or giving way, persisting for more than 6 months

192
Q

What is type III tibialis posterior tendon dysfunction?

A

Fixity and mortise signs

193
Q

Which direction does the hip most commonly dislocate in?

A

Posteriorly

194
Q

Describe the management of a loose body

A

Arthroscopic removal can help troublesome symptoms but won’t help degenerative joint pain

195
Q

Name the directions for a complete knee dislocation

A

Posterior, anterior, medial, lateral, rotatory

196
Q

What is a grade 2 ligament injury?

A

Partial tear - some fascicles disrupted

197
Q

Describe the examination findings in trochanteric bursitis

A

Pain on palpation of the greater trochanter and on restricted abduction

198
Q

Which region of the 5th metatarsal is a common site for a stress fracture?

A

Proximal shaft

199
Q

Describe the clinical presentation of a tibial shaft fracture

A

Pain, inability to bear weight, deformity

200
Q

Why are patients with hip fractures mobilised early?

A

To avoid complications of prolonged bed rest

201
Q

Describe the usual mechanism of injury of a hip fracture

A

Low impact fall in the elderly (92% of patients are over 60)

202
Q

Which investigations would you perform for a complete knee dislocation where there is concern over neurovascular status?

A

X-ray, CT angiogram

203
Q

Describe the conservative management of ACL injury

A

Can stabilize with time and physiotherapy

204
Q

Which syndrome may trochanteric bursitis be linked to?

A

Gluteal cuff syndrome

205
Q

When would a pelvic binder for a pelvic fracture be indicated?

A

Initial management for high energy mechanisms to control circulatory loss

206
Q

Which investigation would you perform in a suspected tibial shaft fracture?

A

X-ray - AP and lateral

207
Q

Name the surgical procedure used to treat an undisplaced intracapsular fracture in a patient who was previously high functioning

A

Compression hip screw

208
Q

Describe the x-ray findings in a patella tendon rupture

A

Effusion, patella sitting high

209
Q

Describe the clinical presentation of Achilles tendon rupture

A

Sudden deceleration with resisted calf muscle contraction (e.g. lunging at squash) leads to sudden pain (like being kicked in the back of the leg) and difficulty weight bearing

210
Q

Which investigation would you perform in a suspected meniscal tear?

A

MRI

211
Q

Describe the immediate management of a hip dislocation

A

Urgent reduction, stabilise in tractions if required

212
Q

What is the usual mechanism injury for a hip dislocation?

A

Impact during RTA or contact sports with the hip flexed

213
Q

Which type of intracapsular hip fracture is shown in the diagram?

A

Transcervical neck fracture

214
Q

Describe the usual mechanism of injury for a pelvic fracture in an older patient

A

Frailty fractures of older osteoporotic bone

215
Q

Rupture of which ligaments leads to varus and rotatory instability?

A

Posterolateral corner - PCL, LCL, popliteus and other smaller ligaments

216
Q

Describe the clinical presentation of Achilles tendonitis

A

Pain of the Achilles tendon or at its insertion in the calcaneus

Morning stiffness

Pain and stiffness eases with walking

217
Q

What is the mechanism of injury for ankle ligament damage?

A

Initial contact on a plantarflexed inverted foot, excessive supintion of the rearfoot about an externally rotated leg

218
Q

Why should surgical management of hallux valgus be carefully considered in adolescents?

A

Carries a risk of recurrence of the deformity later in life

219
Q

Why is a CT useful in a Lisfranc injury?

A

Lisfranc fractures usually involve several TMT joints, with multiple ligamentous avulsion fractures

220
Q

Rupture of which ligament may lead to recurrent hyperextension or instability descending stairs?

A

PCL

221
Q

Describe the clinical presentation of trochanteric bursitis

A

Pain on the lateral aspect of the hip

222
Q

Which investigations would you perform in a suspected Lisfranc injury?

A

X-ray - AP and oblique views, CT

223
Q

Describe the clinical presentation of a hip dislocation

A

Flexed, internally rotated and adducted knee

224
Q

Name a fracture associated with a patella dislocation

A

Osteochondral fracture

225
Q

What is a grade 1 ligament injury?

A

Sprain - some fibres torn but macroscopic structure intact

226
Q

Describe the surgical management of hallux valgus

A

Osteotomies to realign the bones and soft tissue procedures to tighten slack tissues and release tight tissues

227
Q

What is the most common cause of acquired flat foot in adults?

A

Tibialis posterior tendon dysfunction

228
Q

Describe the examination findings in plantar fasciitis

A

Fullness or swelling on plantarmedial aspect of heel

Localised tenderness on palpation of the plantar aspect of heel and/or plantarmedial aspect of heel

Tinel’s test positive for Baxter’s nerve

229
Q

Describe the operative management of a pelvic fracture

A

ORIF, external fixators, internal fixators

230
Q

What is a CT used for in a tibial plateau fracture?

A

Shows area of condylar involvement/depth of depression which guides treatment

231
Q

Name the surgical procedure used to treat an intracapsular fracture in a patient who was previously low functioning

A

Hemi-arthroplasty

232
Q

Which direction does the patella always dislocate in?

A

Laterally

233
Q

What is the usual mechanism of injury for a knee extensor mechanism rupture?

A

The patellar tendon or quadriceps tendon can rupture with rapid contractile force which can occur after lifting a heavy weight, after a fall or spontaneously in a severely degenerate tendon

Can be associated with blunt or penetrating trauma

234
Q

Describe the management of pes cavus

A

Soft tissue releases and tendon transfer if supple, or calcaneal osteotomy if more rigid

Arthrodesis for severe cases

235
Q

Describe the clinical presentation of bone marrow oedema (bone bruising)

A

A major source of pain after meniscal tear and ligament injuries

236
Q

What is a Pilon fracture?

A

High energy fractures which occur at the bottom of the tibia and involves the ankle joint

237
Q

Describe the conservative management of Achilles tendonitis

A

Activity modification, analgesia, NSAIDs, physiotherapy

Heel raise to offload the tendon and use of a splint or boot

238
Q

Describe the prognosis of ACL injury

A

May cause little or no problems in some, whilst in others they can give substantial problems with function

Most have radiographic evidence of arthritis within 10 years (even those who have surgery)

239
Q

Which type of hip fracture is prone to femoral head AVN and non-union?

A

Intracapsular fracture

240
Q

Describe the conservative management of hallux rigidus

A

Weight loss if needed

Analgesia, NSAIDs, activity modification

May involve the wearing of stiff soled shoe to limit motion at the MTPJ

241
Q

How might you choose to conservatively treat a small partial tear of the quadriceps?

A

Immobilisation and physio

242
Q

Which patient group is more likely to injure their ACL?

A

Higher incidence in females

243
Q

Describe the examination findings in a knee extensor mechanism rupture

A

Unable to straight leg raise, palpable gap in the extensor mechanism

Partial tears can also occur which may have some extensor mechanism function but reduced power

244
Q

What are claw toes?

A

Hyperextension at the MTPJ with flexion at the PIPJ and DIPJ

245
Q

Describe the examination findings of a PCL injury

A

Positive posterior drawer test, positive sag sign

246
Q

When might you aspirate a knee with a patella dislocation?

A

If intractable pain and very swollen

247
Q

What is the usual mechanism of injury for a patella dislocation?

A

Can occur with a direct blow or sudden quadriceps contraction with a flexing knee

248
Q

Describe the examination findings of a bucket handle meniscal tear

A

Acutely locked knee, 15° springy block to extension, heel height asymmetry indicating fixed flexion deformity

249
Q

Describe the examination findings in Achilles tendon rupture

A

Weakness of plantar flexion and a palpable gap, unable to tiptoe stand, positive calf squeeze (Simmonds) test

250
Q

Which type of intracapsular hip fracture is shown in the diagram?

A

Subcapital neck fracture

251
Q

Describe the examination findings of an LCL injury

A

Lateral joint line tenderness, lateral joint laxity on varus stress test

252
Q

Which investigations would you perform in a hip dislocation?

A

NV assessment, X-ray, CT after reduction if further injury suspected

253
Q

Describe the management of a ruptured LCL diagnosed later (after 3 weeks)

A

Reconstruction with tendon graft

254
Q

Which patient group is most likely to rupture their extensor mechanism?

A

More common in the middle age population who play running or jumping sports

255
Q

Describe the conservative management of Morton’s neuroma

A

Involves RICE, stretching calf muscles, the use of a metatarsal pad or offloading insole, weight loss if appropriate and activity modification

Steroid and local anaesthetic injections may relieve symptoms

256
Q

What causes a loose body in a joint?

A

Trauma, osteochondritis dissecans and joint degeneration can cause a fragment of cartilage +/- bone to detatch

257
Q

Describe the conservative management of an ankle fracture

A

Cast or moonboot

258
Q

Describe the immediate management for a complete knee dislocation

A

Emergency reduction under sedation, may need emergency fix for temporary stabilisation

259
Q

Why are x-rays not very sensitive in low energy pelvic fractures?

A

The fractures are often undisplaced so the x-ray appears normal

260
Q

Describe the management of tibialis posterior tendon tendonitis

A

Medial arch support to avoid rupture, orthosis/bespoke footwear

If fails to settle - surgical decompression and tenosynovectomy may prevent rupture

261
Q

Why does a multiligament knee injury usually require surgical reconstruction?

A

Causes gross instability

262
Q

Which investigations would you perform in a suspected tibial plateau fracture?

A

X-ray - AP and horizontal beam lateral

CT

263
Q

What causes Achilles tendonitis?

A

Can occur due to repetitive strain (from sports) which leads to a peritendonitis or due to degenerative process with intrasubstance microtears

264
Q

Why doe the meniscus have a limited healing potential?

A

Only has an arterial blood supply in its outer third - radial tears won’t settle

265
Q

Name the 4 categories of extracapsular hip fracture

A

Basicervical, intertrochanteric, reverse oblique and subtrochanteric fractures

266
Q

Describe the x-ray findings in a patella dislocation

A

Lipo‐haemarthrosis occurs with characteristic x-ray appearance

267
Q

Describe the mechanism of action of a patella fracture

A

Traumatic injury - direct trauma or rapid contracture of the quadriceps with a flexed knee

268
Q

How would you investigate a high energy pelvic fracture in a polytraumatic patient?

A

CT

269
Q

Describe the surgical management of a tibial plateau fracture

A

ORIF, external fixator, delayed TKR

270
Q

How would you investigate a high energy pelvic fracture where the pelvis is the only site of injury?

A

X-ray first, CT if needed to show fracture detail

271
Q

When would ACL reconstruction be indicated?

A

Rotatory instability not responding to physio, as part of multiligament reconstruction or in professional athletes

272
Q

Which investigations would you perform in a suspected knee extensor mechanism rupture?

A

X-ray

USS or MRI

273
Q

Name three potential complications of a hip dislocation

A

Sciatic nerve palsy, ANV femoral head, secondary OA of hip

274
Q

How can hallux valgus lead to the formation of a bunion?

A

A widened forefoot may cause rubbing of the foot with shoes resulting in an inflamed bursa over the medial 1st metatarsal head

275
Q

What is the usual mechanism of injury for a talus fracture?

A

Forced dorsiflexion/rapid deceleration

276
Q

How would you diagnose trochanteric bursitis?

A

Clinical diagnosis, visible on MRI but not usually needed

277
Q

Describe the usual mechanism of injury for a pelvic fracture in a younger patient

A

High energy injury, typically RTA or fall from height

278
Q

Which patient group is most likely to develop tibialis posterior tendon dysfunction?

A

Obese middle aged female

279
Q

Why does an injury to the ACL cause rotatory instability?

A

Gives way on turning on a planted foot due to excessive internal rotation of the tibia

280
Q

Reperfusion of the knee following neurovascular injury due to complete dislocation can result in what complication?

A

Compartment syndrome

281
Q

Describe the clinical presentation of hallux rigidus

A

Painful 1st MTP joint, stiffness

Pain increases with activity/aggrevated by shoes

282
Q

Which type of extracapsular hip fracture is represented by the yellow line in the diagram?

A

Intertrochanteric

283
Q

What is patellofemoral dysfunction?

A

Describes disorders of the patellofemoral articulation resulting in anterior knee pain - includes chondromalacia patellae, adolescent anterior knee pain and lateral patellar compression syndrome

284
Q

Describe the conservative management of a ruptured Achilles tendon

A

Series of casts in the equinous position - avoids potential for wound problems

285
Q

In patients with recurrent patella dislocation, physiotherapy to strengthen which muscle can help?

A

Quadriceps

286
Q

What is a fabella?

A

Acessory ossicle in the lateral head of gastrocnemius (usually) commonly misdiagnosed as a loose body

287
Q

Describe the surgical management of hallux rigidus

A

In early cases where dorsal osteophytes impinge during dorsiflexion, removal of osteophytes (cheilectomy) may help

Gold standard surgical treatment is arthrodesis

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