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MSK disorders > Disorders of the knee > Flashcards

Disorders of the knee Flashcards

1
Q

Femoral shaft fractures

A

High velocity trauma but in elderly can be falling from standing position

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2
Q

How fragments of femoral shaft fractures look

A

Proximal fragment = abducted due to pull of glut max and med
Distal fragment = adducted due to action of adductor muscles
Tense swollen thigh

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3
Q

Major risks of femoral shaft fractures

A

Blood loss (in open fractures double that in closed) and hypovolaemic shock

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4
Q

Treatment of femoral shaft fracture

A

Surgical fixation

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5
Q

Distal femoral fracture

A 
Youth = high energy sport injury
Elderly = osteoporotic FFSP
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6
Q

Vascular effect of distal femoral fracture

A

Popliteal artery involved if significant displacement

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7
Q

Tibial plateau fractures

A

Diagonal fracture of the condyle of the tibia from high energy injuries, articular cartilage always damaged and end up w post traumatic osteoarthritis

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8
Q

Patellar fractures

A

Direct impact injury or eccentric contraction of quads

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9
Q

Treatment of patellar fracture

A 
Displaced = reduction and surgical fixation
Undisplaced = splinting and crutches
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10
Q

Test of patellar fracture

A

Fracture completely splits patella distal to insertion of quad tendon = patient can’t do straight leg raise

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11
Q

Normal anatomical variant of patella

A

Bipartite = failure of union of secondary ossification centre

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12
Q

Patella dislocation

A

Normally laterally and by trauma - internal rotation of femur on planted foot whilst flexing knee

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13
Q

Predisposition of patellar dislocation

A
  • Lax ligaments
  • Weak quads, esp VMO
  • Shallow patellofemoral groove
  • Long patellar ligament
  • Previous dislocations
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14
Q

Treatment of patellar dislocation

A

Manually reducing patella

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15
Q

Meniscal injuries

A

Tear in the meniscus due to sudden twisting of knee when flexed

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16
Q

Patient description of meniscal tear and signs

A
  • Intermittent pain localised to joint line
  • Knee clicking/catching/locking
  • Joint line tenderness
  • Restricted motion - pain or swelling
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17
Q

Treatment of meniscal tear

A

Surgically by removal or repair.

18
Q

Collateral ligament injury

A

Acute varus or valgus angulation of knee

19
Q

The unhappy triad

A

Injury to:

  1. ACL
  2. MCL
  3. Medial meniscus
20
Q

Anterior and posterior cruciate ligament injury

A

ACL weaker than PCL so more commonly injured - changing direction in sport = quick deceleration then hyperextension or rotation

21
Q

Patient description of ACL injury

A

Could feel it pop and then it immediately swelled, also felt like it was giving way

22
Q

Treatment of ACL injury

A
  • Low functional knee demands = ruptured ACL and joint stabilised by musculature
  • Sportsmen and active = surgical reconstruction
23
Q

Common mechanism of PCL injury

A

Dashboard injury - flexed knee and then large force

24
Q

Knee joint dislocation

A

Uncommon and always from high energy trauma - need 3/4 ligaments ruptured

  • MCL
  • ACL
  • LCL
  • PCL
25
Q

Associated artery injury in knee joint dislocation

A

Popliteal artery passes through political fossa

  • Haematoma
  • Artery crushed = thrombotic occlusion
26
Q

Treatment of knee dislocation

A

Reduction of knee joint

27
Q

Swellings around the knee

A
  • Bony = Osgood-Schlatter’s disease
  • Soft tissue - localised or generalised
  • Fluid - inside the joint = effusion, outside the joint
28
Q

Knee effusions

A

Accumulation of fluid in the knee joint

  • Haemarthrosis - blood in joint e.g. ACL rupture
  • Lipo-haemarthrosis - blood and fat in joint
29
Q

Bursitis of the knee

A

Inflam of a bursa

30
Q

Pre-patellar bursa

A

Knee pain and swelling, repetitive trauma to the bursa = Housemaid’s knee

31
Q

Infrapatellar bursitis

A

Repeated micro trauma when upright kneeling = Clergyman’s knee

32
Q

Suprapatellar bursitis

A

Is extension of synovial cavity = fluid there
Causes:
- OA
- RA
- Infection
- Gout
- Repetitive microtrauma as a result of running on soft/uneven surface

33
Q

Semimembranous bursitis

A

Swelling in the popliteal fossa

Popliteal cyst or baker’s cyst

34
Q

Osgood-Schlatter’s disease

A

Inflammation of site of insertion of patellar ligament into tibial tuberosity
Localised pain and swell
Patients - intense knee pain when active
Treatment - rest and ice

35
Q

OA of knee

A

Knee pain that comes and goes when bending, kneeling etc, morning stiffness and swelling
Varus or Valgus deformity of knee joint
Crepitus
Buckling knee

36
Q

Varus

A

Away from midline

37
Q

Valgus

A

Towards midline

38
Q

Septic arthritis

A

Invasion of joint space by micro-organisms, knee most common joint affected
Staph aureus most common
Damage to articular cartilage

39
Q

Risk factors of septic arthritis

A
  • Extremes of age
  • DM
  • RA
  • Immunosuppression
  • IV drug use
  • Prosthetic joints - infection years can be after initial operation
40
Q

Symptoms and signs of septic arthritis

A
  • Fever
  • Pain
  • Reduced range of motion
  • Erythema
  • Swelling
  • Warmth
  • Tenderness
  • Limitation of active and passive range of motion
41
Q

Investigations of septic arthritis

A

Aspiration of joint and aspirate sent for urgent microscopy, culture and sensitivities

42
Q

Outcome of septic arthritis

A

High morbidity and if survive often decreased range of motion and chronic pain

MSK disorders (8 decks)

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