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Clin Med MSK: > Disorders of the LE > Flashcards

Disorders of the LE Flashcards

1
Q

What are other names for AVN

A

bone infarction, osteonecrosis, ischemic necrosis, aspetic necrosis

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2
Q

What are risk factors for AVN

A

ETOH, Steriod use (most common), sickle cell, lupus, infection, HIV/AIDs, prior joint with AVN

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3
Q

What is the ASEPTIC acronym for

A

AVN

Alcohol/Aids/HIV
SLE/Sickle cell
Exogenous steroids
Pancreatitis
Trauma
Infection/irratation
Caisson disease (decompression sickness)

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4
Q

How does AVN of the hip present

A

groin pain

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5
Q

How is AVN diagnosed

A

imaging - may not be detected early on x-ray
MRI more sensitive for diagnosis

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6
Q

what is the treatment of AVN without bony collapse

A

osteoporosis drugs (bishosphates - aldendrate)
surgical procedures to induce revascularization

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7
Q

what is the treatment for AVN with collapse or in older patients

A

arthroplasty

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8
Q

What is SCFE

A

Slipped Capital Femoral Epiphysis

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9
Q

when does SCFE occur most often

A

adolescents 10-16 with more common in overweight and obese males

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10
Q

What is the common presentation of SCFE

A

hip pain (groin and thigh)
associated with limp or ER of the leg
reduced ROM - loss of IR, reduced flexion and ABDuction

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11
Q

What is the most common treatment for SCFE

A

percutaneous fixation (pinning)

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12
Q

what is the goal of percutaneous pinning for SCFE patients

A

stabilize and prevent further slippage , NOT full reduction

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13
Q

What is the most common orthopedic disorder in newborns

A

Developmental Dysplasia of the hip (DDH)

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14
Q

What newborns are at higher risk for DDH

A

firstborn breech newborns

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15
Q

what other deformities are often associated with DDH

A

metatarsus adductus and torticollis

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16
Q

what is DDH

A

essentially abnormal hip development (acetabulum)

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17
Q

define dysplasia

A

shallow, underdeveloped acetabulum

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18
Q

What is the mainstay diagnostic tests for DDH

A

Barlow and Ortolani maneuvers
all infants routinely screened (until walking)

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19
Q

Barlow Maneuver

A

dislocates a dislocatable hip; “click” on exit

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20
Q

Ortolani maneuvers

A

reduces a dislocated hip; “clunk” on entry

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21
Q

when is imaging started for DDH

A

4 to 6 months when ossification of the femoral head begins

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22
Q

what is the treatment for DDH

A

Pavlik harness first line
Spica casting for 6-18 months or failure of harness

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23
Q

when is open reduction with a spica recommended for DDH

A

older than 18 months with failure of the spica

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24
Q

when is open reduction with osteotomy recommended for DDH

A

older than 2 years with persistent dysplasia

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25
Q

What is trochanteric Bursitis

A

inflammation of the trocanteric bursa between greater trochanter and IT band

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26
Q

What is the treatment for trochanteric bursitis

A

Rest, ice
NSAIDs
PT/stretching
Intra-bursal injection
bursectomy last resort

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27
Q

when are hip dislocations more common

A

s/p THA with less force in comparison to native joint

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28
Q

what is the treatment for hip dislocations

A

closed reduction with sedation or open reduction

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29
Q

what rates are higher after hip fractures

A

high mortality and morbidity rates

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30
Q

what are risk factors for hip fractures

A

advancing age
osteoporosis
history of falls
smokers
prior trauma

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31
Q

what views of x-rays are needed to assess for hip fractures

A

AP, lateral and traction views

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32
Q

when is a CT needed for a hip fracture

A

Delineation of displacement and determine fracture pattern

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33
Q

when is an MRI indicated for a hip fracture

A

if there is concern for occult fracture

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34
Q

When is ORIF used for hip fractures

A

non-displaced or young patients

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35
Q

when is an arthroplasty indicated for a hip fracture

A

when the fracture is displaced or older patients

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36
Q

when is observation or non-operative management indicated for hip fractures

A

if a patient has multiple comorbidities, poor pre-injury functional status or high operative risk

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37
Q

What are complications in regards to hip fractures

A

high readmission rate
high mortality rate
high revision/conversion rate
high risk for functional impairment
risk for osteonecrosis
risk of non-union

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38
Q

How much blood can be ‘stored’ in the thigh

A

one liter of blood

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39
Q

what do you have to use caution with for femur fractures

A

hemodynamic instability

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40
Q

When are femoral shaft fractures common

A

young males 15-24yo (trauma) vs Females >75 (fragility fx)

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41
Q

When is CT indicated for femoral shaft fractures

A

to delineate fracture pattern

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42
Q

what is varus in the knee

A

bow leg

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43
Q

what is valgus in the knee

A

knock kneed

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44
Q

What athletes are at an increase risk for IT band syndrome

A

Runners and cyclists

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45
Q

what knee alignment increases your risk for IT band syndrome

A

knees with Varus alignment

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46
Q

what special test is positive with IT band syndrome

A

Obers test (inability to adduct in extension)

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47
Q

what is Osgood Schlatters disease

A

apophysitis of the tibial tubercle - inflammation at or near the growth plate

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48
Q

what is key on the exam of Osgood Schlatters

A

pain with knee extension against resistance

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49
Q

what type of injury is the leading indication for knee arthroscopy

A

meniscal tears

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50
Q

what is the most common type of meniscal tear

A

medial is more common than lateral

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51
Q

What location is common for degenerative tears of the meniscus

A

posterior horn

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52
Q

what are the mechanical symptoms for meniscal tears

A

clicking, locking especially with flap and bucket handle tears

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53
Q

what special tests are used for meniscal tears

A

apleys compression and McMurrarys test

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54
Q

when is surgical intervention indicated for meniscal tears

A

younger patients and traumatic injury

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55
Q

what determines partial meniscectomy vs repair for meniscal tear

A

location of the tear is important

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56
Q

What does the ACL prevent

A

anterior tibial translation

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57
Q

what is the MOI for ACL injuries

A

sudden stopping and pivoting or direct lateral blow to the knee

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58
Q

what special tests are used for ACL injuries/tears

A

Lachmans/anterior drawer
+ for both is laxity and the ability to pull the tibia towards examiner

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59
Q

what imaging modalities are recommended for ACL injuries

A

MRI

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60
Q

what is the most common treatment for ACL tear

A

ACL reconstruction
Autograft vs allograft

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61
Q

What does the PCL do

A

prevent posterior translation of the tibia

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62
Q

What ligament is stronger the ACL or PCL

A

PCL is stronger

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63
Q

What is the MOI for PCL tears

A

MVC - knee hitting the dashboard
fall directly onto bent knee
hyperextension injury

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64
Q

what special tests are used for PCL tears/ injury

A

posterior drawer and Sag sign

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65
Q

what is the treatment options for PCL tears

A

if not associated with other injuries - non-operative management
if associated with other injuries - PCL repair/reconstruction

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66
Q

what other injuries are associated with MCL injuries

A

ACL and meniscus injuries

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67
Q

what makes up the unhappy triad

A

ACL + MCL _ meniscus tear

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68
Q

what is the MOI for MCL injuries

A

Excessive valgus force (blow from lateral knee)

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69
Q

What special test is used for MCL injuries

A

Valgus stress test

70
Q

when is surgery indicated for patients with MCL injuries

A

multi-ligament or severe complete tear of the MCL - repair vs reconstruction

71
Q

What is the MOI for LCL injuries

A

varus blow to the knee, direct blow to medial knee

72
Q

What special test is used for LCL injuries

A

Varus stress test

73
Q

what treatments are used for LCL injuries

A

activity restriction, RICE, NSAIDs
if complete tear - repair vs reconstruction

74
Q

what age group is most common for Quad tendon rupture

A

> 40 yo

75
Q

what age group is most common for Patellar tendon rupture

A

< 40 yo

76
Q

what increases the risk of quad/patella tendon rupture

A

hx of tendonitis or corticosteroid injections

77
Q

what is the MOI for quad and patella tendon rupture

A

forceful quad contraction or fall on flexed knee

78
Q

what is the treatment for quad/patella tendon rupture

A

urgent surgical repair

79
Q

what is patellar tendonitis also known as

A

jumpers knee

80
Q

what is shown on an MRI with a patient with patellar tendonitis

A

tendon thickening

81
Q

what is the standard treatment for patellar tendonitis

A

RICE, NSAIDs, activity modification, Pt and Chopat strap

82
Q

what is the common cause of a knee dislocation

A

MVC - high energy trauma

83
Q

what are knee dislocation patients at higher risk for

A

vascular injury
assess neurovascular post reduction

84
Q

what is the most common population with patellar dislocations

A

females due to increased Q angle and increased laxity baseline

85
Q

what is the MOI for patellar dislocation

A

blow to the lateral knee or twisting with a foot planted in ER

86
Q

what is long-term treatment for patellar dislocation

A

first time: brace, ice, NSAIDS, activity restriction
repeated: consider operative treatment

87
Q

what is the MOI for distal femur fractures

A

axial load with rotational force

88
Q

what are distal femur fracture at high risk for

A

neurovascular injury - must check on exam

89
Q

what is the first line imaging for a distal femur fracture

A

x-rays

90
Q

when is CT indicated for distal femur fracture

A

complex or intra-articular fractures and pre-operative planning

91
Q

what is the treatment for distal femur fracture

A

splinting until surgical fixation

92
Q

what is the primary population for patellar fractures

A

males between 20-50yo

93
Q

what is the MOI for patellar fractions

A

direct trauma or forceful quads contraction with flexed knee

94
Q

what is the key sign for patellar fractures

A

unable to lift leg straight up with extended knee

95
Q

what are the treatments for patellar fractures

A

non-operative (immobilizing) vs ORIF for more severe fractures

96
Q

what are the two main groups for tibial plateau fractures

A

young from high energy trauma and elderly with osteopenia and minor falls

97
Q

what is the MOI for tibial plateau fractures

A

axial load with varus or valgus stress

98
Q

what are tibial plateau fractures at high risk for

A

neurovascular injury, compartment syndrome and soft tissue injury

99
Q

What are the treatment options for tibial plateau fractures

A

nonop (brace/immobilization) or ORIF

100
Q

what is a large concern with tibial/fibular shaft fractures

A

compartment syndrome

101
Q

what test is used to assess for vascular injury in tibial/fibular shaft fracture patients

A

angiography if there is a concern for vascular injury

102
Q

what is compartment syndrome

A

limb threatening problem caused by bleeding/swelling in a given compartment compressing of nerves, vasculature

103
Q

what are the most common locations for compartment syndrome

A

lower leg, thigh, forearm, hand, foot, buttock, shoulder, paraspinals

104
Q

what are the “6 P’s”

A

diagnosis of compartment syndrome

Pain (first with passive stretch, then out of proportion to exam)
pallor
Pulselessness
Parasthesia
Paralysis
Pressure (<30)

105
Q

what is used to check pressure in compartment syndrome patients

A

Manometer

106
Q

what is necessary for treatment with a pressure over 30

A

emergent fasciotomy

107
Q

what is pes planus

A

flat foot and primarily due to ligamentous laxity

108
Q

when does pes planus become symptomatic

A

increase weight bearing on hindfoot
valgus deformity of hindfoot with weightbearing
lack of arch support

109
Q

what is hallux valgus

A

aka bunions
progressive deformity of the first MTP joint
valgus devision of the phalanx
increasing prominence of the medial head of the 1st MTP

110
Q

what population is hallux valgus often seen in

A

women are 10x more common and increased risk with FH

111
Q

what increases your risk for hallux valgus

A

wearing high heel shoes with narrow toes
anatomic variations and joint laxity
deformity/amputation of the second toe
pes planus
RA
CP

112
Q

what are you assessing with xrays for hallux valgus

A

the angle between the first phalanx and first MT

113
Q

what is the treatment for hallux valgus

A

changes in footwear, padding symptomatic areas and surgical for symptom management

114
Q

define iatrogenic

A

relating to illness caused by medical examination or treatment

115
Q

what is the primary causes of hallux varus

A

iatrogenic - over correction of hallux valgus
Inflammatory arthropathies, neurologic disorders or congenital

116
Q

what is the treatment for hallux varus

A

bracing or taping if early post op
footwear alterations
surgical realignment

117
Q

what is compressed with mortons neuroma

A

compression of interdigital nerve

118
Q

what is the most common location for mortons neuroma

A

3rd webspace

119
Q

what are the theories for MOI for mortons neuroma

A

friction from 3rd and 4th MT heads, traction from intermetatarsal ligament and compression from poor footwear

120
Q

what is the treatment for mortons neuroma

A

footwear changes, padding over metatarsals, steroid injections and surgical removal for definitive treatment

121
Q

what can happen after surgical removal of mortons neuroma

A

post-op sensory deficits

122
Q

What is the importance of plantar aponeurosis

A

muscle attachments, protection of underlying structures, structural support (arches)

123
Q

what increases your risk for plantar fasciitis

A

obesity, lack of dorsiflexion, pes planus or cavus, prolonged standing, standing/walking/running on hard surfaces, poor footwear

124
Q

what is the treatment for plantar fasciitis

A

primarily considervative: Rest, NSAIDs, stretching, ice - tennis ball/water-bottle, splinting or orthosis
if failure >9 mo - surgery for plantar fasciotomy

125
Q

where does achilles tendonitis occur

A

the insertion site of the achilles

126
Q

what is the treatment for achilles tendonitis

A

primarily conservative: activity modification, RICE, NSAIDs, footwear modification, stretching and heel sleeves/padding
AFO
tendon debridement or osteophytectomy

127
Q

what is retrocalcaneal bursitis associated with

A

achilles tendonitis

128
Q

what treatment do you avoid for retrocalcaneal bursitis

A

avoid intra-bursal coticosteroids due to increase risk of tendon rupture

129
Q

what is a drug risk factor for achilles tendon rupture

A

fluoroquinolone antibiotic use or steroid injections

130
Q

what is the MOI for achilles tendon rupture

A

sudden forcible DF/PF
landing from jump, sudden direction change during PF

131
Q

when you have an audible ‘pop’ with sudden heal pain what are you thinking

A

achilles tendon rupture

132
Q

a positive thompson test is indicative of what?

A

Achilles tendon rupture

133
Q

what is the treatment options for achilles tendon rupture

A

immobilization and non-weight bearing vs surgical repair

134
Q

What is the common MOI for ankle sprain

A

inversion “rolled” ankle

135
Q

what ligaments are damaged with a plantar flexion inversion injury

A

ATFL and CFL

136
Q

what ligaments are damaged with a dorsiflexed inversion injury

A

CFL

137
Q

What defines Grade 3 ankle sprain

A

severe functional loss, inability to bear weight, diffuse swelling, diffuse ankle tenderness

138
Q

What does a patient with a grade one ankle sprain present with

A

minimal functional loss, no lump, no to minimal swelling, mild point-tenderness; pain with ankle inversion

139
Q

a patient presents with moderate functional loss, positive limp, localized swelling and moderate point tenderness of the ankle, what grade ankle sprain do they have

A

Grade two

140
Q

What are the grades of ankle sprains

A

1-3

141
Q

Anterior drawer and Talar tilt special tests are used for

A

ankle sprains to assess integrity of ATFL and CFL

142
Q

What are the Ottowa ankle rules

A

to determine if x-rays are necessary for ankle sprain patients
specific vs diffuse tenderness

143
Q

when can Ottowa ankle rules be overridden

A

patient is intoxicated/uncooperative, other distracting injuries, decreased sensation of the LEs, significant edema that limits ability to palpate

144
Q

what is a high ankle sprain

A

syndesmotic injury

145
Q

what is the MOI for high ankle sprain

A

everseion of the ankle

146
Q

patient presents with a high ankle sprain, what test are you going to perform to determine a syndesmotic injury

A

Hopkins test

147
Q

what is a positive Hopkins test indicative of

A

syndesmotic injury

148
Q

what is the most likely MOA for ankle dislocations

A

plantar flexion and inversion

149
Q

what way is the most common location for ankle dislocation

A

posteromedial dislocation

150
Q

what is usually present with a ankle dislocation

A

fracture-dislocation

151
Q

what are ankle dislocations at high risk for

A

neurovascular injury

152
Q

what x-rays do you get when concerned for ankle dislocation

A

AP, lateral and mortise (IR of the ankle)

153
Q

What are the three most common patterns for ankle fractures

A

Isolate malleolar, bimalleolar and trimalleolar

154
Q

what is a Pilon fracutre

A

distal tibia fracture +/- fibula that interrupts the cartilaginous surface

155
Q

if a patient has an adduction force to a supinated foot what is their most likely injury

A

Ankle fracture

156
Q

what is the treatment for stable ankle fractures that are non-displaced or with good reduction

A

cast for usually 4-6 weeks

157
Q

what type of ankle fractures require ORIF

A

unstable and inability to maintain reduction - open fractures

158
Q

What is the typically age range and gender for calcaneal fractures

A

Males 20-30 years of age

159
Q

What is a secondary response to a calcaneal fracture that you have to be aware of

A

compartment syndrome in 10% of calcaneal fractures

160
Q

a patient presents with moderate to severe heel pain, hindfoot edema, widening or shortening of the heel (deformity) , ecchymosis about the heel (extends to the arch) what is their likely diagnosis

A

calcaneal fracture

161
Q

A patient presents with calcaneal fracture - what images would you order for the patient

A

AP, Lateral, and Oblique/axial views

162
Q

what types of calcaneal fractures require operative treatment

A

displaced, intra-articular, fracture-dislocations, and open fractures

163
Q

what is a bulky jones splint used to treat

A

non-operative treatment for calcaneal fracture

164
Q

what metatarsal is the least likely to fracture in the foot

A

first metatarsal

165
Q

what are the common MOI for metatarsal fracture

A

Direct Trauma (drop something on the foot)
Twisting (toes get caught and continue ambulation)
Avulsion fractures
Stress
Fractures

166
Q

What imaging views are recommended for patients with concern for metatarsal fracutres

A

AP, Lateral +/- oblique views

167
Q

when is an MRI indicated for metatarsal fractures

A

to rule out stress fractures with negative x-rays

168
Q

a patient is placed into a hard sole shoe s/p metatarsal fracture - what bones are likely broken

A

second to fourth MT

169
Q

what are the zones that make up with 5th MT bone

A

Avulsion fracture (zone 1) - Pseudo-jones
Jones fracture (zone 2)
Stress fracture (zone 3)
Other

170
Q

What zones of 5th MT fractures have a high rate of non-union

A

Jones Fractures (Zone 2)

171
Q

What is a Lisfranc injury

A

fracture dislocation of TMT joint

Clin Med MSK: (14 decks)

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