Disorders of the LE Flashcards
What are other names for AVN
bone infarction, osteonecrosis, ischemic necrosis, aspetic necrosis
What are risk factors for AVN
ETOH, Steriod use (most common), sickle cell, lupus, infection, HIV/AIDs, prior joint with AVN
What is the ASEPTIC acronym for
AVN
Alcohol/Aids/HIV
SLE/Sickle cell
Exogenous steroids
Pancreatitis
Trauma
Infection/irratation
Caisson disease (decompression sickness)
How does AVN of the hip present
groin pain
How is AVN diagnosed
imaging - may not be detected early on x-ray
MRI more sensitive for diagnosis
what is the treatment of AVN without bony collapse
osteoporosis drugs (bishosphates - aldendrate)
surgical procedures to induce revascularization
what is the treatment for AVN with collapse or in older patients
arthroplasty
What is SCFE
Slipped Capital Femoral Epiphysis
when does SCFE occur most often
adolescents 10-16 with more common in overweight and obese males
What is the common presentation of SCFE
hip pain (groin and thigh)
associated with limp or ER of the leg
reduced ROM - loss of IR, reduced flexion and ABDuction
What is the most common treatment for SCFE
percutaneous fixation (pinning)
what is the goal of percutaneous pinning for SCFE patients
stabilize and prevent further slippage , NOT full reduction
What is the most common orthopedic disorder in newborns
Developmental Dysplasia of the hip (DDH)
What newborns are at higher risk for DDH
firstborn breech newborns
what other deformities are often associated with DDH
metatarsus adductus and torticollis
what is DDH
essentially abnormal hip development (acetabulum)
define dysplasia
shallow, underdeveloped acetabulum
What is the mainstay diagnostic tests for DDH
Barlow and Ortolani maneuvers
all infants routinely screened (until walking)
Barlow Maneuver
dislocates a dislocatable hip; “click” on exit
Ortolani maneuvers
reduces a dislocated hip; “clunk” on entry
when is imaging started for DDH
4 to 6 months when ossification of the femoral head begins
what is the treatment for DDH
Pavlik harness first line
Spica casting for 6-18 months or failure of harness
when is open reduction with a spica recommended for DDH
older than 18 months with failure of the spica
when is open reduction with osteotomy recommended for DDH
older than 2 years with persistent dysplasia
What is trochanteric Bursitis
inflammation of the trocanteric bursa between greater trochanter and IT band
What is the treatment for trochanteric bursitis
Rest, ice
NSAIDs
PT/stretching
Intra-bursal injection
bursectomy last resort
when are hip dislocations more common
s/p THA with less force in comparison to native joint
what is the treatment for hip dislocations
closed reduction with sedation or open reduction
what rates are higher after hip fractures
high mortality and morbidity rates
what are risk factors for hip fractures
advancing age
osteoporosis
history of falls
smokers
prior trauma
what views of x-rays are needed to assess for hip fractures
AP, lateral and traction views
when is a CT needed for a hip fracture
Delineation of displacement and determine fracture pattern
when is an MRI indicated for a hip fracture
if there is concern for occult fracture
When is ORIF used for hip fractures
non-displaced or young patients
when is an arthroplasty indicated for a hip fracture
when the fracture is displaced or older patients
when is observation or non-operative management indicated for hip fractures
if a patient has multiple comorbidities, poor pre-injury functional status or high operative risk
What are complications in regards to hip fractures
high readmission rate
high mortality rate
high revision/conversion rate
high risk for functional impairment
risk for osteonecrosis
risk of non-union
How much blood can be ‘stored’ in the thigh
one liter of blood
what do you have to use caution with for femur fractures
hemodynamic instability
When are femoral shaft fractures common
young males 15-24yo (trauma) vs Females >75 (fragility fx)
When is CT indicated for femoral shaft fractures
to delineate fracture pattern
what is varus in the knee
bow leg
what is valgus in the knee
knock kneed
What athletes are at an increase risk for IT band syndrome
Runners and cyclists
what knee alignment increases your risk for IT band syndrome
knees with Varus alignment
what special test is positive with IT band syndrome
Obers test (inability to adduct in extension)
what is Osgood Schlatters disease
apophysitis of the tibial tubercle - inflammation at or near the growth plate
what is key on the exam of Osgood Schlatters
pain with knee extension against resistance
what type of injury is the leading indication for knee arthroscopy
meniscal tears
what is the most common type of meniscal tear
medial is more common than lateral
What location is common for degenerative tears of the meniscus
posterior horn
what are the mechanical symptoms for meniscal tears
clicking, locking especially with flap and bucket handle tears
what special tests are used for meniscal tears
apleys compression and McMurrarys test
when is surgical intervention indicated for meniscal tears
younger patients and traumatic injury
what determines partial meniscectomy vs repair for meniscal tear
location of the tear is important
What does the ACL prevent
anterior tibial translation
what is the MOI for ACL injuries
sudden stopping and pivoting or direct lateral blow to the knee
what special tests are used for ACL injuries/tears
Lachmans/anterior drawer
+ for both is laxity and the ability to pull the tibia towards examiner
what imaging modalities are recommended for ACL injuries
MRI
what is the most common treatment for ACL tear
ACL reconstruction
Autograft vs allograft
What does the PCL do
prevent posterior translation of the tibia
What ligament is stronger the ACL or PCL
PCL is stronger
What is the MOI for PCL tears
MVC - knee hitting the dashboard
fall directly onto bent knee
hyperextension injury
what special tests are used for PCL tears/ injury
posterior drawer and Sag sign
what is the treatment options for PCL tears
if not associated with other injuries - non-operative management
if associated with other injuries - PCL repair/reconstruction
what other injuries are associated with MCL injuries
ACL and meniscus injuries
what makes up the unhappy triad
ACL + MCL _ meniscus tear
what is the MOI for MCL injuries
Excessive valgus force (blow from lateral knee)