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Musculoskeletal > Elective Lower Limb Surgery > Flashcards

Elective Lower Limb Surgery Flashcards

1
Q

Outline the anterior (Smith-Peterson) approach to the hip

A
  • Via inter-nervous interval between sartorius and TFL

- Rectus femoris is detached to arrive at anterior joint capsule

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2
Q

What structures are at risk during anterior approach to the hip

A
  • Lateral femoral cutaneous nerve
  • Femoral nerve
  • Ascending branch of lateral femoral cutaneous artery
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3
Q

When is an anterior approach to the hip used

A
  • Open reduction in DDH

- Biopsy

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4
Q

Outline the anterolateral (Watson-Jones) approach to the hip

A
  • Approaches joint between TFL and gluteus medius

- Anterior portion of gluteus medius is detached to improve access to the femur

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5
Q

What structures are at risk during an anterolateral approach to the hip

A

Femoral nerve

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6
Q

Outline the posterior (Moore/Southern) approach to the hip

A
  • Patient in lateral decubitus position
  • Lateral incision made over GT and extended one hand above and below
  • Fascial lata is split in line of its fibres
  • Middle of gluteus medius is split in line of its fibres
  • Short external rotators are exposed
  • A stay suture is placed in the short external rotators
  • They are reflected back to protect the sciatic nerve
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7
Q

What structures are at risk during posterior approach to the hip

A

Sciatic nerve

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8
Q

What muscle does the Trendelenburg test test

A

Gluteus medius

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9
Q

What second-line investigation can be used to confirm OA if the hip joint appears relatively well preserved on x-ray

A

Diagnostic local anaesthetic injection into the joint

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10
Q

What type of THR materials may be used in younger patients requiring hip replacement

A

Ceramic-on-polyethylene (as opposed to metal-on-polyethylene)

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11
Q

What causes the snapping hip (coxa saltans)

A

A) Snapping IT band over the GT

B) Iliopsoas snaps over the iliopectineal eminence

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12
Q

How are acetabular labral tears diagnosed

A

MRI

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13
Q

What are the attachments of the medial meniscus

A
  • Anterior and posterior intercondylar areas
  • Capsule
  • MCL
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14
Q

What muscle ‘unlocks’ the knee

A

Popliteus

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15
Q

Outline the medial parapatellar approach to the knee

A
  • Longitudinal incision skirting the medial border of the patella
  • Joint is opened from medial border of quadriceps tendon
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16
Q

Outline the procedure for knee aspiration

A
  • Knee in full extension
  • Clean anterior aspect of knee
  • Enter suprapatellar pouch on either medial or lateral side
17
Q

What deformity is typically present in knee OA

A

Varus

18
Q

What surgical intervention can be applied to young people with unicompartmental knee OA

A

High tibial (or distal femoral) osteotomy can be used to realign the weight-bearing surface of the limb

19
Q

Describe the limits of subtalar joint movement

A
  • Inversion 10 degrees

- Eversion 20 degrees

20
Q

Describe the limits of forefoot movement

A
  • Inversion 15 degrees

- Eversion 10 degrees

21
Q

What causes claw toes

A

Weakness of the interosseous and lumbrical muscles (which normally extend the PIP and DIPs of the toes and flex MTPs)

22
Q

Associations of hammer toes

A
  • Hallux valgus

- Overcrowding of toes in pointed/small shoes

23
Q

What is hammer toe

A
  • Hyperextension of MTP and DIP
  • Flexion of PIP
  • Affects 2nd/3rd/4th toes
24
Q

List the neurological causes of Pes Cavus

A
  • Poliomyelitis
  • Spinocerebellar degenerative diseases (e.g. Friedreich’s ataxia)
  • Spastic diplegia
25
Q

How may Pes Cavus be surgically corrected

A
  • Lengthening of Achilles tendon
  • Calcaneal osteotomy
  • Flexor-to-extensor tendon transfer
26
Q

Describe a bunion

A

Inflamed adventitious bursa produced over the prominent head of the first metatarsal by pressure and friction

27
Q

Outline the surgical procedures for Hallux valgus correction

A
  • Mild-moderate = distal osteotomy of the 1st metatarsal and bunionectomy
  • Severe = shaft or proximal osteotomy
28
Q

How does hallux rigidus develop in young people

A
  • Injury e.g. kicking a football

- Causes osteochondritis dissecans of 1st metatarsal head

29
Q

How may hallux rigidus be treated

A
  • Stiff-soled shoes
  • MUA +/- steroid
  • Fusion of MTP joint
30
Q

What is the most common cause of forefoot pain

A

Metatarsalgia

31
Q

Describe Morton’s neuroma

A

Plantar of digital neuroma commonly affecting the plantar nerve running between the 3rd and 4th metatarsal heads of the 3rd webspace

32
Q

What muscle provides the main support for the longitudinal arch of the foot

A

Tibialis posterior

33
Q

What is the main cause of adult ‘flat feet’

A

Tibialis posterior insufficiency

Musculoskeletal (5 decks)

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