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OSCE Revision 2022 > Femur > Flashcards

Femur Flashcards

1
Q

What is the angle of femoral inclination, and what is the norm in a newborn child and in an adult?

A
  • angle formed between the long axis of the HoF and NoF and the long axis of the shaft of the femur
  • newborn: 150 degrees
  • adult: 128 degrees
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2
Q

What is coxa valga?

A
  • increased angle of inclination
  • femoral inclination angle has not reduced to 128 degrees
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3
Q

What is coxa vara?

A
  • decreased angle of inclination
  • femoral inclination angle has reduced past 128 degrees
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4
Q

What are some signs of coxa valga?

A
  • degree of HJ dislocation
  • may be associated with genu varum
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5
Q

What may cause coxa valga?

A
  • lack of development of the HoF and NoF relative to the shaft (dysplasia)
  • trauma may cause unilateral coxa valga
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6
Q

What are some signs of coxa vara?

A
  • shorter limb on affected side
  • decreased abduction and medial rotation
  • positive trendelenberg
  • may have associated genu valgum
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7
Q

What may cause coxa vara?

A
  • primary defect in the endochondral ossification of the medial aspect of the NoF
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8
Q

What is ‘version’ in the femur?

A

“state of having been turned, deviated, oriented”
relates to the NoF and HoF which is normally turned or tilted towards the anterior aspect of the body (towards the frontal plane) by around 16 degrees (15-20)

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9
Q

What is anteversion?

A
  • the NoF and HoF is turned or tilted further towards the anterior aspect of the body (towards the frontal plane)
  • results in lateral rotation of the leg
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10
Q

What is retroversion?

A
  • the NoF and HoF is turned or tilted away from the anterior aspect of the body
  • results in medial rotation of the leg
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11
Q

What is torsion in the femur?

A

A structural, osseous state of twist in a bone along it’s longitudinal axis.

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12
Q

What is antetorsion?

A
  • medial femoral torsion
  • a medial twist of the distal end of the femur on the proximal end of the femur
  • medially rotated thigh
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13
Q

What is retrotorsion?

A
  • lateral femoral torsion
  • lack of normal medial torsion or a true lateral twist of the distal end of the femur on the proximal end of the femur
  • laterally rotated thigh
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14
Q

What is the normal amount of version/torsion in a newborn?

A

Version: anteversion = 60 degrees
Torsion: antetorsion = 30 degrees
Overall 30 degrees laterally rotated position of the hip

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15
Q

What is the normal amount of version/torsion in an adult?

A

Version: anteversion = 15-20 degrees
Torsion: antetorsion = 15-20 degrees

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16
Q

A position of anteversion and retrotorsion will result in…

A

a laterally rotated gait profile and retrograde pronatory forces through the foot

17
Q

A position of retroversion and antetorsion will result in…

A

a medially rotated gait profile and either supinate type foot or splayed pronated foot type

18
Q

How can torsion be corrected?

A

If torsion is great enough that it requires treatment then surgical reduction and fixation to derotate the femur is only option.

19
Q

What happens if attempt to correct torsion by creating opposing torsion in the lower limb?

A

it will twist at the place of resistance e.g. the knee - can de-stabilise the knee

20
Q

What is the assessment for femoral torsion?

A

Ryder’s Test

21
Q

What is the Ryder’s Test?

A

Clinical measure of femoral torsion - best measure possible without using imaging.
Femoral torsion = Ryder’s finding +/- assumed amount of anteversion

22
Q

What is Legg-Calve-Perthes Disease?

A

Idiopathic juvenile avascular necrosis of the HoF

23
Q

What is the pathology of Legg-Calve-Perthes?

A

Repeated bouts of infarction and pathological #’s as a result.
3 stages - blood supply disrupted, softening and collapse of bone because of interrupted blood supply, and re-establishment of blood supply and some repair and remodelling of HoF

24
Q

What is the result of Legg-Calve-Perthes?

A

Widening and flattening of the HoF - instead of spherical appearance

25
Q

What are the symptoms/clinical signs of Legg-Calve-Perthes?

A
  • pain at groin or anterior HJ/greater trochanter/medial knee
  • limp exacerbated with activity and alleviated with rest
  • restricted ROM with decreased medial rotation and abduction
  • positive Trendelenburg
26
Q

What is the aim of treatment for Legg-Calve-Perthes?

A

To preserve and maintain HoF shape and reduce stiffness and the risk of degenerative arthritis

27
Q

What is the treatment for Legg-Calve-Perthes?

A

Treatment involves monitoring, analgesics, slings/casting, or surgery (containment in lateral rotation, abduction and flexion to encourage spherical modelling of the HoF).

28
Q

What is Slipped Upper Femoral Epiphysis (SUFE)?

A

The NoF and the shaft displace upwards and anteriorly.

29
Q

What signs are associated with SUFE?

A

Antalgic gait, out-toeing, shortening of affected limb, obligatory lateral rotation of the thigh with HJ flexion

30
Q

What is the treatment for a SUFE?

A

-requires prompt diagnosis and treatment
- immobilise
- analgesics
- urgent orthopaedic assessment
- surgery to stabilise the capital femoral epiphysis onto the NoF to prevent further slippage
- hospital admission

31
Q

What are the complications of a SUFE?

A
  • osteonecrosis
  • chondrolysis
  • OA
  • impingement
32
Q

What are the symptoms of an acute SUFE?

A
  • sudden onset of pain
  • # like pain
  • unable to WB
  • refusal to mobilise the limb
  • needs to be immobilised
33
Q

What are the symptoms of chronic SUFE?

A
  • groin pain radiating to anteromedial thigh and KJ
  • antalgic limp
  • pain for >3 weeks
  • no sudden exacerbation
    85% of pts with SUFE have chronic form
34
Q

What is the ratio of M:F who are diagnosed with SUFE?

A
  • M>F 60% of the time
  • boys mean age 13.5, girls 12
35
Q

What is the ratio of M:F who are diagnosed with Legg-Calve-Perthes?

A
  • boys>girls, 4-5:1

OSCE Revision 2022 (15 decks)

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