Final Exam Flashcards
Osteochondral dissecans (OCD)
a condition seen in older children, teenagers, and young adults, particularly those active in sports. Clinical signs include dull pain, subtle limp, mechanical symptoms (popping, locking), and joint effusion are exacerbated with weight-bearing activity.
Osgood-Schlatter Disease
11-15 yo
Growth spurts
Male>female
Self Limiting
Degenerative Joint Disease
pain worse with weight-bearing activities, intermittent joint effusions, in advanced stages, there is loss of function and varus or valgus deformations.
The characteristic radiographic signs of degenerative joint disease at the knee may include the following…
- Decreased radiographic joint space
- Sclerosis of subchondral bone
- Osteophyte formation at joint margins
- Subchondral cyst formation
- Varus or valgus joint deformity
Fracture of the femur
pain, inability to bear weight, and swelling. Can be caused by high energy collision, MVA, or falls.
Fracture of the tibial plateau
Traumatic fracture that can extend to the joint surface or exhibit articular depression that affects joint stability and function. Can be caused by valgus or varus force combined with axial loading, fracture can also occur in osteoporotic bone from low impact trauma
Signs and symptoms of tibial plateau fracture
Pain, inability to bear weight or flex knee, knee joint effusion
Peripheral arterial occlusive disease
Age >60, history of type 2 diabetes, ischemic heart disease, smoking, sedentary lifestyle, concurrent intermittent claudication
Peripheral arterial occlusive disease symptoms
unilateral cool extremity (may be bilateral if aorta is site of occlusion), prolonged capillary refill time (>2 sec), decreased pulses in arteries below level of occlusion, prolonged vascular filling time, ankle-brachial index <0.90
Deep vein thrombosis
Recent surgery, malignancy, pregnancy, trauma, or leg immobilization. symptoms include calf pain, edema, tenderness, and warmth
Compartment syndrome
History of blunt trauma, crush injury, or unaccustomed exercise
Compartment syndrome symptoms
severe, persistent leg pain that is intesified with stretch applied to involved muscles, swelling, tenderness and palpable tension/hardness of involved compartment, paresthesia, paresis, pallor, or pulselessness.
Septic arthritis
History of recent infection, surgery, or injection, coexisting immunosuppressive disorder
Septic arthritis symptoms
constant aching, or throbbing pain, joint swelling, tenderness, or warmth, May have elevated body temp
Cellulitis
history of recent skin ulceration or abrasion, venous insufficiency, congestive heart failure, or cirrhosis
Cellulitis symptoms
Pain, skin swelling, warmth, irregular margin of erythema/reddish streaks, fever chills, malaise, and weakness
Radiologic signs of ankle instability following severe sprains are seen on the…
anteroposterior view as an abnormal position of the talus and increased width of the ankle mortise joint space, and positive anterior drawer test.
ottowa ankle rule for trauma: Any pain in the malleolar zone AND any one of the following:
Bone tenderness along the distal 6 cm of the posterior edge of tibia or tip of medial malleolus OR
Bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus OR
An inability to bear weight both immediately and in the emergency department for four steps
Weber Classification system
- Fracture below the ankle joint, usually stable but may require ORIF if medial malleolus is fractured.
- Fracture at the level of the joint, with the tibiofibular ligaments intact, variable stability
- Fracture above the joint level which tears the syndesmotic ligaments, unstable, required ORIF
Maisonneuve fracture
refers to a combination of a fracture of the proximalfibulatogether with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distaltibiofibular syndesmosis,deltoid ligament) and/or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism.
low-risk stress fracture areas
posteromedial tibia, 2nd/3rd metatarsals, calcaneous, distal fibula, cuboid, and cunieforms
high-risk stress fracture areas
anterior tibial cortex, medial malleous, navicular, talus, base of 5th, base of 2nd metatarsal, and hallux sesamoids
Tarsal coalition
Congenital bony or fibrocartilaginous union between two or more tarsal bones with talocalcaneal and calcaneonavicular being most common. S/x include painful ambulation and limit foot ROM, which becomes pronounced after bones are ossified in late childhood or early adolescence.
Fracture of talar neck
Can be caused by hyperdorsiflexion which forces the talus against anterior tibia as seen in landing from height or MVA. Talus is predisposed of developing avascular necrosis after fracture
Osteomyelitis in foot of diabetes patients
ulcers tend to be at weightbearing bones. Cellulitis and draining sinus tracts may be present. Pain is variable due to neuropathy
Boehler’s angle
often used to evaluate the angular relationship of the talus and the calcaneus in the presence of trauma. This angle is determined by the intersection of lines drawn from the posterior aspect of the subtalar joint to the anterior process of the calcaneus (a) and across the posterior superior margin of the calcaneus (b). Normal values range from 25 to 40 degrees, and lesser values will be seen in the presence of impacted calcaneal fractures.
Trauma: Ottawa Ankle Rule (Foot): Any pain in the midfoot zone and any one of the following:
Bone tenderness at the base of the fifth MT OR
Bone tenderness at the navicular bone OR
An inability to bear weight both immediately and in the emergency department for four steps.
Lisfranc fracture-dislocations
the most common type of dislocation involving thefootand correspond to the dislocation of the articulation of the tarsus with the metatarsal bases. Look for medial plantar bruising which is considered to be a hallmark sign of a lisfranc injury
Hallux valgus
deformity of the forefoot in which the first metatarsal is deviated medially and the great toe is deviated laterally.
Pes cavus
abnormally high medial longitudinal arch of the foot, with a calcaneal inclination greater than 30 degrees as measured on the lateral view.
Pes planus
an abnormally low medial longitudinal arch of the foot, the result of a developmental deformity, tarsal coalition, soft tissue injury or dysfunction, and neuromuscular conditions.
Hallux Valgus degree angles
Normal: less than 15 degrees / 9 degrees
Mild: 15 to 30 degrees / 9 to 13 degrees
Moderate: 30 to 40 degrees / 13 to 20degrees
Severe: over 40 degrees / over 20 degrees
Talipes Equinovarus
Club foot
Forefoot is in adduction relative to the hindfoot
Also equinus/PF position of the heel
Inversion of the subtalar joint with varus hindfoot
Ottawa knee rules
Knee radiographs are indicated when patient presents with any of these:
Age >55 years
tenderness at head of fibula
isolated tenderness on patella
inability to flex knee to 90 degrees
inability to weightbear 4 steps both immediately and in the emergency department
