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M3 ORTHO > Hip And Knee > Flashcards

Hip And Knee Flashcards

1
Q

Name the unhappy triad of the knee

A

ACL,MCL,medial meniscus

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2
Q

Which meniscus is more prone to acute which and is prone to lateral injury

A

Medial: chronic
Lateral: acute

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3
Q

Gardens classification is?

A

Neck of femur fracture

G1:partial fracture with valgus impaction
G2: complete fx undisplaced
G3:complete fx partial displacement
G4:complete fx complete displacement

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4
Q

What is Segond fracture and what is it associated with

A

Avulsion fx of tibial tuberosity
A/w ACL tear

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5
Q

What does disruption of Shentons line suggest

A

Displaced NOF fx

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6
Q

General principle for surgical mx of NOF fx

A

Displaced replace
Undisplaced fix

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7
Q

Radiological invx for OA knee

A
  1. AP lateral knee
    2.Skyline
    3.Long bone weight bearing
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8
Q

What do posterior and anterior drawer test for

A

Posterior drawer is PCL
Anterior drawer is ACL

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9
Q

Injectable options for knee OA

A
  1. Corticosteroids
  2. Hyaluronic acid with Lignocaine
  3. +-Autologous Protein Solution
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10
Q

Surgical mx of knee OA

A
  1. High Tibial osteotomy
  2. Unicompartmental KR
  3. TKR
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11
Q

XR findings for ACL tear

A

Segonds sign/fracture:avulsion fx from ALL
Terminalis sign?
Osteochondral bodies
Signs of joint effusion

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12
Q

Most common mechanism of injury

A

Twisting injury where knee is flexed,valgus and externally rotated

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13
Q

Types of ACL reconstruction grafts

A

Allogenic vs autologous
Hamstring vs Bone Patella Tendon graft

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14
Q

Absolute CIs for total knee replacement

A

Knee sepsis, chronic infection,severe vascular disease,etc

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15
Q

Three compartments of the knee

A

Medial, lateral and patellofemoral

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16
Q

Three compartments of the knee

A

Medial, lateral and patellofemoral

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17
Q

Main indications for TKR

A

Tricompartmental knee disease causing significant morbidity to patient

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18
Q

Demographic for high tibial osteotomy

A

Young or active patients with unicompartmental knee OA

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19
Q

Goals of TKR

A
  1. Restore neutral alignment of joint
  2. Restore joint line
  3. Balance ligaments
  4. Normal Q angle
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20
Q

How to dydx Gardens 3 and 4 fx

A

Presence of trabeculae is grade 4

21
Q

Types of femur fracture more common in each age group

A

Older: IT fx( Osteoporotic area)
Younger:NOF fx

22
Q

Type of femur fx that can heal well without surgical intervention

A

Intertrochanteric fx as it is cancellous bone

23
Q

What does the Crescent sign indicate

A

Fixation Arlet stage 3, subchondral collapse has collapsed and collapse of femoral head impending

24
Q

Direct risk factors for hip AVN

A

Irradiation
Haematologic diseases - leukemia, lymphoma)
Dysbaric disorders - Caisson disease
Marrow replacing diseases
Sickle cell disease

25
Q

Indirect risk factors for hip AVN

A

Alcoholism
Hypercoagulable states
Steroids (endogenous or exogenous)
SLE
Transplant patient
Virus (CMV, HIV, rubella)
Protease inhibitors (HIV medications)
Idiopathic

26
Q

Characteristic of hip dysplasia

A

Shallow acetabulum with lack of anterior and lateral coverage:femoral head prone to subluxation and lateralisation, coxa valga

27
Q

Radiological dx of AVN hip

A

XR sufficient if gross changes
MRI if early/clinical suspicion strong for AVN hip

28
Q

Mx of Hip AVN

A

Conservative: Mixed evidence for bisphospho

29
Q

Classifying management of intratrochanteric fx

A

?
Stable:

30
Q

Rhyme for mx of intertrochanteric fx

A

1 2 screw
3 4 Austin moore

(For Gardens)

31
Q

Use of Gardens

A

Risk of AVN and hence whether to fix or replace

32
Q

Age to guide NOF fx mx

A

<65 is young NOF: Emergent surgery to fix and preserve native hip

33
Q

Hemiarthroplasty vs THR

A

Bipolar for relatively low functional needs OR increased comorbids

THR for high activity/functional status

34
Q

Risk factors for AVN Hip

A

Alcoholism
Smoking
Steroid use:TCM or drugs
Endocrinopathy
Trauma
Diving
Hypercoagulable state
Congenital hip pathology
Retroviral drug use

35
Q

Mx of AVN Hip

A

Conservative: Analgesia, Bisphosphonates +-

Surgical: divided into joint preserving and joint replacing

P: Core decompression or osteotomy
R: THR

36
Q

main blood supply of femoral head

A

medial circumflex femoral artery

37
Q

Indication for PFNA

A

Intertrochanteric hip fx

38
Q

Classification system for Intertrochanteric fx

A

Evans

39
Q

Differentiating THR vs bipolar hemi vs unipolar hemi

A

1) THR - femoral + acetabular component (must be screws/some structure going into the pelvic bone)

2) Bipolar - round ball with a cap (nothing done on the acetabular, but acetabulum surface rotating on the round cap)

3) Unipolar - round ball with stem
Moore’s - 2 holes (2x OO)
Thompson’s - 1 hole

40
Q

Treatment of Osgood Schlatter disease1

A

Mainly non surgical
1. Pain mx eg NSAIDs
2. Lifestyle changes eg quadriceps stretching

41
Q

Risk factors for Hip AVN

A

Modifiable
1. Trauma
2. Smoking
3. Corticosteroid/TCM use
4. Deep sea diving
5. Radiation exposure
6. Alcoholism
7. Septic Arthritis
8. Malignant infiltration

Non Modifiable
1. Childhood Hip disorders(DDH, Perthes, SCFE)
2. Sickle cell anemia
3. Thrombophilias
4. Autoimmune eg SLE, RA
5.Gaucher
6. Idiopathic

42
Q

Mx of Hip AVN

A

Nonoperative:
- bisphosphonates for pre-collapsed AVN (FA 0-II)
Operative:
- Core decompression +/- bone graft to relieve IO HTN  early AVN, pre-collapse
- Rotational osteotomy for small lesions that have rotated away from WB surface
- Curettage + bone grafting for pre-collapsed
- Vascularized-free fibular transfer  remove large necrotic area and fill with fibular to prevent collapse
- THR
-Total hip resurfacing
- Hip arthodesis

43
Q

Mx of Hip AVN Ficat Arlet 0-2

A
  1. Bisphosphonates
  2. Core decompression
  3. Rotational osteotomy( For small lesions)
  4. Curettage and bone grafting
44
Q

Mx of Hip ACN Ficat Arlet 3

A

Removal of necrotic area + replacement with fibular strut

45
Q

Mx of Hip AVN Ficat Arlet 4

A
  1. Hemi-resurfacing arthroplasty(<1/3 of femoral head involved and relatively intact acetabulum)
  2. THR
  3. Arthrodesis
46
Q

Ficat Arlet staging

A

For Hip AVN

1: Normal XR +- osteopenia
2. Signs of bone remodelling( Cystic or sclerotic changes)
3. Crescent sign(subchondral collapse) or flattening of femoral head
4. Narrowing of joint space and degenerative changes of acetabulum

47
Q

Causes of positive Trendelenburg sign

A
  1. Iatrogenic – post surgical (direct trauma to muscles, superior gluteal nerve injury from retraction) – usually in anterolateral approach
  2. L5 radiculopathy
  3. Advanced AVN of the hip
  4. Hip OA
  5. DDH, SCFE, Perthes
48
Q
A

M3 ORTHO (10 decks)

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