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Orthopaedics and Trauma > Hip and knee > Flashcards

Hip and knee Flashcards

1
Q

Features of hip dislocation presentation

A

90% posterior, normally in high-impact (e.g. RTC)

10% sciatic nerve injury

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2
Q

Radiographic features of hip dislocations

A

posterior acetabulum

Head of femur superior to acetabulum

Femur in internal rotation + adduction

Affected femoral head may appear smaller

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3
Q

Which femoral fractures can disrupt blood supply

A

Intracapsular (i.e. proximal to intertrochanteric line)

  • Subcapital, transcervical
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4
Q

Management of extracapsular #NOF

A

Retain head + neck because blood supply preserved

DHS or intramedullary nail

Medical management of osteoporosis!

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5
Q

Garden classification of femoral fractures

A

1 + 2 better than 3+4

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6
Q

Intracapsular # NOF management options

A

Non-operative: Medically moribund

Operative:

  • Retaining head + neck (3 screws or DHS)
    • Garden I + II, DHS (it rhymes!)
    • More controversial for elderly
  • Replacement:
    • Young, active –> THR
    • Elderly, low functional baseline –> hemiarthroplasty

Medical management of osteoporosis!

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7
Q

Complications of hip replacement

A

Anaesthetic, bleeding, infection

Malunion

Leg length discrepancy

Fat embolus

VTE/pressure sores

Dislocation

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8
Q

Investigation of #NOF

A

Bloods: FBC, U+E, clotting, G+S, LFT

X: AP + lateral hip X-ray, X-rays of other images (incl CT head); CXR

ECG:

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9
Q

Complications of internal fixation of fractures

A

Non-union

AVN

Loss of reduction

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10
Q

Poor prognostic factors for mortality in #NOF

A

Delirium/dementia

Poor social/physical f(x)

Delay in surgery

Post-op chest infection, wound infection

Heart failure

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11
Q

Complications of #NOF

A

Chest infection

DVT/PE

Post-traumatic arthritis (related to AVN)

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12
Q

Early features of hip OA

A

Exercise-induced groin/anterior-medial thigh pain

Loss of internal rotation

Difficulty bending down e.g. shoelaces

May be referred pain to knee!

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13
Q

Presentation of greater trochanteric bursitis

A

Tenderness over greater trochanter + pain on lying/walking

Normal ROM

Evidence on US/MRI

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14
Q

Management of greater trochanteric bursitis

A

Self-limiting

Steroid injections if recurring

Surgical lengthening of fascia lata/removalof bony spur if intractable

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15
Q

Presentation of avulsion fractures of the hip

A

Young aptients (tendon > bone)

Pain first felt when kicking/twisting against resistance

Tenderness over rectus femoris origin

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16
Q

Types of avulsion fractures

A

Rectus femoris + AIIS

Tendon fascia lata/sartorius + ASIS

Hamstrings + ischium

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17
Q

Sources of referred hip pain

A

Lumbar spine spondylosis

Lumbar radiculopathy

Spinal stenosis

Sacro-iliac joint dysfunction

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18
Q

Mechanism for knee dislocation

A

High-impact e.g. RTC

Low-impact: athletic w/ rotational component, morbid obesity is a risk factor

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19
Q

Associated injuries knee dislocations

A

Vascular (5-15%)

Common peroneal nerve (25%)

Fractures (60%)

Ligaments

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20
Q

Features of patellar dislocation

A

Usually direct blow/sudden twist, often dislocates laterally

Intense pain w/ effusion

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21
Q

Management of patellar dislocation

A

Closed reduction

Post-reduction X-ray –> check reduction + for patellar #

Immobilisation in plaster/cast

Rehab w/ quad strengthening exercises

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22
Q

Causes of recurrent patellar subluxation

A

Tight lateral retinaculum –> pulls knee laterally (medial pain!)

Girls with valgus knees

Patella alta

Joint laxity

Hypotrophic lateral femoral condyle

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23
Q

Collateral ligament injury presentation

A

Valgus/varus stress on knee (direct blow on fixed foot)

Effusion + tenderness over affected ligament

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24
Q

Management of knee collateral ligament tear

A

Medial (more common) > normally managed conservatively (rest + support in hinged knee brace)

Lateral may need surgery if unstable/other ligamentous injury

25
Q

Cruciate ligament tear presentation

A

Twisting injury to the knee or dashboard injury

Pain, effusion, positive draw tests

Haemarthrosis

Manage with rest + physio + consider reconstruction (more difficult with PCL)

26
Q

Mechanism for meniscal tears

A

Adduction + internal rotation for lateral

Twisting/blow to flexed knee for medial

27
Q

Presentation of meniscal tears

A

Unable to walk, or only on tiptoe

Knee ‘locking’/’clicking’ (limited extension) due to lodging of torn fragment OR knee giving way

McMurray test +ve

IX: MRI to guide management

28
Q

Typical injury trid of the knee

A

ACL + medial collateral + medial meniscus

29
Q

Differential diagnosis dep on timing of knee swellign

A

Immediate: fracture (haemarthrosis)

Minutes-hours: ACL tear likely

Within 24h: Synovial effusion, ACL tear less likely, possible meniscal tear

30
Q

Epidemiology of tibial shaft fractures

A

Most common long bone fracture in adults

Commonly young males

Most commonly open fracture

31
Q

Management of closed tibial shaft fractures

A

Assess fo compartment syndrome

Interlocking intramedullary nailing

32
Q

Presentation of patellofemoral pain syndrome

A

Young atheletes, often associated with increase in training load

Patellar tracking/malalignment (ask for Hx of trauma or subluxation)

Symptoms: Patella aching after prolonged sitting or stairs

Signs: Medial retropatellar tenderness and tenderness on patellofemoral compression

33
Q

Management of patellar tendinopathy or patellofemoral pain syndrome

A

Rest, physio +/- NSAIDs

34
Q

Superficial bursitis presentation

A

Pain/swelling anterior to patella (can be prepatellar or infrapatellar bursa) and exacerbated by kneeling

Common overuse injury

35
Q

Knee bursitis management

A

Must not be aspirated so as not to seed infx!

May be treated with topical NSAIDs or steroid injection

36
Q

Pathophysiology of Baker’s cysts

A

Primary: Herniation of joint synovium

Secondary:Fluid buildup in semimembranosus bursa following chronic effusions in knee OA

37
Q

Management of Baker’s cyst

A

Rule out DVT/popliteal aneurysm

Analgesia

38
Q

Presentation of knee OA

A

Most common in black women, esp if >55 and high BMI

Knee pain on initiating movement, esp following inactivity (stairs, uneven ground)

Varus deformity

Crepitus + limited ROM

39
Q

Management of knee OA

A

NSAIDs

Weight loss

Quadriceps exercises

Osteotomy if young, active

TKR (if night pain or significant life impact)

40
Q

Signs of pelvic fracture

A

Leg length discrepancy

Abdominal distension

PV/urethral bleeding

PR: haematoma, # line, rupture

Loin bruising

Perineal/scrotal haematoma

41
Q

NOF mortality

A

1 month: 10%

1 year: 30%

42
Q

Management of pelvic fracture

A

External fixation with pelvic binder

Consider IR embolisation

43
Q

Insertions of ACL

A

Lateral condyle to intercondyloid eminence of tibia

Anterior attachment on tibia

44
Q

Insertions of PCL

A

Medial condyle of femur to posterior intercondyloid eminence of tibia

Posterior attachment on tibia

45
Q

Evaluation of hip screw placement

A

Tip-apex distance, determined under fluoroscopy

46
Q

Risks of knee replacement

A

Bleeding

Infection

Fracture

Soft tissue damage

NOT dislocation

47
Q

Late features of hip OA

A

Loss of ext rotation/abduction

Limb shortening

Fixed flexion/rotation

48
Q

Management of acutely locked knee

A

Get MRI first!

Do not force

49
Q

Function of ACL

A

Prevents FEMUR subluxing posteriorly on tibia (or tibia anteriorly on femur)

50
Q

Blood supply to femoral head

A

Medial circumflex artery

Lateral lesser extent

51
Q

Shapes of mensici

A

Medial: More crescent-shaped

Lateral: More circular

Blood supply from outside>in –> central avascular

52
Q

Inspection of hip

A

360d view

Increased lumbar lordosis - ?fixed flexion deformity 2ry to OA

Walking aids and gait - esp antalgic, Trendelenburg (abductor weakness)

Trendelenburg test (abductor weakness)

Leg length discrepancy

53
Q

Trendelenburg test

A

Standing on one leg, feel ASIS movement

ASIS moves down = weak hip abductors ON CONTRALATERAL SIDE

54
Q

Assessing leg length discrepancy

A

True - bony deformity e.g. due to fracture

ASIS > medial malleolus

Assess w/ flexed knees to find where discrepancy is

Apparent - joint deformity - e.g. fixed flexion due to OA/pain

Xiphisternum>medial malleolus

55
Q

Modified Thomas’ test

A

One hand under lumbar spine

Both knees up to chest actively, then passive from examiner to compare flexion

Extend normal hip then abnormal hip

If abnormal hip not extending fully OR lumbar spine pressure reduced then test + ve

Indicates fixed flexion deformity, note femur angle

56
Q

Special tests hip

A

FABER - flexion, abduction, external rotation, press down on knee - indicates intra-articular pathology

FADIR - flexion, adduction, internal rotation - indicates femoro-acetabular impingement

SLR - for sciatica, reproduces pain

57
Q

Causes of varus and valgus deformities

A

Valgus - usually RA

Varus: - OA medial degeneration

58
Q

Special tests knee

A

Leg lag test - Quad weakness

Anterior draw/Lachman’s: ACL

Posterior sag: PCL

Collaterals: Valgus/varus stress

Mensici: Joint line tenderness, McMurray’s

Orthopaedics and Trauma (8 decks)

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