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Clin Med IV Exam 1 > Hip and LE Injuries > Flashcards

Hip and LE Injuries Flashcards

1
Q

Hip Fracture mechanism

A

After a fall from standing position in person >50yo

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2
Q

Hip Fx presentation

A
  • hip/groin pain
  • NON-AMBULATORY or need assistance
  • May have internal/external rotation of leg
  • INTERNAL ROTATION very sensitive for fx
  • TTP
  • pain w/ passive/active ROM
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3
Q

60yo female pt w/ osteoporosis falls from standing position and presents w/ internal rotation of femoral head on pelvic x-ray. What fracture is it?

A

HIP FRACTURE

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4
Q

Risk Factor for hip fracture

A

osteoporosis

female

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5
Q

X-Ray views for hip

A

AP pelvis

Frog lateral

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6
Q

Tx hip fracture

A
  • always SURGICAL

- approx 25% pt w/ hip fx do not survive past 1 yr

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7
Q

Tx NON-DISPALCED femoral neck fx

A

Cannulated screws

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8
Q

Tx DISPALCED femoral neck fx

A

Hemiarthroplasty (half hip replacement)

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9
Q

Tx intertrochanteric fx

A

IM nailing
DHS compression screws

*worried about blood supply

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10
Q

Subtrochanteric fx tx

A

IM nailing

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11
Q

Hip arthritis presentation

A
  • ACHY pain in hip and/or groin
  • **stiffness in morning of after prolonged sitting, -“loosening up” after 30min activity
  • Pain increase w/ prolong activity, and relieved w/ rest
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12
Q

What kind of gait may a pt w/ hip arthritis have?

A 
Antalgic gait (antalgic = "against pain")
Trendelenburg gait
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13
Q

1st line tx hip arthritis

A

Tylenol w/ NSAID as adjunct

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14
Q

Common risk factors for hip arthritis

A 
Adv age
Female
Obesity
Post-trauma
Structural changes to joint
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15
Q

Greater Trochanteric Bursitis presentation

A
  • Achy, intense, LATERAL SIDED hip pain
  • worse w/ direct pressure like sitting, laying on affected side
  • painful ambulation
  • pain RADIATES down lateral THIGH
  • TTP over great troch
  • pain w/ passive hip rotation, adduction & resisted hip abduction
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16
Q

Mechanism of injury for greater troch bursitis

A

minor DIRECT trauma over great troch

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17
Q

Pt presents w/ achy pain, stiff in morning, but loosens up after walking around during the day. Gets stiff when sitting for too long again. Has Antalgic gait. Pain does not radiate.

What hip injury may this be?
A. Hip fracture
B. Femoral neck fx
C. Hip arthritis
D. Greater trochanteric bursitis
A

Hip Arthritis

Key words: achy pain, stiffness that gets better, antalgic gait

Treatment:
#1 tylenol w/ NSAIDs
-activity modification
-PT
-Cane, brace
-Intra-articular cortisone injection
-Total hip arthroplasty
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18
Q

Femoral Acetabular Impingement (FAI) presentation

A
  • GROIN pain, RADIATE to lateral HIP
  • Dull ache, waxes/wanes w/ activity/rest
  • Improves w/ PT but sx return after PT stopped
  • Can present as sharp, stabbing pain
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19
Q

Etiology of Femoral acetabular impingement?

A
  • femoral neck abnormally shaped during childhood growth
  • impingement sx in femoracetabular joint
  • athletically active ppl may experience sx earlier
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20
Q

2 types of FAI

A

Cam Bone Spur–abnormal femoral head/neck junction w/ increase radius at waist

Pincer Bone Spur–excessive acetabular coverage; linear contact between labrum & femoral head/neck junction

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21
Q

Dx test for FAI

A

Impingement Test

-hip flexion to 90deg, adduct to 20, internal rotation

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22
Q

Tx FAI

A

Surgical:

  • Arthroscopy
  • Femora head/neck resection to correct deformity

Nonsurgical:

  • activity mod
  • NSAIDs
  • PT

*good prognosis PT + activity modification

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23
Q

60yo pt has left lateral sided hip pain that radiates down lateral thigh after minor injury to that area. Pain worsens w/ laying on left side. Pain w/ passive hip rotation, adduction & resists hip abduction.
What hip injury may this be?

A. Hip fracture
B. Hip arthritis
C. Greater Trochanteric Bursitis
D. Femoral Acetabular Impingement

A

Great Trochanteric Bursitis

Key works: lateral hip pain, radiate to lateral THIGH, pain w/ direct pressure on that area, pain w/ passive movement

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24
Q

Femur Fracture presentation

A
  • presents after trauma
  • NWB
  • mod-severe pain
  • affected leg may be rotated & shortened
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25
Q

Mechanism of energy of femur fx

A
  • HIGH ENERGY/VELOCITY injury
  • MVA, fall from height
  • Potential for severe blood loss & loss of life/limb if femoral artery severed

*check for other injuries

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26
Q

Why can there be a lot of bleeding w/ a femur fx?

A

Bc of FEMORAL ARTERY severed/injured

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27
Q

Tx femur fx

A
  • address life threatening injuries 1st; may need Ex-Fix
  • IM nailing preferred definitive tx
  • Analgesic & anticoag
  • PT
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28
Q

Definitive tx femur fx

A

IM nailing

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29
Q

25yo female pt presents w/ NWB, non-ambulatory. Hip pain after falling off a cliff. Femur is internally rotated on x-ray. Pain on palpation. Pain w/ active/passive ROM. What injury may this be?

A. Hip Fracture
B. Femur Fracture
C. Hip Arthritis
D. Femur Acetabular Impingement?

A

Hip Fracture

*high velocity traumas can cause hip fracture in younger pts; but more commonly in older females w/ osteoperosis

Key word: internally rotated femur; pain w/ active/passive ROM

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30
Q

Mechanism of injury Tibial Plateau Fx

A
  • High-energy/DECELERATION injury
  • Seen from falls and MVC
  • Will occur in conjunction w/ other LE fx
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31
Q

Tibial plateau fx presentation

A
  • NWB
  • mod-severe pain
  • RESIST active/passive ROM
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32
Q

Imaging for tibial plateau fx

A

Standard Trauma series of knee

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33
Q

Tx tibial plateau fx

A

Stable –> Hinged knee brace, crutches, long-leg cast for initial immobilization

Unstable –> ORIF w/ side plate & screws

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34
Q

Segond Fx presentation

A
  • Knee pain/swelling after trauma
  • Knee held in approx 20deg flexed
  • NWB
  • Mod-large effusion over lateral aspect knee
  • Resist full extnesion
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35
Q

Mechanism of injury Segond Fx

A
  • Avulsion fx involving lateral aspect tibial plateau

- seen in sports (skiing, basketball, baseball)

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36
Q

Tx Segond fx

A
  • Cancellous screw

- Surgical Intervention

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37
Q

Patella fx presentation

A
  • NWB or protected WB
  • mod-severe pain
  • Large area swelling/large joint effusion
  • ABSENT extensor mechanism
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38
Q

Mechanism of injury patellar fx

A
  • Direct trauma to anterior patella (dashboard injury)
  • Sudden forceful contraction of quad muscles during sports
  • After ACL reconstruction/total knee repalcement
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39
Q

Patella fx tx

A
  • ORIF w/ tension band wiring

- NWB in hinged knee brace locked in extension (20 deg)

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40
Q

20yo present NWB, knee pain after falling from skiing. Effusion over knee. Knee is in 20deg flexion and resists full extension. Avulsion fx seen on x-ray. What injury is this?

A. Tibial plateau fracture
B. Segond Fracture
C. Patella Fracture
D. Quad tendon rupture

A

B. Segond Fracture!

Key words: knee 20deg flexed, & resists full extension
*needs cancellous screws!

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41
Q

Quad tendon rupture presentation

A
  • “popped”
  • NWB w/ large effusion to affected knee
  • ABSENT extensor mechanism
  • Large area of swelling
42
Q

Quad tendon rupture Mechanism of injury (MOI)

A
  • Forced flexion against resistance/extension
  • ex. person jumping down onto deck of boat as it is coming up toward him from water
  • Often seen in heavy set males in 40-50s & young adults
43
Q

Tx quad tendon rupture

A
  • Surgically!!
  • then place in locked hinged knee brace at -20deg extension, NWB
  • transition to partial WB after 6wks
  • then work on ROM (strengthening)
  • may take 1yr before return to normal
44
Q

Patella tendon rupture presentation

A

-Palpable defect of patellar ligament
-High riding patella (patella alta)
-ABSENT extensor mechanism
(may have some extension if partial tear)

45
Q

MOI patella tendon rupture

A
  • RARE in young athletes unless they use steroids

- <40yo

46
Q

Risk factors patella tendon rupture

A
  • RA
  • long term DM
  • long term steroid use
  • fluoroquinolone
47
Q

Tx patellar tendon rupture

A

Conservative for partial tears –> immobilize hinge knee brace 4-6wks

Surgical for complete tears

48
Q

50yo pt on fluoroquinolones feel a pop in his leg after jumping onto his yacht. Presents as NWB, w/ large effusion to left knee. CANNOT extend his left leg. What kind of injury may this be?

A. Segond fracture
B. Patella fracture
C. Quad tendon rupture
D. Patella tendon rupture

A

C. QUAD TENDON RUPTURE

Key words: fluoroquinolones, jumping onto boat, lack extensor mechanism

*knee is in forced flexion against resistance/extension

49
Q

18yr old pt was in a passenger seat of a car with knees flexed up during a MVA. Knees ended up hitting the dashboard. Pt presents NWB, large effusion on knee joint. Pt cannot extend knee! What kind of injury may this be?

A. Segond fracture
B. Patella fracture
C. Quad tendon rupture
D. Patella tendon rupture

A

Patella Fracture

Key Words: direct trauma to anterior patella (dashboard injury), absent extensor mechanism

50
Q

35yo pt w/ T2DM for 20years and on fluoroquinolones presents w/ pain on right knee. Patella alta is palpable on exam. Pt cannot extend knee. What kind of injury may this be?

A. Segond fracture
B. Patellar fracture
C. Quad tendon rupture
D. Patella tendon rupture

A

D. Patella tendon rupture

Key words: long term DM, fluroqinolones, patella alta (high riding patella), absent extensor mechanism.

51
Q

Spiral fx of proximal fibula + ankle injury = ?

A

Maisonneave Fracture

52
Q

Where does the ankle exam begin?

A

At the knee

53
Q

( ) is the strongest predictors of knee OA progression?

A

MISALIGNMENT

54
Q

ACL tear presentation

A
  • “pop” at moment of injury
  • Effusion to knee within 2hrs
  • Protected WB
55
Q

ACL tear MOI

A
  • common sport injury to knee

- result from VALGUS stress to knee or distal thigh w/ ipsilateral foot planted

56
Q

ACL special test

A

Lachman

Anterior Drawer

57
Q

Medial Collateral Ligament Tear presentation

A
  • Acute onset of pain medial aspect
  • Instability esp when changing directions of stairs
  • Antalgic gait
  • TTP over tract to MCL medially (femoral condyle to prox tibia)
  • ROM preserved if no effusion
58
Q

MCL tear MOI

A
  • sport injury (football, hockey, skiing, soccer)

- Cause by VALGUS type force directed to lateral knee

59
Q

Dx MCL?

A

VALGUS stress at 0 and 30deg. Note laxity >5mm

60
Q

What is the lachman test used for?

A

ACL tear dx

61
Q

Pt presents w/ acute onset of right knee pain on the medial side after playing football. Effusion is present on the affected knee and he pt has an antalgic gait. On exam a valgus stress is done at 0 and 30 deg and a laxity 7mm is noted. What injury may this person have?

A. Knee Arthritis
B. ACL tear
C. Medial Collateral Ligament Tear
D. Maisonneuve Fracture

A

Medial Collateral Ligaments

Key words: medial side knee pain. Antalgic gait. Valgus stress test w/ laxity >5mm

62
Q

Patella Femoral Syndrome presentation

A

-Anterior knee pain
Pain w/ deep flexion of knee, stairs (descending) & prolonged sitting
-NORMAL WB
-“stiff” feeling when getting up from prolonged sitting
-Pain free during activities by “achy” discomfort afterwards
-No effusion

63
Q

Patella Femoral Syndrome aka? MOI?

A

aka Chondromalacia

MOI: lateral mal-tracking of patella during flex/extension activity
-weakness of vastus medialis obliques & tightness of IT band

64
Q

Patella Femoral Syndrome Dx

A

Patella Apprehension positive

Tenderness w/ medial/lateral/subluxation of patella

65
Q

X-RAY view of patella femoral syndrome?

A

Standard views

SUNRISE (merchant) view

66
Q

Can a pt continue sports/activity w/ patella femoral syndrome?

A

YES but they have to go to PT for strengthening of the vastus medialis obliques and adductor muscles

NSAIDs regularly
Patella brace prn
Resolve within 4-6wks if pt is compliant

67
Q

What is the McMurray test used for?

A

Meniscus tears

68
Q

Meniscus Tears Presentation

A
  • “pop”
  • Medial/lateral sided pain “inside” the knee over joint line
  • medial
69
Q

MOI of Meniscus Tears

A
  • 10-30yo

- “twisting” or rotational movement of flexed knee during sports

70
Q

Dx Meniscus Tears

A
  • Pos McMurray test

- inability to squat deeply

71
Q

Tx Meniscus Tears

A
  • Arthroscopy of knee
  • Meniscal repair in young pt
  • Menisectomy in older, less active pt
  • excellent prognosis
72
Q

Tibia Fx Presentation

A
  • NWB or protected WB
  • Mod-severe pain
  • Swelling
  • TTP
73
Q

MOI Tibia Fx

A

High-energy DECELERATION injury
Falls, MVC
Direct impact to tibia

(often occur in conjunction w/ other LE fx d/t MOI)

74
Q

20yo pt presents w/ medial sided pain after hearing a “pop” during a soccer game. Pt presents w/ mild effusion over the knee and cannot fully extend or flex knee. McMurray test is positive What injury may this be?

A. ACL tear
B. MCL tear
C. Meniscus tear
D. Patella Femoral Syndrome

A

Meniscus tear!

Key words: Cannot fully extend/flex knee = “locking”, medial >lateral, McMurray positive

Pt should get a meniscal repair since they are young!

75
Q

X-RAY views of ankle

A

AP
Mortise
Lateral

76
Q

Ankle Fracture MOI

A

Occurs when foot is planted on ground/surface & body sustains rotation force

77
Q

How do you tx a stable ankle fracture?

A

Casts or TALL walking boot

78
Q

How do you tx an unstable ankle fracture?

A

ORIF

79
Q

What is the most common sports injury in outpatient clinics?

A

Ankle sprain

80
Q

MOI of Ankle Sprain

A
  • “turning the ankle” during a fall or after landing on irregular surface
  • commonly INVERSION & PLANTARFLEXION sprain
81
Q

Tx of Ankle Sprain

A

RICE
NSAIDs
Early ROM
PT

82
Q

Calcaneus Fracture MOI

A

-High energy deceleration injuries
(MCV, fall from height)
-younger pt

83
Q

What else may a pt w/ a calcaneus fx complain of?

A

Low back pain (secondary to associated lumbar compression fx)

84
Q

What is significant about smokers who get fractures?

A

They heal slower than non-smokers

85
Q

Tx of calcaneus fracture?

A
  • Well padded posterior splint to LE
  • Protected WB w/ crutches
  • Analgesics
  • ORIF delayed 7-10days to allow swelling to resolve
  • pt will have chronic heel pain even after ORIF
86
Q

MOI of 5th Metatarsal Fx

A

Forcible INVERSION of foot in plantar flexion
(stepping on a curb or climbing steps)

Force pulls at insertion of peroneus brevis
*one of the most common foot avulsion injuries

87
Q

Tx of 5th Metatarsal Fx

A
  • Tx conservatively

- Operative fixation only required for large or very displaced fragments w/ intra-articular extension

88
Q

What is a Jones Fx?

A
  • Transverse fx at base of 5th metatarsal
  • D/t adduction force to forefoot w/ ankle in plantar flexion
  • Prone to non-union
  • Almost always take >2mo to heal
89
Q

How do you tx a Jones Fx?

A
  • Immobilization w/ NWB cast for 6-8wks

- Internal fixation & bone grafting may be required for non-union cases of if fx significantly displaced

90
Q

What is the classic presentation of Plantar Fasciitis?

A
  • Sharp volar sided heel pain of mod-severe intensity
  • pain is worst first thing in the morning when pt gets out of bed
  • Pain reduces as pt walks around for a bit
  • Normal gait but may limp w/ worsening pain
  • Flat foot w/ tight achilles w/ active/passive dorsiflexion of ankle
91
Q

What type of pt population is plantar fasciitis seen in?

A
  • Runners

- Occupations that require prolonged standing

92
Q

Risk factors of plantar fasciitis?

A
  • Obesity
  • Pes planovalgus orientation (flat feet)
  • Reduced dorisflexion (tight heel cord)
93
Q

Tx of plantar fasciitis?

A
  • Night splint
  • Ice
  • NSAIDs
  • PT

RARELY corticosteroid injection or surgery

94
Q

Achilles Tendon Rupture presentation

A
  • Pt reports “pop”
  • Weakness & difficulty walking
  • Palpable defect
  • Weak ankle plantarflexion

common in men 30-40yo

95
Q

MOI of Achilles Tendon Rupture

A
  • traumatic injury during sporting event
  • sudden forced plantar flexion
  • violent dorsiflexion in plantar flexed foot
96
Q

Risk factors of Achilles Tendon Rupture?

A

“weekend warrior”
Fuoroquinolones
Steroid injections

97
Q

What special test would you do to test for a ruptured achilles tendon?

A

Thompson test

*pt lie prone on table w/ knee FLEXED to 90deg. Squeeze calf muscle at position slightly distal to place of widest girth

Positive = calf squeeze results in NO plantar movement

98
Q

Do you always have to operate/fix an achilles’ tendon rupture?

A

No. Its pt/provider preference

No operation will result w/ decreased plantar flexion strength.

99
Q

28yo pt training for the boston marathon presents with right heel volar pain and is limping. Pt describes the pain was worsening 1st thing in the morning when he gets out of bed but gradually reduces as he gets along with his day. What kind of injury may this be?

A. Calcaneus fracture
B. Plantar Fasciitis
C. Jones Fracture
D. Ankle sprain

A

B. PLANTAR FASCIITIS

KEY WORDS: Volar pain, worse 1st thing in the morning, reduces w/ ambulation, runners

100
Q

15yo male pt presents as NWB and severe pain to his right foot after jumping off the roof of his one story house. What injury may this be?

A. Calcaneus fracture
B. Plantar Fasciitis
C. Jones Fracture
D. Ankle sprain

A

A. Calcaneus fracture

Key Words: NWB, high energy deceleration injury (like jumping/fall from height)

*check smoking status and if theres any associated back pain

101
Q

24yo female presents with a history of “stiff” feeling in the knee after sitting down for a long time. She also has achy pain after walking down the stairs. ROM is intact and no effusion is present. What injury may this be?

A. Meniscus Tear
B. ACL tear
C. Knee arthritis
D. Patella Femoral Syndrome

A

Patella Femoral Syndrome!
(aka chondromalacia patella)
d/t patella tracking laterally

  • Pain free during activities but “achy” discomfort after
  • “stiff” feeling when getting up from prolong sitting
  • ROM in tact, normal WB
102
Q

What test would you do on a pt suspected of patella femoral syndrome?

A. Lachman test
B. McMurray test
C. Patella apprehension test
D. Anterior drawer test

A

Patella Apprehension test

Clin Med IV Exam 1 (9 decks)

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