Hip and Legs Flashcards
Why is it important to not externally rotate the hip on X-ray?
Shortens the neck of the femur
What is the most common type of hip dislocation?
Posterior (85-90%)
How is the leg positioned after a posterior hip dislocation?
Internally rotated and adducted (across midline) and leg is superior to acetabulum
If the femur is seen superior on X-ray following a dislocation, what type probably occurred?
Posterior
Where does the leg lie after an anterior hip dislocation?
Externally rotated, abducted, and flexed
Anterior hip dislocations may be associated with what other condition?
Femoral neck fracture
If the femur is seen inferior on X-ray following a dislocation, what type probably occurred?
Anterior
Where would the femur end up after a central hip dislocation?
Into pelvic outlet
What is the most serious complication of fractures of the proximal femur?
AVN
What gender is more likely to be affected by fractures of the proximal femur? Age population?
Females; elderly
What is the most common location for a fracture of the proximal femur?
Subcapital
What two kinds of stress can cause a fracture of the proximal femur?
Overuse or insufficiency
What is the most common fracture seen due to insufficiency?
Hip (proximal femur)
What imaging procedure should be used following hip trauma?
MRI to check for marrow edema
How long does it take for a stress fracture to appear as a transverse radiolucency or fluffy periosteal reaction?
7-10 days
Why do stress fractures usually appear radiographically normal?
Less than 30% bone destruction, so unable to be seen
What is most likely the cause of a femoral shaft fracture in children under 5?
Abuse (usually transverse or comminuted)
What is the best recommendation for an athlete with a stress fracture?
REST for 6 months to allow healing
The FBI sign is more important in what area?
Knee
What is the most common area to be affected of the proximal tibia?
Lateral tibial plateau
An avulsion of the anterior tibial spine is more common in what population?
Children
An avulsion of the anterior tibial spine results from what mechanism?
Hyperextension (usually fall of bicycle)
What soft tissue injury is likely to occur with an avulsion of the anterior tibial spine?
ACL (more common in adults)
What is the most common patella fracture type?
Transverse/horizontal
What is an important differential diagnosis when assessing patellar fractures?
Bipartite patella (look to history)
What is the usual location for a bipartite patella?
Superlateral margin
What is the most common knee ligament to be damaged?
MCL
What is the second most common knee ligament to be damaged?
ACL
What is the most common forced directed to the knee for injury?
Lateral to medial
What makes up the Odonohue’s triad?
MCL tear, ACL tear, lateral meniscus compression (MAYBE medial meniscal damage, too)
How do tendons and ligaments appear on MRI?
Black (signal hypointense) when normal
What is the term for a longitudinal vertical tear of the meniscus?
Bucket handle tear
What is the term for a fraying of free edge of one of the menisci?
Parrot beak tear
The increased density (white) of a tendon/ligament tendon must extend where to be classified as a tear?
To articular surface
What shape are the menisci on sagittal MRI?
Triangles
If a meniscoidal tear does not contact the articular edge, what is it then called?
Meniscoidal degeneration
Which area of the meniscus is likely to have the tear visible on MRI?
Posterior horn
How does marrow convert in children: red to yellow marrow or yellow to red?
Red to yellow as we mature
What is the most common fracture of the lower leg?
Both tibia and fibula together
How long does it take for tibial fractures to heal in adults?
16 weeks (decreased vascularity of tibias)
When a fracture of the lower leg is isolated, which bone is it likely to involve?
Fibula alone
Stress fractures of the lower leg occur mostly in what part?
Proximal third
Fractures of the lower leg occur mostly in what parts?
Middle or distal third
What fracture of the lower leg is a type of avulsion fracture of the lateral tibial condyle of the femur?
Segond fracture
What other injuries are likely to be associated with a segond fracture?
ACL tear or medical meniscus compression
Which fracture of the lower leg is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane?
Maisonneuve fracture
What other injuries are seen to accompany a Maisonneuve fracture?
Medial malleolus or rupture of the deep deltoid ligament
What is the most common type of ankle fracture?
Bimalleolar
What kind of mechanism can result in a trimalleolar fracture?
Usually severe rotation (to get the posterior malleolus involved)
What is the “3rd” malleolus?
Posterior aspect of distal tibia
What makes up Neer’s ring?
Tibia, fibula, talus
What is the most common combination for a break of Neer’s ring?
Bimalleolar fracture
When the talar dome angulation is greater than 16 degrees, what does that indicate?
Soft tissue injury
What is the most commonly fractured tarsal bone?
Calcaneus
What is usually the mechanism of injury for a calcaneal fracture?
Fall from height
What angle of measurement is used to assess for a calcaneal fracture?
Boehler’s angle
What fracture of the axial skeleton is likely to be accompanied with a calcaneal fracture?
Thoracolumbar junction compression fracture
Boehner’s angle should be no less than how many degrees?
28 degrees (less would indicate fracture)
What two bones are the slowest to heal?
Scaphoid and tibia (decreased vascularity)
What is the second most common fractures tarsal?
Talus
What type of fracture is a transverse fracture at the base of the fifth metatarsal?
Jones/Dancer’s fracture
What motion/positions cause a Dancer’s fracture?
Plantar flexion and inversion of foot
What tendon is involved with the avulsion associated with a Dancer’s fracture?
Peroneus (fibularis) brevis tendon
Where is the pain referred with a Jones/Dancer’s fracture?
Lateral malleolus (because fibularis brevis tendon wraps around it)
How can a Dancer’s fracture be differentiated from a growth center of the 5th metatarsal?
Growth centers will be vertical, fractures will be transverse
What is sometimes referred to as a “bedroom” fracture?
Oblique fracture to proximal portion of distal metatarsal
What is another name for stress fractures of the feet?
March fractures
Stress fractures of the feet most commonly involve which digits?
2nd and 3rd metatarsal shafts
A Lisfranc dislocation is usually in which direction?
Dorsal
What mechanism usually causes a Lisfranc dislocation?
Fall from height
What is the rare mid tarsal dislocation where the foot is displaced medially?
Chopart’s dislocation