Hip and Lower Leg - Conditions Flashcards
what is avn
bone infarct
which parts of the body are higher risk of avn and why
femoral head, scaphoid, talus, lunate, since tenuous BS
risk factors for avn
alcohol, CCS, hyperlipidaemia, sickle cell
investigations for avn of the hip
early: mri
late: xr showing hanging rope sign
management of ealry and late presentations of avn of the femoral head
early; decompression, late; THR
another name for irritable hip
transient synovitis
age and gender most commonly affected by irritable hip
boy 2-5yr
presentation of irritable hip
can’t bear weight after URTI +- pyrexic
investigations for irritable hip
normal bloods, US effusion
irritable hip management
self-limiting
risk factors for sufe
10-16yr black obese male
what does sufe stand for
slipped upper femoral epiphysis
presentation of sufe
acute/chronic knee+-distal thigh pain, loss of internal rotation
what is sufe
femoral epiphysis slips inferior to femoral neck
what is seen on xr in sufe
Trethowan’s sign
SUFE Mx
surgical stabilization of physis
complication of sufe
avn
what is perthes disease
unilateral transient AVN of femoral head
risk factors for perthes disease
4-8yr short hyperactive boy
what is seen on examination in perthes disease
Trendeleberg gait
complication of perthes disease
oa
risk factors for ddh
breech, FH, 1st born, girl
what does ddh stand for
developmental dsyplasia / dislocation of the hip
investigations for ddh
US, XR; uncalcified epiphysis
management of ddh presenting early
palvik harness
management of ddh presenting <2yr
reduce + cast
presentation of ddh >2yr
trendelenberg, short leg, no pain, >OA
what is the 1st sign of hip pathology
loss of internal rotation
what is trochanteric bursitis
abductor gluteus medius tendonitis
trochanteric bursitis presentation
pain/tender at greater trochanter & on abduction
presentation of ddh in newborn
asymmetric skin crease, feel for click
what is seen on examination in hip fractures
shortened externally rotated leg. can’t SLR
classification of hip fractures
intracapsular, extracapsular
complications of intracapsular hip fractures
avn, non-union
investigations for hip fractures
x-ray showing break in shenton’s line
management of intracapsular hip fracture in inactive old people
THR or hemiarthroplasty
management of intracapsular hip fracture in young people or active old people
internal fixation
management of extracapsular hip fractures
ORIF dynamic hip screw
infection rate in hip surgeries
5%
what are the risks in femoral shaft fractures and what is done to prevent them
blood loss, fat embolus, ARDS. thomas splint
management of unstable femoral shaft fracture
IM nail
complications of tibial plateau fracture
compartment synd, neurovascular injury
risk factor for tibial plateau fracture
op
management of tibial plateau fracture
orif or ex-fix
describe tibial plateau fracture on x-ray
intra-articular, 80% lateral condyle
complication of tibial shaft fracture
compartment s.
what is a maisonneuve fracture
proximal tibial fracture + interosseous membrane rupture
what is the slowest healing bone
tibia
what is a pilon fracture
intraarticular distal tibia# +-fibula / ankle#
pilon fracture mx
debride + ex-fix, soft tissue settles ORIF
which meniscus is more commonly torn and why
medial since its less mobile
menisci function
absorb shock, distribute load from convex femoral condyles to flat tibial articular surfaces
function of mcl
resists valgus
function of lcl
resists varus & external tibial rotation
function of acl
resists anterior tibial subluxation & internal tibial rotation in extension
function of pcl
resists posterior subluxation of the tibia & knee hyperextension
components of the posterolateral corner
PCL, LC, popliteus & smaller ligaments
function of posterolaternal corner
resist tibial external rotation on flexion
what types of cartilage are in the knee
hyaline and fibrocartilage
consequence of failed extensor mechanism
can’t extend knee or SLR
knee deformity caused by rickets
genu varum or genu valgum
knee deformity caused by skeletal dysplasia
genu varum
complication of genu varum
medial oa
complication of genu valgum
lateral oa
when to refer genu valgum
asymmetric, pain, >16°/>8cm age 11
management of genu varum in an adult
osteotomy
what is severe genu varum
> 16°
what is abnormal genu varum
> 6°
what is normal knee alignment
6° valgum
what is housemaid’s knee
prepatellar bursitis
what is jumper’s knee
Patellar tendonitis
jumper’s knee mx
self limiting
condition associated with baker’s cysts
oa
pathology of baker’s cysts
popliteal synovial fluid outpouching
baker’s cyst mx
self-limiting
what is osgood schlatter
lump at tibial tuberosity
presentation of osgood-schlatter’s disease
unilateral pain/tenderness worse after exercise in teenager
what scan to refer for if suspected meniscus problem
mri
presentation of patello-femoral dysfunction
tender knee, worse downhill, teenage girl, clicks
imaging to view quadriceps and patellar tendon
us
imaging to view cruciate ligaments
mri
causes of knee haemarthrosis
ACL ruptur, tibial plateau #, patellar dislocation
how quickly do knee haemarthrosis and effusions present
haemarthrosis 1 hour
effusion 1 day
difference in pain between haemarthrosis and effusion
haemarthrosis all over knee, effusion localised to joint line
causes of knee effusions
meniscal/chondral injury
risk factors for patella dislocation
adolescent valgus female
which way does the knee dislocate
laterally
management of patellar dislocation
3wk splint
management of recurred patellar dislocaion
osteotomy or soft tissue reconstruction
complication of knee dislocation
50% popliteal artery injury, also common fibular nerve injury
which age are affected by patellar and quadriceps tendon rupture
patellar <40 yr
quad >40 yr
knee injury caused by valgus
mcl
mcl injury mx
heals itself
lcl injury mx
repair/reconstruct
complications of lcl injury
peroneal nerve palsy
presentation of acl rupture
pop, haemarthrosis, +ve Lachman test, 50% + mensicular tear
management of acl rupture
1/3 reconstruction; patellar tendon / semitendinosus / hamstring / allograft / Achilles / synthetic
injury mechanism of acl rupture
internal rotation
mechanism of pcl rupture
hyperextension/direct blow
examination test postive in pcl rupture
posterior drawar test
examination test positive in meniscal tear
steinman
management of a meniscal tear in a young patient
arthroscopic repair
management of a meniscal tear repair catching/locking in a young patient
arthroscopic menisectomy
what surgery can be done for patients over 40 and when is it indicated for meniscal tears
if unstable or pain for >3mth do arthroscopic menisectomy
cause of an acute locked knee
bucket handle meniscus tear
how to diagnose bucket handle meniscus tear
mri
what is a complication of bucket handle meniscus tears
ffd fixed flexion deformity
management of a meniscal tear in patients over 40yrs
ccs injection
classification of pes planus
flexible or fixed
age and gender affected by tibialised posterior dysfunction
40-50 female
presentation of tibialis posterior dysfunction
adult acquired flat foot, progressive midfoot/ankle pain,
management of tibialis posterior dysfunction
no CCS, synovectomy
intoeing pathology
femoral neck anteversion, internal tibial torsion, metatarsus adductus
club foot aka
Talipes equinovarus
club foot mx
Ponseti splint +- tenotomy
condition associated with club foot
ddh
bunion aka
Hallux valgus
risk factors for hallux valgus
> age, female, high heel, RA
toe affected by hallux valguss
big toe or pinky
management of hallux valgus
conservative -> osteotomy
what is hallux rigidus
1st MTPJ OA
management of hallux rigidus
change shoe, wait 2 yr -> cheilectomy/arthrodesis
high arched feet aka
pes cavus
what is hallux valgus
1st metatarsal medial deviation lateral toe deviation
age and gender affected by morton’s neuroma
female 45-55
pathology of morton’s neuroma
digital nerve fibrosis -> neuroma
presentation of morton’s neuroma
forefoot burn/tingles, Mulder’s click test
diagnosis of morton’s neuoma
us
management of morton’s neuroma
insole, nerve injection, surgical excision
plantar fasciitis prsentation
pain on exercise, swell/tender
plantar fasciitis mx
NSAID, splint, rest, CCS injection, 50% success surgery
achilles tendinopathy pathology
repetitive microtrauama collagen repair failure
achilles tendinopathy presentation
morning stiff, pain better w/ walking
achilles tendinopathy dx
clinical diagnosis or US
achilles tendinopathy mx
splint, activity, analgesia, NSAID, PT
tendo-achilles rupture presentation and which examination test is positive
can’t bear weight, weak plantarflexion, Simmond’s test
tendo-achilles rupture mx
no CCS, cast or surgery
does an ankle fracture or sprain take longer to heal
sprain
when to xr a suspected ankle sprain
bony tenderness or can’t bear weight
what is an unstable ankle fracture
bimalleolar, >1cm talar shift XR
management of stable ankle fracture
6wk boot
management unstable ankle fracture
orif
what is a lisfranc injury
2nd TMTJ avulsion # / subluxation
lisfranc injury mx
orif
lisfranc injury dx
AP & oblique XR + CT
what is claw toe
MTPJ hyperextension, PIPJ/DIPJ hyperflexion
what is mallet toe
MTPJ hyperextension, PIPJ hyperflexion, DIPJ hyperextension
what foot fracture isn’t seen on xr (seen on mri)
talar dome fracture
