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ms 1 - 2nd shift > knee clinical conditions pt 1 (DFF to Patellofemoral Pain) > Flashcards

knee clinical conditions pt 1 (DFF to Patellofemoral Pain) Flashcards

1
Q

includes both supracondylar and condylar regioms

A

distal femur fractures

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2
Q

zone between femoral condyles and the junction of metaphysis w femoral shaft

comprises the distal 10 to 15 cm of femur

A

supracondylar area

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3
Q

extends more distally and is mire convex than lateral femoral condyle

physiologic valgus of femur

A

medial condyle

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4
Q

this flexes distal fragment, causing posterior displacement and angulation

A

gastrocnemius

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5
Q

they exert proximal traction, resultimg in shortening of lower ex

A

quads and hamstrings

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6
Q

mechanism of injury of distal femur fractures

A

severe axial load w varus, valgus, rotational force

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7
Q

mechanism of injury of distal femur fracture in young adults

A

high energy trauma like motor vehicle collision or fall from a height

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8
Q

mechanism of injury of distal femur fracture in elderly

A

minor slip or fall onto a flexed knee

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9
Q

general principles of dff treatment

A
  • restore articular congruity
  • rigid stabilization of articular fracture
  • indirect reduction of metaphyseal component to preserve vascularity of fractyre fragments
  • stable (not necessarily rigid) fixation of articular block to shaft
  • early knee ROM
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10
Q

intervention of stable non operative fractures of dff

A

hinged knee brace w partial weight bearing

full time bracing for 6-8 wks, closed chain rom at 3-4 wks

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11
Q

non operative intervention of displaces fractures in dff

A

6-12 wks period of skeletal traction followed by bracing

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12
Q

complication of skeletal traction

A

varus and internal rot deformity, knee stiffness, prolonged hospitalization and bed rest

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13
Q

indications of non operative treatment of dff

A

nondisplaced or incomplete fractures, impacted stable fractures in elderly pts, severe osteopenia, advanced underlying medical conditions, gunshot injuries

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14
Q

operative treatment. indicated for extra articular fractures and simple intra articular fractures

A

retrograde intramedullary (im) nail

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15
Q

operative treatment, indicated when associated with pre existing joint arthroplasty and select cases when stable internal fixation not achievable

A

arthroplasty (metal implant)

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16
Q

uncommon injury that may be limb threatening, orthopedic emergency

A

knee dislocation

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17
Q

significant soft tissue injury of knee dislocation

A

ruptures of at least three or four major ligamentous structures of the knee

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18
Q

most common knee dislocation

A

posterolateral

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19
Q

complications if knee dislocation

A

vascular injury, neurologic injury, stiffness/ligament, ligamentous laxity

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20
Q

nerve affected if neurologic injury of knee dislocation occurs

A

peroneal nerve, fibular nerve

+ foot drop if there is injury

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21
Q

most common complication of knee dislocation

A

stiffness/arthrofibrosis

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22
Q

treatment for knee dislocation

A

emergent reduction if pt did not present reduced

revascularize within 6 hrs if there is significant arterial injury

care for soft tissue injuries (open knee dislocations)

ligament reconstruction

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23
Q

largest sesamoid bone in body, articular cartilage may be up to 1cm thick

A

patella

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24
Q

articular facets of patella

A

7 articular facet, lateral facet is largest

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25
Q

most common type of patellar dislocation

A

lateral dislocation

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26
Q

ensures that the resultant vector of pull with quadriceps action is laterally directed

A

Q angle

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27
Q

Q angle in women is ______ degrees greater than men

A

4.6 deg

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28
Q

lateral moment is normally counterbalanced by

A

patellofemoral
patellotibial
retinacular structures
patellar engagement within the
trochlear groove.

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29
Q

predisposes to patella dislocation

increases tendency of patellar dislocation because it can move more lateral

A

Increased/wider Q angle

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30
Q

Why is Lateral patellar dislocation more common in Women

A

Women have higher Q angle

Ligaments of women are lax

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31
Q

functions of patella

A

increase the mechanical advantage and leverage of the quadriceps tendon

aid in nourishment of the femoral articular surface

protect the femoral condyles from direct traum

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32
Q

Reduction and casting or bracing in knee extension
- Usually for first time dislocation

may ambulate in locked extension for 3 weeks, at which time progressive flexion can be instituted with physical therapy for quadriceps strengthening
- Isometrics, no aggressive ROM

after 6 to 8 weeks, patient may be weaned from the brace as tolerated

A

Non-operative treatment for Patellar Dislocation

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33
Q

primarily used with recurrent dislocations

no single procedure corrects all patellar malalignment problems

patient’s age, diagnosis, level of activity, and condition of the patellofemoral articulation must be taken into consideration

A

Operative treatment for Patellar dislocation

34
Q

Surgical interventions for Patellar disloc

A

Lateral release
Medial plication
Proximal patella realignment
Distal patellar realignment

35
Q

Test for patellar disloc

A

+ apprehension test

36
Q

hemarthrosis (there’s bleeding inside)

inability to flex the knee

displaced patella on palpation

patients with reduced or chronic patella dislocation may demonstrate a positive apprehension test

A

Clinical evaluation for Patellar Disloc

37
Q

Not common

Represent 1% of all skeletal injuries

Male-to-female ratio (2:1)

Most common age group 20 to 50 years old

Bilateral injuries (uncommon)

A

Patellar Fracture

38
Q

Trauma to the patella may produce incomplete, simple, stellate, or comminuted fracture patterns.

minimal displacement owing to preservation of the medial and lateral retinacular expansions

abrasions over the area or open injuries are common
active knee extension may be preserved

A

Direct mechanism of injury for Patellar fracture

39
Q

most common

secondary to forcible quadriceps contraction while the knee is in a semiflexed position (e.g., in a a stumble or a fall)

intrinsic strength of the patella is exceeded by pull of the musculotendinous and ligamentous structures

transverse fracture pattern

active knee extension is usually lost

A

Indirect mechanism of injury for Patellar Fracture

40
Q

Most common mechanism of injury for Patellar fracture

A

Indirect

40
Q

Classification of Patellar fracture

A

Undisplaced

Transverse

Lower or upper pole

Multifragmented undisplaced

Multifragmangted displaced

Vertical

Osteochondral

41
Q

cylinder cast or knee immobilizer for 4 to 6 weeks

early weight bearing to FWB with crutches as tolerated

early SLR and isometric quadriceps strengthening
exercises should be started within a few days

After radiographic evidence of healing, progressive active flexion and extension strengthening exercises are begun with a hinged knee brace initially locked in extension for ambulation

A

Non operative treatment for Patellar fracture

42
Q

Indications for Non operative treatment for Patellar fracture

A

nondisplaced or minimally displaced (2- to 3-mm)
fractures with minimal articular disruption (1 to 2 mm)

requires an intact extensor mechanism

43
Q

Techniques
- tension band wiring
- screws
- circumferential cerclage wiring

retinacular disruption should be repaired

postoperatively, patient should be placed in a splint for 3 to 6 days until skin healing, with early institution of knee motion

AAROME, progressing to partial and full weight bearing by 6 weeks

A

Operative treatment for Patellar Fracture

44
Q

Indications of operative treatment for patellar fracture

A

> 2-mm articular incongruity
3-mm fragment displacement
open fracture

45
Q

major weight-bearing bone of the leg (85% load)

A

Tibia

46
Q

composed of the articular surfaces of the medial and lateral tibial plateaus,

separated by the intercondylar eminence (nonarticular, attachment of the cruciate ligaments)

10-degree posteroinferior slope

A

Tibial plateau

47
Q

larger and concave

A

medial plateau

48
Q

extends higher and convex

A

lateral plateau

49
Q

3 bony prominences 2 to 3 cm distal

A

tibial tubercle: patellar tendon
pes anserinus: medial hamstrings
Gerdy’s tubercle : iliotibial band)

50
Q

More common tibial plateau fracture

A

Lateral Plateau fractures

51
Q

tibial tubercle: patellar tendon

pes anserinus: medial hamstrings
Gerdy’s tubercle : iliotibial band)

A

Medial plateau fractures

52
Q

Mechanism of Injury for Tibial Plateau fractures

A

Varus or valgus forces coupled with axial loading

bicondylar split fracture results from a severe axial force exerted on a fully extended knee

53
Q

MVA
split fractures + ligamentous disruption

A

Mechanism of injury for Younger Indiv

54
Q

Falls
depression and split-depression fractures
lower rate of ligamentous injury

A

Mechanism of injury for Elderly px w osteoponic bone

55
Q

Associated Injuries of Tibial Plateau fractures

A

Meniscal tears (50%)

Cruciate or collateral ligament injuries (30%)

Peroneal nerve or popliteal neurovascular lesions

56
Q

Young adults: highest risk of collateral or cruciate ligament rupture

A

Cruciate or collateral ligament injuries (30%

57
Q

Medial tibial plateau fractures

Peroneal nerve injuries are caused by stretching (neurapraxia) which usually resolve over time

Arterial injuries

A

Peroneal nerve or popliteal neurovascular lesions

58
Q

traction induced intimal injuries presenting as thrombosis (transection injuries secondary to laceration or avulsion is rare)

A

Arterial injuries

59
Q

caused by stretching (neurapraxia) which usually resolve over time

A

Peroneal nerve injuries

60
Q

AP and lateral views supplemented by 40-degree interna

A

lateral plateau

61
Q

external rotation

oblique views

A

medial plateau

62
Q

useful for delineating the degree of fragmentation or depression of the articular surface

A

3D CT Scan

63
Q

useful for evaluating injuries to the menisci, the cruciate and collateral ligaments, and the soft tissue envelope

A

MRI

64
Q

Avulsion of the fibular head

Segond sign

Pellegrini-Steida lesion

A

Signs of associated ligamentous injury

65
Q

lateral capsular avulsion - ACL injury

A

Segond sign

66
Q

calcification along the insertion of the medial collateral ligament

A

Pellegrini-Steida lesion

67
Q

Classification for Tibial Plateau Fracture

A

Schatzker Classification

Type I: Lateral plateau, split fracture
Type II: Lateral plateau, split depression fracture
Type III: Lateral plateau, depression fracture
Type IV: Medial plateau fracture
Type V: Bicondylar plateau fracture
Type VI: Plateau fracture with separation of the metaphysis from the diaphysis

68
Q

are low-energy injuries

A

Types I to III

69
Q

are high-energy injuries

A

Types IV to VI

70
Q

usually occurs in older individuals

A

Type III

71
Q

usually occurs in younger individuals and is associated with medial collateral ligament injuries

A

Type I

72
Q

for nondisplaced or minimally displaced fractures and in patients with advanced osteoporosis

protected weight bearing and early ROM in a hinged fracture-brace

isometric quadriceps exercises and progressive passive, active-assisted, and active ROM exercises

Partial Weight Bearing (PWB) (30 to 50 lb) for 8 to 12 weeks is allowed, with progression to FWB

A

Non operative treatment for Tibial Plateau fracture

73
Q

articular step-off >2mm

Instability >10 degrees of the nearly extended knee compared to the contralateral side

Split fractures more unstable than pure depression fractures

Open fractures
Compartment syndrome
Associated vascular injury

A

Operative treatment for Tibial plateau fracture

74
Q

Postoperative: non-weight bearing with continuous passive motion and AROM

Weight bearing is allowed at 8 to 12 weeks

A

Rehab for Tibial Plateau Fracture

75
Q

Knee stiffness

Infection

Compartment syndrome

Malunion or nonunion (Schatzker VI)

Post-traumatic arthritis

Peroneal nerve injury
- Causing foot drop deformity

Popliteal artery laceration

Avascular necrosis of small fragments (results to loose bodies)

A

Complications of Tibial Plateau Fracture

76
Q

characterized by pain in the vicinity of the patella that is worsened by sitting and climbing stairs, inclined walking and squatting

A

Patellofemoral Pain

77
Q

Incidence of Patellofemoral pain

A

F > M if non athletic

M > F if athletic

78
Q

4 classic factors implied in the genesis of the instability

A

trochlear dysplasia

patella alta

Increase in Q angle

patellar tilt (excessive patellar tilt with medial ligamentous disruption)

79
Q

The single most important factor implied in the genesis of patellar instability

The femoral sulcus is not sufficient to provide the osseous restraint capable of avoiding patellar dislocations

A

Femoral trochlear dysplasia

80
Q

Moving of patella causes friction, will cause pain

A

Patellar morphology and the amount of congruence of the patellofemoral joint

81
Q

Position can be baja (below) or up (alta)

A

The positioning of the patella (alta or baja)

ms 1 - 2nd shift (13 decks)

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