Knee Conditions Flashcards
Femoral shaft fractures causes
High- velocity trauma, child abuse. Elderly osteoporotic/ bone metastases/ bone lesions low-velocity injury.
Femoral shaft fracture position of limb, complications and treatment
Muscles deforming force, proximal fragment abducted and flexed, distal segment adducted varus deformity and extended. Tense swollen thigh.
Closed (open worse) fractures -> blood loss -> hypovalaemic shock. May damage neurovascular structures RARE.
Surgical fixation ✅
Distal femoral fractures causes and complications
Young High - energy sporting injury. Elderly- osteoporotic bone fall from standing.
Significant displacement -> popliteal artery damaged.
Tibial plateau fractures cause, classification and complications
High-energy injuries, axial loading with varus or Vargas angulation.
Articulating surface of tibia affected. Unicondylar or bicondylar. Lateral is more common.
Articulate cartilage damaged-> post- traumatic osteoarthritis. Also can meniscal tears, anterior crucible ligament injuries.
Patellar fractures, cause, 3 signs, 4 treatments
Direct impact injury/ eccentric contraction quadriceps. 20-50yrs.
Palpable defect patella, haemarthrosis. If extensor muscle disrupted -> unable straight leg raise. 8% bipartite patellar naturally.
Displaced: reduction, surgical fixation.
Undisplaced: splinting, crutches.
Patella dislocation cause and treatment
Subluxation = partial displacement.
Q-angle most common laterally.
Trauma, twisting injury slight flexion/ direct blow. Athletic teens, internal rotation of femur planted foot.
✅ extending knee, manually reducing patella. Then immobilise, physiotherapist strengthen VMO (vastest medialis obliquus)
Patella dislocation 5 predisposing factors
Generalised ligamentous laxity, weakness quadriceps, shallow trochlear groove with flat lateral lip, long patellar ligament, previous dislocations
Meniscal injuries (tear) cause, 7 symptoms, 2 complications
Meniscal tears most common, sudden twisting motion weight-bearing flexion.
Intermittent pain, knee clicking, catching, locking, giving way, swelling. Joint line tenderness.
Haemarthrosis (indicates tear peripheral vascular aspect OR associated injury anterior crucible ligament), chronic effusion can occur synovitis
Meniscal tear treatment
Acute traumatic- surgically (meniscetomy or meniscal repair)
Chronic- normally conservative management
Collateral ligament injury, 2 classifications and 3 symptoms
Acute valgus strain (lateral angulation of distal segment) - medical CL . More common.
Varus strain (medial angulation distal segment) - lateral CL. Higher chance -> knee instability - lateral tibial plateau shallower and less stable socket for femoral condyle.
Pain and swelling, knee unstable give way
Unhappy triad
‘Blown knee’ injury to anterior cruciate ligament, medial meniscus and medial collateral ligament.
Strong force lateral knee.
Anterior cruciate ligament tear cause, symptoms, treatment, tests
Quick deceleration/ hyper extension OR rotational injury, large force back knee partly flexed.
Popping sensation -> swelling, instability tibia slides anterior under femur ‘giving way’. Anterolateral rotatory instability tibia MR during flexion knee & opens up laterally.
Low demand function well, sportsmen need surgical reconstruction.
Tests: anterior drawer test, Lachman’s test
Posterior cruciate ligament injury cause, treatment, test
Dashboard injury- knee flexed large force upper tibia displacing it posteriorly. Fall on flexed knee with ankle plantatflexed. Severe hyperextension.
Tibia displaced posteriorly on femur
Conservative management- bracing and rehabilitation
Tests: posterior drawer test
Dislocation knee joint, definition, cause, complications, treatment
Uncommon, high energy trauma, 3/4 ligaments must rupture (MCL, LCL, ACL, PCL)
Associated arterial injury common, popliteal artery immobile -> tear = haematology OR -> crushed or -> traction injury (endothelial damage thrombotic occlusion)
Reduction of joint, assess vascularity e.g. MRA (magnetic resonance angiography)
Swellings around knee 3 types
Bony e.g. Osgood- Schlatter’s disease
Soft tissue - localised e.g. enlarged popliteal lymph node/ popliteal artery aneurysm
- generalised e.g. lymphoedema of lower limb
Fluid -inside joint = effusion
- outside joint = soft tissue haematology
Knee effusions acute and delayed classifications
Accumulation of fluid inside joint, never normal.
Acute <6hrs after injury
- haemarthrosis (ACL rupture)
- Lipo-haemarthrosis (blood and fat) fracture. Fat (darker)-fluid interface on X-Ray
or delayed (usually reactive synovitis)
Pre-patellar bursitis 5 symptoms and 3 causes
Superficial bursa, synovial lining.
Knee pain and swelling, erythema, difficult to walk, not able to kneel.
Repetitive trauma ‘Housemaid’s knee’ OR history of fall on knee Or blunt trauma to knee
Infrapatellar bursitis cause
Two bursae, one superficial between patellar tendon and skin. Most common.One deep between patellar tendon and tibia bone.
Repetitive microtrauma kneeling ‘clergyman’s knee’
Suprapateller bursitis and knee effusion cause
Extension of synovial cavity of knee, knee effusion swelling pouch (superior beneath patellar under quadriceps), sign of pathology to knee I.e.: osteoarthritis, rheumatoid arthritis, infection (septic A), gout and pseudogout, repetitive microtrauma (running soft/uneven surfaces)
Semi membranous bursitis position and cause
’popliteal cyst’/ ‘Baker’s cyst’Indirect consequence of swelling within knee. Beneath Deep fascia of popliteal fossa between semi membranous muscle and media, head gastrocnemius. Attached posterior capsule of knee. Fluid from knee get into semimebrnaous bursa.
Osgood-Schlatter’s disease definition, who, symptoms, treatment
Inflammation of apophysis of patellar ligament into tibial tuberosity.
Teens sport
Localised pain (running, jumping, squatting, ascending, descending, kneeling) and swelling.
Rest and ice, resolve when apophysis fuses, bony prominence usually remains.
Knee osteoarthritis 6 symptoms
Stiffness, swelling, knee pain (chronic Low level with severe flare ups, precipitated by activities a.k.a bending/ kneeling/ squatting/climbing), or pain and stiffness worse after prolonged activity or rest), varus deformity (deviation distal component toward midline) or fixed flexion deformity (knee can’t be fully extended), Loss articulate cartilage-> friction bone rubs on bone (crepitus), May get effusion, knee give way (down stairs)
Risks and types of Osteoarthritis of knee
Risks: older, female, previous trauma! Obesity, family history OA, another condition affects joint
Uni/bi/tri compartmental (affecting one/2/3 medial femorotibial, lateral femorotibial and patellofemoral compartments.
Treatment OA knee 5
Strengthening exercises -> analgesia-> weight loss-> activity modification-> surgery (TKR)
Septic arthritis of knee definition
Invasion of joint space by micro-organisms, usually bacteria/ viruses/ mycobacterium/ fungi. Different to reactive = sterile inflammatory from extra-articulate infection e.g. gastroenteritis
Usually staphylococcus aureus or staph. Epidermidis, neisseria gonorrhoeae, group B streptococci
Risks septic arthritis of knee
Older, diabetes mellitus, rheumatoid arthritis, immunosuppressive, IV drugs abuse, prosthetic joints (intra-operative contamination or haematogenous spread from distant infective focus) months or years after initial operation.
Septic arthritis cause and treatment
Damage articulate cartilage from organisms’s pathologic response OR hosts’s immune response (neutrophils-> cytokines-> hydrolysis collagen and proteoglycan.
Aspiration of joint sent for urgent microscopy, culture and sensitivities. High morbidity.
Septic arthritis symptoms
Fever, pain, reduced range of motion, erythema, swelling, warmth, tenderness, draining sinus (tract between site of infection and surface overlying skin)
