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Surgery finals > Knee, foot and ankle > Flashcards

Knee, foot and ankle Flashcards

1
Q

Describe the bony anatomy of the foot

A

Phalanges
Metatarsals
Tarsal bones: talus + calcaneus -> navicular -> cuboid and 3 cuneiforms

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2
Q

Which tarsal bones are most frequently fractured? How can these occur?

A

Talus and calcaneus

Fall from a height most commonly

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3
Q

How can fractures of the metatarsals occur?

A
  • Direct blow eg. heavy object falling
  • Stress fractures
  • Sudden inversion
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4
Q

Describe bony anatomy of the leg

A

2 bones
-Fibula laterally
-Tibula medially
Articulate proximally with the femur at the knee joint and distally with the talus at ankle joint

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5
Q

Which movements occur at the sub-talar joint?

A

Mostly inversion and eversion

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6
Q

Which movements occur at the ankle joint?

A

Plantar-flexion and dorsiflexion

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7
Q

Which muscles are responsible for inversion and eversion of the foot? What are they innervated by?

A

Inversion (+dorsiflexion): tibialis anterior. Innervated by deep peroneal nerve
Eversion (+plantarflexion): lateral compartment (peroneus longus + brevis). Innervated by superficial peroneal nerve

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8
Q

What is a foot-drop? What is it caused by?

A

A clinical sign indicating weakness/paralysis of the muscles in the anterior compartment of the leg
Caused by injury to the common/deep peroneal nerve

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9
Q

Which muscles are responsible for dorsiflexion and plantarflexion of the foot? What are they innervated by?

A

Dorsiflexion: Anterior compartment (tibialis anterior) Innervated by deep peroneal nerve
Plantarflexion: posterior compartment (eg. gastrocnemius, tibialis posterior, soleus) Innervated by tibial nerve

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10
Q

Which ligaments are most likely to be damaged in the ankle? Why?

A 
Lateral ligaments (most commonly ATFL)
Weaker + resists inversion (most common mechanism of sprain)
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11
Q

What is a sprain?

A

Partial or complete tear in the ligaments of a joint

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12
Q

Describe the types of ankle fractures

A
  1. (most common) lateral malleolar fracture
  2. Bimalleolar fracture
  3. Trimalleolar
  4. Pilon fracture (tibia)
    - Displaced vs non-displaced
    - Talar shift vs no talar shift
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13
Q

What are the types of lateral malleolar fracture? What implication does this have for management?

A 
Danis-Weber classification 
A: infrasyndesmotic
B: syndesmotic
C: suprasyndesmotic 
A is usually stable, does not require ORIF 
C is usually unstable, requires ORIF
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14
Q

What are the most common mechanisms of ankle fracture?

A

Usually rotatory forces

  • Low energy fall
  • Inversion
  • Sporting injury
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15
Q

Describe the presentation of an ankle fracture

A

-Pain
-Swelling
-Inability to weight-bare
+/- wound, impaired arterial supply

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16
Q

What is a Maisonneuve fracture?

A

Type of injury in which there is a fracture of the proximil fibula assoc w injury (eg. sprain/fracture) at the ankle

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17
Q

Name the Xray views needed to diagnose ankle fractures. When should you Xray?

A

AP
Lateral
Mortise
Xray if tenderness over the malleoli or inability to weight bare

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18
Q

Describe the management of ankle fractures

A

Analgesia
Depends on stability/open etc
Immobilisation or ORIF

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19
Q

When should MRI be ordered for ankle injuries?

A

Suspected soft tissue damage if:

  • Pain ongoing or severe despite treatment
  • Worsening function
  • Persistent symptoms
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20
Q

Describe the management of ankle sprain

A

Conservative: mainstay

  • RICE
  • Analgesia
  • Early mobilisation (2-3 days)
  • Physiotherapy

Surgical: if ruptured

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21
Q

Describe the risk factors for Achilles tendinopathy + rupture

A
  • Sports eg running!, tennis
  • Family hx
  • High cholesterol
  • Rupture: steroids, quinolones
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22
Q

Describe the presentation of Achilles tendinopathy and rupture

A

Tendinopathy:
-Gradual onset pain + stiffness, worse w exertion
Rupture:
-Sudden onset pain (hit in back of leg) w pop sound
-Inability to stand on tiptoe, push off toes

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23
Q

Describe the signs of Achilles tendon rupture on examination

A
  • Gait abnormality (cannot push off toes)
  • Swelling, bruising
  • Inability to stand on tiptoes/plantarflexion
  • Thompson’s test positive (no foot movement when squeezing calf)
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24
Q

Describe the management of Achilles tendon injury

A

Tendinopathy: conservative (reduce exertion, analgesia, heel lifts, stretching, physio)
Rupture: non-weight bearing, analgesia
-Surgery or plaster cast
-> physio

25
What is a bunion?
Aka hallux valgus -Lateral deviation of 1st toe to create valgus deformity on 1st MTP -> bone proliferation Can be painful
26
Describe the risk factors for bunions
- Female - Footwear: tight-fitting or heels - Ligament laxity etc
27
Describe the management of bunions
Conservative: - Footwear - Analgesia - Ice packs Surgical: -Osteotomy (remove bone), arthrodesis (fuse joint)
28
What is Morton's neuroma?
A benign fibrotic thickening of the plantar digital nerve in the 3rd (or less commonly 2nd) intermetatarsal space
29
Who classically gets Morton's neuroma?
F > M | 50s
30
Describe the presentation of Morton's neuroma
- Pain in forefoot, shoots into toes. Worse on walking - Feeling of stepping on a marble/stone - Tingling/burning in affected toes (eg. 3+4)
31
Describe the management of Morton's neuroma
Conservative: - Footwear modification - NSAIDs -> referral for steroid injection, surgery
32
What is plantar fasciitis?
Inflammation of the fascia (band of tissue)on the plantar side of the foot
33
Who typically gets plantar fasciitis?
Middle aged overweight/obese | Runners
34
Describe the presentation of plantar fasciitis
- Achy foot pain in heel + arch | - Worse on walking esp barefoot, relieved by rest
35
Describe the signs of plantar fasciitis on examination
- Pin point tenderness on palpation of calcaneum | - Pain with dorsiflexion-eversion + Windlass test
36
Describe the management of plantar fasciitis
Conservative: -Rest, orthotics, stretching, NSAIDs, ice -> ESWT (extracorporeal shockwave therapy), surgery
37
Describe the borders of the popliteal fossa
Semimembranosus Biceps femoris Gastrocnemius
38
What is a Baker's cyst?
A synovial fluid-filled sac in the popliteal fossa
39
Describe the presentation of a Baker's cyst
- Discomfort and pressure in knee, +/- reduced ROM | - May rupture causing sudden onset pain
40
Describe the risk factors for Baker's cyst
- Meniscal tear and other injury - OA - Inflammatory arthritis
41
Describe the signs of Baker's cyst on examination
-Smooth, fluctuant swelling in popliteal fossa -Most obvious when extended, disappears when flexed (Foucher's sign) +/- reduced ROM
42
Describe the management of Baker's cyst
Conservative: - Analgesia - Physio - Therapeutic aspiration - Surgical Mx of underlying pathology eg tear
43
Describe the anatomy of the knee joint
The articulation of femur and 2 leg bones (tibia + fibula) 2 menisci (fibrocartilage structures): medial + lateral 4 bursae: supra, pre + infrapatellar, semimembranosus Patellar tendon 2 collateral ligaments: medial + lateral (MCL + LCL) 2 cruciate ligaments: anterior + posterior (ACL + PCL)
44
Describe the functions of the collateral and cruciate ligaments
Collateral: prevent excessive medial + lateral movement Cruciate: prevent anterior + posterior dislocation -ACL: runs A-P, prevents tibia moving anteriorly -PCL: runs P-A, prevents tibia moving posteriorly
45
Describe the most common soft tissue injuries of the knee + the mechanism of injury
Most common is meniscal tear -Sports injury commonest Most common ligament injury is collateral ligament. Occurs when force applied to the side of knee - MCL: valgus, LCL: varus - When MCL injured, medial meniscus also Cruciate ligaments: - ACL from hyperextension/blow to back of knee - PCL from 'dashboard injury' blow to shin while flexed
46
What are the types of knee bursitis?
Prepatellar: 'housemaid's knee' Infrapatellar: 'clergyman's knee'
47
Describe the presentation of meniscal injury
- Usually sports injury w twisting movement - Knee pain (may be mild/intermittent), swelling, stiffness - May have catching, locking, buckling
48
Describe the signs of meniscal tear on examination
- Swelling +/- Baker's cyst - Crepitations + tenderness over joint line - Pain in extension - McMurray test +, Apley grind test +
49
Describe the presentation of knee ligament injury
MCL: -Injury causing pain over medial aspect of knee +/- pop sound, stiffness, swelling, locking, etc ACL: -Injury causing sudden pain + pop sound, difficulty weight-bearing, feeling of instability, effusion PCL: -Knee pain, difficulty going down stairs/hill
50
Describe the signs of MCL injury on examination
- Inspection: swelling, effusions - Tenderness over medial aspect - **Abduction stress test
51
Describe the signs of ACL injury on examination
- Inspection: large effusion - Tenderness over lateral aspect * *Lachman's test - Anterior drawer test
52
Describe the signs of PCL injury on examination
- Inspection: effusion, positive sag sign | * *Posterior drawer test
53
Describe the investigations for soft tissue knee injury
MRI best test | Xray if indicated eg. suspected bony injury
54
Describe the management of soft tissue knee injuries
Conservative: for MCL, ACL, meniscal tears - Immediate: RICE - Knee brace + protected weight-bearing (crutches) - NSAIDs - > physio Surgical: - Chronic MCL injury/multiple ligaments - ACL in active person: reconstruction w graft - Meniscal injury large or persistent: meniscectomy
55
What are the indications for knee xray?
Age >55 Inability to weight-bear Inability to flex knee to 90˚ Tenderness over fibular head or patella only
56
Where do fractures of the tibia and fibula tend to occur?
Tibia: shaft, along with fibula Fibula: lateral malleolus
57
What is patellofemoral syndrome?
A very common condition of unknown aetiology causing knee pain in young active people
58
Describe the presentation of patellofemoral pain syndrome
- Insidious onset anterior knee pain. Worse on climbing stairs, squats, prolonged sitting - Stiffness

Surgery finals (16 decks)

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