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Surgery finals KTB > 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
Q

What is a bunion?

A

Aka hallux valgus
-Lateral deviation of 1st toe to create valgus deformity on 1st MTP -> bone proliferation
Can be painful

26
Q

Describe the risk factors for bunions

A
  • Female
  • Footwear: tight-fitting or heels
  • Ligament laxity etc
27
Q

Describe the management of bunions

A

Conservative:

  • Footwear
  • Analgesia
  • Ice packs

Surgical:
-Osteotomy (remove bone), arthrodesis (fuse joint)

28
Q

What is Morton’s neuroma?

A

A benign fibrotic thickening of the plantar digital nerve in the 3rd (or less commonly 2nd) intermetatarsal space

29
Q

Who classically gets Morton’s neuroma?

A

F > M

50s

30
Q

Describe the presentation of Morton’s neuroma

A
  • 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
Q

Describe the management of Morton’s neuroma

A

Conservative:

  • Footwear modification
  • NSAIDs

-> referral for steroid injection, surgery

32
Q

What is plantar fasciitis?

A

Inflammation of the fascia (band of tissue)on the plantar side of the foot

33
Q

Who typically gets plantar fasciitis?

A

Middle aged overweight/obese

Runners

34
Q

Describe the presentation of plantar fasciitis

A
  • Achy foot pain in heel + arch

- Worse on walking esp barefoot, relieved by rest

35
Q

Describe the signs of plantar fasciitis on examination

A
  • Pin point tenderness on palpation of calcaneum

- Pain with dorsiflexion-eversion + Windlass test

36
Q

Describe the management of plantar fasciitis

A

Conservative:
-Rest, orthotics, stretching, NSAIDs, ice

-> ESWT (extracorporeal shockwave therapy), surgery

37
Q

Describe the borders of the popliteal fossa

A

Semimembranosus
Biceps femoris
Gastrocnemius

38
Q

What is a Baker’s cyst?

A

A synovial fluid-filled sac in the popliteal fossa

39
Q

Describe the presentation of a Baker’s cyst

A
  • Discomfort and pressure in knee, +/- reduced ROM

- May rupture causing sudden onset pain

40
Q

Describe the risk factors for Baker’s cyst

A
  • Meniscal tear and other injury
  • OA
  • Inflammatory arthritis
41
Q

Describe the signs of Baker’s cyst on examination

A

-Smooth, fluctuant swelling in popliteal fossa
-Most obvious when extended, disappears when flexed (Foucher’s sign)
+/- reduced ROM

42
Q

Describe the management of Baker’s cyst

A

Conservative:

  • Analgesia
  • Physio
  • Therapeutic aspiration
  • Surgical Mx of underlying pathology eg tear
43
Q

Describe the anatomy of the knee joint

A

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
Q

Describe the functions of the collateral and cruciate ligaments

A

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
Q

Describe the most common soft tissue injuries of the knee + the mechanism of injury

A

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
Q

What are the types of knee bursitis?

A

Prepatellar: ‘housemaid’s knee’
Infrapatellar: ‘clergyman’s knee’

47
Q

Describe the presentation of meniscal injury

A
  • Usually sports injury w twisting movement
  • Knee pain (may be mild/intermittent), swelling, stiffness
  • May have catching, locking, buckling
48
Q

Describe the signs of meniscal tear on examination

A
  • Swelling +/- Baker’s cyst
  • Crepitations + tenderness over joint line
  • Pain in extension
  • McMurray test +, Apley grind test +
49
Q

Describe the presentation of knee ligament injury

A

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
Q

Describe the signs of MCL injury on examination

A
  • Inspection: swelling, effusions
  • Tenderness over medial aspect
  • **Abduction stress test
51
Q

Describe the signs of ACL injury on examination

A
  • Inspection: large effusion
  • Tenderness over lateral aspect
  • *Lachman’s test
  • Anterior drawer test
52
Q

Describe the signs of PCL injury on examination

A
  • Inspection: effusion, positive sag sign

* *Posterior drawer test

53
Q

Describe the investigations for soft tissue knee injury

A

MRI best test

Xray if indicated eg. suspected bony injury

54
Q

Describe the management of soft tissue knee injuries

A

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
Q

What are the indications for knee xray?

A

Age >55
Inability to weight-bear
Inability to flex knee to 90˚
Tenderness over fibular head or patella only

56
Q

Where do fractures of the tibia and fibula tend to occur?

A

Tibia: shaft, along with fibula
Fibula: lateral malleolus

57
Q

What is patellofemoral syndrome?

A

A very common condition of unknown aetiology causing knee pain in young active people

58
Q

Describe the presentation of patellofemoral pain syndrome

A
  • Insidious onset anterior knee pain. Worse on climbing stairs, squats, prolonged sitting
  • Stiffness

Surgery finals KTB (16 decks)

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