Knee, Wrist, Ankle conditions

Question 1

What are the two red flags for compartment syndrome?

Answer 1

Pain out of proportion to injury

Pain worse on passive stretch of affected compartments

Question 2

Why is a CT scan needed for a spiral fracture of distal tibia?

Answer 2

Assess for a fracture of posterior malleolus

Question 3

Emergency management of tibia fracture

Answer 3

Realign
Bring tibia to length and rotation 
Above knee backslab
Elevation 
Monitor for compartment syndrome 
Radiography post-manipulation

Question 4

Surgical management of tibial fracture

Answer 4

Shaft: Intramedullary nailing

Proximal/ distal: ORIF and locking plates

Question 5

Which tibial plateau is more frequently fractured?

Answer 5

Lateral

Typically varus deforming force

Question 6

What does lipohaemarthrosis indicate?

Answer 6

Intra-articular fracture present

Question 7

Tibial plateau fracture conservative management

Answer 7

Hinged knee brace

Question 8

Tibial plateau fracture operative management

Answer 8

ORIF

Hinged knee brace

Question 9

What is an ankle fracture?

Answer 9

Fracture of any malleolus, with or without disruption to syndesmosis

Question 10

Weber classification

Answer 10

A- below syndesmosis
B- at the level of syndesmosis
C- above syndesmosis

Question 11

What are the Ottawa rules for radiograph

Answer 11

Bone tenderness at posterior edge of lateral/medial malleolus
Inability to weight bear both immediately and in ED for 4 steps

Question 12

What is the most fractured tarsal bone?

Answer 12

Calcaneum

Question 13

How do intra and extra articular calcaneal fractures differ?

Answer 13

Intra-articular: subtalar joint articular surface involved

Extra-articular: avulsion fractures, Achilles’ tendon

Question 14

Shortened and widened heel with varus deformity

Answer 14

Calcaneal fracture

Question 15

What fracture does a decreased Bohlers angle indicate?

Answer 15

Calcaneus

Usually 20-40degrees

Question 16

Surgical management for calcaneal fractures

Answer 16

ORIF

Or closed reduction with percutaneous pinning

Question 17

Risk factors for Achilles’ tendon rupture

Answer 17

Unfit with sudden increase in exercise frequency
Poor footwear
Male
Obesity
Recent fluoroquinolone use

Question 18

Mechanism of injury of talus fracture

Answer 18

Ankle forced into dorsiflexion

Talus against tibial plafond

Question 19

Where in the talus do most fractures occur

Answer 19

Talar neck

Question 20

What is the blood supply to the talus?

Answer 20

Extra-osseous artery

High risk of avascular necrosis

Question 21

What classification is used for Talar fractures?

Answer 21

Hawkins

Subtalar dislocation, tibiotalar dislocation, talonavicular dislocation

Question 22

What are tibial pilon/ plafond fractures

Answer 22

Severe injuries of distal tibia

Talus punches up into tibial plafond

Question 23

Classification for tibial pilon fractures

Answer 23

Ruedi and Allgower classification

Question 24

What is a Lisfranc injury?

Answer 24

Severe injuries to tarsometatarsal joint

Between medial cuneiform and the base of 2nd metatarsal

Question 25

How does a Lisfranc injury occur?

Answer 25

Severe torsional or translational force applied through a plantar-flexed foot

Question 26

What is a red flag for Lisfranc injury

Answer 26

Plantar bruising Pain provoked by stressing mid foot Piano key sign

Question 27

What are some radiological features of a Lisfranc injury?

Answer 27

Widening of interval between base of 1st two metatarsals Bony fragment between 1/2 metatarsal (Fleck sign) Disruption of line drawn from medial base of 2nd metatarsal to medial side of middle cuneiform

Question 28

What is the most common cause of infracalcaneal pain?

Answer 28

Plantar fasciitis

Question 29

What does a plantar heel spur on XRSY indicate?

Answer 29

Plantar fasciitis

Question 30

Surgical management of plantar fasciitis

Answer 30

Corticosteroid injections | Plantar fasciotomy

Question 31

What is a colle’s fracture

Answer 31

Distal radius fracture with dorsal angulation and displacement of hand Extra-articular fracture From forcing wrist into supination, FOOSH

Question 32

What is a smiths fracture

Answer 32

Extra-articular fracture of distal radius Volar displacement Falling backwards, forced pronation

Question 33

What is a Bartons fracture

Answer 33

Intra-articular fracture of the distal radius | Associated dislocation of radiocarpal joint

Question 34

Radiograph findings on distal radius fracture

Answer 34

Radial height >11mm Radial inclination <22degrees Volar tilt>11degrees

Question 35

Complications of distal radius fracture

Answer 35

Malunion: redcued wrist motion, wrist pain, reduced forearm rotation Median nerve compression OA

Question 36

What are the lateral borders of the anatomical snuffbox?

Answer 36

Abductor pollicis longus | Extensor pollicis brevis

Question 37

Medial border of anatomical snuffbox

Answer 37

Extensor pollicis longus

Question 38

Contents of snuffbox

Answer 38

Radial artery Cephalic vein Superficial radial nerve

Question 39

Why is the palm spared in carpal tunnel syndrome?

Answer 39

Palmar cutaneous branch of the median nerve passing over carpal tunnel

Question 40

Management of carpal tunnel syndrome

Answer 40

Wrist splint to prevent flexion in sleep Corticosteroid injections Carpal tunnel release surger

Question 41

Risk factors for dupuytrens contracture

Answer 41

Smoking Alcoholic liver cirrhosis Diabetes mellitus Occupational exposures (use of vibration tools or heavy manual work)

Question 42

What does Hueston’s test positive indicate?

Answer 42

Dupuytren contracture | Cant lay hand flat on table

Question 43

What tendons are involved in De Quervain’s tenosynovitis

Answer 43

Tendons of extensor pollicis brevis | Abductor pollicis brevis

Question 44

Clinical features of De Quervain’s tenosynovitis

Answer 44

Pain near base of thumb Associated swelling Movements involving grasping or pinching are particularly painful and difficult

Question 45

What does positive Finkelstein’s test indicate

Answer 45

De Quervain’s tenosynovitis Longitudinal traction and ulnar deviation to affected thumb Pain at styloid process and along the tendons

Question 46

What are Ganglionic cysts

Answer 46

Non-cancerous soft-tissue lumps that occur along any joint or tendon Filled with synovial fluid

Question 47

What is trigger finger?

Answer 47

Finger or thumb clicks/locks when in flexion, preventing a return to extension

Question 48

Where does the patella sit?

Answer 48

Trochlear groove

Question 49

What is patella dysplasia, and what can it lead to?

Answer 49

Patella not fitting properly in trochlear groove | Patella-femoral OA

Question 50

How do you get an ACL tear?

Answer 50

Twisting knee whilst weight-bearing

Question 51

What is the most common cause of haemarthrosis in the knee

Answer 51

ACL tear

Question 52

What is a Segond fracture?

Answer 52

Bony avulsion of lateral proximal tibia

Question 53

How do you get a PCL tear?

Answer 53

High-energy trauma | Hyper flexion of knee with plantar flexed foot

Question 54

What nerve can be damaged in MCL tear?

Answer 54

Saphenous nerve

Question 55

What are the four types of meniscal tear?

Answer 55

Vertical Transverse (parrot beak) Horizontal (bucket handle) Degenerative

Question 56

If the knee is locked in flexion, what soft tissue injury should be suspected?

Answer 56

Meniscal tear

Question 57

What is a bipartite patella

Answer 57

Failure of patella fusion

Question 58

What is osteochondritis dissecans?

Answer 58

Bone underneath cartilage of a joint dies due to lack of blood flow Subchondral bone and cartilage breaks loose, causing pain and possible hindering joint motion