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Course 2 - Orthopedics > Lower Extremities (foot, ankle, knee, hip) > Flashcards

Lower Extremities (foot, ankle, knee, hip) Flashcards

1
Q

what is the typical etiology of an achilles tendon rupture?

A

kick to the post calf, males, missed 25% of time

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2
Q

what are the two endpoints of the wtbearing axis?

A

femoral head to talar dome

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3
Q

what is the physiological heel position?

A

valgus, varus when walking

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4
Q

what predisposes people to rolling ankles?

A

naturally varus ankles

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5
Q

what joint is responsible for dorsi/plantar flexion of the foot?

A

tibiotalar joint

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6
Q

what joint is responsible for inversion/eversion of the foot?

A

subtalar joint

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7
Q

should you inject steroids into the achilles tendon?

A

no

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8
Q

what tendons make up the achilles?

A

gastrocnemius and soleus

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9
Q

why is the achilles tendon slow healing?

A

watershed area at calcaneous

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10
Q

what is the most effect Dx of achilles rupture?

A

thompson test
no plantarflexion of ankle with squeezing calf
ability to plantar-flex is not good method (FDL, Tib Post, FHL, Plantaris, Peroneus Longus can also plantar-flex)

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11
Q

what is the best Tx for achilles rupture?

A

plantarflex splint for 1-2 wks, refer to surgery if needed
high risk DVT, follow up
rehab

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12
Q

what is the typical mechanism of ankle sprains?

A

inversion and plantarflexion

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13
Q

what ligament is the most commonly torn in ankle sprains?

A

ATFL

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14
Q

according to the ottawa ankle rules, when is an XR needed in ankle sprains?

A

bony tenderness of lateral & medial malleoli, inability to bear wt, age >55

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15
Q

what is the Tx for ankle sprains?

A

RICE, functional rehab (months)

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16
Q

when would you order an MRI in ankle sprains?

A

usually people

suspected talar osteochondral injury, peroneal tendon damage

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17
Q

DDx for persistant ankle sprain (2-3 mo):

A

bony injury, tendon injury, ligament injury

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18
Q

what type of fractures usually happen in the ankle?

A

rotational

pilon fractures from axial load

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19
Q

what Hx elements indicated an ankle fracture?

A

sounds like sprain but unable to bear wt, or reported dislocation

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20
Q

when is surgery needed in ankle sprains?

A

displaced LM fracture, bimalleolar/trimalleolar fracture

avulsive lateral malleoli fractures are on the same spectrum as ankle sprains and can be treated like them

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21
Q

what is the biggest risk factor for bunions (hallux valgus)?

A

genetics

medial deviation of first metatarsal and lateral deviation and pronation of hallux

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22
Q

what is the firstline Tx for bunions?

A

accommodative footwear

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23
Q

when is surgery indicated in bunions?

A

pain, progression, transfer metatarsalgia (secondary pain)

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24
Q

what is hallux rigidus?

A

arthritis in big toe MTP joint
trauma, idiopathic
may coexist with bunions
osteophytes

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25
Q

what Tx are given for HR?

A

rest, NSAIDs, activity mod. footwear mod, mortons extension shoe inserts
cortisone
surgical options avail

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26
Q

in what cases are flatfeet (Pes planovalgus) problematic?

A

pediatric stiff flatfeet (bony fusions), progressive, acquired flatfeet in adults

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27
Q

what are the dynamic stabilizers of the foot?

A

Tibialis posterior tendon (key), spring ligament, deltoid ligament, plantar fascia

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28
Q

what symptoms would be seen in TPT dysfunction?

A

pain in medial foot first, then lateral, static stabilizers fail first
test with single limb heel rise
Tx with RICE, NSAID, ankle supports, no cortisone, surgery

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29
Q

what does healthy articular cartilage need?

A

attachment to healthy subchondral bone (if detached, detect as foreign material and sets off inflammation), healthy synovial fluid in joint

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30
Q

what causes abnormal forces on cartilage in joint?

A

instability, malalignment, obesity

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31
Q

what are the hallmarks of degenerative joint disease (DJD)?

A

increased water, decrease chondrocytes and proteoglycan, abnormal collagen

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32
Q

what are the primary causes of arthritis?

A

degenerative, autoimmune

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33
Q

what are the XR features of arthritis?

A

joint space narrowing, subchondral sclerosis, cysts, osteophytes

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34
Q

what does varus knees indicate?

A

significant OA

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35
Q

what is the trendelenberg sign?

A

limp in arthritis

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36
Q

what are common signs of hip arthritis?

A

limb length discrepancy, muscle atrophy

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37
Q 
in classical OA of hip, which motion is lost first?
A.	Flexion 
B.	Abduction 
C.	Internal rotation 
D.	External rotation
A

internal rotation

38
Q

what does the crescent sign indicate?

A

fracturing femoral head

39
Q

what is the last stage of hip arthritis?

A

femoral head collapse and secondary arthritis

40
Q

can arthroscopy fix arthritis?

A

No

in setting of head collapse, total hip replacement and decompression

41
Q

what is the requirement for knee realignment?

A

joint space

42
Q

what causes knee replacement failure?

A

infection, loosening (infection or aseptic), plastic wearing out, trauma
revision arthroplasty has higher risk of DVT/PE, failure, stiffness, etc.

43
Q

what is the cause of aseptic loosening?

A

obesity

44
Q

what is the gold standard for advanced AVN?

A

total arthroplasty

45
Q

what’s the most common mechanism of ACL injury?

A

non-contact pivot external

46
Q

what is a chronic risk of torn ACL?

A

arthritis due to bone shift (instability)

47
Q

what Tx can be done for an ACL tear if the pt is too young for knee replacement?

A

stabilizing plates

48
Q

what are indications for urgent MRI in acute soft tissue knee problems?

A

hemarthrosis in the skeletally immature, multiply ligamnet injury, patellar dislocation/osteochondral fractures, discordance between Hx and PE, comorbidities that contraindicate XR, inability to distinguish locked and stiff knee

49
Q

can a locked knee perform flexion?

A

yes

50
Q

what can cause a locked knee?

A

meniscus tear, torn ACL, loose body

51
Q

if the joint is swollen immediately after injury, what is the fluid made of?

A

blood

52
Q

what test can be used to Dx a dislocated knee cap?

A

apprehension sign w varus/valgus

53
Q

what is the typical mechanism of patella/quad tendon rupture?

A

EC loading

54
Q

how would a meniscus tear present?

A

no swelling/bruising, tenderness at joint line

55
Q

what does the MCL prevent?

A

genu valgus

56
Q

what is the Lachman’s test used for?

A

ACL/PCL function test

57
Q

what common radiographic feature can be found on ACL tears?

A

segond fracture from avulsion

58
Q

what is a risk factor for ischemia in knee dislocation?

A

proximity to popliteal artery

59
Q

what is hemarthrosis?

A

bleeding in joint capsule

60
Q

what’s the difference between acute and chronic MSK injuries?

A

acute-trauma, energy input to tissue> absorbed

chronic-overuse, inadequate recovery between stress

61
Q

what are the most common areas of stress fractures?

A

lower extremity (tibial and metatarsal)

62
Q

what do you Dx stress fractures?

A

TBS

63
Q

why are stress fractures in the anterior tibia harder to tx?

A

higher rate of delay and non union

64
Q

what part of the LE is most affected by periostitis?

A

medial tibia

65
Q

how should quadricep contusions (crush injury) be managed?

A

immobilize in flexion to prevent stiffness, compression to prevent hematoma

66
Q

what is a potential complication of muscle strain/tear?

A

myositis ossificans secondary to muscular bleed

67
Q

what types of tendon tears are indicative of urgent surgery?

A

young RC tear, distal biceps tendon, quads/patellar tendons, achilles/peroneal/post tib

68
Q

what disorder is indicated by lateral knee pain worse with downhill, “catching feeling”, and lack of knee swelling?

A

ITBS

69
Q

where is acute post trauma bursitis likely to occur?

A

olecranon or pre-patellar area

70
Q

what causes frozen shoulder?

A

capsule synovitis and fibrosis

71
Q

what is synovial fluid

A

ultrafiltrate of blood plasma
lubrication, nutrition, shock absorption
10cc

72
Q

DDx of hemarthrosis

A 
bleeding disorder (hemophilia A,B, VWD)
fracture (patella, femoral condyle, tibial plateau)
extensor mechanism injury 
meniscus tear 
ligament tear
73
Q

Ottawa knee rules include

A 
Age 55 or older 
Isolated tenderness of patella or 
tenderness of head of fibula or 
inability to flex >90 degrees or 
inability to bear weight both immediately and in the emergency department for 4 steps
74
Q

describe patellar dislocation (extensor mechanism injury)

A

Hx: pop, painful, deformity, risk factors of valgus, F>M, ‘double jointed’
Tx: imaging often normal, usually non-operative (PT + bracing)

75
Q

describe quadriceps/patellar tendon rupture (extensor mechanism injury)

A

Hx: pain, pop, difficulty weightbearing, eccentric contraction, risk factors of steroids, Abx, age, pre-existing tendonitis, uremia
Dx: straight leg raise, XR,
Tx: surgical correction

76
Q

mechanism of injury for tendon rupture; which of the following is incorrect?
Lunging for ball in squash game (Achilles)
Catching a TV that’s falling off a shelf (biceps)
Clean and jerk (quadriceps)
Landing from a basketball lay-up (Achilles)
Lifting a heavy tire into the back of a pickup truck (biceps)

A

Lifting a heavy tire into the back of a pickup truck (biceps)

77
Q

function of meniscus

A

stability, lubrication and nutrition, axial load transfer, shock absorption

78
Q

describe bucket handle tear

A

tear along the length, leaves handle-like flap
Hx: pop, twisting mechanism, no bruising, PMT along joint line
Dx: Mcmurray/Apleys
MRI
Tx: non-op if no pain, transplant from cadavers

79
Q

Medial collateral ligament (MCL) prevents ____ and can be tested with ______

A

Medial collateral ligament (MCL) prevents valgus and can be tested with valgus stress at 0 and 30 degrees

80
Q

Lateral collateral ligament (LCL) prevents ____ and can be tested with ______

A

Lateral collateral ligament (LCL) prevents varus and can be tested with varus stress at 0 and 30 degrees

81
Q

Anterior cruciate ligament prevents ____ and can be tested with ______

A

anterior translation, rotation

Anterior drawer test, pivot shift

82
Q

Posterior cruciate ligament prevents ____ and can be tested with ______

A

posterior translation, posterior drawer/Lachman

83
Q

what is a segond fracture?

A

avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee

84
Q

healing potentials of knee ligaments

A

ACL has no potential to heal

MCL & LCL have better blood supply and are surrounded by synovial fluid

85
Q

Tx for ligament tears

A 
Crutches; collaterals: 4-6 weeks, cruciates: for comfort purposes
Bracing; collaterals: 4-6 weeks, cruciates: no, put PCL is exception 
Surgical reconstruction (ACL)
86
Q

define valgus

A

bone segment distal to a joint is angled outward, that is, angled laterally

87
Q

define varus

A

excessive inward angulation (medial angulation) of the distal segment of a bone or joint

88
Q

composition of articular cartilage (joint)

A

65-80% water
Type II collagen
proteoglycans
chondrocytes

89
Q

Tx for knee arthritis

A

NSAID, cortisone, visco-supplementation, analgesic, walking aids, weight loss, PT, orthotics, conditioning

severe: arthroscopy

90
Q

Etiology of avascular necrosis

A

SCD, viral, bacterial, fracture, dislocation, EtOH, Gaucher’s, hyperlipidemia, steroid therapy, MM, irradiation induced, Caisson’s disease (nitrogen bubble)

Course 2 - Orthopedics (7 decks)

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