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Clin Med I > lower extremity injuries > Flashcards

lower extremity injuries Flashcards

1
Q

who do hip fx usually occur in?

A
  • elderly female with osteoporosis

- generally fx happens first then they fall

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2
Q

clinical presentation for femoral head fx

A
  • hip/groin pain s/p fall
  • non-ambulatory or need assistance
  • internal or external rotation of leg on affected side
  • TTP over fx area
  • pain with AROM and PROM
  • pain with IR very sensitive for fx*
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3
Q

imaging to order for hip fx

A
  • AP pelvis, frog lateral

- if suspect fx but it is not visible on x-ray then order MRI

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4
Q

treatment for femoral head fx

A
  • almost always surgical
  • cannulated screws
  • hemiarthroplasty
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5
Q

garden classification

A
  • for femoral neck fx
  • predicts dev of AVN
  • stages I- IV
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6
Q

garden stage I

A
  • nondisplaced incomplete fx
  • possible greenstick fx
  • valgus impaction fx
  • stable fx
  • can be treated with internal fixation
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7
Q

garden stage II

A
  • nondisplaced complete fx
  • stable fx
  • can be treated with internal fixation
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8
Q

garden stage III

A
  • complete fx, incompletely displaced
  • femoral head tilts into varus position
  • unstable
  • requires arthroplasty
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9
Q

garden stage IV

A
  • complete fx completely displaced
  • unstable
  • requires arthroplasty
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10
Q

intertrochanteric fx

A
  • hip fx that happens between greater and lesser troch
  • extracapsular
  • fx through cancellous bone with good blood supply so heals well
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11
Q

treatment for intertrochanteric fx

A
  • IM nailing

- DHS compression screw

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12
Q

subtrochanteric hip fx

A
  • fx below greater and lesser troch

- requires IM nailing

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13
Q

which hip fx get a hemiarthroplasty

A
  • displaced femoral neck

- supcapital hip fx

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14
Q

which hip fx get cannulated screws

A
  • nondisplaced femoral neck fx
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15
Q

which hip fx get nailing/ compression screws

A
  • intertrochanteric fx

- subtrochanteric fx

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16
Q

prognosis of hip fx

A
  • 25% of pts do not survive past 1 year

- of those who do survive, often return one level below baseline ambulatory/ ADL status

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17
Q

greater trochanteric bursitis

A
  • usually women, more common in 40s and 50s
  • triggered by minor direct trauma over greater troch
  • pain in lateral hip
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18
Q

clinical presentation of greater troch bursitis

A
  • aching, intense lateral hip pain
  • worsened with direct pressure
  • pain radiates down lateral thigh
  • painful ambulation
  • TTP over greater troch
  • pain with resisted hip abduction and passive hip rotation
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19
Q

treatment for greater troch bursitis

A
  • ice
  • NSAIDs
  • PT
  • steroid injection
  • surgery rare
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20
Q

femoral acetabular impingement

A
  • femoral neck abnorm shaped during childhood growth
  • active people may experience pain sooner
  • cam bone spur vs. pincer bone spur
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21
Q

cam bone spur

A
  • abnormal femoral head/ neck junction
  • increased radius at waist
  • impingement occurs during flexion, adduction, IR
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22
Q

pincer bone spur

A
  • excessive acetabular coverage

- linear contact between labrum and femoral head/ neck junction

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23
Q

clinical presentation of femoral acetabular impingement

A
  • pain in groin, may radiate to lateral hip
  • dull ache which waxes/ wanes with activity and rest
  • improves withPT but sx will return
  • sharp stabbing pain with turning, twisting, squatting
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24
Q

diagnosis of femoral acetabular impingement

A
  • impingement test- hip flexion to 90, adduct to 20 degrees the IR, will prod pain
  • x-ray for bone morphology
  • MRI for labrum and articular cartilage assessment
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25
Q

treatment for femoral acetabular impingement

A
  • surgery- arthroscopic labral repair/ debridement, femoral neck/head resection
  • activity modification
  • NSAIDs
  • PT
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26
Q

femur fx

A
  • usually d/t high velocity injuries
  • common site for metastatic lesions
  • potential for severe blood loss and loss of life/limb
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27
Q

clinical presentation of femur fx

A
  • NWB usually
  • distracting injury
  • mod- severe pain if pt is conscious
  • affected leg shortened and rotated
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28
Q

diagnosis of femur fx

A
  • assess NV status
  • assess for other injuries
  • xrays- AP, lateral of femur
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29
Q

treatment for femur fx

A
  • address life threatening injuries first
  • IM nailing best sx option
  • analgesics and anticoags
  • PT
  • follow healing through serial x-rays
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30
Q

tibial plateau fx

A
  • high energy deceleration injury
  • femoral condyles piston down onto tibial plateau
  • often occurs in conjunction with other LE injuries
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31
Q

clinical manifestations of tibial plateau fx

A
  • mod-severe pain
  • NWB
  • very TTP
  • resist AROM and PROM
  • distracting injury- assess for other injuries
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32
Q

diagnosis of tibial plateau fx

A
  • trauma series of knee
  • CT if unstable and need ORIF
  • if no fx seen on plain film but pt has sx order MRI
  • assess if open vs closed and NV status
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33
Q

treatment of tibial plateau fx

A
  • stable- hinged knee brace and crutches

- unstable- ORIF with side plate and screws

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34
Q

segond fx

A
  • avulsion fx involving lateral aspect of tibial plateau
  • 75% also have ACL inj
  • usually seen in falls or sports
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35
Q

clinical presentation of segond fx

A
  • knee pain/ swelling after trauma
  • hold knee at 20 degree flexion
  • NWB but stable
  • mod- large effusion
  • resist full ext and may not be able to flex past 90 d/t hemarthrosis
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36
Q

diagnosis of segond fx

A
  • standard knee trauma series

- may show curvilinear fx

37
Q

treatment of segond fx

A
  • if small fx can use cancellous screw
  • if extensive ligamentous injury requires surgery
  • good prognosis
38
Q

patella fx

A
  • often d/t direct injury to anterior patella
  • can be d/t sudden forceful contraction of quad
  • can occur after ACL reconstruction or TKR
39
Q

clinical presentation of patella fx

A
  • NWB or protected WB
  • mod-severe pain
  • large area of swelling or large joint effusion
  • absent extensor mechanism
  • may have defect in distal quad tendon
  • assess NV status
40
Q

diagnosis of patella fx

A
  • knee trauma series

- CT if severely comminuted

41
Q

treatment of patella fx

A
  • ORIF with tension band wiring
  • NWB in hinged knee brace locked into exxt
  • can unlock brace to 20 degrees for swing leg while walking
  • active ROM in brace under PT supervision X 4 weeks
42
Q

quad tendon rupture

A
  • forced flexion against resistance/ ext
  • i.e. person jumping down onto deck of boat as it is coming up at him
  • usually heavy set males in 40s or 50s
  • rupture at musculotendinous junction
43
Q

clinical presentation of quad tendon rupture

A
  • hears pop
  • if complete rupture will be NWB with large effusion
  • absent extensor mechanism
  • lg area of swelling
    likely defect in distal quad tendon
  • assess NV status
44
Q

treatment for quad tendon rupture

A
  • sx
  • pt held to - 20 degrees extension and NWB in locked hinge knee brace
  • may transition to PWB after 6 weeks
  • once ROM restored then strengthen
  • may take up to 1 year
45
Q

patella tendon rupture

A
  • palpable defect in patellar ligament
  • patella alta
  • absent extensor mechanism
  • risk factors- RA, long term DM, long term steroids
  • rupture rare in young athletes unless steroid use
46
Q

treatment for patella tendon rupture

A
  • standard knee trauma xrays
  • conservative tx for partial tear- immobilization in hinged knee brace for 4-6 weeks
  • surgery if complete tear
47
Q

maisonneuve fx

A
  • combo of spiral fx of proximal fibula with an ankle injury
  • widened ankle joint d/t rupture of distal tibiofibular syndesmosis
  • deltoid ligament disruption
  • +/- fx of medial malleolus
48
Q

ACL tear

A
  • valgus stress to knee or distal thigh with ipsilateral foot planted
  • young women
49
Q

ACL tear clinical presentation

A
  • hears “pop”
  • mild- mod pain
  • massive effusion
  • instability
50
Q

diagnosis of ACL tear

A
  • lachman test- most sensitive
  • anterior drawer sign
  • xray to r/o segond fx
  • MRI
51
Q

treatment of ACL tear

A
  • reconstruction to return to sports/ occupation
  • joint instability puts pt at higher risk post traumatic OA
  • occult osteochondral lesions in majority of pts
52
Q

MCL tear

A
  • common sports injury

- d/t valgus force to lateral knee

53
Q

clinical presentation of MCL tear

A
  • acute onset pain in medial aspect of knee
  • instability when changing directions or stairs
  • +/- swelling
  • antalgic gait
  • TTP over MCL
  • ROM preserved if no effusion
  • pain with valgus stress 0-30 degrees
54
Q

diagnosis of MCL tear

A
  • standard xray series

- no MRI required unless ACL tear suspected

55
Q

treatment of MCL tear

A
  • RICE
  • gentle NWB ROM 3-5 days
  • hinged knee brace
  • PT
  • most treated conservatively with good prognosis
56
Q

patella femoral syndrome

A
  • aka chondromalacia patella
  • common cause of anterior knee pain
  • lateral mal-tracking of patella during flex/ ext
  • weakness of VMO and tightness of ITB
  • pain during knee flexion, descending stairs, prolonged sitting
57
Q

clinical presentation of patella femoral syndrome

A
  • normal WB and minimal impact on ADLs
  • diffuse pain around knee
  • pain may be localized to medial joint line
  • stiff feeling after prolonged sitting
  • achey during activities
  • inflammation but no effusion
  • VMO atrophied
  • ITB tenderness
  • patella aprehension
  • ROM not usually impacted
58
Q

diagnosis of patella femoral syndrome

A
  • xrays- sunrise (merchant) view most important
  • lateral subulxation of patella
  • usually xrays are normal
59
Q

treatment of patella femoral syndrome

A
  • activity modification
  • strengthen VMO
  • NSAIDs
  • Patella brace PRN
  • good prognosis if compliant with PT
  • some require sx- lateral release
60
Q

meniscus tear

A
  • medial more common than lateral
  • acute injury- twisting or rotational mvmt of flexed knee while foot planted
  • if older adult d/t degeneration
61
Q

clinical presentation of meniscus tear

A
  • hear “pop”
  • medial/lat sided pain “inside” knee over joint line
  • +/- swelling
  • pain worse with activities, improves with rest
  • locking** or inability to fully ext/flex knee
62
Q

diagnosis of meniscus tear

A
  • TTP over affected joint line
  • pos McMurray test
  • unable to squat deeply
  • in older pts may not have pos McMurray but will be TTP
  • standard xray to r/o fx
  • MRI for surgical assessment
63
Q

treatment of meniscus tear

A
  • meniscus repair for younger pts -> portected WB with gentle ROM X 6 weeks
  • meniscetomy in older less active pts -> return to activity quickly
64
Q

tibia fx

A
  • high energy deceleration injury

- often occurs in conjunction with other LE fx

65
Q

clinical presentation of tibia fx

A
  • NWB or protected WB
  • mod- severe pain
  • may have obvious skin deformity
  • swelling
66
Q

diagnosis of tibia fx

A
  • det if open vs closed (often open)
  • TTP over fx site
  • assess ankle and knee ROM
  • xrays- AP and lateral views
67
Q

treatment of tibia fx

A
  • midshaft tibia fx often unstable
  • IM nail fixation
  • if multi-trauma may need ex- fx
68
Q

ankle fx

A
  • from foot being planted and body sustains rotational force
  • ext rotation -> spiral fx of fibula +/- medial malleolus fx
  • abduction force -> transverse fx of fibula and avulsion of medial malleolus
69
Q

clinical presentation of ankle fx

A
  • NWB or protected
  • swelling
  • reduced ROM
  • crepitus
  • assess prox fibula
70
Q

diagnosis of ankle fx

A
  • xray 3 views- AP, mortise, lateral

- may need stress views to det if stable vs unstable

71
Q

treatment for ankle fx

A
  • stable- tall walking boot or cast

- unstable- ORIF

72
Q

ankle sprain

A
  • “turned the ankle” during fall or landing
  • most common mechanism is inversion and plantarflexion causing damage to ATF ligament
  • eversion can cause high ankle sprain d/t damge to deltoid ligament
73
Q

clinical presentation of ankle sprain

A
  • pain/ swelling
  • TTP
  • antalgic WB
  • ecchymosis 24-48 hours later
  • exam finidngs similar to fx, need an xray
74
Q

treatment of ankle sprain

A
  • RICE
  • tall boot
  • NSAIDs
  • early ROM
  • PT
  • good prognosis if compliant
75
Q

calcaneus fx

A
  • high energy deceleration injury, esp fall from height

- may complain of LBP secondary to associated lumbar compression fx

76
Q

clinical presentation of calcaneus fx

A
  • NWB
  • severe pain
  • +/- NV injury
  • assess back*
  • check smoking status
  • often results in chronic heel pain
77
Q

diagnosis of calcaneul fx

A
  • well padded posterior splint
  • crutches or wheelchairs
  • analgesics
  • ORIF delayed 7-10 days d/t swelling
78
Q

5th metatarsal avulsion fx

A
  • d/t inversion of foot and plantarflexion
  • pulls at insertion of peroneus brevis
  • must include 5th metatarsal base in lateral ankle xray
  • usually treated conserv and heal well
79
Q

jones fx

A
  • transverse fx at base of 5th metatarsal
  • d/t significant adduction force to forefoot with ankle in plantar flexion
  • prone to non-union and take long to heal
  • increased risk fx displacement with WB
80
Q

treatment for Jones fx

A
  • NWB for 6-8 weeks

- internal fixation and bone grafting may be required

81
Q

plantar fasciitis clinical presentation

A
  • shape volar sided heel pain
  • usually normal gait but may limp
  • pain worst in AM
  • pain decreases as pt ambulates
82
Q

diagnosis of plantar fasciitis

A
  • TTP at origin of plantar fascia on calcaneus
  • pes planovalgus orientation on exam common
  • tight achilles
  • xrays
83
Q

treatment for plantar fasciitis

A
  • night splint
  • ice
  • NSAIDs
  • PT
  • steroid injection and sx rare
84
Q

achilles tendon rupture risk

A
  • fluoroquinolone use
  • steroid injections
  • usually traumatic injury
85
Q

achilles tendon rupture cause

A
  • sudden forced plantar flexion

- violent dorsiflexion in plantar flexed foot

86
Q

clinical presentation of achilles tendon rupture

A
  • hears pop
  • weakness and difficulty walking
  • pain in heel
  • palpable defect
  • weak plantarflexion
87
Q

diagnosis of achilles tendon rupture

A
  • thomson test
  • xray to r/o other pathology
  • US
  • MRI not usually needed
88
Q

Thompson test

A
  • used to dx achilles tendon rupture
  • pt in prone with knee flexed at 90
  • squeeze calf at widest girth
  • pos if calf doesnt plantar flex when squeezed
89
Q

treatment of achilles tendon rupture

A
  • almost alway surgical

- non operative based on pt preference or if pt is frail

Clin Med I (16 decks)

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