Lower extremity injury

Question 1

Transient synovitis of the hip

Answer 1

Epidemiology- ages 3-10
Etiology- viral, post vaccine or drug induced
Exam: holds hip slightly flexed and ER, any motion causes pain (with log roll), refuses to bear weight, otherwise looks ok

Test- sed rate 35-60 mm/hr CBC - mild leukocytosis

Treatment: NSAIDs for 1-3 wks

Question 2

Slipped capital Femorla epiphysis

Answer 2

SCFE- usually overweight early adolescent w/ history of groin of knee pain, may be referred to anteromedial thigh

Often occurs- bilaterally (but not simultaneously)
Etiology- repetitive overload
Presentation- vague symptoms, worse with activity

On exam- limitation of hip internal rotation
Test- plain x ray
Treatments- surgery fixation

Question 3

Septic joint

Answer 3

etiology- gonorrhea or skin flora
Exam- swollen, extremely painful joint, passive and active ROM very painful, red/hot, usually systemic sign (can be absent in diabetic or immunosuppressed pt)

Treatment: surgery and ID followed by IV antibiotics
Comp: articular surface destroyed

Question 4

Knee articulations

Answer 4

3 surfaces: femoral condyles, Tibial plateau, patella

Knee ligaments: medial meniscus (C-shaped), lateral meniscus (O shaped), Cruciates (Anterior ACL), Posterior ligament

Medial/tibial collateral
Lateral/fibular collateral

Question 5

Lachmans test and anterior drawer

Answer 5

Lachmans test: with pt knee bent 20-30deg, grasp limb over distal femur and proximal tibia, Tibia movement more than 5 mm – anterior cruciate ligament rupture

Anterior drawer test- hip flexed at 45 degrees, knee at 90. Sit on pts foot stabilizes, push behind tibia, movement more

Question 6

PCL tear vs s acl tear

Answer 6

PCL blow to the front

ACL, blow to the black

Question 7

valgus vs varus stress

Answer 7

Valgus- push lateral femoral, pull tibia lateral

Varus opposite

Question 8

Joint stability

Answer 8

Dislocation- complete displacement
Subluxation- transient. partial displacement
Laxity- normal variant in joint looseness

Question 9

Acute compartment syndrome

Answer 9

Signs and symptoms: poikilothermia- cool extremity often earliest sign of impending compartment syndrome

Pain- to passive motion, out of proportion to exam, pain ful, tight- tense compartment to palpation/squeeze
Patesthesias, pulselessness and pallor rare

Surgical eemergency

Question 10

compartment syndromes

Answer 10

Deep Fibular nerve for anterior compartment (web of big toe)

Tibial nerve- all posterior compartment and plantar surface

Superficial fibular nerve- lateral compartment

Question 11

compartments of the leg

Answer 11

know the chart w/o muscles