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Clin Med semester 2 > Lower Extremity Orthopedics lower leg and ankle disorders- Jaynstein- Exam 2 > Flashcards

Lower Extremity Orthopedics lower leg and ankle disorders- Jaynstein- Exam 2 Flashcards

1
Q

Tibial Plateau fracture: describe this fracture

A

Fracture of the proximal tibia–> intra-articular fx

-Represents a high energy injury – often associated with other ST injuries

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2
Q

Tibial Plateau fracture MOI:

A
  • Valgus or varus twist with axial loading

- Direct trauma

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3
Q

Tibial Plateau fracture Sxs:

A

Severe pain, swelling

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4
Q

Tibial Plateau fracture dx:

A
  • Xray – make sure you eval proximal and distal tibia

- Xrays often miss this fx, if high suspicion get a CT wo contrast

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5
Q

Tibial Plateau fracture tx:

A
  • Pain control
  • Consult ortho on all
  • -Non-op – no to min displacement–> Hinged brace, crutches

–Operative – displaced, comminuted, open–> ORIF (surgery)

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6
Q

Tibial plateau fx complications

A
  • Peroneal nerve injury – assess for and document foot drop!
  • May need MRI to assess for ST injury – ACL and meniscal tears common
  • Compartment syndrome
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7
Q

Tibial Shaft fracture: -how common?

-MOI?

A

Common fracture

MOI: torsional injury, direct blow

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8
Q

Tibial shaft fx dx:

A

xray

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9
Q

Tibial shaft fx tx:

A
  • No to minimal displacement–> splint with crutches, then walking cast
  • Displaced or comminuted –>splint with crutches, ORIF
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10
Q

Fibula Shaft Fracture Dx?

Tx?

A

**The fibula is non-weight bearing bone

Dx: xray – make sure you visualize entire bone

Tx: splint –> cast, weight bearing fine

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11
Q

What is the MC reason for missed athletic participation?

A

ankle sprains

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12
Q

______ injuries are 80% of ankle sprains

A

inversion

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13
Q

CFL- MOI?

A

CFL= calcaneofibular ligament

-torn CFL MOI: inversion injury. Pain at the base of fibula

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14
Q

ATFL- MOI:

A

ATFL= anterior tibiofibular ligament

*ATFL is the weakest ligament
MOI: inversion injury
-Pain across tib/fibula syndesmosis

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15
Q

How common is an ATFL injury?

A

Most common! Isolated ATFL tear in 70%

  • CFL 2nd MC
  • Lateral Malleolus fx- 3rd
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16
Q

High ankle sprain accounts for ___% of ankle sprains

A

10%.

  • Syndesmosis injury
  • *Tibiofibular and interosseous ligaments
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17
Q

Low ankle sprain accounts for __% of ankle sprains

A

> 90%

-*Anterior talofibular ligament (ATFL) and Calcaneofibular ligament (CFL)

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18
Q

Ankle sprain PE: Anterior drawer test assesses ______

A

ATFL

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19
Q

Ankle sprain PE: Talar tilt test assesses _____ and ____

A

ATFL & CFL

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20
Q

Ankle sprain Dx:

A

XRAYS OVER ORDERED! Evaluates for fx, not ligamentous injury

Ottawa Ankle Rules: (96-99% sensitive in ruling out ankle fracture):

  • Inability to bear weight
  • Medial or lateral malleolus point, bony tenderness
  • 5MT(5th metatarsal) base tenderness
  • Navicular tenderness

-MRI evaluates for ligamentous injury

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21
Q

Ankle sprain: 1st degree (KNOW)

A

=stretching of the fibers

-Walkable, min swelling

Tx: RICE, ace bandage, keep moving and weight bearing

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22
Q

Ankle sprain: 2nd degree (KNOW)

A

=partial tear
-+/- walking, moderate swelling

Tx: RICE, might need 2-3 days NWB, airsplint

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23
Q

Ankle sprain: 3rd degree (KNOW)

A

Third degree: complete tear
-No walking, **“egg-shaped” swelling within 2 hours, can be less painful than 2nd deg

Tx: -RICE, NWB(non weight bearing) 3-7 days with re-exam in 5-7 days.
-+/- surg vs PT

24
Q

Ankle sprain: Prolonged ________ leads to more complications!

A

immobilization

25
Q

The ____ bears more weight per unit area than any other joint in the body

26
Q

ankle fracture -Malleoli Fractures:

  • Lateral malleolus- fx of ______
  • Medial malleolus- fx of the _____
A
  • lateral malleolus- fx of the fibula

- medial malleolus= fx of tibia

27
Q

The fibula is a ______ bone

28
Q

Tx of Isolated lateral malleolus fracture with < 3mm displacement:

A

Ortho referral, likely walking boot 6-8 weeks

-if Displaced, comminuted, open –>surgical repair

29
Q

MedialMalleoli Fx: The tibia is the _____ _____ bone of the LE

A

weight bearing

30
Q

__-__% of tibia fractures occur in conjunction with fibular fracture

31
Q

MedialMalleoli Fractures tx

A
  • More likely to be surgical

- -Splint, crutches, ortho referral

32
Q

Bimalleolar fracture=

A

Fracture of both the medial and lateral malleoli

33
Q

Trimalleolar fracture=

A

fracture of the medial malleolus, lateral malleoli, and fracture of the posterior aspect of the tibia

34
Q

Achilles tendon rupture demographic

A
  • More common in men, 30-40yo
  • Risks: “weekend warrior,” fluoroquinolone use
  • MOI: Traumatic, abrupt injury – “someone just shot me in the foot” or “pop”
35
Q

Achilles tendon rupture Sxs:

A

Severe pain, inability to bear weight

**“someone just shot me in the foot” or “pop”

36
Q

PE tests for achilles tendon rupture

A
  • Thompson Test

- Achilles feels soft

37
Q

PE tests for achilles tendon rupture

A
  • Thompson Test (= flip them over, squeeze their ankle and they should dorsiflex)
  • Achilles feels soft
38
Q

Achilles tendon rupture tx:

A
  • Ortho referral –> surgical repair

- Splint, crutches, pain meds

39
Q

Phalangeal fx: how common

A
  • Very common!

- Rarely surgical – buddy tape +/- hard soled (cast) shoe

40
Q

Metatarsal fractures: non-operative tx?

A
  • stiff soled shoe or walking boot with weight bearing as tolerated
  • Non-displaced fractures of 1-4
41
Q

Metatarsal fractures: operative tx?

A
  • percutaneous pinning
  • Open fractures
  • Any displacement in the first metatarsal fracture or multiple fxs
42
Q

5th Metatarsal fracture: how common?

A

Very common fracture – “dancers fracture”

43
Q

5th Metatarsal fracture MOI:

A
  • Forced inversion during plantar flexion of the foot and ankle
  • The peroneus brevis and lateral band of plantar fascia insert on base
44
Q

Jones vs Pseudo-Jones

A

*Avulsion = Pseudo Jones
Wt bearing ok

*Jones and stress fractures require non-weight bearing

45
Q

Plantar Fasciitis:

  • describe this condition
  • Risks?
A
  • Inflammation of the aponeurosis at its origin on the calcaneus
  • Chronic overuse leads to microtears in the origin of the plantar fascia

Risks: obesity, decreased ankle dorsiflexion in a non-athletic population (tightness of the foot and calf musculature), and weight bearing endurance activity (dancing, running)

46
Q

Plantar Fasciitis Sxs and Dx

A

Sxs: Sharp heel pain – insidious upon stepping out of bed, worse at end of the day, may be bilateral

Dx:
Clinical – pinpoint tenderness, dorsiflexion of the toes and foot increases tenderness with palpation

47
Q

Plantar Fasciitis tx:

A

stretching, NSAIDs and arch support

48
Q

Other common foot disorders

A

Hammer toe
Corns and Calluses
Bunions
Ingrown Toe Nails

49
Q

Hammer Toe

A

=Flexion deformity of the PIP joint with extension of DIP (toes 2-5)

  • Common in high heel wearers
  • Clinical dx

Tx:
Non-op to start – “wide” shoes, padding/splinting
Podiatry referral for chronic pain

50
Q

Describe Corns vs calluses

A

=A toughened area of skin which has become relatively thick and hard in response to repeated friction, pressure, or other irritation

Corn – painful, small with very hard center

Callus – larger, non-painful

51
Q

Tx corns and calluses

A

file/remove, padding

52
Q

bunions aka ____ _____

A

hallux valgus

53
Q

Bunions: etiology

A

=Pressure on the lateral MCP joint causes the metatarsal head displaces medially – bony deformity

  • Slow onset, can become very painful
  • *Huge genetic component!
54
Q

bunions tx

A
  • Wide shoes, padding
  • Pain control
  • Podiatry referral–> Surgery
55
Q

Ingrown toe nails

A

=Painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed

-May or maybe not be concurrently infected

Tx: warm water soaks, antibacterial ointment, well fitting shoes (open toe shoes best), nail lifting or removal

Clin Med semester 2 (24 decks)

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