Lower extremity part 2 trigger Flashcards
Sudden deceleration with rotational trauma/hyperextension force applied to knee is MOI for what
ACL tear
Pt presents with sudden collapse of knee while going up for a layup in basketball. She reports hearing an audible pop. Now, 2 hrs post injury, she has developed joint effusion. Xray of knee shows effusion.
ACL tear
an avulsion fracture of the lateral capsular margin of the tibia appear with what injury? what is this called?
ACL tears
this is a segond fracture!!
tibial eminence fractures occur in children commonly alongside what injury
ACL tear
Pt presents with sudden give out of the knee after hearing a loud pop when she landed after a jump in volleyball. Xray 1 hr post injury shows Well-defined rounded homogeneous soft tissue density within suprapatellar recess on lateral view. Lachman and pivot shift test are both negative.
what is it
PCL tear
this xray is describing joint effusion.
direct blow to the tibia or extreme hyperextension of the knee are MOIs for what injury
PCL tear
With this injury, we should do an ABI, which should be greater than 0.9 to rule out.
PCL tear especially if you suspect multiligamentous injury (idk how to spell that(0
surgery for PCL is ONLY indicated in what circumstances
- PT fails to restore stability
- Multi-ligamentous injury
assocaited with sequelae of OA
PCL tear
if you have this injury you are at increased risk of medial meniscal injuries
ACL tear
pt reports with localized tenderness, swelling and stiffness of the knee that worsened progressively after she injured it. She reports she was able to bear weight after. 1 day later the lateral knee has ecchymosis and effusion
collateral ligament tear
MOI is rotational force with planted foot
meniscal tear
My 49 y/o momma pt presents with cc of knee pain after an injury 2 weeks ago ago. She reports the pain and stiffness has worsened since the injury occurs. It swelled a lot for a few days and then she began experiencing locking and popping of the joint. PE shows tenderness alog the joint lines.
what special test would likely be positive in this patient? what is the imaging of choice in this scenario? what is dx?
meniscal injuries.
mcmurray test
weight bearing xray in 45 degree of flexion!!!! (this is in all pts w meniscal injury over 40! if under 40 i think just regular AP lateral knee views)
which of the following would NOT indicate referral to ortho in meniscal tear?
a. young pt w traumatic tear
b. joint line tenderness despite conservative therapy
c. excessive popping/locking of the knee
d. excessive ecchymosis along the lateral aspect of the knee
e. positive lachmans or pivot test.
D
referall is indicated with:
Young pt with traumatic tear
Failure of conservative (aka joint line stays tender)
Mechanical symptoms
Evidence of instability
50% of what type of dislocations reduce spontaneously
knee dislocation
Hyperextension > 30deg when leg is lifted by the foot indicates what
instability of the ligaments in knee dislocation
what is the order of imaging that occurs in a knee dislocation
Xray - initial and after reduction
CT - assesses for occult fx after reduced and stabilized
MRI - assessses internal damage after reduction and sabilized.
what type of injury is immobilized in 20 degrees of flexion? what is the mechanism of stabilizing this injury prior to immobilizing it?
knee dislocation
longitudinal traction
extreme valgus stress is likely to lead to what fracture
lateral plateau fx
12 yo pt reports a sudden onset pain in the anterior knee after landing “awkwardly” from blocking in volleyball. PE shows loss of ROM and superior displacement of patella. what is the suspected dx and what would cause you to urgently refer this patient to ortho.
tibial tuberosity fracture.
tx: knee immobilizer w long leg post splint and NWB.
Urgent referral if its a complete avulsion!! if only partial then FU w ortho in 1 week.
posterior long leg splint with stirrup is used for
displaced tibial shaft fx after reduction
distal fibula fx requires stirrup splint/air cast splint (idk if thats the same or diff from this)
this is non-weight bearing bone
fibula fracture
what muscles invert the foot
anterior and posterior tibialis
what muscles plantar flex vs dorsal flex the foot
plantar - posterior tibialis(2 p’s!)
dorsal - anterior tibialis
what muscles dorsiflex the great toe and plantarflex the great toe
dorsiflex - extensor hallicus longus
plantarflex - flexor hallicus longus
what positive test suggests anterior talofibular ligament injury
anterior drawer test of foot/ankle
Place patient prone and squeeze their calf what is this called and what is a pos test indicate
thompson test
pos = absence of plantar flexion
pos = achilles tendon rupture
will NOT be positive in achilles tendon strain!!
when do you use mortise view
veiwing the ankle
Pt presents with complaints of ankle pain which a loud “pop” after attempting to “break a players ankles” in basketball. on exam you see a palpable defect 6cm from the calcaneus and the pt is experiencing weak plantar flexion. what is the likely dx? what special PE test is positive in these patients? what is the confirmatory diagnostic? what is the tx?
achilles tendon rupture
thomas test= +
confrim dx: MRI or US
tx: NWB, posterior leg splint in slight plantar flexion. consider surgical management
when do we use a controlled ankle motion boot?
for achilles tendon tear (not rupture)
pt presents with acute posterior ankle pain with localized tenderness along the calcaneus. there is no palpable defects and thomas test is negative. what is dx and tx? what is confirmatory diagnostic?
achilles tendon tear
CAM boot and FU ortho in 1 wk
confrim dx with MRI or US
a pt presents to your office with burning and stiffness of the ankle that is worse with activity and relieved w rest. she reports shed like to recieve a fast tx so she can get back to her marathon training which she started 3 months ago. what deformity may occur in this patient if left untreated long term. what is dx and tx
palpable calcaneal spur.
achilles tendonitis
RICE 7-10 days (PT if no improvement)
palpable calcaneal spur occurs in what diagnosis
long standing achilles tendonitis
what type of ankle sprain affects the ATFL and the CFL
lateral ankle sprain
what type of ankle sprain affects the deltoid ligament
medial ankle sprain (less common)
what type of ankle sprain affects with tibiofibular syndesmosis
high ankle sprain (severe inversion)
when do you do the squeeze test and what does it indicate
used in ankle sprains to assess damage to tibiofibular syndesmosis
positive is squeezing of mid calf causes pain in distal tib/fib
when do you do tylenol before NSAIDS
ACL tear
widening of the distal tibiofibular syndesmosis on XR is an indicator of what
high ankle sprains (severe inversion)
a unilateral fracture of the malleolus with associated ligament disruption is considered what kind of ankle fracture
bimaleolar ankle fx
the other bimaleolar fx is when both malleoli are fx
Both malleoli + injury of posterior lip of tibia is considered what kind of ankle fx
trimaleolar ankle fx
other kind is Both malleoli + ligament disruption
when would you emergently refer vs urgently refer for an ankle fx
emergent: open, NV compromise, associated dislocation and unstable+displaced
urgent: unstable but NONdisplaced
what would give away the presence of an occult fx on repeat xrays after 10-14 days of injjry
bony callus formation around the area where the fx is.
Posterior short leg split with lots of padding is used when
calcaneal fx
which of the following is not a common MOI for talus fx:
a. high energy plantar force
b. high energy eversion force
c. high energy inversion force
d. high energy dorsiflexion force
B
this foot/ankle fracture has extensive blood supply and therefore you must be extra wary of AVN
talus
pt presents with pain to the foot/ankle. on exam you see that her foot is in plantar flexion with an increased prominence of the anterior tibia on palpation. what is the likely dx? what is the tx?
posterior ankle dislocation
reduction via downward traction
a ffracture at the base of the 5th metatarsal is called what
jones fracture
pt presents w midfoot pain and inability to bear weight. there is obvious deformity, swelling and ecchymosis over the injury and XR shows cmobined tarsal metatarsal injury. what kind of XR should you have used? what is the Dx? what isthe tx?
dx: lisfranc
dianostic weight bearing XR
tx: NWB for 6-8 wks. rigid arch suppport 3 months
tx is NWB for 6-8 wks and rigid arch support for 3 months
non displaced lisfranc injury
Proximal fibula fx + medial malleolus fx/ligament disruption of the ankle w/o fx
maisonneuve fx
when do you use a digital block in phalangeal injuries
if there is a dislocation
burning plantar pain in the forefoot
mortons neuroma
walking on a marble
mortons neuroma
risks include obesity, flat feet, and prolnmged jumkping/standing
plantar fascitiis
pt reports heel pain that is worse during the first few steps of walking
plantar fasciitis
Tenderness over medial calcaneal tuberosity and 1-2cm along plantar fascia
plantar fasciitis
pain w passive dorsiflexion
plantar fascciitis
