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Orthopaedics ST3 > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

what are normal compartment pressures?

A

0-8mmHg

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2
Q

what compartment pressure would indicate compartment syndrome?

A

> 30mmHg or within 30mmHg of patients diastolic blood pressure

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3
Q

what is the delta pressure?

A

Delta pressure = Diastolic BP - intercompartment Pressure

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4
Q

what delta pressure is indicative of compartment syndrome?

A

<30mmgHg

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5
Q

where do you place the anterolateral incision in a fasciotomy?

A

2cm lateral to the lateral border of the tibia

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6
Q

where do you place the posteromedial incision in a fasciotomy?

A

1-2cm medial to the medial border of the tibia

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7
Q

which artery lies in the posterior compartment?

A

Posterior tibial a

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8
Q

which nerve lies in the superficial posterior compartment?

A

Sural Nerve

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9
Q

which artery lies in the anterior compartment?

A

Anterior tibial a

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10
Q

which artery lies in the lateral compartment?

A

Fibula artery

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11
Q

peroneus tertius lies in what compartment?

A

anterior

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12
Q

the nucleus pulposus makes up which part of the intervertebral disc?

A

central

helps distribute pressure

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13
Q

what makes up the outer portion of an intervertebral disc?

A

annulus fibrosus

multiple laminae of fibrocartilage - withstand compressive forces

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14
Q

which peripheral nerves make up the caudal equina?

A

L2 - S5

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15
Q

which structures are at risk in the anterolateral approach to the hip?

A

Femoral artery, vein, nerve

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16
Q

what is the inter muscular plane used in the anterolateral approach to the hip?

A

Tensor fascia lata + gluteus medius

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17
Q

what is the inter muscular plane in the lateral approach to the hip?

A

Gluteus medius + vastus lateralis

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18
Q

what structures are at risk in the lateral approach to the hip?

A

Femoral n

superior gluteal nerve

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19
Q

what is the inter muscular plane used in the posterior approach to the hip?

A

Gluteus maximus along its fibres

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20
Q

which structures are at risk in the posterior approach to the hip?

A

sciatic nerve
inferior gluteal nerve
superior gluteal nerve + artery
Femoral vessels

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21
Q

which structures are at risk in the lateral approach to the ankle?

A

Sural nerve
Superficial peroneal nerve
short saphenous vein

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22
Q

where does the superficial peroneal nerve cross from the lateral to anterior compartment of the leg?

A

10cm proximal to tip of fibula

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23
Q

what position should the patient be in for anterolateral approach to the hip?

A

Lateral Decubitus Position

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24
Q

where is the incision for the anterolateral approach to the hip?

A

2.5 distal and posterior to ASIS - centred over GT - over proximal shaft of femur

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25
Q

which structures are at risk in the direct lateral approach to the hip?

A

Superior gluteal nerve

Femoral nerve

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26
Q

where does the superior gluteal nerve run in relation to the greater trochanter?

A

3-5cm above GT

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27
Q

what is the inter muscular plane in the direct lateral approach to the hip?

A

Split of Gluteus Medius distal to innervation

Split of Vastus laterals lateral to innervation

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28
Q

in what position would you splint a dislocated knee after relocation?

A

Above knee backstab in 30 degrees flexion to control for rotation

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29
Q

what are the boundaries of the popliteal fossa?

A

Superolateral - biceps femoris
Superomedial - semitendinosus, semimembranosus
Inferolateral/inferomedial - gastrocnemius
floor - popliteus, back of knee
roof - skin and fascia

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30
Q

what is the most common knee dislocation?

A

anterior

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31
Q

what is the most common nerve injury in knee dislocation?

A

common peroneal nerve

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32
Q

what classification is used in knee dislocation?

A

Kennedy

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33
Q

what is the kennedy classification based on?

A

Direction of displacement

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34
Q

what is the schenck classification based upon in knee dislocation?

A

ligamentous injury

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35
Q

what classification system is used in tibial plateau fractures?

A

Schatzker classification

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36
Q

what is a type I schatzker tibial plateau fracture?

A

Lateral split

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37
Q

what is a type II schatzker tibial plateau fracture?

A

Lateral split depression

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38
Q

what is a type III schatzker tibial plateau fracture?

A

Lateral pure depression

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39
Q

what is a type IV schatzker tibial plateau fracture?

A

Medial plateau fracture

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40
Q

what is a type V schatzker tibial plateau fracture?

A

BIcondylar fracture

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41
Q

what is a type VI schatzker tibial plateau fracture?

A

metaphysical-diaphyseal dissociation

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42
Q

what drill size is used in a large fragment set? (cortical screws)

A

3.2

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43
Q

what screw size is used in a large fragment set? (cortical screws)

A

4.5

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44
Q

what drill size is used in a small fragment set? (cortical)

A

2.5

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45
Q

what screw size is used in a small fragment set? (cortical)

A

3.5

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46
Q

conservative management can be considered in what type of tibial plateau fractures?

A

Minimally displaced split or depressed fractures

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47
Q

what is the main complication of tibial plateau fractures?

A

Post traumatic arthritis

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48
Q

what is the definition of an open fracture?

A

Fracture which has direct communication to the external environment

49
Q

what is a gustilo anderson type IIIc open fracture?

A

any open fracture with VASCULAR INJURY requiring repair

50
Q

what is a gustilo anderson type I open fracture?

A

Wound <1cm
minimal contamination
minimal soft tissue damage
simple fracture pattern

51
Q

what is a gustilo anderson type II open fracture?

A

Laceration >1cm (but <10cm)
moderate soft tissue damage
simple fracture pattern
minimal contamination

52
Q

what is a gustilo anderson type IIIb open fracture?

A

IIIa + Periosteal stripping + bone exposure

requiring soft tissue coverage

53
Q

what is a gustilo anderson type IIIa open fracture?

A

Laceration >10cm
Extensive soft tissue damage
segmental fracture
heavily contaminated wounds

54
Q

patients with open fractures of long bones should be managed where?

A

specialist centre with orthoplastics care

55
Q

what dressing should be used on initial assessment of open fractures?

A

Saline soaked gauze

occlusive dressing

56
Q

within what time frame should antibiotics be given in open fractures?

A

1 hour

57
Q

in which circumstances should immediate debridement of an open fracture take place?

A
  • highly contaminated wounds (farmyard, sewage, aquatic)

- associated vascular compromised

58
Q

in which circumstances should debridement of an open fracture take place within 12 hours?

A

high energy open fractures

59
Q

in which circumstances should debridement of an open fracture take place within 24 hours?

A

low energy open fractures

60
Q

in what time frame should definitive soft tissue coverage or closure be achieved in open fractures?

A

Within 72 hours

61
Q

what antibiotics should be used in open fractures initially?

A

Coamoxiclav or cephalosporin

*clindamycin/teicoplaning if severe allergy

62
Q

what antibiotics should be added at initial debridement for open fractures?

A

Gentamicin

63
Q

how long should Abx should be continued after debridement for open fractures?

A

24 hrs

64
Q

what antibiotics should be added at time of fixation for open fractures?

A

Teicoplanin + Gentamicin

65
Q

what are the 4 Cs to identify muscle necrosis?

A

Colour
Contractility
Consistency
Capacity to bleed

66
Q

what test is used to identify healthy bone at time of debridement?

A

Tug test

67
Q

what is the exception to removing bone that fails the tug test?

A

Articular fragments which can be fixed with absolute stability

68
Q

what are the nerve roots of the sciatic nerve?

A

L4-S3

69
Q

where does the sciatic nerve bifurcate?

A

apex of popliteal fossa

70
Q

where does the sciatic nerve travel in relation to piriformis muscle?

A

below piriformis (90% of cases)

71
Q

what muscles does the sciatic nerve supply in the thigh?

A

Hamstrings - semimembranosus, semitendinosus, hamstring portion of adductor magnus

72
Q

what muscles does the superficial peroneal nerve supply?

A

lateral compartment of leg - fibularis longus + brevis

73
Q

what muscles does the deep peroneal nerve supply?

A

anterior compartment of leg - tib ant, EDL, EHL, PT

74
Q

where does the superficial peroneal nerve supply sensation?

A

lateral leg + dorsum of foot

75
Q

where does the deep peroneal nerve supply sensation?

A

lateral leg and 1st webspace

76
Q

where does the tibial nerve supply sensation?

A

sole of foot + posterior leg

77
Q

what muscles does the tibial nerve supply?

A

Superficial and deep compartment of posterior leg

78
Q

what basic maneouvres are used in relocation of dislocated hip?

A

Traction
Countertraction
Knee flexed
internal rotation

79
Q

in a native hip what investigation must be performed after dislocation?

A

CT hip

80
Q

from what plexus does the sciatic nerve originate?

A

lumbosacral plexus

81
Q

where does the sciatic nerve enter the thigh?

A

By passing deep to long head of biceps femoris

82
Q

how does the sciatic nerve leave the pelvis?

A

Greater sciatic foramen

83
Q

which nerve is most commonly injured in a knee dislocation?

A

Common peroneal nerve

84
Q

after reduction of knee dislocation what immobolisation is recommended?

A

Knee splint or above knee backslab in 20 degrees flexion

85
Q

what are the x ray signs of an ACL tear?

A

Segond fracture
Anterior tibial translation

86
Q

what are the x ray signs of an ACL tear?

A

Segond fracture
Anterior tibial translation

87
Q

what are the attachments of the ACL?

A

origin - anterior intercondylar area, blends with medial meniscus
insertion - lateral femoral condyle

88
Q

what are the attachments of the PCL?

A

origin - posterior intercondylar fossa
insertion - medial femoral condyle

89
Q

what are the 2 major branches of the femoral artery?

A

Superficial Femoral Artery
Profunda femoral artery

90
Q

what are the 2 major branches of the femoral artery?

A

Superficial Femoral Artery
Profunda femoral artery

91
Q

where can the femoral artery be palpated?

A

mid inguinal point - 1/2 way between ASIS and pubic symphysis

92
Q

which artery travels through the adductor canal?

A

popliteal artery

93
Q

what are the 2 major branches of the popliteal artery?

A

Anterior tibial artery
Tibioperoneal trunk

94
Q

the posterior tibial artery travels behind which structure?

A

medial malleolus

95
Q

the anterior tibial artery becomes which artery in the foot?

A

dorsalis pedis

96
Q

a common peroneal palsy will present with what signs?

A

Foot drop + loss of eversion

97
Q

what structures are in the popliteal fossa?

A

Tibial nerve
popliteal vein
Popliteal artery

98
Q

in what percentage of subtalar dislocations are occult talus fractures present?

A

44%

99
Q

what are the 3 main blood supply to the talus?

A

Posterior tibial artery (body)
Anterior tibial artery
Perforating peroneal artery via artery of tarsal sinus

100
Q

the talus is at high risk of AVN because of what?

A

retrograde blood supply

101
Q

what 3 joints articulate with the talus?

A

Subtalar (talus + calcaneum)
Tibiotalar
Talonavicular

102
Q

what classification system is used in talus fractures?

A

Hawkins

103
Q

the prescence of subchondral lucency seen 2 months after a fracture indicating reperfusion of the talus - describes what sign?

A

Hawkins sign

104
Q

what is the average diameter of a lag screw used in DHS?

A

12.5mm

105
Q

what tip apex distance should be aimed for in intertrochanteric fractures?

A

<25mm

106
Q

what is the size of the guidewire used in DHS?

A

2.5mm

107
Q

what is the definition of tip apex distance?

A

Summation of distance between apex of screw and apex of femoral head on AP and lateral radiographs

108
Q

what is the definition of a subtrochanteric fracture?

A

upto 5cm below the trochanters

109
Q

what classification system is used for intertrochanteric fractures?

A

Evans

110
Q

what classification system is used for subtrochanteric fractures?

A

Russel Taylor

111
Q

what number classification is hip fractures used for in AO?

A

31 (31A for extracapsular)

112
Q

where is the anterior attachment for the hip capsule?

A

Along the intertrochanteric line

113
Q

where is the posterior attachment for the hip capsule?

A

more proximal midway along the femoral neck

114
Q

what 3 ligaments stabilise the hip joint?

A

iliofemoral
pubofemoral
ischofemoral

115
Q

what are some associated injuries in calcaneum fractures?

A
  • extension into calcaenocuboid joint
  • contralateral calcaneum fractures
  • vertebral fractures
116
Q

what structures can obstruct an ankle from reduction?

A

Deltoid ligament
periosteum
soft tissues

117
Q

what is a mortise view?

A

10 degrees internal rotation

118
Q

how do you test the syndesmosis?

A

stress views
bone hook

Orthopaedics ST3 (7 decks)

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