Lower limb

Question 1

What are the bursae of the knee?

Answer 1

Suprapatellar (deep)
Prepatellar (superficial)
Infrapatellar (superficial and deep)

Semimembranosus bursa

Question 2

What type of joint is ankle?

Answer 2

-hinge synovial joint

Question 3

What is hindfoot, midfoot and forefoot?

Answer 3

-Hindfoot: Calcaneum and talus
-Midfoot: Cuboid, navicular, cuneiforms
-Forefoot: rest

Question 4

Borders of tarsal tunnel:

Answer 4

-Floor: medial tibia, talus and calcaneus
-Roof: flexor retinaculum -medial malleolus to medial tubercle of calcaneum

What goes through it? everything that runs behind medial malleolus

Anterior to posterior tom dick and very naughty harry

Has 4 compartments:
–> 1 for each tendon and one for neurovascular structures

Question 5

Intrinsic muscles on dorsum of foot

Answer 5

-Extensor hallucis brevis
-Extensor digitorum brevis

both innervated by deep peroneal nerve

Question 6

Plantar

Answer 6

1st layer:
-Abductors hallucis and digiti minimae flexor digitorum brevis

-lumbricals, quadratus plantae

-flexor hallucis brevis, flexor digiti minimii brevis, adductor hallucis

-3 plantar and 4 dorsal interossei

All innervated by tibial nerve (dorsal deep peroneal)

Question 7

What type of joint is subtalar m joint

Answer 7

Synovial joint

Articulation between talus and calcaneum

Posterior, medial and lateral talocancaneal ligaments

Question 8

Foot arches

Answer 8

Medial and lateral longitudinal, transverse

Question 9

Lymphatic drainage

Answer 9

of lower limb

Question 10

Primary vs secondary bone healing

Answer 10

-Primary: healing by direct union. Osteoblastic bone forms between two fragments. No callus formation

-Secondary: bone ends aren’t well aligned. Will heal via callus formation.

Steps of secondary:
1. Haematoma
2. Inflammation: haematoma provides framework for inflammatory/osteoprogenitor cells
3. SOft callous: uncalcified tissue that provides anchorage to bone ends but no structural support
4. Hard callous: woven bone, endochondral ossification
5. Remodelling: woven bone replaced by lamellar bone. Pt must start mobilising

Wolf’s law: done will strengthen to resist loads put on it

Question 11

Malunion vs non union

Answer 11

Malunion: suboptimal position

Non union: no evidence of healing 3 months, failure to reach bony union by 9 months.

Failure of union by 6 months: delayed union

Question 12

Factors affectoing bony hgealing

Answer 12

smoking
alcohol
obesity
diabetes
Functional status
Nutritional status
Immunocompromise

Injury factors
-mechanism/energy level
-stability post injury/surgery (degree of immobilisation)
-Infected wound/contaminated wound
-soft tissue loss
-skeletal loss
-Pathological fractures

Question 13

Why are nsaids bad for bony healing

Answer 13

cox inhibitors: stop inflammation which is a step in bone healing

Question 14

Bisphosphoates

Answer 14

-Inhibit osteoclast activity
-Bind to calcium phosphate crystals to prevent breakdow