Lower Limb 2 Flashcards
Vascular dx of leg pain
- DVT (constant/assymetrical pain)
- PVD (intermittent bilateral pain)
Neurospinal dx of leg pain
- disc disease
- spinal stenosis
Neuropathic dx of leg pain
- diabetes (increased sorbitol, myelin sheat gets holes leading to parathesia)
- chronic etoh abuse
Musculoskeletal dx of leg pain
-chronic compartment syndrome
Ankle brachial index (ABI)
systolic BP in ankle/systolic BP in brachial artery
ABI values
- > 0.9 is normal
- ## .5-.9 intermitent claudication
Risk factor modifications of leg pain
- smoking cessation
- BSL control
- BP control
- lipid lowering medicine
Exercise modification for leg pain
- claudication exercise (leads to collateral circulation)
- 45-60min 3x weekly for 12 weeks
- 6 months later + 6.5 min walking time before pain
Medical mgmt of leg pain
- antiplatelet meds
- phosphodiesterase inhibitor
- foot care
- pt education
PCI/SX required when?
- poor response to exercise rehab and meds
- significant disability by claudication
- morphology of lesion
- bypass
5 Ps of acute ischemic limb
- pain
- pallor
- pulselessness
- perishing cold (poikilothermia)
- parathesias
- paralysis is an extra one that is rare
Further history of pts w/ PVD reveal
- lot of cigs
- 4 months of “leg cramps” in both legs
- 2-3 weeks of intermittent chest pain
- no doctor visits in last month
Examination finding of PVD
- below knee is pale/col
- irregulary irregular pulse
- slow capillary refill
- reduced pulse
Type I salter harris
- through physis
- child has point tenderness at epiphyseal plate
- no growth disturbance
- SCFE
Type II SH fracture
- through physis and metaphysis
- most common SH fracture
- rarely results in functional limitations
Type III SH fracture
- through physis and epiphysis
- prone to chronic disability bc it extends into articular surface of the bone
- rarely results in significant deformity
- Tillaux fracute is this type prone to disability
Type IV SH fracture
- through epiphysis, physis, metaphysis
- can cause deformity and result in chronic disability
Type V SH fracture
- Compression/crush injury of epiphyseal plate
- associated w/growth disturbance at the physis
- axial load injury
- poor functional prognosis
Ossification of Femur
center of shaft-7th week IU lower end of femur-9th month IU head-first year greater trochanter-4th year lesser trochanter-12th year upper 3 fuses w/shaft around 18 years old
Retinacular arteries
supply NOF and the head
Subcapital fracture
- fracture of neck of femur occurs very close to femur head
- most common intrascapular fracture
cervical fracture
fracture of neck of femur occurs cery close to midpoint of femur
basal fracture
fracture of the neck of femur occurs very close to the shaft
If the femur neck fracture is not impacted this deformity will be present
shortening of the limb bc the distal fragment is pulled upward by the rectus femoris, adductors and hamstrings resulting in overlaps
Proximall fragment goes where from a femur fracture
- abducted by glut medius/minimus
- laterally rotated by glut max, piriformus, obturators, and quadratus femoris
- flexed by iliopsoas
Distal fragment goes where from a femur fracture
- pulled upward behind proximal fragment by hamstirngs and quadriceps femoris
- adducted and laterally rotated by adductors
- drawn back by gastrocs which may injure popliteal artery
largest sesamoid bone
patella, acts as a fulcrum for other muslces
Patella stabilized superiorly by….
inferiorly. ..
medially. …
laterally. ..
- quadriceps
- patellar ligament
- vastus medialis
- lateral condyle
In a patella dislocation, it goes where? more common in whom?
- laterally from a twisting motion
- women, due to shape of hips (cause genu valgum or knock kneed appearance)
Direct patella fracture
- considerable comminution
- little displacement of fractured fragments
- fall onto knee/hits dashboard
Indirect patella fracture
- less comminuted
- displaced and often transverse
- jumping/rapid flexion of knee joint against fully contracts quads
In tib/fib fracture the distal fragments are drawn where?
upward behind the proximal fragments by the gastroc and soleus
Potts fracture
- lateral or medial malleolus fracture
- forcible eversion of the ankle
Bi-malleolar fracture
both medial and lateral malleolus
Dupuytren’s fracture
talus thrust upward between tib/fib
syndesmosis
- cord of fibrous tissue called a ligament
- common in football/skiing
- painful external rotation
high ankle sprain
- aka syndesmotic sprain
- injury to distal tib/fib joint, injuring the interosseus of syndesmotic ligaments from excessive dorsi or plantar flexion
Weber classification A
- fracture inferior to syndesmosis
- syndesmosis intact
- medial malleolus may be fractured
- usually stable
Weber classification B
- fracture at level of syndesmosis
- syndesmosis intact or partial tear
- possible medial fracture or deltoid damage
- stability variable
Weber classification C
- fracture above level of ankle joint
- tibfib syndesmosis injured
- usually medial fracture or deltoid injuy
- unstable
Metatarsal stress fracture
- occurs in distal 1/3 of metatarsals
- most common in 2nd and 3rd metatarsal
- minimal displacement
- aka march fracture
SCFE
-posterior and medial displacement of femoral capital epiphysis
mechanical etiology of SCFE
- thinning of perichondral ring complex
- relative or absolute femoral retroversion
- change in inclination of adolescent proximal femoral physis relative to femoral neck and shaft
predispositions to SCPE
- obesity
- rapid growth
- endorcinopathies
Stable SCFE
- pain in groin, referred to anteromedial aspect of thigh and knee
- loss of internal rotation w/ complaints of pain at limit of internal rotation
Unstable acute SCFE
- severe fracture like pain in hip region as a result of a fall or twisting injury
- unable to bear weight
intracapsular hip fracture
- includes femoral head and neck fractures (subcapital, transvervical, basicervical)
- at risk of non union and avascular necrosis from disrupted blood supply to femoral head
extracapsular hip fracture
which includes trochanteric, intertrochanteric, and subtrochanteric fractures
hip fracture stats
- highest in elderly pts
- 15-20% die within 1 year of fracture
- more common in females
risk factors of hip fracture
- nutrition (lack of Vit D, eating disorder, high caffeine)
- smoking/etoh
- medications (steroids, diuretics, anticonvulsants
- environmental factors
Garden I
incomplete fracture of femoral neck
Garden II
complete fracture w/o displacement
Garden III
complete fracture w/partial displacement
Garden IV
complete fracture w/full displacement
Pauwels classification
more vertical the line, the greater the risk of non union b/c increased shear stresses across the fracture
Achilles tendon rupture
- largest, most powerful tendon in body
- primarily seen in males w/sporting event with sudden starting and stopping
- weak plantarflexion, positive thompson test
Assocaited achiiles tendon rupture conditionss
- ochronosis
- steroid use
- quinolones
- inflammatory arthritis
