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Orthopaedics > Lower Limb and Pelvis > Flashcards

Lower Limb and Pelvis Flashcards

1
Q

What factors decide whether a total hip replacement should be done

A

pain and disability persisting after conservative interventions

ask about - analgesia, slee disturbance, rest pain, ADLs, walking distance, impact on job or hobbies

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2
Q

conservative interventions for OA of the hip are

A

weight loss
physio
walking aid
analgesia

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3
Q

early complications or THR

A

infection
dislocation
nerve injury - sciatic
leg length discrepency

general - MI, PE, hypovolemia, Mi etc.

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4
Q

late complications of THR

A

early loosening
late infection
late dislocation

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5
Q

causes of avascular necrosis of the hip

A

idiopathic

secondary to alcohol, steroids, hyperlipidaemia or thrombophilia

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6
Q

sign of AVN on x ray

A

‘hanging rope sign’ due to lytic zone under femoral head

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7
Q

management of AVN

A

if detected pre collapse - drill holes into femoral neck and head to relieve pressure

if collapsed - THR

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8
Q

typical presentation of trochanteric burstitis

A

pain and tenderness in the regoin of greater trochanter and pain on ressited abduction

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9
Q

which part of the body has the thickest hyaline cartelage

A

patella

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10
Q

role of the menisci in the knee

A

shock absorbers

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11
Q

the four ligaments of the knee are

A

ACL - prevents internal rotation of tibia
PCL - prevents hyperextension
MCL - resists valgus force
LCL - resits varus force

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12
Q

what prediscopses to easrly OA in the knee

A

meniscal tears
ligament injuries
genu varum (medial)
genu valgum (lateral)

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13
Q

risks after TKR

A

higher risk of unexplained pain

less risk of dislocation
other risks are similar to that of hip replacement

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14
Q

when do meniscal injuries classically occur

A

twisting force on a loaded knee eg during football

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15
Q

typical signs of a meniscal tear are

A

pain localised to either medial (most) or lateral joint line
effusion
pain and catching sensation
difficulty fully straightening the knee
knee may feel as though it is about to give way (sign of a loose fragment)
positive steinmann’s test

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16
Q

what is true knee locking

A

mechanical block to full extension caused by significantly torn meniscus flipping over and getting stuck in the joint line

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17
Q

what is pseudolocking

A

in other pathology eg arthritis the knee may feel as though it becomes stuck temporarily but is recovarable

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18
Q

how is an ACL injury typically sustained

A

turning the upper body laterally on a planted foot - higher rotational force

usually skiing, rugby, footbal

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19
Q

features of an ACL injury

A

pop usually felt or heard
haemarthrosis within an hour
deep knee pain
may complain in rotatory instability more chronically

positive lachman’s test and anterior drawer test

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20
Q

mechanism of MCL tear

A

usually valgus stress e.g. tackle from side in rugby

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21
Q

mechanism of LCL tear

A

varus stress

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22
Q

mechanism of PCL rupture

A

high force direct blow to anterior tibia with knee flexed

eg.RTA

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23
Q

investigation of choice in meniscal tear

A

MRI

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24
Q

most common side of meniscal tear

A

medial 10 x more common

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25
Q

what is a bucket handle meniscal tear

A

large meniscal fragment is able to flip out of its normal position and displace anteriorly or into the intercondylar notch where the knee locks and is unable to fully extend due to mechanical obstruction from the trapped meniscal fragment.

26
Q

how can you differentiate between a degenerate meniscal tear and an acute traumatic tear

A

degenerate tears typically occur in older people
steinmann’s negative
associate with early signs and symptoms of OA

27
Q

treatment of meniscal tears

A

repair - only in fresh longitudinal tears in outer 1/3 in young patients

most not suitable for replair - settle with time, steroid injections if degenerate, arthroscopic partial meniscetomy if not improved by 3 months

degenerate tears generally do not get surgery

28
Q

prognosis of ACL tear

A

1/3 no problems
1/3 manage by avoiding certian activities and sports
1/3 poor with giving away during ADLs

29
Q

treatment of ACL rupture

A

physio
can have repair but usually not effective
reconsturction with tendon graft

30
Q

where is the graft usually taken from for an ACL reconstruction

A

patellar tendon

semitendinosis and gracilis autograft

31
Q

management of MCL tear

A

most do well
acute tears treated with hinged knee brace
chronic instability - tightening of MCL or reconstruction with tendon graft

32
Q

complications of complete knee dislocation

A

usually rupture all four knee tendons
risk of neurovascular injury
thrombosis and impaired circulation to lower limb
compartment syndrome

need vascular surgery input

33
Q

factors which predispose to tendon rupture

A 
tendontitis
chronic steroid use
diabetes
rheumatoid arthritis
chronic renal failure
quinolones
34
Q

patellar tendon ruptures tend to occur in what age group

A

young people under 40

35
Q

quadriceps tendon ruptures tend to occur in what age group

A

older people over 40

36
Q

chondromalacia patellae is

A

softening of the hyaline cartilage

37
Q

what typically cause patellofemoral dysfucntion/anterior knee pain

A

excessive lateral pull on the patella

more common in adolescent females due to wider hips

38
Q

in what direction does the patella usually dislocate

A

laterally

39
Q

what ligament tears in patella dislocation

A

patella femoral

40
Q

what occurs in the joint in patellar dislocation

A

lipo-haemarthrosis which has a characteristic x ray appearance

41
Q

predisposing factors to patella dislocation

A 
ligamentous laxity
female
genu valgum
femoral neck anteversion
high riding patella (patella alta)
42
Q

treatment options for ankle OA

A

after conservative

arthrodesis - young patines
ankle replacement - better range of motion but more likley to loosen earlier and leave a shortened limb once failure is corrected

43
Q

what are the ottowa rules for ankle injury

A

this determins whether or not to get an xray

need pain in malleolus zone plus one of the following:
bony tenderness at the lateral malleolar zone
bony tenderness at the medial malleolar zone
inability to walk four weight bearing steps immediately after the injury and in the emergency department

44
Q

what is charcots foot

A

a joint which has become badly disrupted and damaged secondary to a loss of sensation
common in diabetics

45
Q

what is hallux rigidus

A

OA of the first MTPJ

46
Q

gold standard surgical treatment of hallux rigidus

A

arthrodesis

47
Q

what is morton’s neuroma

A

irritated pplanter intergdigital nerves become inflamed and swollen forming a ‘neuroma’

48
Q

typical symptoms of mortons neuroma

A

pain and burning in ball of the foot

49
Q

examination finding in mortons neurmoma

A

mulder’s click test

squeexin metatarsal head result sin a click or reproduces symptoms

50
Q

diagnosis of mortons neuroma

A

ultrasound

51
Q

management or mortons neuroma

A

conservative - insole, sterois injections

surgical excision

52
Q

management of metatarsal stress fracture

A

prolonged rest for 6-12 weeks in a rigid soled boot

53
Q

who typically gets stress factures

A

runner’s
dancers
soldiers on long marches

54
Q

what is never a treatment of achilles tendonitis

A

steroid injection - will predispose to rupture!

55
Q

clinical test used to confrim achilles tendon rupture

A

simmonds test

squeezing calf muscle will not produced plantar flexion

56
Q

management of achilles tendon rupture

A

surgical repair

non operative management in a series of casts with ankle plantar flexed for 8 weeks - usually has good outcome

57
Q

typical history of plantar fasciitis and risk factors

A

pain in instep of foot
tenderness on palpation

diabetes obestity and lots of walking can predispose

58
Q

causes of pes cavus

A

abnormally high arched foot

can be idiopathic but often related to neuromuscular conditons e.g. cerebral palsy, spina bifida
Marfan’s

59
Q

what is claw toe

A

hhyperextension at MTPJ and hyperfelxtion ar PIP and DIP

60
Q

what is hammer toe

A

Hammer toes are similar to claw toe but have hyperextension at the DIPJ.

61
Q

what causes claw and hammer toe

A

acquired imbalance between the flexor and extensor tendons in feet

62
Q

management of claw and hammer toe

A

Toe “sleeves” and corn plasters can prevent skin problems. Surgical solutions include tenotomy (division of an overactive tendon), tendon transfer, arthrodesis (PIPJ) or toe amputation.

Orthopaedics (25 decks)

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