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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
what is a bucket handle meniscal tear
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
how can you differentiate between a degenerate meniscal tear and an acute traumatic tear
degenerate tears typically occur in older people steinmann's negative associate with early signs and symptoms of OA
27
treatment of meniscal tears
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
prognosis of ACL tear
1/3 no problems 1/3 manage by avoiding certian activities and sports 1/3 poor with giving away during ADLs
29
treatment of ACL rupture
physio can have repair but usually not effective reconsturction with tendon graft
30
where is the graft usually taken from for an ACL reconstruction
patellar tendon | semitendinosis and gracilis autograft
31
management of MCL tear
most do well acute tears treated with hinged knee brace chronic instability - tightening of MCL or reconstruction with tendon graft
32
complications of complete knee dislocation
usually rupture all four knee tendons risk of neurovascular injury thrombosis and impaired circulation to lower limb compartment syndrome need vascular surgery input
33
factors which predispose to tendon rupture
``` tendontitis chronic steroid use diabetes rheumatoid arthritis chronic renal failure quinolones ```
34
patellar tendon ruptures tend to occur in what age group
young people under 40
35
quadriceps tendon ruptures tend to occur in what age group
older people over 40
36
chondromalacia patellae is
softening of the hyaline cartilage
37
what typically cause patellofemoral dysfucntion/anterior knee pain
excessive lateral pull on the patella more common in adolescent females due to wider hips
38
in what direction does the patella usually dislocate
laterally
39
what ligament tears in patella dislocation
patella femoral
40
what occurs in the joint in patellar dislocation
lipo-haemarthrosis which has a characteristic x ray appearance
41
predisposing factors to patella dislocation
``` ligamentous laxity female genu valgum femoral neck anteversion high riding patella (patella alta) ```
42
treatment options for ankle OA
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
what are the ottowa rules for ankle injury
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
what is charcots foot
a joint which has become badly disrupted and damaged secondary to a loss of sensation common in diabetics
45
what is hallux rigidus
OA of the first MTPJ
46
gold standard surgical treatment of hallux rigidus
arthrodesis
47
what is morton's neuroma
irritated pplanter intergdigital nerves become inflamed and swollen forming a 'neuroma'
48
typical symptoms of mortons neuroma
pain and burning in ball of the foot
49
examination finding in mortons neurmoma
mulder's click test squeexin metatarsal head result sin a click or reproduces symptoms
50
diagnosis of mortons neuroma
ultrasound
51
management or mortons neuroma
conservative - insole, sterois injections surgical excision
52
management of metatarsal stress fracture
prolonged rest for 6-12 weeks in a rigid soled boot
53
who typically gets stress factures
runner's dancers soldiers on long marches
54
what is never a treatment of achilles tendonitis
steroid injection - will predispose to rupture!
55
clinical test used to confrim achilles tendon rupture
simmonds test squeezing calf muscle will not produced plantar flexion
56
management of achilles tendon rupture
surgical repair | non operative management in a series of casts with ankle plantar flexed for 8 weeks - usually has good outcome
57
typical history of plantar fasciitis and risk factors
pain in instep of foot tenderness on palpation diabetes obestity and lots of walking can predispose
58
causes of pes cavus
abnormally high arched foot can be idiopathic but often related to neuromuscular conditons e.g. cerebral palsy, spina bifida Marfan's
59
what is claw toe
hhyperextension at MTPJ and hyperfelxtion ar PIP and DIP
60
what is hammer toe
Hammer toes are similar to claw toe but have hyperextension at the DIPJ.
61
what causes claw and hammer toe
acquired imbalance between the flexor and extensor tendons in feet
62
management of claw and hammer toe
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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