Lower Limb Clinical

Question 1

Which way does the femoral head tend to dislocate?

Answer 1

Posterior - head of femur pushed back wars in something like an RTA.
The leg appears short and medially rotated

Question 2

What happens in a congenital hip dislocation?

Answer 2

Femoral head does not locate fully in the acetabulum- the limb looks shorter and they cannot abduct the affected leg.

Question 3

Where is a transcervical femoral fracture?

Answer 3

Shaft

Question 4

What is an important feature that should be identified on Xray when looking at femoral fractures and why is it important?

Answer 4

Intra or extracapsular fracture

Intracapsular risks avascular necorsis as the medial circumflex artery may be damaged.

Question 5

What is the most common site for a compound fracture?

Answer 5

Tibial shaft- superficial and has a poor blood supply

Question 6

A fibula fracture is often linked with what other injury?

Answer 6

ankle dislocation

Question 7

What causes fibula fractures?

Answer 7

Excessive inversion

Question 8

If a patient falls from a height on to their feet- which bone in the foot could be fractured?

Answer 8

calcaneus

Question 9

Extreme dorsiflexion may fracture which bone?

Answer 9

talus

Question 10

Which muscle may avulse the tuberosity of the 5th metatarsal on sudden inversion?

Answer 10

Fibularis brevis

Question 11

What is compartment syndrome and how is it treated?

Answer 11

Pressure building up with in the fascial compartment of a leg due to inflammation or haemorrhage. The pressure build up compresses neuromuscular structures making distal limb ischaemic- evidenced by temp drop or loss of pulse in the distal limb.

Fasciotomy

Question 12

Which nerve block is performed 2cm inferior to the inaugural ligament and which spinal roots does it effect?

Answer 12

Femoral nerve L2-L4

Question 13

Why does the proximal fragment of a patella fracture move cranially?

Answer 13

Action of quadriceps

Question 14

How do you locate the femoral artery?

Answer 14

Midways between ASIS and the pubic symphysis

Question 15

Outline the pathogenesis of a femoral hernia.

Answer 15

The femoral ring is a weakness in the absdominal wall which may permit a small protrusion of bowel. Its normally encased here between the femoral vein and lacunar ligament. But in advance cases it may pass through Saphenous opening of tensor fascialata

Question 16

What is a trendelenburg sign?

Answer 16

If the superior gluteal nerve is injured when you stand on that leg the contralateral pelvis drops.

Question 17

What would happen if an gluteal IM injection was given in the wrong place and damaged a nerve (the nerve we worry about in this procedure)?

Answer 17

Sciatic nerve damaged

• hip extension lost
• leg flexion lost
• ankle movements lost

Question 18

How do we decide where is safe for IM intragluteal injection.

Answer 18

Index finger on ASIS spread fingers out along iliac crest. Middle finger will feel the tubercle then between first and middle finger is safe.

Question 19

How might the tibial nerve be damaged and what would happen?

Answer 19

Deep populate fossa laceration- uncommon.
Muscles in the back of the leg lost.
flexion of the leg, plantar flexion and ankle inversion are all lost.
Sole of the foot loses sensation.

Question 20

A pedestrian is hit on the side of the knee by a car and comes to A+E with a plantar flexed inverted foot- what is this and why has it happened?

Answer 20

Foot drop
Common fibular nerve damaged as it curves round the fibular neck.
Loss of dorsi-fexion and eversion of the ankle.
Sensation will be lost anterolateral leg and dorm of foot

Question 21

What gaits may result from a common fibular nerve injury?

Answer 21

High stoppage gait
Waddling gait
Swing out gait

Question 22

Which nerve supplies the web space between toe 1 and 2?

Answer 22

Deep fibular

Question 23

A 40 year old man decides he would like to get fit and joins a rugby club. He runs in to make a tackle and there is an audible snap as he pushes off he is back foot. He then falls to the ground clenching his leg. What injury may he have suffered and how would you test for it?

Answer 23

Calcaneal tendon rupture

Squeeze calf when the knee is flexed on a chair and the foot should plantar flex if the tendon has good continuation

Question 24

Which two foot pulses can we check?

Answer 24

Posterior tibial artery behind the medial malleolus
Dosalis Pedis (a continuation of the anterior tibial artery) pulse between the tendon of extensor hellucis longs and extensor digitorum longus

Question 25

The tibial nerve splits into what nerves in the foot?

Answer 25

Medial and lateral plantar nerves

Question 26

The saphenous nerve is a terminating bunch of which nerve?

Answer 26

the femoral

Question 27

The anteromedial leg is supplied by the …… nerve

Answer 27

saphenous

Question 28

The superfiacl fibular never supplies which area of skin on the leg and foot?

Answer 28

The dorsum of the foot by medial and lateral doral cutaneous nerves
The anterolateral leg

Question 29

Which nerve supplies the outer edge of the foot?

Which nerves contribute to the rural nerve?

Answer 29

sural

Tibial and the common fibular

Question 30

What do you look for if you are worried about peripheral vascular disease?

Answer 30

Pulsless
Paresthesia 
Parlysis
Pressingly cold 
Pain 
pallor

Question 31

An 80 year old woman presents in A+E and the paramedics said she fell down the stairs. Her right leg is shortened and externally rotated- what do you suspect and what must you do if Xray confirms?

Answer 31

Femoral neck fracture

The medial and lateral circumflex after supply may be lost. Hip replacement is needed.

Question 32

Posterior dislocation of the hippy affect which nerve?

Answer 32

sciatic

Question 33

What tends to fracture in a hip fracture dislocation anteriorly? How does the injury happen?

Answer 33

Acetabulum fracture

Leg forced into extension, abduction and lateral rotation e.g. Catching a ski

Question 34

What is the unhappy triad and how does it happen?

Answer 34

Injury of the medial collateral ligament which causes a medial meniscus tear and an ACL injury.
Blow to the lateral side of an extended knee.

Question 35

What will be seen on a draw test if the PCL is injured?

Answer 35

the distal leg will move backwards.

Question 36

What is Bakers cyst?

Answer 36

Popiteal cyst- fluid filled sac in the synovial membrane of the knee

Question 37

List the possible bursitis’ around the knee.

Answer 37

Pre-patellar (housemaids)
Subcutaneous infrapatellar (clergy mans knee)
Deep infra patellar bursistis
Supra patellar bursistis

Question 38

Which side of the ankle are ligaments commonly torn and through what mechanism?

Answer 38

Lateral - anterior talofibular ligament and calcaneofibular ligament
Inversion

Question 39

What is hammer toe?

Answer 39

Foot deformity in which the big toe is dorsiflexed.

Question 40

Hallux valgus is when the big toe is turned ….. the midline.

Answer 40

away from

Question 41

How do people get flat feet?

Answer 41

Loose or degenerated intrinsic ligaments
Tibilais posterior offers dynamic arch support and if dysfunctional will give a rigid flat foot as talus drops inferomedially because the calcaneotalar ligament lacks integrity.