Lower Limb Disorders (2)

Question 1

Hip Fracture:
How does it present?

What are the risk factors?

How is it classified?
→ Which of these requires more urgent surgery? Why?

What is a recognised complication that can occur after THR?

Answer 1

➊ Shortened, abducted, and externally rotated leg, Pain, Inability to weight bear

➋ Increasing age, Osteoporosis

➌ Intracapsular and Extracapsular
→ Intracapsular as there’s a higher risk of avascular necrosis

➍ Posterior hip dislocation - pt will have a shorterned, but internally rotated leg

N.B. External rotation = Fracture. Internal rotation = Dislocation.

Question 2

Meniscal Tears:
When does it often occur?

How does it present?

Which investigations need to be done?

Answer 2

➊ During twisting movements

➋ Pop sound during initial injury, Pain, Swelling, Stiffness, Reduced range of motion, Locking of knee, Knee instability

➌ McMurray’s and Apley Grind tests, MRI, Arthroscopy

Question 3

ACL Injury:
What is the function of the ACL?

When does it often occur?

How does it present?

Which investigations need to be done?

Answer 3

➊ Stop tibia from sliding forwards

➋ During sudden deceleration or twisting of the knee

➌ Pop sound during initial injury, Pain, Swelling, Knee instability, Knee moves forward

➍ Anterior Drawer test, MRI, Arthroscopy

Question 4

Achilles Tendinopathy:
What are the risk factors?

How does it present?

What needs to be ruled out? How?

Answer 4

➊ Sport, Inflammatory conditions, DM

➋ Pain, Stiffness, Tender, Swelling, Thickening

➌ Achilles tendon rupture by doing Simmonds’s calf squeeze test

Question 5

Achilles Tendon Rupture:
How does it present?

Which investigations need to be done?

Answer 5

➊ Sudden onset pain, Snapping sound during initial injury, Feels like something hit them on back of the leg, Weakness of plantarflexion

➋ Simmond’s calf squeeze test, US

Question 6

Plantar Fasciitis:
How does it present?

Answer 6

Gradual onset of pain, worse with pressure e.g. walking or standing for long periods

Question 7

Ankle Fracture:
How is this classified?

Which of these are stable?
→ How is it managed?

Which of these are unstable?
→ How is it managed?

Answer 7

➊ Weber Classification:
• Type A - Below syndesmosis
• Type B - At level of syndesmosis
• Type C - Above syndesmosis

➋ Type A
→ Plaster of paris cast

➌ Type B and C
→ Surgery