Lower Limb DLA

Question 1

What is shenton’s line?

Answer 1

Formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus

Question 2

Describe types of intracapsular fractures

Answer 2

Fractures of the neck of the femur

Subcapital: below the femoral head

Transcervical: across the mid femoral neck

Basicervical: across the base of the femoral neck

Important note: extracapsulsr fractures don’t involve the neck of the femur

Question 3

Describe extra capsular fractures

Answer 3

Fracture line runs between the two trochanter

• there is comminution with separation of the lessser trochanter
• Note the fracture does not involve the femoral head and neck

Question 4

What is a posterior hip dislocation

Answer 4

The femoral head lies superior and lateral to the acetubulum

-can be accompanied by fractures or soft tissue injuries not visible on X-ray

Question 5

What is the clinical significance of posterior hip dislocation?

Answer 5

• posterior dislocations are most common
  
  • ischiofemoral ligament is weak

The fibrous layer of the joint capsule ruptures inferiorly and posteriorly allowing the the femoral head to pass through the tear in the capsule and over the posterior margin of the acetubulum onto the lateral surface of the ilium, shortening and medially rotating the affected limb

What neurovascular injuries can occur due to this fracture?
-Sciatic nerve can be damaged

Question 6

What is the use of horizontal beam lateral view for clinical use on knee X-ray?

Answer 6

The horizontal lateral beam view is useful in assessing soft tissue as well as bones

Quadriceps tendon and patellar ligament are visible

The assessment of the suprapatellar bursa (an extension of the knee joint, not a true bursa) between the fat pads is important in trauma

Question 7

What is indicated by pulling the proximal head of the tibia away from the femur?

Answer 7

Indicates possible ACL tear

Question 8

What is the posterior drawer test?

Answer 8

The proximal head of the tibia can be used posteriorly on the femur indicating a possible PCL tear

Question 9

Summarize the petallar tendon ‘knee jerk’ reflex

Answer 9

Patient should be relaxed

• strike the patella tendon
• observe the knee extension
• testing L3-L4 spinal nerve

Question 10

What is a bakers cyst?

Answer 10

Collection of synovial fluid from the knee joint or a bursa forming a synovial-lined sac I; the popliteal soace(typically the semimembranous bursa)

Question 11

What is a communicated fracture?

Answer 11

A fracture in which a bone is broken, splintered, or crushed into a number of pieces

Question 12

What stabilizes the ankle joint?

Answer 12

The ankle joint is stabilized by multiple ligaments that are not usually visible on X-ray image

Medially: deltoid ligament: anterior/posterior tibiotalar, tibiocaneal, tibionabivicular

Laterally: lateral collateral ligaments: anterior/posterior talofibular, calcaneofibular

Question 13

Describe a prolapse herniated disc

Answer 13

There is NO such thing as a “slipped disc”, it is a rupture of nucleus pulposus (notochord)

Question 14

Describe prolapsed intervertebral disc herniation

Answer 14

Usually affects the nerve root numbered inferior to the herniated disc in the lumbar region

L4/L5 herniation= L5 nerve compression

Question 15

Describe Achilles tendon ‘ankle jerk refkex’

Answer 15

• patient should be relaxed
• strike the Achilles’ tendon
• observe for plantar flexion-testing the S1 spinal nerve