Lower limb orthapaedics

Question 1

Meniscal tears usually are due to ________ injuries but there can also be to ____________ tears in the elderly. __________ meniscus tears are more common than ________ meniscus tears. Healing is limited and _______ tears are more likely to heal than ________ tears. In young patients __________ repair may be necessary but if the tear is irreparable and troublesome then you’d need to consider an _________ ___________.

Answer 1

sporting
degenerate
medial
lateral
longitudinal
radial
arthroscopic
arthroscopic meniscectomy

Question 2

Acute locked knee requires urgent surgery and is caused by what specific tear?

Answer 2

displaced bucket handle meniscal tear

Question 3

What do the following resist?

Answer 3

MCL- valgus stress
LCL- varus stress
PCL- posterior subluxation of tibia and hyperextension of the knee
ACL- anterior subluxation of tibia and internal rotation of tibia on extension

Question 4

MCL tears usually heal well whereas LCL do not heal- how are they treated?

Answer 4

Brace, early movement, physio

Question 5

What is the classic presentation of an ACL tear?

Answer 5

pop sound, haemarthrosis, giving way on turning

Question 6

What is Haemarthrosis?

Answer 6

bleeding within a joint caused by either injury or a clotting disorder. Associated with swelling, warmth pain of joint.

Question 7

Give an overview of the prognosis of an ACL tear

Answer 7

1/3 compensate and function well
1/3 can avoid instability by avoiding certain sports
1/3 do not compensate, frequent instability avoid high contact sport
50% reconstructive surgery

Question 8

When is reconstructive surgery recommended for ACL rupture?

Answer 8

When there is rotatory instability that is not responding to physio

Question 9

Name three possible complications of knee dislocation

Answer 9

popliteal artery injury
peroneal nerve injury
compartment syndrome

Question 10

What causes a quads or patellar tendon rupture? requires urgent repair

Answer 10

falling onto a flexed knee

Question 11

What is osteochondritis dissecans and in whom does it often present?

Answer 11

A fragment of bone or cartilage breaks off due to poor blood supply. Often occurs in adolescent/ young adult males

Question 12

What is the name of the ossicle that is often misdiagnosed as a loose body?

Answer 12

Fabella

Question 13

What is the initial investigation of acute haemarthrosis?

Answer 13

MRI

Question 14

What is the classical presentation of a meniscal tear?

Answer 14

getting up from squatting, medial joint line pain, effusion, recurrent pain and catching/locking

Question 15

What does the conservative management of knee osteoarthritis consist of?

Answer 15

analgesia
NSAIDs
Weight loss
Physio
modify activity

Question 16

when is TKR recommended for osteoarthritis patients?

Answer 16

over 55 and severe pain

Question 17

Why is revision TKR unfavoured?

Answer 17

big surgery, significant blood loss, risk of complications

once fails need amputation

Question 18

How does OA present on an X-ray?

Answer 18

joint space reduction, osteophyte formation, synovial fluid cysts

Question 19

What characterises RA on an X-ray?

Answer 19

marginal erosion from pannus formation

Question 20

How does Achilles tendinosis present? Give two possible causes

Answer 20

painful, tender swelling a few cm from calcaneal tendon insertion.
over-exercise and quinolone therapy e.g. ciprofloxacin

Question 21

What is the most common cause of flatfoot deformity in adults? How does it present?

Answer 21

tibialis posterior dysfunction

Pain, swelling posterior to middle malleolus, diminished walking ability and hallux valgus

Question 22

Give three treatments of tibialis posterior dysfunction

Answer 22

physio, insole, surgery

Question 23

What is plantar fasciitis?

Answer 23

it is enthesitis at the insertion of the plantar fascia into the calcaneum. causes localised pain and tenderness under the heel

Question 24

What is hallux valgus? It is a common complication of what disease?

Answer 24

medial migration of the great toe

RA

Question 25

What is hallux rigidus?

Answer 25

stiff dorsiflexed big toe brought about by osteoarthritis of first MTP joint.

Question 26

What is Morton’s neuroma?

Answer 26

fibrosis of a digital artery at it’s bifurcation

Question 27

What can cause claw hammer and mallet toes

Answer 27

an acquired imbalance of flexors and extensors

Question 28

What is the weber classification used for?

Answer 28

classifying fractures of the ankle

Question 29

Give three common fractures of the 5th metatarsal

Answer 29

avulsion fracture
Jones’ fracture
proximal shaft fracture

Question 30

Femoral deformities and pincer acetabulum deformities are both examples of FAI. what does this stand for?

Answer 30

Femoroacetabular impingement syndrome

Question 31

How does FAI present?

Answer 31

activity related pain in groin
difficulty sitting
C sign positive
FADIR provocation test positive

Question 32

Give four common hip conditions

Answer 32

Femoroacetabular Impingement syndrome
osteonecrosis
osteoarthritis
trochanteric bursitis
femoral neck fracture

Question 33

Management of Avascular necrosis is based on whether damage is reversible or irreversible. what treatments are used in each case?

Answer 33

reversible; biphosphonates, bone grafting

irreversible; TKR osteotomy

Question 34

What causes trochanteric bursitis?

Answer 34

repetitive trauma caused by iliotibial band over trochanteric bursa

Question 35

What THA type is used for young people and which for older people?

Answer 35

young- hybrid THA

old- cemented THA