Lower limb orthapaedics Flashcards
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 _________ ___________.
sporting degenerate medial lateral longitudinal radial arthroscopic arthroscopic meniscectomy
Acute locked knee requires urgent surgery and is caused by what specific tear?
displaced bucket handle meniscal tear
What do the following resist?
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
MCL tears usually heal well whereas LCL do not heal- how are they treated?
Brace, early movement, physio
What is the classic presentation of an ACL tear?
pop sound, haemarthrosis, giving way on turning
What is Haemarthrosis?
bleeding within a joint caused by either injury or a clotting disorder. Associated with swelling, warmth pain of joint.
Give an overview of the prognosis of an ACL tear
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
When is reconstructive surgery recommended for ACL rupture?
When there is rotatory instability that is not responding to physio
Name three possible complications of knee dislocation
popliteal artery injury
peroneal nerve injury
compartment syndrome
What causes a quads or patellar tendon rupture? requires urgent repair
falling onto a flexed knee
What is osteochondritis dissecans and in whom does it often present?
A fragment of bone or cartilage breaks off due to poor blood supply. Often occurs in adolescent/ young adult males
What is the name of the ossicle that is often misdiagnosed as a loose body?
Fabella
What is the initial investigation of acute haemarthrosis?
MRI
What is the classical presentation of a meniscal tear?
getting up from squatting, medial joint line pain, effusion, recurrent pain and catching/locking
What does the conservative management of knee osteoarthritis consist of?
analgesia NSAIDs Weight loss Physio modify activity
when is TKR recommended for osteoarthritis patients?
over 55 and severe pain
Why is revision TKR unfavoured?
big surgery, significant blood loss, risk of complications
once fails need amputation
How does OA present on an X-ray?
joint space reduction, osteophyte formation, synovial fluid cysts
What characterises RA on an X-ray?
marginal erosion from pannus formation
How does Achilles tendinosis present? Give two possible causes
painful, tender swelling a few cm from calcaneal tendon insertion.
over-exercise and quinolone therapy e.g. ciprofloxacin
What is the most common cause of flatfoot deformity in adults? How does it present?
tibialis posterior dysfunction
Pain, swelling posterior to middle malleolus, diminished walking ability and hallux valgus
Give three treatments of tibialis posterior dysfunction
physio, insole, surgery
What is plantar fasciitis?
it is enthesitis at the insertion of the plantar fascia into the calcaneum. causes localised pain and tenderness under the heel
What is hallux valgus? It is a common complication of what disease?
medial migration of the great toe
RA
What is hallux rigidus?
stiff dorsiflexed big toe brought about by osteoarthritis of first MTP joint.
What is Morton’s neuroma?
fibrosis of a digital artery at it’s bifurcation
What can cause claw hammer and mallet toes
an acquired imbalance of flexors and extensors
What is the weber classification used for?
classifying fractures of the ankle
Give three common fractures of the 5th metatarsal
avulsion fracture
Jones’ fracture
proximal shaft fracture
Femoral deformities and pincer acetabulum deformities are both examples of FAI. what does this stand for?
Femoroacetabular impingement syndrome
How does FAI present?
activity related pain in groin
difficulty sitting
C sign positive
FADIR provocation test positive
Give four common hip conditions
Femoroacetabular Impingement syndrome osteonecrosis osteoarthritis trochanteric bursitis femoral neck fracture
Management of Avascular necrosis is based on whether damage is reversible or irreversible. what treatments are used in each case?
reversible; biphosphonates, bone grafting
irreversible; TKR osteotomy
What causes trochanteric bursitis?
repetitive trauma caused by iliotibial band over trochanteric bursa
What THA type is used for young people and which for older people?
young- hybrid THA
old- cemented THA
