Lower Limb Orthopaedics Flashcards by Jane Keery

How should a metatarsal stress fracture be treated?

Prolonged rest for 6-12 weeks in a rigid soled boot

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What surgical treatment is available for an ACL rupture?

ACL reconstruction

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X-rays may not demonstrate a metatarsal stress fracture until when?

Around 3 weeks after the injury

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Intensive rehabilitation is required after an ACL reconstruction. It may take up to how long to get back to high impact sports?

One year

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More than 90% of meniscal tears are not suitable for repair. If symptoms are ongoing, what management option could be used for a) degenerate tears and b) non-degenerate tears?

a) steroid injection b) partial meniscectomy

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Describe what happens in Simmond’s test for Achilles tendon rupture?

No plantar flexion occurs when the calf is squeezed

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The use of which antibiotics is a risk factor for tendonitis and tendon rupture?

Quinolones (e.g. ciprofloxacin)

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Describe the deviation which occurs in hallux valgus?

There is medial deviation of the 1st metatarsal, and lateral deviation of the toes themselves

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In a low demand, older patient, a total hip arthroplasty can be expected to last for how long before failure from wear or loosening?

15-20 years

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Chronically, patients who have experienced an ACL rupture may develop ACL deficiency. What is the main symptom of this?

Rotatory instability (knee gives way when turning on a planted foot)

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What clinical test will be positive during examination of a meniscal tear?

Steinmann’s test

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What treatment option should be avoided near tendons due to increasing the risk of tendon rupture?

Steroid injections

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Which bone is most likely to be affected by a metatarsal stress fracture?

The 2nd metatarsal

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What injury is most likely to cause ruptures of multiple knee ligaments?

Knee dislocation

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An x-ray showing patchy sclerosis on the weight-bearing area of the femoral head, with a lytic zone underneath is suggestive of what pathology?

AVN of the femoral head

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Ongoing pain and effusion after a knee injury warrants further investigation for what?

Cartilage injury

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Describe the typical pain which occurs as a result of a meniscal tear? This pain may be worse on what movement?

Pain will be localised to the corresponding medial or lateral joint line, and may be worse on straightening the knee

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Both surgical and non-surgical treatment of Achilles tendon rupture require the leg to be in a series of casts for how long?

8 weeks

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Which nerve is most likely to be injured when undergoing a total hip replacement?

Sciatic nerve

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What are the four main structures of the extensor mechanism of the knee?

Tibial tuberosity, patellar and quadriceps tendons, patella and quadriceps femoris muscles

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Pain in the buttocks may come from the hip joint, but this is less specific as it may also result from pathology where?

The spine and sacroiliac joints

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Acquired pes planus (flat foot) may occur as a result of what other pathology?

Tibialis posterior tendon rupture

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In order to develop pes planus (flat feet), what structure does not develop properly in childhood?

The medial longitudinal arch

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What are the gold standard materials for a total hip replacement?

Cemented metal on polyethylene

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What is the name for a condition which usually occurs in children and is when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply, and may fragment completely?

Osteochondritis dissicans

What are the two surgical treatment options for osteoarthritis of the ankle joint?

Arthrodesis or ankle replacement

On examination, hip pain may cause a reduced range of movement. What is usually the first movement to be lost as a result of hip pathology?

Internal rotation

As part of non-surgical management of an Achilles tendon rupture, the ankle should be maintained in an equinous position- describe what is meant by this?

The ankle is plantar flexed

Sudden pain in the back of the leg and difficulty weight-bearing is most suggestive of what diagnosis?

Achilles tendon rupture

Diagnosis of a meniscal tear is made using what investigation?

Knee MRI

Chronically, patients who have experienced PCL rupture may develop what symptoms?

Knee hyperextension and instability

What treatment option can be considered for reasonably fresh, longitudinal meniscal tears involving the outer 1/3rd of the meniscus in a younger patient?

Arthroscopic meniscal repair

What is the classic mechanism of injury for a meniscal tear?

A twisting force on a loaded knee

What is the classic mechanism of injury for a LCL tear?

Varus stress injury

In patients with an Achilles tendon rupture, there will be weakness of what movement?

Plantar flexion of the foot

What is the gold standard treatment for hallux rigidus (osteoarthritis of the 1st MTP joint)?

Arthrodesis

Hyperextension at the MTP with hyperflexion at the PIP and DIP joints describes which deformity of the toe?

Claw toe

Trochanteric bursitis is most likely to occur in what demographic of patient?

Women aged 50-70

What clinical tests will be positive during examination of an ACL rupture?

Anterior drawer test and Lachmann's test

Hip pathology often causes pain in the knee joint due to a joint sensory supply from which nerve?

Obturator nerve

What pathology often presents with pain on the instep of the foot when walking, and localised tenderness on palpation of this site?

Plantar fasciitis

With altered biomechanics or weakness from chronic disease of the hip, abductor weakness may result in what clinical signs?

A positive Trendelenburg test, or a Trendelenburg gait

What are the two most common causes of AVN of the femoral head?

Long-term steroid use and alcohol abuse

Some cases of plantar fasciitis can take up to how long to resolve?

2 years

What surgical treatment option is available for younger patients with isolated medial compartment knee osteoarthritis (common in those with varus malalignment)?

Osteotomy of the proximal tibia

Pes cavus (high arched foot) is most commonly idiopathic, but can be secondary to what conditions?

Neuromuscular conditions (e.g. cerebral palsy, spina bifida)

What is the investigation of choice for suspected AVN of the femoral head?

Hip MRI

How soon after a meniscal tear does an effusion generally develop?

By the next day

Which knee pathology is often associated with hearing a 'pop' at the time of injury, the development of a haemarthrosis within an hour of the injury and deep pain in the knee?

ACL rupture

What clinical test can be used to assess if the extensor mechanism of the knee is intact?

Straight leg raise

What is the classic mechanism of injury for a MCL tear?

Valgus stress injury

What is the classic mechanism of injury for a rupture of the ACL?

Turning the upper body laterally on a planted foot with a bent knee

How are acute MCL tears treated?

Knee bracing and physiotherapy

25% of ACL ruptures are associated with which other injury of the knee?

Medial meniscal tear

Clinical examination of the knee revealing an effusion, joint line tenderness and pain on tibial rotation localising to the affected compartment is suggestive of what pathology?

Meniscal tear

What are the classic mechanisms of injury for a PCL rupture?

A direct blow to the anterior tibia with the knee flexed OR hyperextension of the knee

If an arthroscopic meniscal repair fails, what intervention is required?

Arthroscopic meniscectomy

An LCL tear may or may not be associated with injury to which neurovascular structure? What clinical feature may this present with?

Common fibular nerve- causes a permanent foot drop

Popliteal pain and bruising is almost diagnostic of which injury to the knee?

PCL rupture

Hip pathology may sometimes produce pain which is purely felt in the knee joint- this phenomenon commonly occurs with which condition?

Slipped upper femoral epiphysis (SUFE)

The patellar or quadriceps tendons can rupture with rapid contractile force. Describe the demographic that each is more likely to occur in?

Patellar tendon rupture is more common in those aged \< 40, quadriceps tendon rupture is more common in those aged \> 40

What are the three different types of knee replacement available?

Total knee replacement, unicompartmental knee replacement, patello-femoral replacement

How is trochanteric bursitis treated?

Analgesia and physiotherapy (the condition is self-limiting)

Hip pathology typically produces pain where? Where is this likely to radiate to?

Pain in the groin, which may radiate to the knee

What pathology can cause the knee to lock and be unable to fully extend due to mechanical obstruction?

Bucket-handle meniscal tear

What pathology often presents with a burning pain and tingling radiating to the affected toes, associated with a characteristic 'click' on compression of the metatarsal heads?

Morton's neuroma

Joint replacement surgery for osteoarthritis of the hip is usually performed when individuals are aged \> 65, and have one or both of what two clinical features?

Reduced functional ability and uncontrollable pain

Hyperextension at the MTP, hyperflexion at the PIP joint and hyperextension at the DIP joint describes which deformity of the toe?

Hammer toe

Trochanteric bursitis typically causes pain in the region of the greater trochanter, particularly on what movement?

Resisted abduction

What is the treatment of choice for a) early and b) late AVN of the femoral head?

a) decompression b) total hip replacement

Symptoms of anterior knee pain, a grinding/clicking sensation at the front of the knee and stiffness after prolonged sitting causing 'pseudo-locking' is most suggestive of what diagnosis?

Patello-femoral dysfunction