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Int Spec (Ortho) > Lower Limb Orthopaedics > Flashcards

Lower Limb Orthopaedics Flashcards

1
Q

How should a metatarsal stress fracture be treated?

A

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

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2
Q

What surgical treatment is available for an ACL rupture?

A

ACL reconstruction

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3
Q

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

A

Around 3 weeks after the injury

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4
Q

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

A

One year

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5
Q

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

a) steroid injection b) partial meniscectomy

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6
Q

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

A

No plantar flexion occurs when the calf is squeezed

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7
Q

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

A

Quinolones (e.g. ciprofloxacin)

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8
Q

Describe the deviation which occurs in hallux valgus?

A

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

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9
Q

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

A

15-20 years

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10
Q

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

A

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

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11
Q

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

A

Steinmann’s test

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12
Q

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

A

Steroid injections

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13
Q

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

A

The 2nd metatarsal

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14
Q

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

A

Knee dislocation

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15
Q

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?

A

AVN of the femoral head

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16
Q

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

A

Cartilage injury

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17
Q

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

A

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

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18
Q

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

A

8 weeks

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19
Q

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

A

Sciatic nerve

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20
Q

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

A

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

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21
Q

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

A

The spine and sacroiliac joints

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22
Q

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

A

Tibialis posterior tendon rupture

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23
Q

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

A

The medial longitudinal arch

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24
Q

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

A

Cemented metal on polyethylene

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25
Q

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?

A

Osteochondritis dissicans

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26
Q

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

A

Arthrodesis or ankle replacement

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27
Q

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?

A

Internal rotation

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28
Q

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?

A

The ankle is plantar flexed

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29
Q

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

A

Achilles tendon rupture

30
Q

Diagnosis of a meniscal tear is made using what investigation?

A

Knee MRI

31
Q

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

A

Knee hyperextension and instability

32
Q

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

A

Arthroscopic meniscal repair

33
Q

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

A

A twisting force on a loaded knee

34
Q

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

A

Varus stress injury

35
Q

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

A

Plantar flexion of the foot

36
Q

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

A

Arthrodesis

37
Q

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

A

Claw toe

38
Q

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

A

Women aged 50-70

39
Q

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

A

Anterior drawer test and Lachmann’s test

40
Q

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

A

Obturator nerve

41
Q

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

A

Plantar fasciitis

42
Q

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

A

A positive Trendelenburg test, or a Trendelenburg gait

43
Q

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

A

Long-term steroid use and alcohol abuse

44
Q

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

A

2 years

45
Q

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

A

Osteotomy of the proximal tibia

46
Q

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

A

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

47
Q

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

A

Hip MRI

48
Q

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

A

By the next day

49
Q

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?

A

ACL rupture

50
Q

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

A

Straight leg raise

51
Q

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

A

Valgus stress injury

52
Q

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

A

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

53
Q

How are acute MCL tears treated?

A

Knee bracing and physiotherapy

54
Q

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

A

Medial meniscal tear

55
Q

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?

A

Meniscal tear

56
Q

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

A

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

57
Q

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

A

Arthroscopic meniscectomy

58
Q

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

A

Common fibular nerve- causes a permanent foot drop

59
Q

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

A

PCL rupture

60
Q

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

A

Slipped upper femoral epiphysis (SUFE)

61
Q

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

A

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

62
Q

What are the three different types of knee replacement available?

A

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

63
Q

How is trochanteric bursitis treated?

A

Analgesia and physiotherapy (the condition is self-limiting)

64
Q

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

A

Pain in the groin, which may radiate to the knee

65
Q

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

A

Bucket-handle meniscal tear

66
Q

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?

A

Morton’s neuroma

67
Q

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?

A

Reduced functional ability and uncontrollable pain

68
Q

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

A

Hammer toe

69
Q

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

A

Resisted abduction

70
Q

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

A

a) decompression b) total hip replacement

71
Q

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?

A

Patello-femoral dysfunction

Int Spec (Ortho) (10 decks)

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