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Orthopaedics > Lower Limbs > Flashcards

Lower Limbs Flashcards

1
Q

Most Common causes in-toeing (3) in children

A

Metatarsus adductus
Increased femoral anteversion
Increased internal tibial torsion

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2
Q

3 risk factors for developing dysplasia of the hip

A 
5 Fs:
Female
Family history
Frank Breech
First born
LeFt hip
Syndromic child '
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3
Q

!!! Typical clinical picture of slipped upper femoral epiphysis (SUFE) (5)

A 
Leg length discrepancy
In flexion, hip goes into abduction and external rotation
Knee pain
Antalgic gait
Decreased internal rotation
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4
Q

Clin tests for developmental dysplasia of the hip (DDH)

A 
Ortolani test (safe)
Barlow test (unsafe)
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5
Q

! Describe foot position of clubfoot:7

A 
CAVE
cavus (high arch)
adduction of midfoot-kidney shaped
Varus -hind foot rotated in
Equinus - foot plantarflexed
Also: Achilles tendon short, 1st metatarsal flexed, medial displacement of cuboid and navicular bones.
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6
Q

What is leg-calve-perthe’s disease?

A

Avascular osteonecrosis of femoral epiphysis. Idiopathic

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7
Q

What kind of patient Is most likely to present with Perthes disease?

A

5-10 year old boy

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8
Q

Clinical presentation of perthe’s disease (8)

A 
Limping child
Usually unilateral
Pain hip/groin, may refer to knee
Decreased abduction and internal rotation of hip
Trendelenburg gait and sign
Out-tœing, LLD, quad atrophy
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9
Q

Diagnosis Perthes disease

A

XR showing AVN of femoral epiphysis

Normal bloods

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10
Q

Treatment Perthes

A

Conservative.

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11
Q

Clin test to test for tarsal tunnel syndrome

A

Positive Tinel sign

Tap area of post tibial nerve behind lateral malleolus. Positive = pain

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12
Q

Describe normal position of legs at birth

A

Bowed legs

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13
Q

Describe normal position of legs by 2 years

A

Straight

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14
Q

Describe normal position of legs at 4 years

A

Maximal genu valgum (up to 15 degrees)

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15
Q

What is pes planus

A

Flat foot

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16
Q

3 features of pes planus

A
  1. Collapsed medial arch
  2. Heel valgus
  3. forefoot varying degrees of abduction
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17
Q

Most common cause pes planus

A

Tibialis posterior tendon degeneration

Inflammation or rupture

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18
Q

What is pes cavus

A

High arched foot

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19
Q

What is cavovarus

A

High arched foot

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20
Q

! Name 4 features pes cavus (3 extra bonus)

A
  1. high arched foot!
  2. Heel varus (inversion)!.
  3. Forefoot adduction
  4. Clawed toes
    Other: plantar soft tissue and Achilles tight with callosities under metatarsal heads , first metatarsal drop
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21
Q

Causes pes cavus. 3 broad and 1 example each

A

Neuromm d/o: Charcot Mary tooth disease (weak/paralysed intrinsic foot muscles).
Congenital: arthrogryposis(rare)
Trauma: compartment syndrome (volkmann’s ischaemic contracture) and circumferential burns.

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22
Q

What is metatarsalgia

A

Pain over forefoot in region of metatarsal heads. Bottom of foot.

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23
Q

Define Morton’s neuroma

A

Interdigital neuroma mostly 3rd Webspace. Numbness/neuritic pain in distrib of common digital nerve (pathological enlarge of nerve)

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24
Q

First line rx Morton’s interdigital neuroma

A 
Infiltration with lignocaine (steroid) - also a diagnostic test.
If fail (doesn't last longer than 6weeks) - resect.
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25
Q

Features of claw toes (2)

A

Dorsiflexion metatarsophalangeal joint
Flexion proximal distal IP joint.
(Usually ass with pes cavus)

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26
Q

What is Achilles tendonosis

A

Chronic inflamm and degen

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27
Q

Subclassify Achilles tendinosis (2)

A

Insertional (degen of tendon as it inserts on calcaneus)

Non-insertional (degen of mid substance)

28
Q

What is genu recurvatum

A

Bending backwards knees

29
Q

What is patellar tracking

A

Patella shifts out of place as leg bends or straightens.

30
Q

What is patella baja

A

Low riding patella

31
Q

What is patella Alta

A

High riding patella

32
Q

What is the q angle and what is the normal?

A 
Quadriceps angle (between quads and patella tendon)
Men 14°
Women 17° (higher = knock knees and dislocation lateral, lower = bow-legged)
33
Q

Name 8 complications skin traction

A
  • Distal oedema
  • vascular obstruction
  • Peroneal nerve palsy - foot drop, path sensation top (dorsum) of foot and upper lateral + lower posterolateral leg and anterolateral leg, slapping gait
  • skin necrosis over bony prominences
  • compartment syndrome
  • allergic reactions to adhesive
  • excoriation of skin from slipping of adhesive strapping (abrasion of epidermis)
  • pressure sores around malleoli and over tendo calcaneus
  • complications of bed rest: thromboembolism, pneumonia, constipation, UTI, bed sores…
34
Q

Describe the Danis Weber classification

A

Lateral malleolus fibula fractures (ankle)
• type A: below syndesmosis and oblique # medial malleolus
• type B: at level syndesmosis with # of medial malleolus with disruption medial ligament
• type c: above level syndesmosis, tibiafibular ligament torn, unstable # subluxation of ande joint

35
Q

Major complication of tibia metaphysis fracture?

A

Extreme swelling and blisters

36
Q

Which patellar dislocation is most common?

A

Lateral

37
Q

Treatment ankle fractures?

A

All ORIF
except undisplaced lateral malleolus fracture without medial tenderness (tenderness= medial malleolus #or deltoid ligament injury)

38
Q

Which structure is in danger in fibula neck fracture?

A

Common peroneal nerve

39
Q

Thomas splint indication?

A
  • femur #

* use with skin or skeletal traction

40
Q

How determine size and weight of Thomas traction?

A
  • Measure thigh circumference at groin, add 4 cm for ring
  • measure true limb length (ASIS to medial malleolus), add 20cm for length splint
  • Max weight 5 kg (more = skin sloughing) or 10% of patient’s body weight if <5kg
41
Q

Name 3 indications skin traction

A
  • femur #
  • hip dislocation or #disloc
  • Dunlop traction for supracondylar #
42
Q

How measure apparent limb length?

A

Measure how patient walks -altered mechanisms of lower extremities, compensatory mechanisms
From umbilicus to medial malleolus

43
Q

Most common tarsal fracture?

A

Calcaneal fracture

44
Q

Mechanism of calcaneal fracture?

A
  • high energy, axial loading, fall from height onto heels which drives talus downwards onto calcaneus
  • 10% ass with compression fractures of thoracolumbar spine so NB to rule out spine injury
  • 75% intra-articular
  • 10% bilateral
45
Q

Clinical features calcaneal fracture? (5)

A
  • makes swelling and bruising on heel/sole
  • wider, shorter, flatter heel when viewed from behind
  • varus heel
  • compartment syndrome of foot frequent
  • hold heel in palm of hand and gently squeeze. Pain = calcaneal #
46
Q

Treatment calcaneal fractures?

A

TREATMENT PRINCIPLES:

  • soft tissue resuscitation
  • restore articular congruity
  • restore normal calcaneal width and height
  • maximal functional recovery may take longer than 12 months
  • conservative if undisplaced: non weight bearing cast for 3 months with early ROM and strengthening
  • displaced = ORIF
47
Q

Name and describe the classification used for neck of femur #

A 
Garden classification (ap xray)
• type 1: incomplete #, valgus impacted , trabeculae malaligned
. Type 2: complete #, nondisplaced, neutral alignment. trabeculae aligned
• type 3: complete, partially displaced , varus alignment, trabeculae malaligned
. Type 4: complete, fully displaced, varus alignment, trabeculae aligned
48
Q

Position of limb in displaced neck of Femur #?

A

External rotation and abduction with shortening

49
Q

Name 4 complications neck of femur fracture

A

. Avn / osteonecrosis (disruption medial and lateral femoral circumflex arteries )
• nonunion
• dislocation
• DVT (nb to give clexane )

50
Q

Name 6 causes AVN of femoral head

A
  • Neck of femur #
  • chronic systemic steroid use
  • SUFE
  • leg calve Perthes disease
  • SLE
  • ra
51
Q

Treatment intertrochanteric #?

A

Closed reduction under fluoroscopy then dynamic hip screw or IM nail

52
Q

Name 5 complications intertrochanteric # of the femur

A
  • DVT
  • varus displacement of proximal fragment
  • malrotation
  • non-union
  • failure of fixation device
53
Q

Subtrochanteric femur fracture treatment?

A

Closed reduction under fluoroscopy then plate fixation or IM nail

54
Q

Name 3 complications subtrochanteric femur #

A

.Malalignment
• non-union
• wound infection

55
Q

Treatment neck of femur #? (4)

A

• Garden 1: internal fixation to prevent displacement ( valgus impacted # )
. Garden 2: internal fixation to prevent displacement
• garden 3: young orif; elderly hemi-arthroplasty
. Garden 4: young orif; elderly hemi-arthroplasty

56
Q

Treatment femoral diaphysis # adults?

A

Orif with IM nail

External fixator for unstable patients, open #, highly vascular areas

57
Q

Mechanism of injury lisfranc #? (2)

A
  • Fall onto plantarflexed foot

* direct crush injury

58
Q

What is a lisfranc injury?

A

Tarsometatarsal fracture dislocation between 1st and 2nd mt

59
Q

Clinical presentation lisfranc injury? (4)

A
  • Shortened forefoot
  • prominent base
  • pain dorsal foot
  • plantar medial bruising! (Unique)
60
Q

Treatment lisfranc #?

A

Orif with K wires if displaced

61
Q

Which 3 other fractures must be excluded when a calcaneal # is seen?

A
  • Spine
  • pelvis
  • hip
62
Q

When a pes cavus is diagnosed, what other pathologies must be examined for? (3)

A
  • Spastic diplegia
  • old poliomyelitis
  • spina bifida occulta
63
Q

Which foot bones fracture commonly in sports?

A

Metatarsals 2-5

64
Q

Which foot bones fracture commonly in mva?

A

Talus

65
Q

Identify picture 66 and its indication

A

Thomas splint with Balkan frame

Older children > 12,5 kg femoral shaft #

Orthopaedics (20 decks)

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