MIDTERMS: LE disorders (hip , Knee,, foot) Flashcards
Includes medial (internal) and lateral (external) rotation of the hip.
Hip Rotation
Q: What is tibial torsion?
A: Twisting of the tibia (shinbone), affecting foot alignment.
Q: What does a negative foot progression angle (FPA) indicate?
A: In-toeing.
Q: What is the normal range for femoral anteversion?
A: Less than 70 degrees.
Q: What degree of femoral anteversion is considered moderate?
A: 80-90 degrees.
Q: What is the thigh-foot angle (TFA)?
A: The angular difference between the axis of the thigh and foot.
Q: What does a positive foot progression angle (FPA) indicate?
A: Out-toeing, common in young children due to greater lateral hip rotation.
Q: What is a positive Trendelenburg test?
A: The opposite hip drops when weight is placed on the affected side.
Q: What is slipped capital femoral epiphysis (SCFE)?
A: A condition where the femoral head slips through the growth plate, common in overweight children.
Q: What degree of femoral anteversion is considered mild?
A: 70-80 degrees.
Q: What is congenital hip dislocation (CHD)?
A: A condition where a child is born with an unstable hip joint.
Q: What degree of femoral anteversion is considered severe?
A: Greater than 90 degrees.
Q: What is the normal range for the thigh-foot angle (TFA)?
A: Between negative and 20 degrees.
Q: How is leg length discrepancy (LLD) managed?
Less than 1 inch: Heel lift.
More than 1 inch: Elevate the entire shoe
Q: What condition is indicated by a TFA greater than 20-30 degrees?
A: Medial tibial torsion.
Q: What is metatarsus adductus?
A: A congenital foot deformity where the lateral border of the foot is curved instead of straight.
Q: What is epiphysiodesis?
A: A surgical procedure on the growth plate to slow the growth of the longer leg.
Q: What is femoral anteversion?
A: Inward twisting of the femur, causing a pigeon-toed appearance (in-toeing).
Q: What is Legg-Calvé-Perthes disease?
A: Avascular necrosis of the femoral head in children, causing hip pain and limping.
Q: What is Galeazzi’s sign?
A: Uneven knee heights when the child is lying supine with knees flexed, indicating hip dislocation.
Q: What are the three limb lengthening procedures?
A: Wagner, Ilizarov, and De Bastiani methods.
Q: What is Van Nes rotationplasty?
A: A procedure where the lower limb is rotated so the ankle and foot function as a knee joint in a prosthesis.
Q: What is proximal femoral focal deficiency (PFFD)?
A: A congenital partial aplasia of the femur, leading to a short femur and hip/knee flexion contractures.
Q: What is iliotibial band friction syndrome?
A: ITB rubbing against the lateral femoral condyle, causing lateral knee pain.
Q: What are the two osteotomy procedures for Legg-Calvé-Perthes disease?
A: Femoral Varus Derotational Osteotomy and Innominate Osteotomy.
Q: What are the three types of SCFE?
A: Acute, acute-on-chronic, and chronic.
Q: What causes anterior snapping hip syndrome?
A: The iliopsoas tendon snapping over the iliopectineal eminence.
Q: What are the four types of hip bursitis?
Iliopectineal/Iliopsoas bursitis (anterior hip/groin pain).
Superficial trochanteric bursitis (outer hip pain).
Deep trochanteric bursitis (outer hip pain, radiating down the thigh).
Ischiogluteal bursitis (“Weaver’s bottom,” pain from prolonged sitting).
Q: What causes lateral snapping hip syndrome?
A: The iliotibial band (ITB) snapping over the greater trochanter.
Q: What is the most common complication of SCFE?
A: Avascular necrosis.
Q: What are the stages of chondromalacia patella?
Swelling & softening of cartilage.
Fissuring.
Fasciculation (deformation of the surface).
Osteoarthritis (fissuring reaches subchondral bone with vascular response).
Q: What are the treatment options for SCFE?
A: In situ pinning, reduction, and screw placement.
Q: What are the causes of congenital knee dislocation?
A: Muscle imbalance, intrauterine positioning, associated disorders (arthrogryposis, myelodysplasia, congenital dislocation of elbow/hip, torticollis).
Q: What are the dynamic and static stabilizers of the patella?
Dynamic: Quadriceps, especially vastus medialis oblique (VMO).
Static: Bony contour of the distal femur, joint capsule, medial & lateral retinacula, medial patellofemoral ligament.
Q: Why is congenital knee dislocation an orthopedic emergency?
A: Because the knee is hyperextended or dislocated, with the tibia anterior and lateral to the femur.
Q: What are the types of patellar fragmentation?
Fragmented: Asymptomatic, smooth borders on patellar fragments (bilateral).
Fractured: History of trauma, hemarthrosis, point tenderness, sharply outlined fragment.
Q: What are the management options for congenital knee dislocation?
A: Manipulative reduction or surgery.
Q: What is true synchondrosis?
A: A joint where surfaces are connected by a cartilaginous plate.
Q: What is patella alta and baja?
Patella alta: High-riding patella.
Patella baja: Low-riding patella.
Diagnosis: Lateral X-ray with knee at 30° flexion; patellar ligament length >20% of patella length = abnormal.
Q: What is the management of symptomatic patellar fragmentation?
A: Excision along with lateral retinacular release.
Q: Why is cartilage damage often asymptomatic?
A: Because cartilage is avascular, alymphatic, and aneural—symptoms arise when a synovial reaction occurs.
Q: How can quadriceps and hamstring function be improved?
A: Contracting both simultaneously with the knee slightly flexed.
Q: What is osteochondritis dissecans?
A: Fragmentation of articular cartilage with varying degrees of subchondral bone occlusion.
Q: What exercises help with patellofemoral dysfunction?
Isometric contraction of the vastus medialis oblique (VMO).
Wall-leaning to stretch soleus & gastrocnemius.
SLR stretch for hamstrings.
Bicycle riding to strengthen knee flexors.
Q: What are the stages of osteochondritis dissecans?
Stage 1: Bulge on medial femoral condyle, cartilage intact.
Stage 2: Separation of fragment by articular cartilage.
Stage 3: Fragment becomes a loose body, may migrate to medial/lateral gutter.
Q: What are the common symptoms?
A: Insidious pain, aching, stiffness, loose body sensation, knee locking or giving out.
Q: What is Sinding-Larsen-Johansson syndrome?
A: Inflammation of the inferior pole of the patella at the patellar tendon insertion, common in adolescents.
Q: How is it treated?
JUMPERS KNEE
Rest, ice, patellar strap for support.
Stretching for tight muscles.
Q: What are the management options?
Stable fragment: Splint, NWB with crutches.
Loose fragment: Arthroscopic removal or ORIF if on weight-bearing surface.
Q: What are congenital meniscal variations?
A: Abnormal meniscus development leading to knee dysfunction.
Q: What is the Ogden-Watson Classification?
Type I: Avulsion of ossification center.
Type II: Separation of tibial tuberosity.
Type III: Fracture into knee joint.
Type IV: Posterior extension (Ryu classification).
Q: What is Osgood-Schlatter disease?
A: Inflammation of the patellar ligament at the tibial tuberosity, common in adolescents during growth spurts.
Q: What is a Baker’s cyst?
A: A collection of synovial fluid forming a sac at the back of the knee.
Q: What is plica syndrome?
A: Irritation of synovial folds, most commonly on the medial femoral condyle.
Q: What are the causes of a Baker’s cyst?
A: RA, OA, knee effusion, trauma, repetitive activities.
Q: What is pes cavus?
A: A condition with an excessively high medial longitudinal arch, causing forefoot plantarflexion and increased weight-bearing on the lateral foot border and metatarsal heads.
Q: What are the types of knee bursitis?
Suprapatellar
Prepatellar (Housemaid’s/Nun’s knee)
Infrapatellar
Popliteal (Baker’s cyst)
Q: What are the treatment options?
Nonsurgical: Rest, compression, massage, NSAIDs, cortisone injection, fluid drainage.
Surgical: Excision if persistent or symptomatic.
Q: What causes it?
(JUMPERS KNEE)
A: Increased tension on the growth plate due to overuse, jumping, running, and tight quadriceps.
Q: What are the orthotic prescriptions for talipes equinovarus?
Outflare last (worn with Denis Browne splint for non-ambulatory correction).
Lateral heel & sole wedge.
Reverse extended Thomas heel.
Long medial counter.
Q: What are the symptoms?
JUMPERS KNEE
QA: Pain at the bottom of the kneecap, swelling, activity limitation.
Q: What is talipes equinovarus?
A: A congenital deformity where the foot is plantarflexed, inverted, and adducted.
Q: What orthotics can help pes cavus?
Medial longitudinal arch support.
Metatarsal pad or bar.
High quarters for ankle stability.
High toe box for pressure relief.
Q: What are the treatment objectives for talipes equinovarus?
Maintain improvement achieved.
Provide correction by abducting the forefoot, everting the midfoot and hindfoot, and reducing plantarflexion.
Q: What are the objectives of treatment?
Reduce load on lateral border, metatarsal heads, and heel.
Contain the deformed foot.
Q: What is pes planovalgus?
A: A condition characterized by flattening of the medial longitudinal arch with excessive foot eversion.
Q: What orthotic prescriptions help with pes planovalgus?
Medial longitudinal arch support.
Extended Thomas heel and long medial counter.
Medial heel wedge.
Heel seat to hold the calcaneus in a vertical position.
UCBL insert with reinforced medial and heel counters.
Q: What are the treatment objectives?
Correct eversion.
Support the medial longitudinal arch.
Relieve ligamentous strain.
Q: What is tarsal coalition?
A: A condition where two or more tarsal bones fail to separate properly, causing rigid flatfoot and restricted foot motion.
Q: What treatments are used for ankle sprains?
Rest, Ice, Compression, Elevation (RICE).
Taping & bandaging.
Ankle immobilizers.
Strengthening exercises.
Q: What are the common types of ankle sprains?
Inversion Sprain (most common, affecting the anterior talofibular ligament).
Eversion Sprain (affecting the deltoid ligament).
High Ankle Sprain (affecting the syndesmosis between tibia & fibula).
Q: What are the two most common types of tarsal coalition?
Calcaneonavicular Coalition
Talocalcaneal Coalition
Q: What special tests help diagnose ankle sprains?
Anterior Drawer Test – Tests the anterior talofibular ligament.
Talar Tilt Test – Assesses inversion stress.
External Rotation Test – Used for high ankle sprains.
Squeeze Test – Assesses tibiofibular syndesmosis injury.
Q: What are risk factors for plantar fasciitis?
Overuse or prolonged standing.
Obesity.
Tight Achilles tendon or calf muscles.
Improper footwear.
Q: What is Achilles tendonitis?
A: Inflammation of the Achilles tendon, often due to overuse or excessive strain.
Q: What is plantar fasciitis?
A: Inflammation of the plantar fascia, causing heel pain, especially with the first steps in the morning.
Q: What are common treatments?
Rest and activity modification.
Stretching and strengthening exercises.
Heel lift inserts to reduce tendon stress.
Eccentric strengthening programs.
Q: What are effective treatments?
Stretching exercises (plantar fascia & Achilles).
Orthotic insoles for arch support.
Night splints to maintain dorsiflexion.
NSAIDs & corticosteroid injections for pain relief.Q
