MSK 5 with pictures Flashcards
What part of the femur is associated with abduction?
Greater trochanter
What part of the femur is associated with adduction?
Lesser trochanter
What are the 2 greatest risk factors of hip fx?
Osteoporosis and female gender
What is very important to determine w/hip fx?
Baseline ambulatory status (after fx move one step down i.e. if cane, now need walker)
Approximately how many pts don’t survive past 1 year post-hip fx?
25%
What is the weakest part of the femur?
femoral neck
What are the 3 types of fractures of the neck of the femur?
-Subcapital: femoral head/neck junction -Transcervical: midportion of the femoral neck -Basicervical: base of femoral neck
What are the 2 hip x-ray views?
AP pelvis frog lateral
What are 6 findings on x-rays of femoral neck fxs?
1) Loss of contour b/w normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus 2) Lesser trochanter is more prominent d/t external rotation of femur 3) Asymmetry of lateral femoral neck/head 4) Sclerosis in fx plane 5) Smudgy sclerosis from impaction 6) Bone trabeculae angulated
What are the steps for tx a femoral neck fx?
Hemiarthroplasty→ protected weight bearing for 6 weeks and DVT prophylaxis w/Lovenox for 2 weeks, then low dose ASA after
In what 3 instances do you use cannulated screws instead of a hemiarthroplasty for femoral neck fxs?
(1) in younger pts w/an impacted fx (2) in pts too sick where it is too big of a surgery for them (3) if a pt is very immobile
What are the 3 tx principles of intertrochanteric hip fxs?
(1) traverse the fx as a rigid support (2) nail prevents fx translation ant/posterior (3) locking screws prevent rotation of the fx
What is the main tx used for intertrochanteric fxs?
Intramedullary (IM) nailing (w/protected weight bearing for 4-6 wks and DVT prophylaxis)
What is a key finding indicating a pubic rami fx and how is it treated?
Pain with weight bearing tx: walker/crutches, non-weight bearing, pain management, anticoagulation
What are 4 findings on clinical presentation of hip arthritis?
(1) insidious onset achy pain in hip +/or groin (2) ℅ stiffness in morning or after prolonged sitting w/”loosening up” after ~30 mins of activity (3) pain inc after prolonged activity relieved w/rest (4) pain/stiffness affecting ADLs and causing dec ROM
What are 6 things to assess/check in pts w/suspected hip arthritis?
1) Assess gait: antalgic gait, trendelenburg gait 2) Tenderness to palpation over anterior hip and groin 3) Active ROM limited by pain +/or structural deformity 4) Passive ROM limited by structural deformity 5) Assess neurovascular status in bilat LEs (not all hip pain comes from hip) 6) Check for pelvic obliquity which suggests leg-length discrepancy
What type of walk is commonly found in hip arthritis?
Trendelenburg gait
What are the 2 x-rays ordered for hip arthritis?
AP pelvis lateral of affected hip
What 2 things should you assess on x-ray of suspected hip arthritis?
Joint space and congruity of femoral head/acetabular surface
What is a traumatic cause and 5 atraumatic causes of AVN?
Traumatic: femoral neck fx Atraumatic: chronic corticosteroid therapy, alcoholism, smoking, chronic renal failure, diabetes
What is the most common finding on clinical presentation of AVN?
Pain out of proportion in region of affected hip
What x-ray view do you need to order to find a crescent sign and what is a crescent sign?
Need to order frog leg view crescent sign: linear area of subchondral lucency→ indicates imminent articular collapse
What is the first line tx of hip arthritis? What are the 5 other tx options?
1st line: Tylenol (w/NSAIDs adjunct) 1) Activity modification 2) PT for strengthening/ROM 3) Ambulatory assistive devices (cane, brace) 4) Intra-articular cortisone injections (under fluoroscopy) 5) Total hip arthroplasty
Where is the pain usually located with greater trochanteric bursitis?
lateral hip
What are 5 possible clinical presentations of greater trochanteric bursitis?
1) Aching, lateral-sided hip pain; worsened w/direct pressure like sitting, lying on affected side 2) Pain radiates down lateral thigh 3) Pain over lateral hip w/pain to palpation over greater trochanter 4) Pain w/passive hip rotation, abduction 5) Inc pain w/resisted hip abduction
What is the main tx of greater trochanteric bursitis?
Corticosteroid injection: 1 ml of 80 mg of depo-medrol 2 ml of 1% lidocaine w/o epi 2 ml of .25% marcaine
What is slipped capital femoral epiphysis (SCFE)?
A disorder of proximal femoral physis, leading to slippage of epiphysis from femoral neck
What is the pathophysiology of SCFE?
d/t mechanical forces acting on susceptible physis; slippage occurs through hypertrophic zone of physis
What is the most important x-ray view to order for SCFE?
frog-leg lateral
What is the tx of SCFE?
Percutaneous in situ fixation; stabilize epiphysis from further slippage and promote closure of the proximal femoral physis
What 2 x-ray views should be ordered for femur fxs?
AP and lateral of the femur
What are the 5 components of femur fx tx?
1) Treat life-threatening injuries first 2) Ex-fix as temporizing measure 3) IM nailing preferred for definitive tx 4) Analgesics and anticoags after 5) PT
What 2 things do you order when suspecting a tibial plateau fx?
(1) Standard trauma series of knee (2) CT scan to determine if unstable fx requiring ORIF
What is the tx for stable tibial plateau fxs?
-Hinged-knee brace, crutches -NWB, but can do active ROM exercises from seated/lying position +/- long-leg cast for initial immobilization
What is the tx for unstable tibial plateau fxs?
-ORIF w/side plate and screws -NWB but can do active ROM exercises from seated/lying position
What is ex-fix and when should it be used?
A bridge to definitive internal fixation; used when life-saving procedures should/must be avoided or in concert w/life-saving procedures
What is the tx of a patella fx?
-ORIF w/tension band wiring -NWB in hinged knee brace locked in extension -Mild active ROM in brace under PT direction after 4 weeks
What causes quad tendon ruptures and where are they usually seen?
“Forced flexion during extension” usually at the musculotendinous junction
What mechanism is absent with quad tendon ruptures?
Absent extensor mechanism (pts ℅ not being able to extend their leg)
Which 2 knee x-ray views should be ordered if suspecting quad tendon rupture?
AP and lateral
What is the tx of quad tendon ruptures?
Surgery→ pt held out to -20 degree extension and NWB in locked hinged knee brace until healing allows for gentle active ROM; may transition to partial WB after 6 wks as tissue heals
How long may it take for a pt to return to normal after a quad tendon rupture?
Up to one year before return to normal