MSK Session2 And 3 Clinical

Question 1

Femoral shaft injuries are usually the result of

Answer 1

high velocity trauma

Question 2

Risk of blood loss in closed femoral shaft fracture

Answer 2

Hypovolaemic shock

Question 3

Treatment of femoral shaft fractures

Answer 3

Surgical fixation

Question 4

Distal femoral fractures mechanisms

Answer 4

high energy sporting injury in kids and osteoporotic falls in elderly

Question 5

Tibial fractures are

Answer 5

Fractures affecting articulating surface of tibia within knee joint, can be unicondylar or bicondylar

Question 6

Tibial plateau fractures outcome

Answer 6

Articular cartilage always damaged, most patients will develop post traumatic osteoarthritis

Question 7

Tibial plateau fractures are associated with

Answer 7

Meniscal tears and ACL injuries

Question 8

Patellar fractures key points

Answer 8

Often palpable defect, if fracture splits patella, patient cannot perform straight leg raise as extensor mechanism disrupted

Question 9

Most common direction for patella to dislocate

Answer 9

Laterally

Question 10

What is the the unhappy triad /blown knee

Answer 10

Injury to anterior cruciate ligament, medial collateral ligament and medial meniscus, results from strong force applied to lateral aspect of knee

Question 11

ACL tear key features

Answer 11

usually non contact, result of quick deceleration, hyperextension or rotational injury, sudden sensation of knee giving way (anterolateral rotatory instability), tibia can slide anteriorly under femur when ACL ruptures

Question 12

PCl injury key features

Answer 12

Dashboard injury- knee flexed and large force applied to upper tibia, displacing it posteriorly, tibia can be displaced posteriorly

Question 13

tests for ACL and PCL injuries

Answer 13

Anterior and posterior drawer tests, lachman’s test

Question 14

Dislocation of knee joint key features

Answer 14

At least 3 of 4 ligaments have to be ruptured (MCL, LCL, ACL, and PCL), associated arterial injury is common as popliteal artery is immobile, endothelial damage can lead to thrombotic occlusion (Virchow’s triad)

Question 15

What is knee effusion

Answer 15

Accumulation of fluid inside knee joint

Question 16

2 types of knee effusion

Answer 16

Haemoarthrosis (blood in joint, usually ACL rupture), Lipo-haemarthrosis (blood and fat in joint, usually fracture as fat released from bone marrow)

Question 17

What is bursitis

Answer 17

Inflammation of a bursa

Question 18

Pre-patellar bursitis key features

Answer 18

Housemaids knee, knee pain and swelling, may be some erythema, superficial bursa with a thin synovial living between skin and patella

Question 19

Infrapatellar bursitis key features

Answer 19

2 bursa- one between patella tendon and skin and another between patella tendon and bone. Occurs due to repeated micro trauma such as clergyman’s knee

Question 20

Suprapatellar bursitis

Answer 20

Extension of synovial cavity of knee joint, a knee effusion presents with swelling in suprapatellar pouch. Usually a sign of pathology - OA, RA, Infection, Gout, microtrauma from running on weird surface

Question 21

Semimembranosus bursitis

Answer 21

Indirect consequence of swelling within knee joint, located between deep fascia of popliteal fossa and posterior capsule of knee joint. Fluid can force its way through from knee joint. Swelling in popliteal fossa known as popliteal cyst or Baker’s cyst

Question 22

Osgood-Schlatter’s disease

Answer 22

Inflammation of apophysis of patellar ligament into tibial tuberosity, teenagers who play sport, intense knee pain. Pain and swelling resolve when apophysis fuses when older.

Question 23

OA symptoms

Answer 23

Knee pain, stiffness and swelling. Deformity (varus, valgus or fixed flexion)

Question 24

OA signs

Answer 24

Loss of articular cartilage leads to friction, can be felt as crepitus, effusion may develop, muscle weakness (especially quadriceps)

Question 25

Septic arthritis of knee aetiology

Answer 25

Invasion of joint by micro-organisms, often staph aureus, prosthetic joints particularly at risk, articular cartilage damaged, hydrolysis of collagen and proteoglycans

Question 26

Septic arthritis symptoms and treatment

Answer 26

Fever, pain, reduced range of motion, aspiration of joint

Question 27

Primary causes of OA

Answer 27

Age, sex, ethnicity, nutrition, genetics

Question 28

Secondary causes of OA

Answer 28

Obesity, trauma, malalignment, infection, RA, metabolic/haematological/endocrine disorders

Question 29

Pathology of OA

Answer 29

XS loading of joint and damage to articular cartilage, increased proteoglycans synthesis by chondrocytes, flaking and fibrillation of articular cartilage, erosion of cartilage down to subchondral bone

Question 30

Altered joint biomechanics in OA leads to

Answer 30

Vascular invasion, cystic degeneration and osseous metaplasia of connective tissue

Question 31

Radiological features of OA

Answer 31

Sclerosis (more white), no joint space, cysts noted, osteophytes

Question 32

Management of OA

Answer 32

Activity modification, weight loss, walker, physio, NSAIDs, Corticosteroids, joint replacement

Question 33

Hip fractures signs and symptoms

Answer 33

Reduced mobility, pain, shortened and rotated

Question 34

NOF fracture definition

Answer 34

Fracture of proximal femur, up to 5cm below the lesser trochanter

Question 35

Types of NOF

Answer 35

Intracapsular, extracapsular (intertrochanteric or subtrochanteric)

Question 36

Problem with Intracapsular fracture

Answer 36

More likely to disrupt ascending cervical branches of MFCA (artery of ligamentum teres cannot sustain metabolic demand), risk of avascular necrosis. Increased risk if fracture displaced

Question 37

NOF presentation

Answer 37

Shortened, abducted and externally rotated

Question 38

Why does NOF cause hip to be shortened, abducted and externally rotated

Answer 38

Short lateral rotators (piriformis, obturator internus, superior and inferior gemellus and quadratus femoris) contract and laterally rotate. Iliopsoas also now acts as lateral rotator. Glut med and min abduct and rotate laterally. Rectus femoris, adductor magnus and hamstring muscles shorten the limb by pulling distal fragment of femur up

Question 39

Dislocation of hip definition

Answer 39

Femur being fully displaced out of acetabulum

Question 40

2 types of hip dislocation

Answer 40

Congenital, traumatic

Question 41

90% of hip dislocations are

Answer 41

Posterior

Question 42

Most common cause of knee dislocation

Answer 42

Impact of dashboard during road traffic collision

Question 43

Posterior Hip dislocation presentation

Answer 43

Shortened, flexed, adducted and medially rotated. Sciatic nerve palsy present in 8-20% of cases

Question 44

Why do shortening and internal rotation of the limb occur after posterior dislocation of the hip?

Answer 44

Femoral head pulled upwards by strong extensors (glut max and hamstrings) and adductors after being pushed backwards over acetabulum. Anterior fibres of glut med and min cause internal rotation by pulling on posteriorly displaced greater trochanter.

Question 45

Anterior hip dislocation presentation

Answer 45

Externally rotated and abducted with slight flexion. Femoral nerve palsies can be present but are uncommon

Question 46

Central hip dislocation presentation

Answer 46

Head of femur driven into pelvis though acetabulum. Always fractured. Femoral head is palpable on rectal examination. High risk of intra pelvic haemorrhage. Life threatening