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Clin Med 4 > MSK V - Hip and Lower Extremity > Flashcards

MSK V - Hip and Lower Extremity Flashcards

1
Q

most common etiology of hip fractures? age?

A

after a fall from standing position in person >50 y/o

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2
Q

what are the greatest risk factors of hip fracture?

A

osteoporosis, female gender

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3
Q

what is important to determine about the pt if hip fracture?

A

their baseline ambulatory status

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4
Q

common sx’s of hip fractures?

A

pain in anterior hip/groin after fall

non-ambulatory

non-weight bearing

external rotation of leg on affected side

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5
Q

what is the most sensitive test to identify a hip fracture?

A

internal rotation - pt will have pain

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6
Q

physical exam for hip fracture?

A

pain on palpation over fracture area and pain with active/passive ROM

pain on internal rotation

assess neuro status

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7
Q

what x-rays for hip fracture?

A

AP pelvis (all the time)

Frog lateral - if pt can tolerate it

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8
Q

when would you order an MRI for hip fracture?

A

if suspected fx not seen on x-ray

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9
Q

when should pt with hip fracture have surgery?

A

recommended to have surgery within first 24hrs

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10
Q

why should you NOT delay surgery past 24hrs for hip fractures?

A

b/c pts will then have 2x the rate of major/minor complications like pneumonia, pressure ulcers, DVT, and death

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11
Q

tx for femoral neck fracture?

A

cannulated screws or hemiarthroplasty

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12
Q

what pts with femoral neck fx get cannulated screws as tx?

A

if younger pt like 55 y/o or older pt that is bad surgical candidate (won’t survive hemiarthroplasty)

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13
Q

what is the reason to do hemiarthoplasty for femoral neck fx?

A

b/c femoral neck fx’s interrupt blood supply to femoral head

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14
Q

tx for intertrochanteric femoral fx’s?

A

IM nailing (M/C) - force is inside the bone here and device is load sharing

DHS Compression Screw (not as good b/c force is on the outside of the bone)

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15
Q

difference b/w intertrochanteric femoral fx’s and femoral neck fx’s?

A

intertrochanteric fx’s don’t interrupt the blood supply

femoral neck fx’s do interrupt the blood supply

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16
Q

tx for subtrochanteric fx?

A

IM nailing

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17
Q

when do you do a hemiarthroplasty?

A

displaced femoral neck, sub capital hip fx

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18
Q

when do you use cannulated screws for hip fx?

A

nondisplaced femoral neck

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19
Q

what do patients and family need to understand about hip fractures?

A

that the surgery is a major surgery and it carries inherent risks

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20
Q

what happens to the people that do survive their hip fx?

A

return to one level below their baseline ambulatory/ADL status

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21
Q

avascular necrosis risk factors?

A

chronic steroid use, post-trauma, post-infection

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22
Q

sx’s of hip arthritis?

A

insidious onset of achy type pain in hip and/or groin

c/o stiffness in morning or after prolonged sitting with “loosening up” after approx. 30 min of activity (“Gelling”)

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23
Q

pain in hip arthritis increased after prolonged what and relieved with what?

A

Pain increased after prolonged activity, relieved with rest

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24
Q

pain in hip arthritis affects what and causes decreased what?

A

ADLs and causes decreased ROM

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25
Q

hip arthritis PE?

A

Assess gait - painful gait, Trendelenburg gait

TTP over anterior hip and groin

Active ROM limited by pain and/or structural deformity

Assess NV status in bilat LEs

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26
Q

active ROM in hip arthritis is limited by?

A

pain and/or structural deformity

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27
Q

if no structural deformity in hip arthritis, what should NOT be interrupted?

A

passive ROM

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28
Q

what should you check for in hip arthritis? what does it suggest?

A

pelvic obliquity - suggests leg-length discrepancy

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29
Q

x-rays for hip arthritis?

A

Standard AP pelvis

Frog lateral or lateral of affected hip

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30
Q

assess what on x-ray for hip arthritis?

A

joint space, congruity of femoral head/acetabular surface

assess for loose bodies, subchondral cysts

assess for evidence of avascular necrosis (may need MRI)

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31
Q

joint space narrowing and sclerosis suggest what?

A

early OA

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32
Q

osteophytes near the femoral head or acetabulum and subchondral bone cysts suggest what?

A

advanced OA

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33
Q

if suspect inflammatory arthritis of hip, run what labs?

A

CBC w/ diff, ESR, CRP, Rheum Factor, ANA, Lyme Titer

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34
Q

if joint pain, always think of what?

A

Lyme disease

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35
Q

when does the patient need surgery for arthritis?

A

when they can’t live their life anymore

-surgery not dependent on the x-rays

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36
Q

1st line tx for hip arthritis?

A

APAP

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37
Q

tx for hip arthritis?

A

***Tylenol 1st line - NSAIDs as adjunct

Activity modification

Physical Therapy - strengthening/ROM

Ambulatory assistive devices (cane, brace) - cane helps a lot

Intra-articular cortisone injection (done under fluoroscopy)

Total hip arthroplasty (definitive)

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38
Q

what is the definitive tx of hip arthritis?

A

total hip arthroplasty

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39
Q

greater trochanteric bursitis triggered by?

A

minor direct trauma over greater trochanter

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40
Q

what does inflammation of the bursa and soft tissue in greater trochanteric bursitis lead to?

A

pain located in lateral hip

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41
Q

what muscles attach to the grater trochanter of the femur?

A

abductors

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42
Q

sx’s of greater trochanteric bursitis?

A

Pts c/o aching, intense lateral-sided hip pain
-Worsened with direct pressure like sitting, laying on affected side

Pain radiates down lateral thigh

Painful ambulation on affected side

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43
Q

pts lateral hip pain in greater trochanteric bursitis is worsened with what?

A

Worsened with direct pressure like sitting, laying on affected side

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44
Q

greater trochanteric bursitis PE?

A

Pain over lateral hip with pain to palpation over greater trochanter

***Pain with passive hip rotation, adduction -> KEY!!!

Increased pain with resisted hip abduction

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45
Q

what is KEY to the PE of greater trochanteric bursitis? what is it doing?

A

Pain with passive hip rotation, adduction

-stretching the IT band over the bursa -> PAIN!!!

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46
Q

tx for greater trochanteric bursitis?

A

CONSERVATIVE TX

  • Ice
  • NSAIDs
  • PT
  • Corticosteroid injection
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47
Q

who is femoral acetabular impingement seen in?

A

younger people

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48
Q

what is femoral acetabular impingement?

A

Condition where femoral neck is abnormally shaped during childhood growth

-Thus, causes impingement sx’s in Femoroacetabular joint

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49
Q

what are the 2 types of femoral acetabular impingement?

A

Cam bone spur and Pincer bone spur

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50
Q

what is Cam bone spur?

A

type of femoral acetabular impingement

Abnormal Femoral Head/Neck junction with increased radius at the waist (bony overgrowth that is hitting the bone)

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51
Q

when does impingement occur in Cam bone spur?

A

during flexion, adduction, internal rotation

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52
Q

what is Pincer bone spur?

A

type of femoral acetabular impingement

  • Excessive Acetabular Coverage
  • Linear contact b/w the labrum and femoral head/neck junction

-Impinges on femoral neck

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53
Q

sx’s of femoral acetabular impingement?

A

dull ache which waxes/wanes with activity/rest

pain in groin area

sharp stabbing pain may occur with turning, twisting, and squatting

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54
Q

improvement of sx’s with femoral acetabular impingement with what?

A

with PT, but sx’s return after PT stopped

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55
Q

what test is done to assess for femoral acetabular impingement?

A

Impingement Test (FAIR test) -> will produce PAIN!!!

  • Hip flexion to 90
  • Adduct to 20
  • Internal Rotation
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56
Q

when do you do an MRI for femoral acetabular impingement?

A

pre-op if think there is a labrum tear

use MRI to assess labrum and articular cartilage

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57
Q

surgical tx for femoral acetabular impingement?

A

Arthroscopy for labral repair and/or debridement

Femoral head/neck resection to correct deformity

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58
Q

what tx is necessary for femoral acetabular impingement if pt wants to keep active?

A

surgery

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59
Q

what is the non-surgical tx for femoral acetabular impingement?

A

activity modification, NSAIDs, PT

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60
Q

causes of femur fractures?

A

high-energy/velocity injuries

-MVA, fall from height, or metastatic lesions

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61
Q

complication for femur fractures?

A

severe blood loss and loss of limb/life if femoral artery injured/severed

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62
Q

sx’s of femur fractures?

A

presents after trauma, non-weight bearing

may have other complants/injuries from high-energy injury

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63
Q

femur fractures are what type of injury?

A

a DISTRACTING INJURY -> need to make sure nothing else is broken b/c this fracture is caused by high energy

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64
Q

what else must you check for if pt has femur fracture?

A

other injuries: pelvis, knee, spine

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65
Q

what will affected leg for femur fracture look like?

A

rotated and shortened

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66
Q

x-rays for femur fracture?

A

AP, lateral of femur

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67
Q

tx of femur fracture

A

IM nailing (definitive tx)

Analgesics and anticoagulation afterward (MUST DO!!!)
-aspirin 325mg daily or Lovenox (LMWH)

PT

Follow healing thru serial x-rays to avoid non-or malunion

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68
Q

what is definitive tx for femur fractures?

A

IM nailing

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69
Q

what is so good about IM nailing as tx for femur fractures?

A

Pts can be mobilized sooner and reduce post-op sequelae (Ex: pneumonia, atelectasis, DVT, etc.)

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70
Q

what must be addressed first for femur fracture? may need what?

A

life-threatening injuries -> may need Ex-Fix

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71
Q

what is something that you MUST do after surgery for femur fx?

A

anticoagulation - aspirin 325mg daily or Lovenox (LMWH)

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72
Q

tibial plateau fx is caused by what injury?

A

high-energy deceleration injury

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73
Q

what is the mechanism of tibial plateau fx?

A

femoral condyles push down onto tibial pleather causing fx

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74
Q

tibial plateau fx seen with?

A

falls

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75
Q

high incidence of what after tibial plateau fx?

A

post-traumatic arthritis

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76
Q

sx’s for tibial plateau fx?

A

mod-severe pain

non-weight bearing

tender to palpation and will resist active/passive ROM

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77
Q

what else should be assessed for with tibial plateau fx’s?

A

other injuries

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78
Q

dx of tibial plateau fx’s?

A

Standard Trauma series of knee

CT scan to be ordered if unstable fracture requiring ORIF (surgery)

If no fx seen on plain film, but patient symptomatic, order MRI to assess joint line

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79
Q

CT scan is the test to get if looking for what in tibial plateau fx’s?

A

articular surface depression

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80
Q

tx for stable tibial plateau fx’s?

A

Hinged-knee brace, crutches

Pt non-weight bearing but can do active ROM exercises from seated/lying position

Some may use long-leg cast for initial immobilization

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81
Q

what is a stable tibial plateau fx?

A

no depression of articular surface

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82
Q

tx for unstable tibial plateau fx’s?

A

ORIF with side plate and screws

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83
Q

what is a Segond fx?

A

Avulsion fracture involving lateral aspect of tibial plateau

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84
Q

Segond fx associated with what?

A

disruption of ACL

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85
Q

Segond fx occurs as a result of?

A

internal rotation and varus stress

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86
Q

Segond fx seen in what 2 settings?

A

falls and sports (skiing, basketball, baseball)

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87
Q

sx’s for Segond fx?

A

knee pain/swelling after trauma

Will hold knee in approx. 20 degrees flexed position for comfort (also common presentation for torn ACL)

Non-weight bearing

Moderate to large effusion with pain over lateral aspect of knee

Pt will resist full extension and may not be able to flex past 90 degrees secondary to hemarthrosis

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88
Q

is the knee stable or unstable in Segond fx?

A

knee stable unless other injury

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89
Q

imaging for Segond fx?

A

standard trauma knee series

MRI

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90
Q

MRI is essential to identify what for Segond fx?

A

to identify internal derangement and to assess the ACL to see if torn

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91
Q

tx for Segond fx if no extensive ligamentous injury?

A

cancellous screw (b/c small fx)

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92
Q

tx for Segond fx if have extensive ligamentous injury?

A

surgical intervention to correct anterior rotational instability

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93
Q

prognosis of Segond fx?

A

good if pt compliant with rehab program of protected weight-bearing and gentle ROM until healed

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94
Q

how is a patella fracture caused?

A

Direct trauma to anterior patella, i.e. dashboard injury

Sudden forceful contraction of quad muscles in context of sport injury

Direct blow to patella

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95
Q

sx’s of patella fx?

A

a lot of swelling/large joint effusion

Absent extensor mechanism - can’t extend leg

pain

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96
Q

what is something that must be checked if suspect patella fx?

A

extensor mechanism of leg -> will be ABSENT

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97
Q

imaging for patella fx?

A

standard trauma knee series - sunrise view (best view)

CT if severely comminuted

98
Q

tx for patella fx?

A

ORIF with tension band wiring

NWB in hinged knee brace in LOCKED EXTENSION

99
Q

when can pt with patella fx “open up brace” to 20 degrees? when can they do active ROM in brace under PT direction?

A

around 2 weeks to open up brace

after 4 weeks for active ROM

100
Q

mechanism of quad tendon rupture? example?

A

forced flexion against resistance/extension

Ex: person jumping down onto deck of boat as it is coming up toward him from water

101
Q

quad tendon rupture seen in who?

A

heavy-set males in 40s-50s

102
Q

sx’s of quad tendon rupture?

A

pts can describe exact moment the tendon “popped”

ABSENT EXTENSOR MECHANISM

a lot of swelling

defect in distal quad tendon

103
Q

in complete quad tendon rupture, what will the pt be and what will they have?

A

pt will be NWB with large effusion to affected knee

104
Q

what is the pain from in quad tendon rupture?

A

from the tear and from the effusion

105
Q

tx for quad tendon rupture?

A

surgery (suture the tendon and tie it off)

pt held out to -20 degrees extension and NWB in locked hinged knee brace until healing allows for gentle AROM

106
Q

pt with quad tendon rupture may transition to partial WB after how many weeks?

A

may transition to partial WB after 6 weeks as tissue heals

107
Q

once ROM is restored in quad tendon rupture, pt works on…

A

strengthening

108
Q

patellar tendon rupture at what age?

A

< 40 y/o

109
Q

complete patella tendon rupture rare in young athlete unless associated with…

A

steroids

110
Q

risk factors for patella tendon rupture?

A

RA, long-term DM, long-term steroid use, fluoroquinolones

111
Q

sx’s of patella tendon rupture

A

palpable defect in patellar ligament - defect below the knee

ABSENT EXTENSOR MECHANISM

112
Q

imaging for patella tendon rupture?

A

standard trauma series of knee

113
Q

conservative tx for patellar tendon rupture for what? what is the tx?

A

partial patellar ligament disruption

tx is immobilization in hinged knee brace for 4-6 weeks

114
Q

surgical tx for patellar tendon rupture for what?

A

complete tears

115
Q

what 3 injuries of the knee have ABSENT EXTENSOR MECHANISM?

A

quad tendon rupture, patellar fracture, and patellar tendon rupture

116
Q

what is a Maisonneuve fracture?

A

Combination of spiral fracture of proximal fibula with ankle injury of one or more:

  • Widening of ankle joint d/t rupture of distal tibiofibular syndesmosis
  • Deltoid ligament disruption
  • Fracture of the medial malleolus
117
Q

sx’s of knee arthritis?

A

Insidious onset of achy type pain in hip and/or groin

***C/o stiffness in morning or after prolonged sitting with “loosening up” after approx. 30 min of activity (“GELLING”)

Pain increased after prolonged activity, relieved with rest

118
Q

strongest predictor of knee OA progression? medial progression? lateral progression?

A

knee malalignment (valgus or virus)

medial progression of knee OA 4x more likely in varus

lateral progression of knee OA 5x more likely in valgus

119
Q

imaging for knee arthritis?

A

arthritis series (with 30 degrees PA flexed view)

STANDING VIEW

120
Q

varus knee does what?

A

meets medially and widens laterally

121
Q

valgus knee does what?

A

meets laterally and widens medially

122
Q

1st line tx for knee arthritis?

A

APAP (same for all types of arthritis)

123
Q

last line/definitive tx for knee arthritis?

A

total knee arthroplasty

124
Q

what does ACL tear result from?

A

valgus stress to knee or distal thigh with ipsilateral foot planted

non-contact pivoting injury

125
Q

what does the ACL connect?

A

ACL connects the posterior aspect of the lateral femoral condyl to the anterior aspect of the tibia

126
Q

what does ACL prevent the movement of?

A

ACL prevents anterior motion of the tibia

127
Q

sx’s of ACL tear

A

“pop” the moment the injury occurred

effusion to knee w/in 2 hours

instability with side-to-side movement

128
Q

if knee swells up in 2 hours, what is it until proven otherwise?

A

If knee swells up in 2 hours = ACL tear until proven otherwise

129
Q

definitive test for dx of ACL tear? when can you do it?

A

Lachman’s test

-can do it if there is NO swelling (swelling prevents the pulling forward)

130
Q

x-rays for ACL tear to rule out?

A

Segond fracture

131
Q

MRI for ACL tear to assess?

A

joint integrity

132
Q

where do ACL tears occur in the ligament?

A

usually in the middle portion of the ligament

133
Q

will see ACL tear with what type of MRI?

A

T2 - fluid shows up white

134
Q

diagnostics for ACL tear?

A

Lachman’s test

X-rays

MRI

135
Q

reconstruction for ACL tear recommended if want to what?

A

if want to return to sports/occupation

136
Q

when may pt use brace instead of surgery for ACL tear?

A

if low physical demand occupation/lifestyle

137
Q

ACL tear puts pt at higher risk for what?

A

for post-traumatic DJD (arthritis) in affected knee

138
Q

what lesions occur in most ACL tear pts? what do they suggest?

A

occult osteochondral lesions

Suggests articular cartilage sustains considerable mechanical impact at time of injury

139
Q

MCL tear caused by what force?

A

valgus-type force directed to lateral knee

140
Q

MCL tear common in what sports?

A

football, hockey, skiing, and soccer

141
Q

MCL can occur with any trauma to what side of knee and with what force?

A

to lateral side of knee with valgus force

142
Q

is MCL surgical or non-surgical?

A

almost always NON-SURGICAL

143
Q

what does the MCL prevent the movement of?

A

MCL prevents lateral movement of tibia on the femur when valgus stress is placed on the knee

144
Q

sx’s of MCL tear?

A

acute onset of pain in medial aspect (b/c MCL stabilizes medial knee)

instability when changing direction or stairs

swelling of knee if ACL also involved

145
Q

swelling of knee in MCL if what is also involved?

A

if ACL is also involved

146
Q

PE for MCL tear

A

pt has antalgic gait

TTP over tract of MCL medially (femoral condyle to proximal tibia)

ROM preserved (if no effusion)

pain with valgus stress at 0 and 30 degrees

147
Q

what stress test do you perform for MCL tear?

A

valgus stress test

148
Q

tx of MCL tear?

A

RICE, gentle, NWB ROM exercised 3-5 days

Hinged knee brace to protect medial/lateral ambulation (prevents lat and medial movement)

PT

149
Q

what is patella femoral syndrome aka?

A

chondromalacia patella

150
Q

patella femoral syndrome is a common cause of?

A

anterior knee pain

151
Q

what is a common cause of anterior knee pain?

A

patella femoral syndrome

152
Q

what is patella femoral syndrome caused by?

A

lateral mal-tracking of patella during flexion/extension activity

-patella moves side to side -> get pain

153
Q

what is muscle weak and what muscle is tight in patella femoral syndrome? what needs to be strengthened and why?

A

vastus medialis obliques is weak and IT band is tight

IT band is trying to pull the patella laterally so need to strengthen VMO to counteract it

154
Q

in what activities does pain occur with patella femoral syndrome?

A

deep flexion of knee, stairs (descending), and prolonged sitting

155
Q

patella femoral syndrome usually seen in who?

A

young, athletic women

156
Q

patella femoral syndrome sx’s

A

normal WB and minimal effect on ADLs

diffuse pain around knee
pt might localize to medial joint line

pt has stiff feeling when getting up from prolonged sitting

pain free during activities but achy afterwards

157
Q

patella apprehension will be what in patella femoral syndrome? what will the pt have?

A

positive and pt will have tenderness with medial/lateral subluxation of the patella

158
Q

what are the IT band and VMO like in patella femoral syndrome?

A

IT band tenderness/tightness

VMO atrophied compared to rest of quad

159
Q

do pts with patella femoral syndrome have pain during activities?

A

NO!!! - they are pain free during activities, but achy afterwards

160
Q

imaging for patella femoral syndrome? may see what?

A

Sunrise (Merchant) view most important

may see lateral subluxation of patella to confirm dx

161
Q

tx for patella femoral syndrome

A

Activity modification
-***Pts can continue in their sport/activity as tolerated, but they must attend PT to work on strengthening VMO and adductor muscles

  • NSAIDs on regular basis initially, then wean off
  • Patella brace prn - keeps the patella in place
162
Q

most important part of tx for patella femoral syndrome?

A

PT

163
Q

when does patella femoral syndrome usually resolve?

A

in 4-6 weeks if pt compliant with PT and strengthening/stretching

164
Q

intractable cases of patella femoral syndrome need what?

A

referral for surgical lateral release of knee capsule

165
Q

what muscles need to be strengthened in patella femoral syndrome?

A

VMO and adductor muscles

166
Q

what meniscus tears are most common?

A

medial meniscus tears

167
Q

when do meniscus tears occur in life?

A

2nd-4th decades

168
Q

meniscus tears result from?

A

a “twisting” or rotational movement of a flexed knee during sports

in older pts, these tears are degenerative in nature

169
Q

sx’s of meniscus tears?

A

medial/lateral sided pain “inside the knee over the joint line

***LOCKING is key finding (piece of meniscus gets stuck)

pain worse with activity/improves with rest

170
Q

what is a key finding of meniscus tears?

A

LOCKING (piece of meniscus gets stuck)

171
Q

PE for meniscus tears

A

TTP over affected joint line (medial > lateral)

+McMurray test (do bilaterally) (won’t be pos if older pts but will have TTP over joint line)

can’t squat deeply

172
Q

imaging for meniscus tear?

A

standard x-rays to r/o fx

173
Q

MRI for meniscus tear?

A

to assess surgical need

174
Q

what test/sign is key to meniscus tear?

A

McMurray test/sign (will be positive in young, but negative in older)

175
Q

tx for meniscus tear?

A

arthroscopy (highly successful)

176
Q

meniscal repair in younger pts requires?

A

requires protected WB with gentle ROM x6 weeks (on crutches for 6 weeks)

177
Q

meniscal repair in older and non-active pts?

A

menisectomy

178
Q

tibia fracture caused by?

A

high-energy deceleration (ex: falls)

direct impact to tibia

179
Q

tibia fractures occur in conjunction with?

A

other LE fx due to mechanism of injury

180
Q

sx’s of tibia fractures?

A

NWB or protected WB

moderate-severe pain

may have obvious deformity

swelling

CONCOMITANT INJURIES

181
Q

PE of tibia fractures

A

TTP over fracture site

assess knee and ankle ROM

182
Q

imaging for tibia fractures?

A

X-rays: AP, lateral views

183
Q

tx for mid shaft tibia fractures?

A

they are unstable fx’s so need IM nail fixation

184
Q

ankle fractures occur when?

A

when foot is planted on ground/surface and body sustains rotation force

185
Q

external rotation force will cause what with ankle fractures?

A

External Rotation causes spiral fx of fibula and greater force will also lead to medial malleolus fx

186
Q

abduction force will cause what with ankle fractures?

A

Abduction force leads to transverse fx of fibula and avulsion fx of medial malleolus

187
Q

sx’s of ankle fx?

A

NWB or protected

lateral swelling

reduced ROM in dorsiflexion; eversion also affected

188
Q

what is it important to assess with ankle fx?

A

proximal fibula

189
Q

imaging for ankle fx?

A

X-rays: AP, Mortise, Lateral

May need stress views to determine stable vs unstable

190
Q

tx for stable ankle fx?

A

cast or walking boot

191
Q

tx for unstable ankle fx?

A

ORIF

192
Q

what do you fix first in ankle fx?

A

the fibula - brings the whole ankle out to length

193
Q

what is the most common sports injury seen in outpt clinics?

A

ankle sprain

194
Q

what do pts report with ankle sprains?

A

“turning the ankle” during a fall or after landing on an irregular surface

195
Q

what is the most common mechanism of injury for ankle sprain?

A

inversion and plantar flexion sprain -> injures anterior talofibular ligament

196
Q

what ligament eversion cause injury to in ankle sprain?

A

injury to deltoid ligament

197
Q

sx’s of lateral ankle sprain

A

pain/swelling

TTP over anterior talofibular ligament, calcenofibular, and PTF ligaments

antalgic WB

ecchymosis after 24-48 hrs

198
Q

sx’s of medial ankle sprain

A

TTP over deltoid ligament also posterior tibial tendon

Swelling medially

Antalgic WB

Ecchymosis after 24-48 hrs

199
Q

what is the most commonly torn/sprained ligament of the ankle? then which 2?

A

anterior talofibular ligament (first)

then PTF, then the calcaneofibular

200
Q

tx for ankle sprain?

A

RICE, NSAIDs, early ROM

PT (but not right away)

air cast for mild sprain

201
Q

calcaneus fracture results from?

A

high-energy deceleration injuries

-MVC, fall from height (ex: jump from the 3rd floor)

202
Q

what may pts complain of in addition to their calcaneus fx?

A

low back pain secondary to associated lumbar compression fx

203
Q

sx’s of calcaneus fx?

A

very swollen, NWB

204
Q

what must be checked for calcaneus fx?

A

smoking status - if smoke, then heal fractures slowly

205
Q

PE of calcaneus fx?

A

assess NV status and ROM

assess for associated injuries (back injuries)

calcaneus x-rays

206
Q

CT for calcaneus fx done to assess?

A

articular surface and fx displacement for surgical staging

207
Q

calcaneus fx’s classified as/

A

intra-, extra-articular

208
Q

tx of calcaneus fx?

A

well-padded posterior splint to LE

protected WB, with crutches (or wheelchair)

ANALGESICS

ORIF (7-10 days after to allow for swelling to resolve)

209
Q

pts often have what even if have ORIF for calcaneus fx?

A

chronic heel pain

210
Q

what are the 2 patterns of 5th metatarsal fractures?

A

Avulsion fx

Jontes fx

211
Q

what is a 5th metatarsal avulsion fx?

A

fx of base of 5th metatarsal from pull of peroneus brevis

212
Q

how does 5th metatarsal avulsion fx occur?

A

Forcible inversion of foot in plantar flexion (same mechanism as an ankle sprain), as may occur while stepping on a curb or climbing steps

Force pulls at insertion of peroneus brevis

213
Q

tx of 5th metatarsal avulsion fx?

A

treated conservative and heal well

for large or very displaced fragment with intra-articular extension may need surgery

214
Q

mechanism of 5th metatarsal fx?

A

fall, inversion injury resulting from mis-steps

215
Q

what is a jones fracture?

A

this is a BAD fracture

transverse fx at base of 5th metatarsal, 1.5-3cm distal to the proximal tuberosity at the metadiaphyseal junction

216
Q

what is a jones fracture so bad?

A

can interrupt the blood supply so almost always fixed with surgery

217
Q

the 5th metatarsal base is the insertion of what muscle?

A

peroneus tertius

218
Q

how does jones fx occur?

A

as a result of significant adduction force to the forefoot with the ankle in plantar flexion

219
Q

jones fx’s are prone to what that avulsion fx’s aren’t?

A

non-union (takes longer than 2 months to heal)

220
Q

tx of jones fx

A

immobilization with a non-weight bearing cast for 6-8 weeks

internal fixation/bone grafting in cases of non-union or if fx significantly displaced

221
Q

what is plantar fasciitis?

A

inflammation of a the plantar fascia (thick band of tissue) that connects the calcaneus to the toes

222
Q

plantar fasciitis risk factors?

A

obesity

pes planovalgus orientation (flat feet)

reduced dorsiflexion (tight heel cords)

223
Q

plantar fasciitis commonly seen in?

A

runners (or people that stand a long time)

224
Q

sx’s of plantar fasciitis

A

Sharp volar sided heel pain of moderate to severe intensity

Normal gait but may limp as pain worsens

***Will report that pain is worse “first thing in the morning when I get out of bed” -> KEY!!!

Pain reduces as pt. ambulates around for a bit

225
Q

what is a key sx of plantar fasciitis?

A

pt reporting that pain is worse “first thing in the morning when I get out of bed”

226
Q

PE of plantar fasciitis

A

TTP at origin of plantar fascia on the calcaneus

Pes planovalgus orientation (flat feet) seen on exam of stance

Tight Achilles’ with active/passive dorsiflexion of ankle

227
Q

imaging for plantar fasciitis

A

weight bearing studies of foot to assess for spurs, loss of arch, and to r/o stress fx

228
Q

tx of plantar fasciitis

A

night splint, ice, NSAIDs, PT

corticosteroids injection used with caution (may cause fascial rupture)

229
Q

what must you warn pts with plantar fasciitis about with corticosteroid injection tx?

A

that it may cause fascial rupture

230
Q

risk factors for Achilles’ tendon rupture?

A

“weekend warrior”

***Fluoroquinolone use

Steroid injections

231
Q

what is the mechanism of Achilles’ tendon rupture?

A

usually traumatic injury during sporting event

  • sudden forced plantar flexion
  • violent dorsiflexion in a plantar flexed foot

-occurs 4-6 cm above the calcanea insertion in hypo vascular region

232
Q

what will pt report for Achilles’ tendon rupture?

A

a “pop”

233
Q

sx’s of Achilles’ tendon rupture?

A

weakness and difficulty walking

pain in heel

can’t get up on heel of affected foot

234
Q

PE of Achilles’ tendon rupture

A

Palpable defect -> can feel it

+Thompson test -> weak/no ankle plantar flexion

235
Q

U/S for Achilles’ tendon rupture?

A

to determine partial vs. complete year

236
Q

when use MRI for Achilles’ tendon rupture?

A

if exam equivocal or if chronic rupture

237
Q

what test is used to evaluate the integrity of the Achilles’ tendon?

A

Thompson’s test

238
Q

positive findings of Thompon’s test?

A

no plantar movement occurs at the foot -> indicates Achilles’ tendon rupture

239
Q

non-operative tx of Achilles’ tendon rupture

A
  • Patient/surgeon preference
  • Sedentary/Frail patient
  • Put in boot with elevated/padded heel to take stress off the tendon
  • Decreased plantar flexion strength results
240
Q

operative tx of Achilles’ tendon rupture

A
  • “end to end” Achilles’ repair
  • For acute ruptures
  • New Level 1 evidence has suggested no difference in re-rupture rates
  • Increased plantar flexion strength compared to non-operative management

Clin Med 4 (11 decks)

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