Orthopaedic - Lower Limb Flashcards
List and briefly describe the risk factors for an ACL injury
Modifiable Risk Factors: Higher risk in females, young age (peaking at 16-18 years), and increased frequency or intensity of sport participation.
Non-modifiable Risk Factors: Bone morphology variations, neuromuscular control deficits, genetic factors, and hormonal fluctuations
Outline/Describe the different types of meniscal and ACL surg and briefly state the implications to recovery in the same detail as the Masterclass notes/discussion.
Meniscal Surgery:
- Meniscectomy: Removes damaged meniscal tissue. Faster recovery (6-8 weeks) but increases the risk of arthritis due to joint stress.
- Meniscal Repair: Sutures the tear, suitable for tears with good blood supply, with a slower recovery (3-6 months) requiring protected weight-bearing.
- Meniscal Transplant: Replacement with donor tissue, used in cases of complete meniscectomy with ongoing pain. Recovery spans several months
ACL Surgery:
- Autograft Reconstruction: Commonly uses the patient’s own hamstring or patellar tendon. Recovery is typically 6-9 months; donor site pain may occur.
- Allograft Reconstruction: Uses donor tissue, with similar recovery time but risks of infection and longer integration.
- Primary Repair: In cases of minimal tearing, the ACL is reattached, allowing faster recovery but with a higher re-tear risk
List the different management considerations esp. with reference to the Weber fractures classification + displaced/non-displaced fractures in the same detail as the Masterclass notes.
Weber A: Fractures below the syndesmosis; usually stable with conservative management.
Weber B: Fractures at the level of syndesmosis; stability varies and may require ORIF (open reduction internal fixation) if instability or ligament damage is present.
Weber C: Fractures above the syndesmosis; often unstable with joint widening, needing ORIF to ensure stability
Describe the management of Weber B fractures (Kortekangas et al 2019) in the same detail as the Masterclass notes.
According to Kortekangas et al., Weber B fractures management considers surgical versus non-surgical approaches based on stability. Conservative treatment is considered for stable fractures, while unstable fractures are more likely to require ORIF to support proper healing and alignment
Compare surgical vs conservative management for gr III Achilles tendon surgeries (use the prep work to help you also).
- From a case, argue the most appropriate approach
- From a case, outline considerations for rehabilitation from a brief patient history for Achilles surg.
Surgical Management: Often preferred for active patients or those with high physical demands, as it may reduce re-rupture rates. Surgery involves reattaching or suturing the tendon, but risks include wound infection and scar tissue.
Conservative Management: Includes immobilization in plantarflexion followed by gradual weight-bearing. This approach can reduce infection risks but may lead to a slightly higher risk of re-rupture. Shared decision-making is crucial, based on patient lifestyle and preferences
Describe (when required) the precautions and length of time of precautions following surgery for ORIF and THR (posterior approach).
ORIF: Initially, patients are often non-weight-bearing for several weeks, gradually progressing based on healing.
THR Precautions: Avoid hip flexion past 90 degrees, adduction, and internal rotation to prevent dislocation, typically for 6 weeks post-surgery
Outline the pathophysiology and risk factors of OA, fracture (i.e. hip) and conditions mentioned in the masterclass
Osteoarthritis (OA): Degeneration of joint cartilage and surrounding structures, influenced by age, sex, obesity, and prior injuries.
Hip Fractures: Often due to osteoporosis, falls, and high-risk activities; increased age and low body weight are key risk factors
Describe the differences in Mx between ORIF and THR surgery as well as the exercises/weight bearing required post-op
ORIF: Stabilizes the fracture with screws/plates; requires early but cautious mobilization and weight-bearing protocols based on fracture healing.
THR: Replaces the joint, with emphasis on restoring movement and strength post-operatively; weight-bearing is usually permitted earlier
Outline the logical progression of walking aids/weight bearing status for THR
Patients typically progress from a frame to crutches, then to a cane as they build strength and balance, with full independence being the final goal. Weight-bearing status and progression are determined based on the surgeon’s protocol and patient recovery
Describe what you must check prior to seeing a patient on day 1 following Sx and why it is important to check these.
Before seeing a patient on day 1 post-surgery, check vital signs, recent pain medications, weight-bearing status, and any specific precautions. This ensures patient safety, especially during mobilization
Outline/Discuss the differences/implications in conservative Mx vs surg Mx for Extrascapular femoral fractures
Surgical management generally involves ORIF to stabilize the fracture, allowing earlier mobilization. Conservative management may be chosen for high-risk surgical patients but can result in prolonged immobilization and potential complications
Describe recommendations to avoid surgical revision following TKR
After TKR, avoiding high-impact activities, maintaining strength through moderate exercises (e.g., walking, swimming), and minimizing load on the joint are advised to reduce wear on the prosthesis
Briefly outline the evidence for traction following hip #
Describe the main points in the manuscript by Skou et al. comparing TKR +PT vs PT for moderate to severe OA.
This study found that TKR combined with physiotherapy resulted in greater functional improvements compared to PT alone, though PT alone was beneficial for some patients with moderate to severe OA
Outline conservative Mx strategies for patients with knee OA without comorbidities
For knee OA without comorbidities, conservative management focuses on weight management, strengthening exercises, and pain relief through NSAIDs, potentially combined with physiotherapy to improve function and decrease pain
