Orthopaedics: Lower limb

Question 1

What is the first movement lost if there is hip pathology?

Answer 1

Loss of internal rotation

Question 2

What are the early local complications of hip replacement?

Answer 2

Infection
Dislocation
Damage to the sciatic nerve
Leg length discrepancy

Question 3

What are the early medical complications of hip replacement?

Answer 3

MI
Chest infection 
UTI 
Blood loss 
Hypovolaemia 
DVT
PE

Question 4

What are the late complications of hip replacement?

Answer 4

Early loosening
Late infection (haemoatogenous spread from a distant site)
Late dislocation

Question 5

What imaging is the first to pick up avascular necrosis?

Answer 5

MRI

Question 6

What does avascular necrosis look like on an ultrasound?

Answer 6

Sclerosis of the weight bearing area of the femoral head with a lytic lesion underneath

Question 7

How do you manage avascular necrosis of the femoral head?

Answer 7

If detected early then drill holes can be made into the femoral neck and into the abnormal area to relieve pressure, promote healing and prevent collapse. If collapse has already occured the only surgical option is total hip replacment

Question 8

How do you treat trochanteric bursisitis?

Answer 8

Analgesia
NSAIDs
Physio
Steroid injections

Question 9

What is the principal role of the ACL?

Answer 9

Prevent abnormal internal rotation of the tibia (even though it is clinically tested by assessing anterior translation of the tibia)

Question 10

Does genu varum cause OA of the medial or lateral collateral ligament?

Answer 10

Medial

Question 11

Does genu valgum cause OA of the medial or lateral collateral ligament?

Answer 11

Lateral

Question 12

What is an osteotomy of the proximal tibia? When is it used?

Answer 12

An operation which shifts loads to the lateral compartment of the knee.This is used is younger patients with isolated medial compartment OA.

Question 13

What operation might be considered in patients with isolated medial compartment OA?

Answer 13

Osteotomy of the proximal tibia

Question 14

What is true knee locking and what causes it?

Answer 14

A mechanical block to full extension of the knee caused by a significantly torn meniscus flipping over and becoming stuck in the joint line.

Question 15

How do ACL ruptures usually occur?

Answer 15

Rotational force ie turning the upper body laterally on a planted foot leading to internal rotation force on the tibia. A pop is usually felt/heard and a haemarthrosis develops within an hour of the injury

Question 16

What can the chronic consequences of an ACL rupture be?

Answer 16

Rotatory instability with the knee giving way when turning on a planted foot

Question 17

What is the best examination of a knee that has been injured but is very difficult to examine due to pain?

Answer 17

MRI

Question 18

What is complete knee dislocation? How is it managed?

Answer 18

Rupture of all four knee ligaments
They have a high incidence of neurovascular injury and need to be reduced as an emergency and may require external fixation. Multiple ligament reconstruction is usually required

Question 19

What is patellofemoral dysfunction? How is it managed?

Answer 19

Disorders of patellofemoral articulation resulting in anterior knee pain

Question 20

Which way does the patella dislocate?

Answer 20

Laterally

Question 21

What are the two surgical options for ankle osteoarthritis?

Answer 21

Arthrodesis

Ankle replacement

Question 22

What is the gold standard treatment of OA of the first MTPJ?

Answer 22

Arthrodesis

Question 23

What is a mortons neuroma?

Answer 23

Irritation of the plantar interdigital nerves becoming inflammed and swollen - causing a neruroma

Question 24

How is a mortons neuroma diagnosed?

Answer 24

Ultrasound