T&O knee and leg Flashcards
How does knee OA present and what are some differentias for this?
Pain in the knee that can radiate to hip and thigh
Exacerbated by exercise and relieved by rest
Joint stiffness
Reduce range of movement
Crepitus
Differentials: meniscal or ligament injury, crystal arthropathies, patellofemoral arthritis
What is patellofemoral arthritis and how is it managed?
OA affecting articular cartilage along the trochlear groove and the underside of the patella. May occur with patella dysplasia or previous patella fracture
Symptoms: anterior knee pain worse when pressure on patella (e.g climbing stairs), joint stiffness, swelling
Dx: skyline plan film radiograph
Mx: conservative then patellofemoral replacement. (if OA in other parts of knee will need TKR)
What is a Segond fracture?
Bony avulsion of the lateral proximal tibia that is most likely caused by an ACL tear
How is ACL managed?
Immediate RICE
Conservative (less active patients)
Patient can often weight bear so cricket pad knee splint for comfort and send home
- Rehabilitation to strengthen quadriceps that stabilise the knee
Surgical (more active)
Arthroscopic reconstruction with tendon or artifical graft. Often done after some time and prehabilitation. Doesn’t reduce risk of OA
Sometimes acute repair can be done if MRI favourable, do GA and arthroscopy and resuture ends of torn ligament
How are MCL tears managed and what are some complications that can arise with an MCL tear?
Grade I: RICE with NSAIDs. Strength training and return to full exercise within 6 weeks
Grade II: Analgesia with knee brace. Weight bearing/strength training and return to exercise within 10 weeks
Grade III: Analgesia with knee brace and crutches. If distal avulsion surgery. Return to exercise within 12 weeks
Complications: instability in joint, damage to saphenous nerve
What are some complications of meniscal tears and arthroscopy to treat them?
Meniscal Tear: OA
Arthroscopy: DVT, damage to saphenous nerve/vein, damage to peroneal nerve, damage to popliteal vessels
How do patella fractures present?
Often in 20-50 year old males due to either direct trauma or rapid eccentric contraction of quadriceps
Anterior knee pain following trauma (e.g dashboard injury)
Pain worse on movement
Cannot straight leg raise
Swollen and bruised
Palpable patella defect
What are the investigations and management for patella fractures
Ix
Plain film radiographs three views (AP, Lateral, Skyline)
CT if comminuted
Mx
Conservative: if non/minimally displaced then put in brace or cylinder cast with early weight bearing in extension
Surgical: if displacement or damage to extensor mechanism then open reduction and internal fixation (ORIF) with tension band wiring. If simple vertical/transverse fracture can screw fix not wiring
How is a tibial shaft fracture managed?
Initially
Reduce in A+E with analgesia/sedation to correct length and rotation and put in above knee backslab
Elevate immediately and closely monitor for compartment syndrome
Post manipulation plain radiographs and neurovascular status reassessed
Definitive
Non operative if closed and stable then Sarmiento cast
Surgical:
Intramedullary nailing so can fully weight bear after
If proximal/distal fracture extending intraarticular then ORIF with locking plates
If multiple injuries may need temporary external fixation until surgery
What is the pathophysiology of tibial plateau fractures and what are some complications of this fracture?
Often due to high energy trauma and impaction of the femoral condyle on the tibial plateau (e.g fall from height, RTA)
Lateral tibial fracture more commonly fracturedas varus deforming force. Associated ligament and meniscal injuries
Complications: post-traumatic arthritis almost definite
How will a tibial plateau fracture present?
History of trauma (usually axial loading)
Sudden onset pain and unable to weight bear
Swelling of knee due to lipohaemarthrosis
Tenderness of medial/lateral tibia
May have ligament instability
Check peripheral neruovascular status
What are some differentials you should consider with knee pain after knee trauma?
Patella dislocation
Patella or distal femur fracture
Meniscal injuries
Ligament injuries
Patella/quadriceps tendon rupture
Tibial fractures
How are tibial plateau fractures managed?
- Open reduction and internal fixation (ORIF) to restore joint surface congruence. Any metaphyseal gaps can be filled with bone graft
- Post operative hinged-knee brace with non-weight bearing for 8-12 weeks
- May need external fixation and delayed ORIF if poly trauma or significant soft tissue injury
What are the risk factors for IT band syndrome and how does it present?
Shared aponeurosis of gluteus medius and tensor fascia lata gets inflammed
- Lateral knee pain exacerbated by knee exercise (often in athletes or people with sudden increase in exercise)
Exam often remarkable but can do Nobles and Renne test
Risk factors: repetitive flexion/extension (runners, weight lifters, cyclists), foot pronation, genu varum, hip abductor weakness
What is a knee dislocation and why is it a serious injury?
When 3 of the 4 ligaments of the knee are disrupted
Limb threatening as can damage popliteal artery causing compartment syndrome
Can also damage common peroneal nerve
Need to reduce and put in knee brace, may need surgery to reconstruct ligaments
