Trauma & Orthopaedics Flashcards
What is the normal range of extension/flexion of the tibiofemoral joint in the knee (in degrees) ?
-5 extension 150 flexion
What is the “screw home” mechanism of the tibiofemoral joint?
The Tibia can externally rotate 5 degrees when the knee is fully extended, allowing the knee to lock when standing.
What is O’Donahue’s triad (unhappy triad)?
Tear of the ACL, MCL and medial meniscus.
List the 5 blood supplies to the knee joint?
1- Five geniculate branches of the popliteal artery
2- The descending geniculate branch of the femoral artery
3- The descending branch of the lateral circumflex femoral artery
4- Two recurrent branches of the anterior tibial artery
5- The circumflex fibulae branch of the posterior tibial artery
List 3 surgical managements of osteoarthritis of the knee?
1- re-alignment osteotomy
2- Unicompartmental knee replacement (UKR)
3- Total Knee Replacement (TKR)
Which ligament is always sacrificed in TKR ?
ACL
List 4 radio graphic views of the knee to assess for Osteoarthritis?
1- Weight-bearing AP
2- Lateral
3- Skyline
4- Schuss/Rosenberg
What does Schuss/Rosenberg radiographic view assess for in the knee?
Lateral compartment arthritis
What are the benefits of Unicompartmental knee replacement (UKR) compared to TKR.
- Preserves non-arthritic bone on the other compartment + ACL
- Reduced surgical complications e.g infection
- Better function than TKR e.g climbing stairs
List 4 causes of knee locking
1- Meniscal tears
2- ACL rupture
3- Loose bodies
4- Tibiofemoral dislocation
Why is tibiofemoral dislocation an orthopaedic emergency ?
10% have popliteal artery injury
What is the most common operative management of Meniscal tears?
Arthroscopic Meniscectomy
A footballer had his studs in the ground when he twisted on his right leg. He heard a “pop” and noticed immediate swelling of his knee.
What is the most likely injury?
ACL tear
What is the imaging modality of choice to assess for ACL tears ?
MRI
List 3 special tests that are positive in ACL tears?
1- Lachman’s (most sensitive)
2- Anterior draw
3- Pivot shift
List 3 causes of anterior knee pain in adolescents ?
1- Osgood-Schlatter
2- Patellar instability
3- Chondromalacia patella
List 5 causes of anterior knee pain in adults ?
1- Patellar/quadriceps tendinitis 2- Bursitis 3- Patellofemoral joint (PFJ) arthritis 4- Fat pad impingement 5- iliotibial band syndrome
Name the sign seen in patellar instability where the patella lateralises excessively on extension then pops back into the groove during flexion.
“J sign”
Which condition occurs in young women who present with anterior knee pain and sensation of the knee giving way on descending stairs?
Chondromalacia Patellae
Which condition occurs more commonly in plumbers/decorators and is associated with anterior knee pain and swelling with preserved ROM.
Prepatellar Bursitis
- common in occupations with excessive kneeling
what is “popeye sign” and what does it indicate ?
A bicep bulge in the distal aspect of the upper arm.
Indicates Long Head of Biceps (LHB) rupture.
List the 4 rotator cuff muscles ?
1- Supraspinatus
2- Infraspinatus
3- Teres minor
4- subscapularis
List the 3 radiographic views used to x-ray the shoulder?
1- AP shoulder
2- GHJ view
3- Axial
Which imaging modality is used to diagnose subacromial bursitis, shoulder Impingement, ACJ synovitis and rotator cuff tears ?
USS
Which imaging modality is used to diagnose shoulder instability and Labral tears ?
MRI
What is the mainstay of management for subacromial impingement ?
Steroid injection into subacromial bursa
Physiotherapy
Which rotator cuff muscle is affected in subacromial impingement ?
Supraspinatus
Which special test is +ve in subacromial impingement ?
Painful arc
Which condition presents with sudden onset severe pain in the shoulder with eventual reduction in ROM and pain at night ?
Calcific tendinitis
Which special test is +ve in Supraspinatus tear?
Jobe’s test (empty can test)
Which 2 special tests are +ve in subacromial impingement?
1- Neer’s test
2- Hawkins test
Which 2 tests are +ve in subscapularis tear?
1- Belly-press test
2- Lift off test
Which special test is +ve in infraspinatus or teres minor tear ?
Resisted external rotation test
