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Musculoskeletal > Conditions of the Hip, Foot, and Ankle > Flashcards

Conditions of the Hip, Foot, and Ankle Flashcards

1
Q

What is developmental dysplasia of the hip (DDH)? How common is it?

A
  • (previously called congenital dislocation of the hip)
  • patients are born with dislocation or subluxation of the hip (femoral head is displaced from the acetabulum)
  • occurs in 1 in 1,000 live births; more common in females; left side is more commonly affected (60%, right is 20%, bilateral is 20%)
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2
Q

What is developmental dysplasia of the hip (DDH)? How common is it?

A
  • (previously called congenital dislocation of the hip)
  • patients are born with dislocation or subluxation of the hip (femoral head is displaced from the acetabulum)
  • occurs in 1 in 1,000 live births; more common in females; left side is more commonly affected (60%, right is 20%, bilateral is 20%)
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3
Q

When is the risk for developmental dysplasia of the hip (DDH) greatest?

A
  • risk is present at 4 times: 12th week, 18th week, final 4 weeks, and the post natal period
  • (DDH increases dislocation probability after birth in the last category)
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4
Q

What is Trendelenburg’s sign/gait?

A
  • single stance
  • a gait/stance abnormality due to a shift in the center of gravity
  • patient lurches towards the affected (weaker) side and the contralateral (normal) hemi-pelvis drops below the normal horizontal
  • (affected hemi-pelvis and hemi-buttocks are tilted and elevated in contrast)
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5
Q

What is Barlow’s test? Ortolani’s test?

A
  • Barlow’s positive: femoral head is dislocated when flexed hip is adducted towards midline and pushing down
  • Ortolani’s positive: reverse of Barlow’s to reduce the dislocated hip (an audible clunk is heard)
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6
Q

Developmental dysplasia of the hip (DDH) is characterized by which findings on X-ray?

A
  • small, delayed ossification center
  • acetabular slope
  • displacement of the femoral head
  • a break in Shenton’s line (this line should be smooth and continuous from the femoral head to the pubic symphysis)
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7
Q

What is Legg-Calve-Perthes disease? How do patients present?

A
  • avascular necrosis of the femoral head in children, possibly due to repeated micro trauma
  • more common in males
  • patients present with recurrent episodes of hip pain and limp
  • younger patients have better prognoses
  • these patients have an increased risk of developing early osteoarthritis
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8
Q

What is Trendelenburg’s sign/gait?

A
  • single stance
  • a gait/stance abnormality due to a shift in the center of gravity
  • patient lurches towards the affected (weaker) side and the contralateral (normal) hemi-pelvis drops below the normal horizontal
  • (affected hemi-pelvis and hemi-buttocks are tilted and elevated in contrast)
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9
Q

What is Barlow’s test? Ortolani’s test?

A
  • Barlow’s positive: femoral head is dislocated when flexed hip is adducted towards midline and pushing down
  • Ortolani’s positive: reverse of Barlow’s to reduce the dislocated hip (an audible clunk is heard)
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10
Q

Developmental dysplasia of the hip (DDH) is characterized by which findings on X-ray?

A
  • small, delayed ossification center
  • acetabular slope
  • displacement of the femoral head
  • a break in Shenton’s line (this line should be smooth and continuous from the femoral head to the pubic symphysis)
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11
Q

What is Legg-Calve-Perthes disease? How do patients present?

A
  • avascular necrosis of the femoral head in children, possibly due to repeated micro trauma
  • more common in males
  • patients present with recurrent episodes of hip pain and limp
  • these patients have an increased risk of developing early osteoarthritis
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12
Q

How do we treat a fractured femur neck?

A
  • minimize best rest and maximize mobility

- only perform operation in high-risk patients (hemiarthroplasty or ORIF: open reduction internal fixation)

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13
Q

Sudden explosive contraction or over stretching results in which type of fracture of the hip? Where are the three most common sites?

A
  • avulsion fracture

- ASIS, superior iliac crest, ischial tuberosity

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14
Q

What causes hip dislocations? Are posterior or anterior dislocations more common?

A
  • mainly caused by high energy trauma (ie, in sports)
  • 85% are posterior (results from an axial load to the femur with the hip flexed)
  • anterior dislocations are caused by forced abduction with external rotation
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15
Q

What causes femur neck fractures in young patients? In elderly patients? What is the prognosis in elderly patients?

A
  • young: high energy trauma (ie, sports)

- elderly: osteoporosis; 25% die within the 1st year, 25% will require residential care; 50% will not regain mobility

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16
Q

How do we treat a fractured femur neck?

A
  • minimize best rest and maximize mobility

- only perform operation in high-risk patients (hemiarthroplasty or ORIF: open reduction internal fixation)

17
Q

What is the most common lower limb injury? Who does it usually occur in? Which two structures are usually involved? What’s the prognosis?

A
  • lateral ankle sprains
  • usually in young, active people
  • tears in either the anterior talofibular ligament (ATFL) if ankle is plantarflexed and/or the calcaneofibular ligament (CFL) if ankle is dorsiflexed; these (along with the posterior talofibular) are the lateral collateral ligaments
  • 95% have a good recovery
  • (the CFL is the strongest lateral ligament)
  • (anterior draw test will test laxity of ATFL)
18
Q

What is the most common mechanism of lateral ankle sprains? What are the anatomic and histologic classifications for ankle sprains? The clinical classification?

A
  • inversion stress with plantarflexion (so anterior talofibular ligament is usually involved)
  • anatomic: I (ATFL), II (ATFL and CFL), III (complete ligamentous disruption)
  • histo: I (stretching), II (partial tearing), III (complete rupture)
  • clinical: I (normal stress tests; lateral tenderness), II (pain and swelling, stress tests can be pos or neg; medial + lateral tenderness), III (severe pain and swelling, positive stress tests; bruising + swelling)
19
Q

What imaging do we use for ankle sprains?

A
  • x-ray only if indicated via the Ottawa ankle rules

- (US and MRI are wastes of time and money)

20
Q

What is Achilles tendinopathy?

A
  • a chronic, degenerative disorder of the Achilles tendon

- usually occurs in elderly patients

21
Q

What is syndesmosis?

A
  • “high ankle sprain”; spraining of the joints between the tibia and fibula (tibiofibular ligaments, interosseous membrane)
  • leads to instability (especially if a fracture is involved)
22
Q

What percentage of ankle sprains are medial? What’s the mechanism of injury? What are they associated with?

A
  • 5% of ankle sprains
  • due to forced eversion and external rotation
  • injures the deltoid ligament
  • associated with syndesmosis and proximal fibular fractures
23
Q

Which patients usually experience Achilles ruptures? How do patients present? Where does the rupture occur?

A
  • usually occurs in middle-aged recreational athletes
  • you’ll hear a loud whip-like snap upon rupture, followed by acute pain when contracting; calf squeeze test is positive
  • you CAN still walk with an Achilles rupture
  • rupture occurs 2-6 cm above the Achilles insertion (a watershed area)
24
Q

What is Achilles tendinopathy?

A
  • a chronic, degenerative disorder of the Achilles tendon

- usually occurs in elderly patients

25
Q

In patients with plantar fascitis, 99% will settle/recover within what time frame?

A
  • 12 to 18 MONTHS

- note that plantar fascitis is very common

26
Q

What is pes planus? What causes it? Which populations are at risk?

A
  • pes planus is adult acquired flat foot due to dysfunction of the posterior tibial tendon
  • patient is unable to perform a single heel raise
  • middle-aged, obese females are at greatest risk
27
Q

Lisfranc Injuries; Fleck Sign

A
  • Lisfranc ligament is between the medial cuneiform and 2nd metatarsal
  • patients classically present with an icepack on the FOOT (not the ankle) and bruising on the plantar surface
  • Fleck sign (malalignment of metatarsals and cuneiform) on weight-bearing x-ray indicates instability
28
Q

How do we treat osteoarthritis of the ankle?

A
  • arthrodesis (fuse the bones together; this will decrease ROM but solve the issue and alleviate the pain)
  • joint replacements are fairly good, but will inevitably wear out and fail
29
Q

How do we treat ankle sprains?

A
  • 3 phases:
  • phase 1: limit extent of injury; RICE (rest, ice, compression, elevation), limit weight-bearing, NSAIDs
  • phase 2 (once pain and edema are relieved): restore ROM and strength; resistance training
  • phase 3 (once strength is about 90% returned): restore agility; gradual increase in activity
30
Q

What should we do for patients with an ankle sprain that don’t improve in 6-10 weeks time?

A
  • occurs in 5-10% of cases
  • do an MRI or CT scan
  • suspect underlying pathology: missed fracture, syndesmosis, osteochondral lesions, peroneal tendinopathy, sinus tarsi syndrome

Musculoskeletal (12 decks)

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