Ortho 3

Question 1

What does an apparent shortening or lengthening in leg length disparity indicate?

Answer 1

Apparent shortening = pelvic tilt upwards or fixed adduction deformity

Apparent lengthening = pelvic tilt downwards or fixed abduction deformity

Question 2

What deformity would Thomas’ test show?

Answer 2

Fixed flexion deformity - affected leg will lift off the couch

Question 3

What would a positive Trendelenburg test indicate? Causes

Answer 3

Normal for pelvis to rise on side of the lifted leg

POSITIVE = pelvis falls on the side of the lifted leg

Abductor muscle paralysis (gluteus medius and minimus)

Upward displacement of the greater trochanter (severe coxa vara, dislocated hip)

Absence of a stable fulcrum

Question 4

What is Coxa Vara? Causes and consequences?

Answer 4

Hip in which angle of the neck and shaft of the femur is <125 degrees

Congenital
SUFE
fracture
softening of bones (rickets, osteomalacia, Paget’s disease)

true shortening of limb - Trendelenburg dip on walking = limp

Question 5

What would swelling in knee indicate?

Answer 5

0-2 hrs = haemarthrosis

6-24 hrs = effusion

> 24 hrs = septic/inflammatory arthritis

Question 6

What tests can be done to test the cruciate ligaments and meniscus of the knee?

Answer 6

Anterior/posterior draw for cruciate
Lachmans for ACL

McMurray’s - unreliable way of detecting peduculated meniscal tears
Thessalys for meniscal

Question 7

What can cause collateral ligament damage?

Answer 7

Medial ligament injuries occur with a lateral blow (valgus stress), twisting injury or with cruciate/meniscal injuries- SKIING

Lateral - occurs with a medial blow but is rare

Question 8

How would a medial collateral ligament injury present?

Answer 8

Pain
Rapid swelling
Hear a pop
medial joint line tenderness
difficulty walking - pain and instability

Question 9

How would you treat a medial collateral ligament rupture?

Answer 9

Non-weight bearing, bracing and surgery

Surgery -repair and reconstruction

Question 10

How do ACL injuries occur?

Answer 10

Usually younger people playing football/basketball

usually with a valgus twisting to bent knee = non-traumatic pivot injury

assoc. with meniscal injury

Question 11

How would an ACL injury present?

Answer 11

Pain 
Rapid swelling --> haemarthrosis
Loss of ROM
Joint line tenderness
discomfort whilst walking

Question 12

How would you investigate an ACL injury?

Answer 12

anterior draw test/Lachman positive

MRI - GS

Question 13

Management of ACL?

Answer 13

Reconstruction/Repair + Physio

Tissue graft to help ligament regrow

Question 14

How does a PCL injury occur?

Answer 14

direct blow from front of knee to proximal tibia flexion - leg bent

hyperextension injuries = dashboard injury

Question 15

How does meniscal damage occur?

Answer 15

Rotational sporting injuries - cutting/pivoting - often with ACL

Question 16

How does meniscal damage present?

Answer 16

Acute Pain
Later Onset Swelling
Popping
Locking/clicking
Knee giving way

Question 17

Management of meniscal damage?

Answer 17

RICE
rehab + physio
Surgery

Question 18

What is osteochondritis dissecans?

Answer 18

subchondral bone becomes avascular, may progress to fragments of bone and overlying cartilage

Question 19

What are some causes of loose bodies in the knee joint?

Answer 19

Osteochondritis dissecans 3 bodies

Osteoarthritis 10 bodies

Chip fractures of joint surfaces 3 bodies

Synovial Chondromatosis >50 loose bodies

Question 20

What can loose bodies in the knee joint present as ?

Answer 20

Knee locking - all movements

Effusion/swelling

Question 21

How would you investigate and treat loose bodies in the knee joint?

Answer 21

Arthroscopy and removal

Question 22

What are the kinds of bursitis?

Answer 22

Pre-patellar bursa (housemaid’s knee) - inflammation and fluid in bursa due to kneeling

Infra-patellar bursa (clergyman’s knee)

Semimembranous bursa (popliteal fossa) - popliteal cyst

Question 23

Treatment of bursitis?

Answer 23

Aspiration
Hydrocortisone injection
Excision
NSAIDs

Question 24

What are differentials for heel pain?

Answer 24

Diseases of calcaneum
Rupture of calcaneal tendon
Postcalcaneal bursitis
Plantar fasciitis
Lymphoma
Arthritis of subtalar joint
Tender heel pad
Infection

Question 25

How do calcaneal fractures often occur? How would you investigate? Manage?

Answer 25

Fall from height onto heels

XR ankle, CT- GS

Cast and period of immobilisation
Closed reduction and Percutaneous Pinning - if minimal displacement

ORIF - if displaced

Question 26

What are causes of metatarsal fractures?

Answer 26

direct trauma
crush injuries
stress injuries (most common 2nd metatarsal)

• most common site of stress fracture

Question 27

How would you manage metatarsal fractures?

Answer 27

analgesia
plaster of P backslab
manipulation
K-wire fixation
ORIF
percutaneous pin

Question 28

Where is most common site for a midfoot fracture?

Answer 28

Proximal 5th metatarsal

can be proximal avulsion or Jones fracture

Question 29

What fracture is associated with lateral ankle sprain?

Answer 29

proximal avulsion

Question 30

How does an achilles )calcaneal tendon rupture present?

Answer 30

sudden pain at the back of the ankle during running or jumptin as the tendon ruptures

Impossible to raise the heel from the floor when standing on affected leg

Gap may be palpated in the tendon course

Question 31

What test can be done to assess achilles tendon rupture?

Answer 31

Simmond’s (squeeze test) - kneel on chair, squeeze both calves

If rupture = less plantar flexion on the affected side

Question 32

What is associated with achilles tendon disorders?

Answer 32

Quinolone

Hypercholesterolaemia