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MSK > Hip, knee and foot conditions > Flashcards

Hip, knee and foot conditions Flashcards

1
Q

Give 2 markers of poor prognosis in neck of femur fractures

A

Impaired mobility pre-fracture

Renal failure

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2
Q

What is the typical presentation of a displaced neck of femur fracture?

A

Leg is typically externally rotated, shortened and abducted

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3
Q

What is the main blood supply to the femoral head?

A

Retrograde from the femoral neck via capsular vessels

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4
Q

What is the main risk of intracapsular neck of femur fractures?

A

Avascular necrosis

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5
Q

Give 3 indications for nonoperative management for a neck of femur fracture

A

Patient does not walk
Minimal pain
High risk of surgery

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6
Q

How do pelvic ring fractures present

A

Pain and inability to weight bear

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7
Q

Where do the common iliac arteries bifurcate?

A

L5/S1

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8
Q

Where does the aorta bifurcate?

A

L4

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9
Q

Give 2 neurological structures at risk in pelvic ring fractures

A

Lumbar plexus

Sacral plexus

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10
Q

Give 3 visceral organs at risk in pelvic ring fractures

A

Bladder
Urethra
Rectum

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11
Q

How are pubic ramus fractures managed?

A

Nonoperatively

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12
Q

What is the main risk of pubic ramus fractures?

A

Damage to the corona mortis (anastomosis of blood vessels on the inner aspect of the pubic symphysis)

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13
Q

How does a posterior hip dislocation classically present?

A

Hip adducted, flexed, internally rotated and shortened

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14
Q

Where might the femoral head be palpable in a posterior hip dislocation?

A

Gluteal region

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15
Q

Where might the femoral head be palpable in superior-anterior hip dislocations?

A

Femoral triangle

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16
Q

What is the management of a hip dislocation?

A

Closed reduction in theatre within 6 hours

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17
Q

What is sciatica?

A

Pain in the lower back, radiating to the buttock and the leg, caused by irritation and compression of the sciatic nerve

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18
Q

What causes piriformis syndrome?

A

Spasm of the piriformis muscle

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19
Q

How does piriformis syndrome present?

A

Buttock pain plus symptoms of sciatica

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20
Q

What is the major risk factor for meniscal injury?

A

ACL deficiency

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21
Q

What is the first line management of meniscal injury?

A

Rest, NSAIDs and rehabilitation

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22
Q

What is the main complication of meniscal injury?

A

Osteoarthritis

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23
Q

What 2 types of event can cause an ACL tear?

A

Valgus collapse

Blow to lateral aspect of the knee

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24
Q

What is the “unhappy triad” of knee injuries?

A

ACL
MCL
Meniscus

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25
Q

What causes the “unhappy triad” of knee injuries?

A

Blow to lateral aspect of the knee

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26
Q

What is the classic history of an ACL tear?

A

Felt a pop in the knee
Knee feels unstable
Difficulty weight bearing

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27
Q

What type of gait is produced by an ACL tear?

A

Quadriceps avoidance gait

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28
Q

What does nonoperative management of ACL tears involve?

A

Weight bearing and range of movement exercises

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29
Q

Give 2 indications for ACL reconstruction

A

Active, young patients

People who “don’t trust their knee”

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30
Q

Give 2 indications for tibial slope levelling after an ACL tear

A

Dogs

People with early arthritis changes

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31
Q

What is the main complication of ACL tears?

A

Increased risk of osteoarthritis via meniscal injury

32
Q

What causes PCL tears?

A

Direct blow to the front of the tibia with knee flexed

Knee hyperextension

33
Q

What causes LCL tears?

A

Varus producing forces

34
Q

How are MCL tears tested?

A

Valgus stress test at 0 and 20 degrees

35
Q

How are LCL tears tested?

A

Varus stress test at 0 and 20 degrees

36
Q

Give 2 causes of patella fractures

A

Direct impact

Rapid flexion against contracted quadriceps

37
Q

How do patella fractures present?

A

Inability to perform a straight leg raise

38
Q

What causes tibial plateau fractures?

A

Varus or valgus load with or withou an axial load

39
Q

Which nerve may be damaged by a head of fibula fracture and what presentation would this cause?

A

Common peroneal nerve

Foot drop

40
Q

Where is the Chopart joint?

A

Between the forefoot and midfoot

41
Q

Where is the Lisfranc joint?

A

Between the midfoot and the hindfoot

42
Q

What is the definition of an ankle sprain?

A

Ligamentous injury of the ankle

43
Q

Which ligaments are most commonly involved in ankle sprains?

A

Anterior talofibular ligament

Calcaneofibular ligament

44
Q

Which special test can be used when examining a potential ankle sprain?

A

Anterior drawer test - may show excessive anterior displacement of the talus relative to the tibia

45
Q

What are the indications for an X ray in an ankle sprain?

A

Inability to bear weight

Bony landmark tenderness

46
Q

What are the indications for an MRI in an ankle sprain?

A

Pain persists for 6-8 weeks

47
Q

What are the indications for surgery in an ankle sprain?

A

Continued pain and instability

Bony avulsion

48
Q

Which classification system is used to determine likelihood of syndesmosis involvement in ankle fractures?

A

Weber classification system

49
Q

What is a Weber type A ankle fracture?

A

Infrasyndesmotic - low risk of syndesmosis involvement

50
Q

What is a Weber type B ankle fracture?

A

At the level of the syndesmosis - intermediate risk of syndesmosis involvement

51
Q

What is a Weber type C fracture?

A

Suprasyndesmotic - high risk of syndesmosis involvement

52
Q

What is the relevance of syndesmosis involvement in ankle fractures?

A

Increases likelihood of ankle instability

53
Q

What classification system is used to determine the risk of avascular necrosis in talus fractures?

A

Hawkins classification

54
Q

What is a Hawkins type I talus fracture?

A

Talar neck fracture

55
Q

What is a Hawkins type II talus fracture?

A

Talar neck fracture with subtalar dislocation

56
Q

What is a Hawkins type III talus fracture?

A

Talar neck fracture with subtalar and tibiotalar dislocation

57
Q

What is a Hawkins type IV talus fracture?

A

Talar neck fracture with subtalar, tibiotalar and talonavicular dislocation

58
Q

What is the management of a talar neck fracture?

A

Internal fixation

59
Q

What fractures are associated with calcaneal fractures?

A

Vertebral fractures

60
Q

What type of events cause calcaneal fractures?

A

Falls from a height

High speed road accidents

61
Q

What is a Lisfranc injury?

A

Tarsometatarsal fracture dislocation characterised by disruption between the medial cuneiform and the base of the 2nd metacarpal

62
Q

When do Lisfranc injuries occur?

A

Occurs when foot externally rotated and plantarflexed

63
Q

What type of X ray is useful in a Lisfranc injury?

A

Weight bearing X ray

64
Q

Which part of the foot is most important to stabilise with plates and screws after a Lisfranc injury?

A

medial side

65
Q

In which demographic are Achilles tendon ruptures most common?

A

Men aged 30-40

66
Q

Which antibiotic is associated with Achilles tendinopathy?

A

Ciprofloxacin

67
Q

What is the Simmonds-Thompson test for Achilles tendon rupture?

A

Squeeze the calf and see if the foot moves

68
Q

What is the nonoperative management of Achilles tendon ruptures?

A

Plaster cast/boot with the toes pointing down to the ground

69
Q

Give 2 indications for surgery for Achilles tendon rupture

A

Repeated injuries

High-level athlete

70
Q

What are the risks of Achilles tendon surgery?

A 
Sural nerve injury
Wound problems (watershed area)
71
Q

What is hallux valgus?

A

Bunion - deformity of the first ray

72
Q

How is hallux valgus generally managed?

A

Shoe modification

73
Q

Why is surgery for hallux valgus generally avoided?

A

Condition tends to recur

74
Q

What causes Morton’s neuroma?

A

Compression of interdigital nerve between metatarsal heads

75
Q

How does Morton’s neuroma present?

A

Shooting pain between toes

76
Q

How is Morton’s neuroma managed?

A

Shoe modification
Steroid injection
Surgical spreading of the metatarsals

MSK (8 decks)

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