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MSK > Hip, knee and foot conditions > Flashcards

Hip, knee and foot conditions Flashcards

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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
What causes the "unhappy triad" of knee injuries?
Blow to lateral aspect of the knee
26
What is the classic history of an ACL tear?
Felt a pop in the knee Knee feels unstable Difficulty weight bearing
27
What type of gait is produced by an ACL tear?
Quadriceps avoidance gait
28
What does nonoperative management of ACL tears involve?
Weight bearing and range of movement exercises
29
Give 2 indications for ACL reconstruction
Active, young patients | People who "don't trust their knee"
30
Give 2 indications for tibial slope levelling after an ACL tear
Dogs | People with early arthritis changes
31
What is the main complication of ACL tears?
Increased risk of osteoarthritis via meniscal injury
32
What causes PCL tears?
Direct blow to the front of the tibia with knee flexed | Knee hyperextension
33
What causes LCL tears?
Varus producing forces
34
How are MCL tears tested?
Valgus stress test at 0 and 20 degrees
35
How are LCL tears tested?
Varus stress test at 0 and 20 degrees
36
Give 2 causes of patella fractures
Direct impact | Rapid flexion against contracted quadriceps
37
How do patella fractures present?
Inability to perform a straight leg raise
38
What causes tibial plateau fractures?
Varus or valgus load with or withou an axial load
39
Which nerve may be damaged by a head of fibula fracture and what presentation would this cause?
Common peroneal nerve | Foot drop
40
Where is the Chopart joint?
Between the forefoot and midfoot
41
Where is the Lisfranc joint?
Between the midfoot and the hindfoot
42
What is the definition of an ankle sprain?
Ligamentous injury of the ankle
43
Which ligaments are most commonly involved in ankle sprains?
Anterior talofibular ligament | Calcaneofibular ligament
44
Which special test can be used when examining a potential ankle sprain?
Anterior drawer test - may show excessive anterior displacement of the talus relative to the tibia
45
What are the indications for an X ray in an ankle sprain?
Inability to bear weight | Bony landmark tenderness
46
What are the indications for an MRI in an ankle sprain?
Pain persists for 6-8 weeks
47
What are the indications for surgery in an ankle sprain?
Continued pain and instability | Bony avulsion
48
Which classification system is used to determine likelihood of syndesmosis involvement in ankle fractures?
Weber classification system
49
What is a Weber type A ankle fracture?
Infrasyndesmotic - low risk of syndesmosis involvement
50
What is a Weber type B ankle fracture?
At the level of the syndesmosis - intermediate risk of syndesmosis involvement
51
What is a Weber type C fracture?
Suprasyndesmotic - high risk of syndesmosis involvement
52
What is the relevance of syndesmosis involvement in ankle fractures?
Increases likelihood of ankle instability
53
What classification system is used to determine the risk of avascular necrosis in talus fractures?
Hawkins classification
54
What is a Hawkins type I talus fracture?
Talar neck fracture
55
What is a Hawkins type II talus fracture?
Talar neck fracture with subtalar dislocation
56
What is a Hawkins type III talus fracture?
Talar neck fracture with subtalar and tibiotalar dislocation
57
What is a Hawkins type IV talus fracture?
Talar neck fracture with subtalar, tibiotalar and talonavicular dislocation
58
What is the management of a talar neck fracture?
Internal fixation
59
What fractures are associated with calcaneal fractures?
Vertebral fractures
60
What type of events cause calcaneal fractures?
Falls from a height | High speed road accidents
61
What is a Lisfranc injury?
Tarsometatarsal fracture dislocation characterised by disruption between the medial cuneiform and the base of the 2nd metacarpal
62
When do Lisfranc injuries occur?
Occurs when foot externally rotated and plantarflexed
63
What type of X ray is useful in a Lisfranc injury?
Weight bearing X ray
64
Which part of the foot is most important to stabilise with plates and screws after a Lisfranc injury?
medial side
65
In which demographic are Achilles tendon ruptures most common?
Men aged 30-40
66
Which antibiotic is associated with Achilles tendinopathy?
Ciprofloxacin
67
What is the Simmonds-Thompson test for Achilles tendon rupture?
Squeeze the calf and see if the foot moves
68
What is the nonoperative management of Achilles tendon ruptures?
Plaster cast/boot with the toes pointing down to the ground
69
Give 2 indications for surgery for Achilles tendon rupture
Repeated injuries | High-level athlete
70
What are the risks of Achilles tendon surgery?
``` Sural nerve injury Wound problems (watershed area) ```
71
What is hallux valgus?
Bunion - deformity of the first ray
72
How is hallux valgus generally managed?
Shoe modification
73
Why is surgery for hallux valgus generally avoided?
Condition tends to recur
74
What causes Morton's neuroma?
Compression of interdigital nerve between metatarsal heads
75
How does Morton's neuroma present?
Shooting pain between toes
76
How is Morton's neuroma managed?
Shoe modification Steroid injection Surgical spreading of the metatarsals

MSK (8 decks)

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