knee injuries

Question 1

1. what is the mechanism of injury for a femoral shaft fracture?
2. what is the site of injury of a femoral shaft fracture?
3. what are the consequences of a femoral shaft fracture?
4. how are femoral shaft fractures treated?

Answer 1

1. high energy injuries - fall from height or large force applied to thigh
2. proximal, mid-shaft or supracondylar
3. blood loss can cause hypovolaemic shock
4. traction splint or surgical fixation

Question 2

1. what is the mechanism of injury of a tibial plateau fracture?
2. what are the 2 types of tibial plateau fractures?
3. what are the consequences of a tibial plateau fracture?
4. how is tibial plateau fracture managed and treated?

Answer 2

1. high energy injury - axial loading and angulation
2. uni or bi condylar
3. articular cartilage damage, instability and arcuate joint surface reduction or post traumatic osteoarthritis
4. order CT scan and fix articular segment to shaft

Question 3

1. what is the mechanism of injury of a patella fracture?
2. what are the two types of patella fractures?
3. how are the 2 types of patella fractures treated?
4. what are the consequences of a patella fracture?

Answer 3

1. direct or indirect force
2. displaced or undisplaced
3. displaced - reduce and fix, undisplaced - splint and protect
4. post traumatic osteoarthritis

Question 4

1. what is dislocation / subluxation of patella?
2. what is the mechanism of injury of a patella dislocation?
3. what factors predispose people to patella dislocations?
4. how are patella dislocations treated?

Answer 4

1. lateral displacement of the patella
2. twisting actions in slight flexion or fall on a flexed knee
3. weakness of vastus medialis, ligamentous laxity, shallow trochlear groove, long patellar ligament
4. reduce and immobolise, soft tissue reconstruction

Question 5

1. what are the causes of meniscal injuries?
2. how do meniscal injuries present?
3. what are the 2 types of meniscal injuries?
4. what imaging would you request?
5. how are the 2 types of meniscal injuries treated?

Answer 5

1. twisting injury in high flexion
2. localised pain, swelling, catching, locking
3. traumatic or degenerative
4. MRI
5. traumatic - menisectomy, degenerative - leave alone and rehabilitate

Question 6

what factors aid knee joint stability?

Answer 6

static - bones and ligaments (menisci, collateral ligaments, cruciate ligaments)
dynamic - muscles and tendons (quadriceps, hamstrings)

Question 7

1. what are the 2 types of collateral ligament injuries?
2. what causes the 2 types of collateral ligament injuries?
3. what are the signs and symptoms of a collateral ligament injury?
4. how are collateral ligament injuries treated?

Answer 7

1. medial collateral or lateral collateral injuries
2. medial collateral - valgus strain, lateral collateral - varus strain
3. pain and/or instability
4. brace + rehabilitate, surgical repair

Question 8

what is the unhappy triad?

Answer 8

in a valgus strain injury the medial collateral ligament, ACL and medial menisci are injured

Question 9

1. what causes an ACL injury?
2. what are the consequences of ACL injury?
3. how are ACL injuries treated?
4. what do patients usually hear in an ACL tear?

Answer 9

1. landing or sudden direction change
2. anterolateral rotatory instability, knee giving way or twisting of knee
3. rehabilitation (surgical intervention if needed)
4. usually hear a pop sound

Question 9

1. what causes a PCL injury?
2. how are PCL injuries treated?

Answer 9

1.fall onto knee or hyperextension
2.brace and rehabilitate

Question 10

1. what causes a knee joint dislocation?
2. what is the associated vascular injury associated with knee dislocations and how would you assess this?
3. what are the consequences of knee dislocations?
4. how are knee dislocations treated?

Answer 10

1. high energy trauma (3 or 4 ligaments must be torn) so uncommon
2. popliteal artery tethers + is assessed using angiography
3. late stiffness + instability
4. reduce + stabalise

Question 11

1. what are bursae?
2. what is bursitis?
3. what symptoms are associated with bursitis?
4. what is housemaid knee?
5. what is clergymans knee?
6. what is knee joint effusion?
7. what is bakers cyst?

Answer 11

1. fluid filled sacs which protect the bony prominences
2. inflammation of a bursa
3. affected portion feels warm, tender and swollen
4. pre-patellar bursitis
5. infra-patellar bursitis
6. supra-patellar bursitis
7. semimembranosus bursitis

Question 12

1. what are the different types of knee arthritis?
2. what are the signs and symptoms of knee arthritis?
3. what sites can knee arthritis effect?

Answer 12

1. osteoarthritis - wear and tear, inflammatory arthritis - rheumatoid or gout
2. synovitis (swelling), pain, stiffness, loss of function, deformity (varus, valgus or fixed flexion)
3. uni, bi or tri compartmental

Question 13

1. how common is knee osteoarthritis?
2. what causes fluctuating symptoms in knee ostoarthritis?
3. what predisposes people to knee osteoarthritis?
4. how is knee osteoarhtirtis treated?

Answer 13

1. 12% of population, 35% >75 years
2. symptoms are provoked by activity and relieved by rest
3. age, sex, weight, post trauma or genetics
4. strengthening exercises, analgesia, weight loss or surgery if needed

Question 14

1. how does septic arthritis present?
2. what are risk factors for septic arthritis?
3. what are the consequences of septic arthritis?
4. what is the treatment for septic arthritis?

Answer 14

1. clinically unwell, pain, swelling, redness and warmth, non-weight bearing
2. recent surgery, knee effusion secondary to bacterial infection
3. articular cartilage damage and sepsis
4. aspirate (withdraw fluid and test microorganism), antibiotics and surgical washout