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Clin Med > Knee pathophysiology: fracture and degenerative changes > Flashcards

Knee pathophysiology: fracture and degenerative changes Flashcards

1
Q

how do we screen for fractures at the knee?

A

ottawa knee rules (Sn 98.5%, Sp 48.6%)
Pittsburgh decision rules (Sn 99%, Sp 61%)

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2
Q

what is the criteria for the ottawa knee rules?

A

> 55 years old
tenderness at the head of fibula
isolated tenderness of patella
inability to flex knee to 90º
inability to walk for weight bearing steps immediately after injury and in the emergency room

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3
Q

what is the Pittsburgh decision rules?

A

if the MOI was blunt trauma or fall and one of the following:
age <12 y/o or >50 y/o
inability to walk four weight bearing steps in the ER

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4
Q

what are the types of fracture in the knee?

A

distal femoral shaft
tibial plateau
patella

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5
Q

what is the MOI for a distal femoral shaft fracture?

A

MVA or fall from great heights
low level force or minor fall

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6
Q

what are the classifications for a distal femoral shaft fracture?

A

non displaced
impacted
displaced
comminuted
condylar
intercondylar

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7
Q

what is the incidence rate for distal femoral shaft farctures?

A

97% fractures > 60 years (females 71.6 years > males 44.1 years)
61% fall from standing height

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8
Q

what is a distal femoral shaft fracture?

A

disruption of the distal femoral shaft; often displaced fracture and/or comminuted (spiral, transverse, oblique)
may lead to massive internal hemorrhage -> shock

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9
Q

what is the clinical picture for a distal femoral fracture?

A

grossly swollen, deformity apparent, often unstable

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10
Q

what is the non-operative management for distal femoral fractures?

A

fewer risks than surgical management however length of time for healing/recovery is much greater
continuous skeletal traction followed by 3-6 weeks of casting

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11
Q

what is the operative management for distal femoral fractures?

A

internal fixation- use of large intramedullary nail to stabilize fracture site
may utilize an open (ORIF)

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12
Q

what are some complications of distal femoral fractures?

A

mal-union (rotated or shortened limb)
joint and or soft tissue adhesions
post traumatic DJD

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13
Q

what percent of overall fractures do proximal tibia fractures contribute to?

A

1%

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14
Q

what is the MOI for proximal tibia fractures?

A

impact with automobile fenders (25%)
axial loading as a result from a fall
individuals with osteoporosis (8% of all fractures in older individuals)

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15
Q

what is the clinical picture for proximal tibia fractures?

A

knee effusion, pain, joint stiffness

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16
Q

what are some complications of proximal tibia fractures?

A

intra-articular and peri-articular adhesions and DJD

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17
Q

where do proximal tibia fractures typically occur in adults?

A

at medial and lateral tibial plateau in individuals 40-60 years

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18
Q

what is the MOI for adult proximal tibia fractures?

A

valgus or varus force with axial compression
car pedestrian accident bumper -> knee
elderly with osteoporosis after twisting

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19
Q

where do proximal tibia fractures typically occur in chidlren?

A

in epiphyseal growth plate and metaphyseal region (3-6 years)

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20
Q

what is the MOI for children proximal tibia fractures?

A

fall
varus/valgus force with axial load

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21
Q

what are the imaging options for proximal tibial plateau fractures?

A

x ray (AP, lateral, and oblique views- parfaot sign)
CT may be indicated to determine extent of fracture line
MRI indicated if associated with suspected ligament injury

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22
Q

what is the pathophysiology for proximal tibial plateau fractures?

A

may see a split (younger) or a depression fracture (older)
more common lateral plateau
may also contribute to ACL tear

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23
Q

at what age range do patellar fractures generally occur in males and females?

A

males 10-19 years
females 60-80 years

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24
Q

what is the MOI for patellar fractures?

A

direct: fall (crush fracture)
indirect: jumping (avulsion fracture)
stress fracture

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25
Q

what is the clinical picture for patellar fractures?

A

pain/tenderness around patella
joint effusion
history of direct or indirect injury

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26
Q

how are patellar fractures diagnosed?

A

radiographs- AP, lateral, merchant (tangential) view
CT- utilized when fracture is not visible on radiograph
bone scan

27
Q

what is the non operative management for patellar fractures?

A

non or minimally displaced fracture site
immobilization 4-6 weeks with FWB and crutches

28
Q

what is the operative management for patellar fractures?

A

significant fragment displaced, articular incongruity or open fracture
pin and wire fixation

29
Q

when is a patellectomy indicated?

A

with comminuted fracture

30
Q

what are some complications of patellar fractures?

A

DJD, loss of quadriceps strength

31
Q

what percent of all knee injuries are patellar dislocations?

A

2-3%

32
Q

who more commonly experiences patellar dislocations?

A

young active individuals
adolescent females and atheltes
lateral > medial

33
Q

what are 2 risk factors for patellar dislocations?

A

increased Q angle, weak VMO

34
Q

what is the normal Q angle for males and females?

A

18º for females and 13º for males

35
Q

what does an increased Q angle lead to?

A

higher likelihood of lateral patellar tracking

36
Q

how do we measure a patients Q angle?

A

patient supine with knee in full extension
PT stands on measuring side
mark the following landmarks: F-midpoint of patella, PA- ASIS, DA- tibial tubercle, align goniometer
positive result is if <13º or >18º

37
Q

how do we treat a patellar dislocation?

A

reduction of dislocation
exercise
modalities
taping
bracing
lateral retinacular release

38
Q

what is the most common form of OA?

A

knee osteoarthritis

39
Q

what is the incidence for knee OA?

A

affects > 16 million Americans
age > 60 years

40
Q

what is the joint disease progression for knee OA?

A

loss of cartilage, bony sclerosis, increased subchondral bone growth, bone cysts, osteophyte formation

41
Q

what is the clinical picture for knee OA?

A

pain and stiffness at knee

42
Q

how is knee OA diagnosed?

A

clinical picture in combination with x-rays
x-ray finding of decreased joint space correlates poorly with clinical symptoms

43
Q

what are some pharmacological managements of knee OA?

A

non-opioid analgesics (acetaminophen, tylenol)
over the counter NSAIDs (ibuprofen)
prescription strength NSAIDs
topical analgesics (capsaicin, methylsalucylate creams)
intra-articular hyaluronan injections
intra-articular steroid injections
opioid analgesics (codeine)

44
Q

what are some non pharmacological managements of knee OA?

A

PT, surgery (TKA or PKA)

45
Q

what is gout at the knee?

A

excessive amounts of uric acid

46
Q

what is pseudogout of the knee?

A

calcium crystals
most common in the knee

47
Q

what are some risk factors for pseudogout?

A

uncommon in premenopausal women
hyperparathyroidism
chronic kidney disease
diuretic use

48
Q

what is the clinical picture for proximal tibial fractures?

A

knee effusion
pain
joint stiffness

49
Q

what are some complications of proximal tibial fractures?

A

intraarticular and periarticular adhesions
DJD

50
Q

what is osteochondritis dissecans (OCD)

A

chronic form of osteochondral fracture
85% medial femoral condyle
occurs in older children, teens and younger adults

51
Q

what are symptoms of osteochondritis dissecans?

A

dull pain
joint effusion (chronic)
loose body in joint common

52
Q

what is the MOI for OCD?

A

shearing and rotational force -> articular cartilage fragment and subchrondral bone

53
Q

what imaging is done for OCD?

A

MRI, x-ray

54
Q

what is reactive arthritis (Reiter’s Syndrome)?

A

swelling triggered by an infection
primarily affects young males age 20-40
usually affects knees and ankles

55
Q

what are the symptoms for reactive arthritis?

A

pain and stiffness
eye inflammation
urinary problems
swollen toes or fingers
skin problems
low back pain

56
Q

what is the criteria for advancing to phase 2 of treatment of OCD?

A

full passive knee extension
knee flexion to 125º
minimal pain and swelling
voluntary quadriceps activity

57
Q

what is rheumatoid arthritis?

A

autoimmune disorder
occurs immune system mistakenly attacks body’s tissues

58
Q

what are some symptoms of rheumatoid arthritis?

A

tender, warm, swollen joints
joint stiffness that is usually worse in the mornings and after inactivity
fatigue, fever and loss of appetite

59
Q

what are some risk factors for rheumatoid arthritis?

A

women > men
smoker
family history
middle age onset
environmental exposure
obesity

60
Q

what is septic arthritis?

A

typically caused by bacterial infection spread through the blood stream
usually only affects one joint- knee or hip
most likely to occur in children and older adults

61
Q

what are some risk factors for septic arthritis?

A

open wounds
weakened immune system
cancer
diabetes
IV drug use

62
Q

what are some symptoms of septic arthritis?

A

chills
fatigue and generalized weakness
fever
inability to move the limb with the infected joint
severe pain in the affected joint, especially with movement
swelling
warmth

63
Q

how is septic arthritis diagnosed?

A

arthrocentesis

Clin Med (17 decks)

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