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Clin Med I > lower extremity injuries > Flashcards

lower extremity injuries Flashcards

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1
Q

who do hip fx usually occur in?

A
  • elderly female with osteoporosis

- generally fx happens first then they fall

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2
Q

clinical presentation for femoral head fx

A
  • hip/groin pain s/p fall
  • non-ambulatory or need assistance
  • internal or external rotation of leg on affected side
  • TTP over fx area
  • pain with AROM and PROM
  • pain with IR very sensitive for fx*
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3
Q

imaging to order for hip fx

A
  • AP pelvis, frog lateral

- if suspect fx but it is not visible on x-ray then order MRI

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4
Q

treatment for femoral head fx

A
  • almost always surgical
  • cannulated screws
  • hemiarthroplasty
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5
Q

garden classification

A
  • for femoral neck fx
  • predicts dev of AVN
  • stages I- IV
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6
Q

garden stage I

A
  • nondisplaced incomplete fx
  • possible greenstick fx
  • valgus impaction fx
  • stable fx
  • can be treated with internal fixation
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7
Q

garden stage II

A
  • nondisplaced complete fx
  • stable fx
  • can be treated with internal fixation
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8
Q

garden stage III

A
  • complete fx, incompletely displaced
  • femoral head tilts into varus position
  • unstable
  • requires arthroplasty
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9
Q

garden stage IV

A
  • complete fx completely displaced
  • unstable
  • requires arthroplasty
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10
Q

intertrochanteric fx

A
  • hip fx that happens between greater and lesser troch
  • extracapsular
  • fx through cancellous bone with good blood supply so heals well
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11
Q

treatment for intertrochanteric fx

A
  • IM nailing

- DHS compression screw

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12
Q

subtrochanteric hip fx

A
  • fx below greater and lesser troch

- requires IM nailing

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13
Q

which hip fx get a hemiarthroplasty

A
  • displaced femoral neck

- supcapital hip fx

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14
Q

which hip fx get cannulated screws

A
  • nondisplaced femoral neck fx
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15
Q

which hip fx get nailing/ compression screws

A
  • intertrochanteric fx

- subtrochanteric fx

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16
Q

prognosis of hip fx

A
  • 25% of pts do not survive past 1 year

- of those who do survive, often return one level below baseline ambulatory/ ADL status

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17
Q

greater trochanteric bursitis

A
  • usually women, more common in 40s and 50s
  • triggered by minor direct trauma over greater troch
  • pain in lateral hip
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18
Q

clinical presentation of greater troch bursitis

A
  • aching, intense lateral hip pain
  • worsened with direct pressure
  • pain radiates down lateral thigh
  • painful ambulation
  • TTP over greater troch
  • pain with resisted hip abduction and passive hip rotation
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19
Q

treatment for greater troch bursitis

A
  • ice
  • NSAIDs
  • PT
  • steroid injection
  • surgery rare
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20
Q

femoral acetabular impingement

A
  • femoral neck abnorm shaped during childhood growth
  • active people may experience pain sooner
  • cam bone spur vs. pincer bone spur
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21
Q

cam bone spur

A
  • abnormal femoral head/ neck junction
  • increased radius at waist
  • impingement occurs during flexion, adduction, IR
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22
Q

pincer bone spur

A
  • excessive acetabular coverage

- linear contact between labrum and femoral head/ neck junction

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23
Q

clinical presentation of femoral acetabular impingement

A
  • pain in groin, may radiate to lateral hip
  • dull ache which waxes/ wanes with activity and rest
  • improves withPT but sx will return
  • sharp stabbing pain with turning, twisting, squatting
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24
Q

diagnosis of femoral acetabular impingement

A
  • impingement test- hip flexion to 90, adduct to 20 degrees the IR, will prod pain
  • x-ray for bone morphology
  • MRI for labrum and articular cartilage assessment
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25
treatment for femoral acetabular impingement
- surgery- arthroscopic labral repair/ debridement, femoral neck/head resection - activity modification - NSAIDs - PT
26
femur fx
- usually d/t high velocity injuries - common site for metastatic lesions - potential for severe blood loss and loss of life/limb
27
clinical presentation of femur fx
- NWB usually - distracting injury - mod- severe pain if pt is conscious - affected leg shortened and rotated
28
diagnosis of femur fx
- assess NV status - assess for other injuries - xrays- AP, lateral of femur
29
treatment for femur fx
- address life threatening injuries first - IM nailing best sx option - analgesics and anticoags - PT - follow healing through serial x-rays
30
tibial plateau fx
- high energy deceleration injury - femoral condyles piston down onto tibial plateau - often occurs in conjunction with other LE injuries
31
clinical manifestations of tibial plateau fx
- mod-severe pain - NWB - very TTP - resist AROM and PROM - distracting injury- assess for other injuries
32
diagnosis of tibial plateau fx
- trauma series of knee - CT if unstable and need ORIF - if no fx seen on plain film but pt has sx order MRI - assess if open vs closed and NV status
33
treatment of tibial plateau fx
- stable- hinged knee brace and crutches | - unstable- ORIF with side plate and screws
34
segond fx
- avulsion fx involving lateral aspect of tibial plateau - 75% also have ACL inj - usually seen in falls or sports
35
clinical presentation of segond fx
- knee pain/ swelling after trauma - hold knee at 20 degree flexion - NWB but stable - mod- large effusion - resist full ext and may not be able to flex past 90 d/t hemarthrosis
36
diagnosis of segond fx
- standard knee trauma series | - may show curvilinear fx
37
treatment of segond fx
- if small fx can use cancellous screw - if extensive ligamentous injury requires surgery - good prognosis
38
patella fx
- often d/t direct injury to anterior patella - can be d/t sudden forceful contraction of quad - can occur after ACL reconstruction or TKR
39
clinical presentation of patella fx
- NWB or protected WB - mod-severe pain - large area of swelling or large joint effusion - absent extensor mechanism - may have defect in distal quad tendon - assess NV status
40
diagnosis of patella fx
- knee trauma series | - CT if severely comminuted
41
treatment of patella fx
- ORIF with tension band wiring - NWB in hinged knee brace locked into exxt - can unlock brace to 20 degrees for swing leg while walking - active ROM in brace under PT supervision X 4 weeks
42
quad tendon rupture
- forced flexion against resistance/ ext - i.e. person jumping down onto deck of boat as it is coming up at him - usually heavy set males in 40s or 50s - rupture at musculotendinous junction
43
clinical presentation of quad tendon rupture
- hears pop - if complete rupture will be NWB with large effusion - absent extensor mechanism - lg area of swelling likely defect in distal quad tendon - assess NV status
44
treatment for quad tendon rupture
- sx - pt held to - 20 degrees extension and NWB in locked hinge knee brace - may transition to PWB after 6 weeks - once ROM restored then strengthen - may take up to 1 year
45
patella tendon rupture
- palpable defect in patellar ligament - patella alta - absent extensor mechanism - risk factors- RA, long term DM, long term steroids - rupture rare in young athletes unless steroid use
46
treatment for patella tendon rupture
- standard knee trauma xrays - conservative tx for partial tear- immobilization in hinged knee brace for 4-6 weeks - surgery if complete tear
47
maisonneuve fx
- combo of spiral fx of proximal fibula with an ankle injury - widened ankle joint d/t rupture of distal tibiofibular syndesmosis - deltoid ligament disruption - +/- fx of medial malleolus
48
ACL tear
- valgus stress to knee or distal thigh with ipsilateral foot planted - young women
49
ACL tear clinical presentation
- hears "pop" - mild- mod pain - massive effusion - instability
50
diagnosis of ACL tear
- lachman test- most sensitive - anterior drawer sign - xray to r/o segond fx - MRI
51
treatment of ACL tear
- reconstruction to return to sports/ occupation - joint instability puts pt at higher risk post traumatic OA - occult osteochondral lesions in majority of pts
52
MCL tear
- common sports injury | - d/t valgus force to lateral knee
53
clinical presentation of MCL tear
- acute onset pain in medial aspect of knee - instability when changing directions or stairs - +/- swelling - antalgic gait - TTP over MCL - ROM preserved if no effusion - pain with valgus stress 0-30 degrees
54
diagnosis of MCL tear
- standard xray series | - no MRI required unless ACL tear suspected
55
treatment of MCL tear
- RICE - gentle NWB ROM 3-5 days - hinged knee brace - PT - most treated conservatively with good prognosis
56
patella femoral syndrome
- aka chondromalacia patella - common cause of anterior knee pain - lateral mal-tracking of patella during flex/ ext - weakness of VMO and tightness of ITB - pain during knee flexion, descending stairs, prolonged sitting
57
clinical presentation of patella femoral syndrome
- normal WB and minimal impact on ADLs - diffuse pain around knee - pain may be localized to medial joint line - stiff feeling after prolonged sitting - achey during activities - inflammation but no effusion - VMO atrophied - ITB tenderness - patella aprehension - ROM not usually impacted
58
diagnosis of patella femoral syndrome
- xrays- sunrise (merchant) view most important - lateral subulxation of patella - usually xrays are normal
59
treatment of patella femoral syndrome
- activity modification - strengthen VMO - NSAIDs - Patella brace PRN - good prognosis if compliant with PT - some require sx- lateral release
60
meniscus tear
- medial more common than lateral - acute injury- twisting or rotational mvmt of flexed knee while foot planted - if older adult d/t degeneration
61
clinical presentation of meniscus tear
- hear "pop" - medial/lat sided pain "inside" knee over joint line - +/- swelling - pain worse with activities, improves with rest - locking** or inability to fully ext/flex knee
62
diagnosis of meniscus tear
- TTP over affected joint line - pos McMurray test - unable to squat deeply - in older pts may not have pos McMurray but will be TTP - standard xray to r/o fx - MRI for surgical assessment
63
treatment of meniscus tear
- meniscus repair for younger pts -> portected WB with gentle ROM X 6 weeks - meniscetomy in older less active pts -> return to activity quickly
64
tibia fx
- high energy deceleration injury | - often occurs in conjunction with other LE fx
65
clinical presentation of tibia fx
- NWB or protected WB - mod- severe pain - may have obvious skin deformity - swelling
66
diagnosis of tibia fx
- det if open vs closed (often open) - TTP over fx site - assess ankle and knee ROM - xrays- AP and lateral views
67
treatment of tibia fx
- midshaft tibia fx often unstable - IM nail fixation - if multi-trauma may need ex- fx
68
ankle fx
- from foot being planted and body sustains rotational force - ext rotation -> spiral fx of fibula +/- medial malleolus fx - abduction force -> transverse fx of fibula and avulsion of medial malleolus
69
clinical presentation of ankle fx
- NWB or protected - swelling - reduced ROM - crepitus - assess prox fibula
70
diagnosis of ankle fx
- xray 3 views- AP, mortise, lateral | - may need stress views to det if stable vs unstable
71
treatment for ankle fx
- stable- tall walking boot or cast | - unstable- ORIF
72
ankle sprain
- "turned the ankle" during fall or landing - most common mechanism is inversion and plantarflexion causing damage to ATF ligament - eversion can cause high ankle sprain d/t damge to deltoid ligament
73
clinical presentation of ankle sprain
- pain/ swelling - TTP - antalgic WB - ecchymosis 24-48 hours later - exam finidngs similar to fx, need an xray
74
treatment of ankle sprain
- RICE - tall boot - NSAIDs - early ROM - PT - good prognosis if compliant
75
calcaneus fx
- high energy deceleration injury, esp fall from height | - may complain of LBP secondary to associated lumbar compression fx
76
clinical presentation of calcaneus fx
- NWB - severe pain - +/- NV injury - assess back* - check smoking status - often results in chronic heel pain
77
diagnosis of calcaneul fx
- well padded posterior splint - crutches or wheelchairs - analgesics - ORIF delayed 7-10 days d/t swelling
78
5th metatarsal avulsion fx
- d/t inversion of foot and plantarflexion - pulls at insertion of peroneus brevis - must include 5th metatarsal base in lateral ankle xray - usually treated conserv and heal well
79
jones fx
- transverse fx at base of 5th metatarsal - d/t significant adduction force to forefoot with ankle in plantar flexion - prone to non-union and take long to heal - increased risk fx displacement with WB
80
treatment for Jones fx
- NWB for 6-8 weeks | - internal fixation and bone grafting may be required
81
plantar fasciitis clinical presentation
- shape volar sided heel pain - usually normal gait but may limp - pain worst in AM - pain decreases as pt ambulates
82
diagnosis of plantar fasciitis
- TTP at origin of plantar fascia on calcaneus - pes planovalgus orientation on exam common - tight achilles - xrays
83
treatment for plantar fasciitis
- night splint - ice - NSAIDs - PT - steroid injection and sx rare
84
achilles tendon rupture risk
- fluoroquinolone use - steroid injections - usually traumatic injury
85
achilles tendon rupture cause
- sudden forced plantar flexion | - violent dorsiflexion in plantar flexed foot
86
clinical presentation of achilles tendon rupture
- hears pop - weakness and difficulty walking - pain in heel - palpable defect - weak plantarflexion
87
diagnosis of achilles tendon rupture
- thomson test - xray to r/o other pathology - US - MRI not usually needed
88
Thompson test
- used to dx achilles tendon rupture - pt in prone with knee flexed at 90 - squeeze calf at widest girth - pos if calf doesnt plantar flex when squeezed
89
treatment of achilles tendon rupture
- almost alway surgical | - non operative based on pt preference or if pt is frail

Clin Med I (16 decks)

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