Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Ortho ST3 Interview > Lower limb > Flashcards

Lower limb Flashcards

(70 cards)

Start Studying
1
Q

What is the blood supply to the head of femur?

A

In adults it is a retrograde blood supply along the neck of femur from retinacular vessels which orginate from the medial/lateral circumflex femoral artery which come from the the profunda femoris

Nutrient vessels

In children there is also blood supply along the ligamentum teres but this is obliterated later childhood. acetbular branch of obturator artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are the origins of the joint capsule?

A

Anterior aspect runs along intertrochanteric line
Posterior aspect 1.5cm proximal to intertrochanteric line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do you consider offering a THR for a NOF?

A

NICE guidelines state:

If able to walk outdoors with no more than 1 stick
No bad medical comorbidities that makes procedure unsuitable
Expected to carry out ADLs for 2 further years minimum (HEALTH Trial- THR better functional outcomes if used for longer than 2 years compared to hemis)

In my practice I also consider if they drive, how far they walk, if they are able to follow hip precautions post op and patient preference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cemented or uncemented hemis?

A

Cemented
Less loosening and periprosthetic fractures
Easier revision surgery

Increased risk of bone cement implantation syndrome- cardiopulmonary compromise from embolic shower during cementing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you reduce the risk of bone cement implantation syndrome?

A

Identify those at high risk:
Male, older, diuretics, cardiopulmonary disease

Inform anaesthetist of risk and pre cementing
Wash and dry femoral canal
Use cement restrictor and suction catheter
Do not use excessive manual pressurisation for those at high risk

Anaesthetic team to be aware the cardiopulmonary support may be required- vasopressors etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some of the BPT required for NOFs?

A

AMTS pre op
Theatre within 36 hours
FIB in ED and pre op
Orthogeris R/V
Bone health
PT day 1- FWB D1
Dietician review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the WHITE 11/FRUTI trial?

A

Fix or replace undisplaced IC NOF #- pragmatic trial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the approaches to the hip you know?

A

Anterior approach- internervous between sartorius + TFL and the rec femoris and gleut medius

Anterolateral- TFL and gleuteus medius

Direct lateral- Hardinge- muscle splitting approach, gleutues medius and minimus cuff, releasing vastus lateralis fibres proximally to expose LT. SGN runs 3-5cm proximal to GT in beneath gleutus minimus and medius

Posterior approach- gleuteus maximus splitting, detach short external (piriformis and Obturator internus) rotators, watch out for sciatic nerve and IGA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of hip dislocation is commonest?

How do they present on examination?

A

Posterior hip dislocation- 90%
Flex, Adducted, internal rotation

Anterior- extended, abducted, external rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do posterior hip dislocations happen and what are the associated injuries?

A

Dashboard injuries classical

Look for:
Posterior wall acetabular injuries
Femoral head #s- Pipkin
NOF#s- do not reduce if present
Sciatic nerve injury- 10-20%
Ipsilateral knee injuries
Aortic injuries- deceleration tear

ATLS approach needed
Trauma CT?

CT pelvis at least pre/post reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you reduce a closed hip dislocation?

And when should you do so?

A

Check there is not a NOF #!!

Explain and consent the patient for the procedure
Ensure you have a suitably trained ED/anaesthetic doctor to perform sedation- propofol ideally
Brief
Supine
Counter traction on ASIS
Flex + in line traction of hip + adduction + internal rotation- Allis vs CM technique

Check xray and then CT pelvis to assess for acetabular/head/neck fractures

Placing in traction afterwards if associated acetabular #

Reduced within 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you classify femoral head fractures?

A

Pipkin classification

1- fracture below fovea- non weight bearing surface affected
2- above fovea- weight bearing surface affected
3- involving femoral neck
4- involving acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the subtalar joint?

A

Synovial joint
Calcaneus and talus
Eversion and inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the Hawkins classification of talar fractures?

A

1- non displaced talar neck fracture
2- subtalar dislocation
3- subtalar and tibiotalar dislocation
4- subtalar, tibiotalar and talo-navicular dislocation

AVN risk increases and type increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of a hip dislocation?

A

AVN
Sciatic nerve injury- most neuropraxia
Recurrent dislocators- place in cricket pad splint to prevent hip flexion
Post traumatic arthritis
#s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What displacement of the parts of femur do you get in a sub troch fracture?

A

Proximal part flexed and ER by attachments from Iliopsoas and SERs

Distal fragment is ADDucted and shortened
Adductors causes this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the ligaments of hip capsule?

A

Iliofemoral- strongest prevents hyperextension
Pubo femoral
Ischiofemoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the iliotibial band?

A

Longitudinal band of fibres formed from gleut max + Tensor fascial lata
Inserts into femoral condyle
Stabilises knee during extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the short external rotators?

A

Pirformis
Gemellus sup
Obturator internus
Gem inf
Obturator ext
Quadratus femoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the course of the sciatic nerve?

A

L4-S3 origin
Exits via the greater sciatic foramen
90% time below piriformis
10% through piriformis
1%< above
Lies beneath gleut max
Post surface of QF

1/3 way between IT and GT
Runs in post compartment behind adductor magnus
to Popliteral fossa
Divides into tibial and common peroneal nerve at superior point of fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the contents of the greater sciatic foramen?

A

Greater- 10 structures, 7ns, 3 vessels

Above Piriformis
SGN + vessels
Below piriformis
Sciatic nerve
IGN + vessels
Internal pudenal vessels
Pudendal nerve
Post femoral cutaneous nerve
N to quadratus femoris
N to obt internus

Lesser sciatic N (PINT)
Pudendal N
Internal pudendal vessels
N to obt internus
Tendon to obturator internus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the aim with a young NOF #

A

ATLS- high energy injuries- exclude other injuries

Aim to reduce and fix rather than replace
Avoid AVN- achieve bony union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can you classify young NOFs

A

Pauwel’s

Degree of angulation of fracture
<30o- stable
30-50- ?stability
>50o- unstable

Determines risk of non union and AVN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you manage a young NOF?

A

Next trauma list as a priority
Closed reduction if possible-Leadbetter’s technique- The affected leg is flexed to 45° with slight abduction and then extended with internal rotation while longitudinal traction is applied.
?Capsulotomy- remove tamponading effect of joint haematoma
Open reduction if unsuccessful- ant approach to the hip + bone hooks/k wires/traction

Garden1/2- Cannulated screws
Garden 3/4- DHS
Pauwels 3- add in derotational screw

Cannulated scews- 6.5mm

Analgesia post op
Protected weight bearing + follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe the anatomy of the PCL and ACL?
LAMP
26
What is the blood supply to the knee joint?
Popliteal A gives off the genicular arteries Superficial femoral a gives off descending genicular as Anterior tibial branch gives off recurrent branch
27
Boundaries and contents of popliteal fossa?
Boundaries Superomedially- semimembranosus/semitendionsus Superolaterally- biceps femoris Inferomedially- gastroc medial Inferolaterally- gastroc lateral Contents (superficial to deep) Common peroneal + tibial N Popliteral vein + short saphenous POpliteal A LNs
28
Differential diagnosis of swelling in popliteal fossa
Trauma DVT cellulitis/abscess Baker's cyst Aneurysm Varicose Vein Bony cancer/lesion
29
Describe the lower leg compartments
Anterior- DPN + anterior tibial A Anterior tibialis EHL EDL Peroneus tertius Lateral- SPN + peroneal A Peroneus brevis + longus Posterior- Tibial N + posterior tibial a Superficial Plantaris Gastroc Soleus Deep Post tib FHL FDL Popliteus
30
What are the major concerns with acute knee dislocations?
These are high energy injuries with high rates of neurovascular injuries Vascular injuries- 7-14% Nerve- CPN -25% #s- 60% Patella tendon rupture Ligamentous injury
31
How can you classify acute knee dislocations?
High energy vs ultra low energy (obese) Direction of dislocation Ligamentous injury
32
What are you looking for on examination of acute knee dislocation?
Thorough examination of neurovascular status pre relocation Dimple sign- medial aspect- buttonhole throughing of medial femoral condyle through the medial capsule- unreducible closed
33
What to do if pulses/absent pulses in acute knee dislocations?
Follow BOAST guidelines for arterial injury Relocate Re-examine CTA + involve vascular If still absent post reduction then for immediate surgical exploration- do not wait for imaging If present pulses ABPI and <0.9 for CTA Need serial ABPI to monitor Genicular arteries can mask popliteal injury
34
How to reduce/maintain reduction in acute knee dislocations?
Traction + reverse deforming forces +/- extension Splint in 20-30o of flexion
35
What are the associated injuries in tibial plateau fractures?
Can be high energy injuries Compartment syndrome Meniscal tears- schatzler 2/4 ACL rupture- 4/5 Neurovascular injury- 4
36
Classify tibial plateau fractures?
Schatzker 1- lateral spit 2- split + depression 3- depression 4- medial plateau 5- bicondylar 6- dissociated shaft and plateau
37
Which nerves are at risk during ankle fracture surgery?
SPN-10cm proximal to lateral malleolus Medial approach- great saphenous nerve runs anteriorly, with tibial nerve running posteriorly in tarsal tunnel Posterolateral- sural nerve
38
Important points in history for ankle fractures?
Type 2 DM, decreased mobility, peripheral neuropathy, PVD, renal disease, smoking, alcohol abuse
39
What to think if a isolated medial malleolus #?
Think maisonneuve!! Knee xray
40
Why do you need a mortise view?
15-20o of internal rotation Assesses the articulation of the talus, fibula and tibia- ie. the mortise Assess lateral joint and lateral talus
41
What are the general management rules for ankle fractures?
If stable for treatment in a cast/boot and WBAT as tolerated If uncertain stability for weight bearing xray at 1/2 weeks If <60 years old and for operative intervention aim for a D0/1 fixation
42
Which ankle fractures are considered unstable?
Weber B #s + talar shift Weber C fractures Bimalleolar/triamalleolar
43
How do you manage unstable ankle fractures?
If <60 years old for ORIF If >60 years old/medically comorbid: If can get reduction and is maintained at 2 weeks for close contact casting for 6 weeks If reduction lost for ORIF vs hindfoot nail
44
What is the aim of surgery for ankle fractures?
To achieve reduction and stability of the ankle mortise
45
How do you manage Pilon fractures?
With difficulty: Span, scan and plan Intra-articular fracture So aim is to provide absolute stability and anatomical reduction of articular surface whilst maintaining soft tissues
46
What are the classical Pilon fragments found on CT?
Medial malleolus fragment Volkmann fragment- posterolateral from PITFL Chaput fragment- anterolateral from AITFL
47
Do you know any research that may guide your decision making about ankle fractures?
AIM study- >60 year olds, unstable ankle fractures- CCC vs ORIF- equivalent ankle fnx at 6 months- loss of reductio with CCC, more infections with ORIF. Awaiting long term follow up to see if long term complications/operations needed in either group FAME has finished recruitment- same as AIM but for 18-60 year olds
48
What do you need to assess in patients with a calcaneal fracture?
Think ATLS + CT scan A lot of associated injuries 10% have contralateral calc and spinal injuries 60% of calc #s extend into joint Hip and lower limb examination is necessary
49
What are the different types of calcaneal #s?
Extra-articular Sustenaculum tali #, calcaneal tuberosity # vs Intra-articular Tongue type and depression type #s
50
How do you manage a calcaneal fracture?
ATLS CT scan Cast + NWB + discuss with F&A specialist Operative management depends on patient vs injury factors Patient: Smoker, T2DM, alcohol, compliance Injury: Intra-articularm Bohler's and Gissane's angle, open, skin necrosis- tongue type Also note the UK HEEL trial from 2014 RCT Multicentre, looking at displaced intra-articular calc #s No differences in outcomes between op and non op at 2 years
51
What is a lis franc injury?A
Tarsometarsal # dislocation characterised by traumatic disruption between the medial cuneiform and 2nd metatarsal articulation
52
How does lis franc injury occur?
Axial and rotational loading through plantar flexed foot
53
What forms the lis franc joint?
Osseous components- transverse arch with 2nd metatarsal base as key stone Ligamentous- lis franc lig runs from medial cuneiform to 2nd metatarsal Strongest ligament- with plantar side stronger- so dorsal subluxation is common
54
What to do when examining for a ?lis franc injury?
Plantar bruising is pathognomic for lis franc injury Tender mid foot Dorsal subluxation of 2nd metatarsal of stressing
55
What would you see on imaging of a lis franc injury?
Fleck sign Widening between 1st and 2nd ray of >2mm Disruption of line from medial aspect of 2nd metatarsal to medial aspect of medial cuneiform Dorsal displacement of metatarsals Weight bearing xray if unsure- can guide non operative management if no displacement CT scan for diagnosis/pre op management
56
Management of lis franc injury?
Non op- if no displacement on weight bearing xray Operative- ORIF vs percutaneous fixation vs tight ropes
57
What are the ligaments around the ankle?
Laterally- lateral collateral ligament- Anterior/post talofibular ligament calcneofibular ligament Medially- Deltoid ligament- superfiscial: Ant tibiotalar, tibionavicular, tibiocalcanea; Deep Post tibiotalar
58
What are the goals of a TKR?
Alleviate pain, enable ADLs, personal independence Restore mechanical alignment, restore joint line, balance soft tissues
59
What are the alternatives to a TKR?
Conservative- NSAIDs, activity mods, weight loss, PT, orthotics, injections Osteotomies Unicompartmental Fusion
60
What are the different types of knee replacements?
Unconstrained- PCL retaining or subsituting Constrained- hinged- global ligamentous instability/trauma
61
When is a patient suitable for a TKR/THR?
Trialled all conservative treatment options Impacting ADLs Night pain
62
What to examine in a normal joint?
Gait Skin Range of movement Stability Leg lengths
63
Post op PNI assessment?
CCRISP A2E- + gather info Sciatic nerve identified? Patient fall post op? Regional nerve blocks? Expanding haematoma Post op dislocation- leg length discrepancies Excessive lengthening Compression vs direct trauma Release compressive bandages Flex knee
64
Classes of nerve injury?
Seddon's 1- neuropraxia full recovery 2- axonotmesis-spontaneous recovery is possible 3- neurotmesis no spontaneous recovery
65
Bedside diagnostic aids for NEc fasc diagnosis?
LRINEC and Finger sweep test
66
Types of Nec Fasc?
1- polymicrobial 2- monomicrobial (GAS) 3- marine 4- fungal
67
Management of Nec Fasc?
Extensive immediate aggressive debridement Microbiologist ITU Plastics for recon 2 consultant decision if for primary amputation
68
Pathophysiology of Charcot's arthropathy?
Sensory neuropathy Leads to to loss of protective sensation Destruction of foot and ankle joint
69
Classical signs of charcot?
Warm and erythematous foot that improves with elevation Collapse of medial arch On xray- fragmentation, subluxing and swelling
70
How to manage charcot arthropathy?
Obs Bloods XRays MRI- abscess vs soft tissue swelling Bone scan- charcot vs abscess vs osteomyseltitis Brace, osteotomies and fusion, or ampuation

Ortho ST3 Interview (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions