Lower Limb 2 Flashcards
(57 cards)
1
Q
Vascular dx of leg pain
A
- DVT (constant/assymetrical pain)
- PVD (intermittent bilateral pain)
2
Q
Neurospinal dx of leg pain
A
- disc disease
- spinal stenosis
3
Q
Neuropathic dx of leg pain
A
- diabetes (increased sorbitol, myelin sheat gets holes leading to parathesia)
- chronic etoh abuse
4
Q
Musculoskeletal dx of leg pain
A
-chronic compartment syndrome
5
Q
Ankle brachial index (ABI)
A
systolic BP in ankle/systolic BP in brachial artery
6
Q
ABI values
A
- > 0.9 is normal
- ## .5-.9 intermitent claudication
7
Q
Risk factor modifications of leg pain
A
- smoking cessation
- BSL control
- BP control
- lipid lowering medicine
8
Q
Exercise modification for leg pain
A
- claudication exercise (leads to collateral circulation)
- 45-60min 3x weekly for 12 weeks
- 6 months later + 6.5 min walking time before pain
9
Q
Medical mgmt of leg pain
A
- antiplatelet meds
- phosphodiesterase inhibitor
- foot care
- pt education
10
Q
PCI/SX required when?
A
- poor response to exercise rehab and meds
- significant disability by claudication
- morphology of lesion
- bypass
11
Q
5 Ps of acute ischemic limb
A
- pain
- pallor
- pulselessness
- perishing cold (poikilothermia)
- parathesias
- paralysis is an extra one that is rare
12
Q
Further history of pts w/ PVD reveal
A
- lot of cigs
- 4 months of “leg cramps” in both legs
- 2-3 weeks of intermittent chest pain
- no doctor visits in last month
13
Q
Examination finding of PVD
A
- below knee is pale/col
- irregulary irregular pulse
- slow capillary refill
- reduced pulse
14
Q
Type I salter harris
A
- through physis
- child has point tenderness at epiphyseal plate
- no growth disturbance
- SCFE
15
Q
Type II SH fracture
A
- through physis and metaphysis
- most common SH fracture
- rarely results in functional limitations
16
Q
Type III SH fracture
A
- through physis and epiphysis
- prone to chronic disability bc it extends into articular surface of the bone
- rarely results in significant deformity
- Tillaux fracute is this type prone to disability
17
Q
Type IV SH fracture
A
- through epiphysis, physis, metaphysis
- can cause deformity and result in chronic disability
18
Q
Type V SH fracture
A
- Compression/crush injury of epiphyseal plate
- associated w/growth disturbance at the physis
- axial load injury
- poor functional prognosis
19
Q
Ossification of Femur
A
center of shaft-7th week IU lower end of femur-9th month IU head-first year greater trochanter-4th year lesser trochanter-12th year upper 3 fuses w/shaft around 18 years old
20
Q
Retinacular arteries
A
supply NOF and the head
21
Q
Subcapital fracture
A
- fracture of neck of femur occurs very close to femur head
- most common intrascapular fracture
22
Q
cervical fracture
A
fracture of neck of femur occurs cery close to midpoint of femur
23
Q
basal fracture
A
fracture of the neck of femur occurs very close to the shaft
24
Q
If the femur neck fracture is not impacted this deformity will be present
A
shortening of the limb bc the distal fragment is pulled upward by the rectus femoris, adductors and hamstrings resulting in overlaps
25
Proximall fragment goes where from a femur fracture
- abducted by glut medius/minimus
- laterally rotated by glut max, piriformus, obturators, and quadratus femoris
- flexed by iliopsoas
26
Distal fragment goes where from a femur fracture
- pulled upward behind proximal fragment by hamstirngs and quadriceps femoris
- adducted and laterally rotated by adductors
- drawn back by gastrocs which may injure popliteal artery
27
largest sesamoid bone
patella, acts as a fulcrum for other muslces
28
Patella stabilized superiorly by....
inferiorly. ..
medially. ...
laterally. ..
- quadriceps
- patellar ligament
- vastus medialis
- lateral condyle
29
In a patella dislocation, it goes where? more common in whom?
- laterally from a twisting motion
| - women, due to shape of hips (cause genu valgum or knock kneed appearance)
30
Direct patella fracture
- considerable comminution
- little displacement of fractured fragments
- fall onto knee/hits dashboard
31
Indirect patella fracture
- less comminuted
- displaced and often transverse
- jumping/rapid flexion of knee joint against fully contracts quads
32
In tib/fib fracture the distal fragments are drawn where?
upward behind the proximal fragments by the gastroc and soleus
33
Potts fracture
- lateral or medial malleolus fracture
| - forcible eversion of the ankle
34
Bi-malleolar fracture
both medial and lateral malleolus
35
Dupuytren's fracture
talus thrust upward between tib/fib
36
syndesmosis
- cord of fibrous tissue called a ligament
- common in football/skiing
- painful external rotation
37
high ankle sprain
- aka syndesmotic sprain
- injury to distal tib/fib joint, injuring the interosseus of syndesmotic ligaments from excessive dorsi or plantar flexion
38
Weber classification A
- fracture inferior to syndesmosis
- syndesmosis intact
- medial malleolus may be fractured
- usually stable
39
Weber classification B
- fracture at level of syndesmosis
- syndesmosis intact or partial tear
- possible medial fracture or deltoid damage
- stability variable
40
Weber classification C
- fracture above level of ankle joint
- tibfib syndesmosis injured
- usually medial fracture or deltoid injuy
- unstable
41
Metatarsal stress fracture
- occurs in distal 1/3 of metatarsals
- most common in 2nd and 3rd metatarsal
- minimal displacement
- aka march fracture
42
SCFE
-posterior and medial displacement of femoral capital epiphysis
43
mechanical etiology of SCFE
- thinning of perichondral ring complex
- relative or absolute femoral retroversion
- change in inclination of adolescent proximal femoral physis relative to femoral neck and shaft
44
predispositions to SCPE
- obesity
- rapid growth
- endorcinopathies
45
Stable SCFE
- pain in groin, referred to anteromedial aspect of thigh and knee
- loss of internal rotation w/ complaints of pain at limit of internal rotation
46
Unstable acute SCFE
- severe fracture like pain in hip region as a result of a fall or twisting injury
- unable to bear weight
47
intracapsular hip fracture
- includes femoral head and neck fractures (subcapital, transvervical, basicervical)
- at risk of non union and avascular necrosis from disrupted blood supply to femoral head
48
extracapsular hip fracture
which includes trochanteric, intertrochanteric, and subtrochanteric fractures
49
hip fracture stats
- highest in elderly pts
- 15-20% die within 1 year of fracture
- more common in females
50
risk factors of hip fracture
- nutrition (lack of Vit D, eating disorder, high caffeine)
- smoking/etoh
- medications (steroids, diuretics, anticonvulsants
- environmental factors
51
Garden I
incomplete fracture of femoral neck
52
Garden II
complete fracture w/o displacement
53
Garden III
complete fracture w/partial displacement
54
Garden IV
complete fracture w/full displacement
55
Pauwels classification
more vertical the line, the greater the risk of non union b/c increased shear stresses across the fracture
56
Achilles tendon rupture
- largest, most powerful tendon in body
- primarily seen in males w/sporting event with sudden starting and stopping
- weak plantarflexion, positive thompson test
57
Assocaited achiiles tendon rupture conditionss
- ochronosis
- steroid use
- quinolones
- inflammatory arthritis
