Lower Limb Injuries

Question 1

State 2 types of hip/groin injuries.

Answer 1

Acute injury. Osteitis pubis. Piriformis syndrome. Femoracetabular impringement. Tendinopathy. Athletic pubalgia.

Question 2

What classification is used for a femoral neck fracture?

Answer 2

Garden classification.

Question 3

What are the different aspects of the Garden Classification for a femoral neck fracture?

Answer 3

Type 1 - Stable (Valgus - outward angulation of the distal segment of a bone). Non-displaced. Complete: partially displaced. Complete: fully displaced.
Type 2 - Non-displaced
Type 3 - Complete: partially displaced
Type 4 - Complete: fully displaced

Question 4

What are the different aspects of the Functional Classification?

Answer 4

Stable (I/II). Unstable (III/IV).

Question 5

Give 2 examples of acute injuries.

Answer 5

Tendon strain. Stress fracture. Trochanteric pain syndrome. Labral tear.

Question 6

Where do you find acute injuries for hips/groins?

Answer 6

In athletes and active adults.

Question 7

What is a stress fracture?

Answer 7

Fatigue induced fracture of the bone due to repeated stress.

Question 8

What is trochanteric pain syndrome?

Answer 8

Trochanteric bursitis - inflammation in the muscles/tendons/fascia/bursae.

Question 9

Define a labral tear.

Answer 9

Injury to the labrum - soft tissue that covers the acetabulum (socket) of the hip.

Question 10

Define osteitis pubis.

Answer 10

Idiopathic, inflammatory disease of pubic symphysis.

Question 11

Define piriformis syndrome.

Answer 11

When the piriformis muscle located in the buttock region spasms- buttock pain. Piriformis muscle can also irritate the sciatic nerve - pain, numbness, tingling along the back of leg and into foot.

Question 12

Define femoracetabular impringement.

Answer 12

Extra bone grows along one/both of bones that form hip joint. Bone gets irregular shape and rubs against each other during movement.

Question 13

Define tendinopathy.

Answer 13

Tendon disorder resulting in pain, swelling and impaired function.

Question 14

Define athletic pubalagia.

Answer 14

Refers to sports hernia (painful soft tissue in groin area).

Question 15

State the management of a femoral shaft fracture.

Answer 15

Start IV fluids. Send bloods. Analgesia.

Question 16

State 3 knee injuries.

Answer 16

Knee soft tissue injury. Fractured patella. Patella dislocation. Segond fracture. Fracture of the tibial condyle.

Question 17

State a sign of a knee soft tissue injury.

Answer 17

Wasting. Deformity. Swelling. Bruising.

Question 18

State 1 thing to be ruled out with a knee soft tissue injury.

Answer 18

Quadriceps tear.

Question 19

State a test used to rule out a quadriceps tear.

Answer 19

Use Movement - McMurray’s test/Drawer test/Lachaman’s test.

Question 20

What knee rule is used to determine whether radiography should be used?

Answer 20

Ottawa’s knee rule.

Question 21

State 2 parts to Ottawa’s knee rule.

Answer 21

Aged 55 or older. Isolated tenderness to patella (not anywhere else). Tenderness at the head of the fibula. Inability to bear weight.

Question 22

Describe the anterior drawer test.

Answer 22

Physical examination used to test the stability of the knee’s anterior cruciate ligament (ACL) - anterior force applied to the tibia.

Question 23

What is a positive anterior drawer test?

Answer 23

If the tibia has more movement/ligament more loose compared with the other knee.

Question 24

State the management of an undisplaced patella.

Answer 24

Bandage.

Question 25

State the management of a displaced patella.

Answer 25

Fixation required.

Question 26

State the management for a patella dislocation.

Answer 26

Analgesia - nitrous oxide. X-ray to exclude osteochondral fracture.

Question 27

Define a segond fracture.

Answer 27

Fracture on the lateral aspect of the proximal tibia, below the articular surface area.

Question 28

State associated injuries to the segond fracture.

Answer 28

Tear of the anterior cruciate ligament. Injury of the medial and lateral menisci (fibrocartilage which serve to disperse the friction in the knee). Avulsion (detachment of a bone fragment) fracture of the fibular head.

Question 29

State another name for a fracture of the tibial condyle.

Answer 29

Tibial plateau fracture.

Question 30

State 2 injuries related to the tibia (leg).

Answer 30

Fracture of the tibial shaft. Fracture of the fibula shaft. Pretibial lacerations. Compartment syndrome.

Question 31

State one place you would find a pretibial laceration?

Answer 31

Elderly. Poor blood supply.

Question 32

State one thing to exclude with a fracture to the fibula shaft.

Answer 32

Exclude common peroneal injury (if at neck). Exclude compartment syndrome.

Question 33

Define compartment syndrome.

Answer 33

When there is increased pressure with one of the body's anatomical compartments - results in insufficient blood supply to tissue within space (therefore swelling/damage to muscles/nerves).

Question 34

State a symptom of compartment syndrome.

Answer 34

Paresthesia (pins/needles). Pallor (pale appearance). Paralysis. Pulselessness.

Question 35

State 2 things that can happen to ankles.

Answer 35

Ankle sprains (80% inversion). Ankle fractures. Tendoachilles tear. Fracture of calcis (heel bone).

Question 36

State a ligament affected in an ankle sprain.

Answer 36

Anterior talofibular ligament. Calcaneofibular ligament. Talofibular ligament.

Question 37

What classification is used for ankle fractures?

Answer 37

Weber's classification.

Question 38

State the types of Weber's classification.

Answer 38

1) Type A - fractured tip of lateral malleolus 2) Type B - undisplaced fracture of the lateral malleolus (high up) 3) Type C - undisplaced fracture of the lateral malleolus and undisplaced transverse fracture of the medial malleolus.

Question 39

State the test used to determine a tendoachilles tear.

Answer 39

Simmond's test - normally when you squeeze the calf it should produce plantar flexion.

Question 40

State the angle measured to determine fracture of the calcis (heel bone).

Answer 40

Boehler's angle (if less than 20 degrees then fracture likely).

Question 41

State the angle measured to determine fracture of the calcis (heel bone).

Answer 41

Boehler's angle (if less than 20 degrees then fracture likely).

Question 42

State the angle measured to determine fracture of a .

Answer 42

Boeher's angle.

Question 43

State the most commonest metatarsal to be fractured.

Answer 43

Base of the fifth metatarsal.

Question 44

State the two main types of metatarsals.

Answer 44

Jones fracture (involves 5th metatarsals) - occur at the metaphyseal-diaphyseal junction. Pseudo jones fracture (5th metatarsal base).

Question 45

Define the Jones fracture.

Answer 45

Occurs at the metaphyseal-diaphyseal 4th and 5th junction.

Question 46

State when a Jone's fracture would be experienced.

Answer 46

Force applied when heel raised and foot plantar flexion.

Question 47

State where a Pseudo Jones fracture is experienced.

Answer 47

5th metatarsal base.

Question 48

State when a Pseudo Jone's fracture would be experienced.

Answer 48

Inversion and plantar flexion. Involves proximal tubercle.

Question 49

Define a Lisfranc fracture.

Answer 49

A fracture where one of metatarsals is displaced.