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Clinical conditions for MSK > Session 4 - Disorders of the Knee > Flashcards

Session 4 - Disorders of the Knee Flashcards

(52 cards)

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1
Q

Femoral Shaft Fractures

Why may femoral shaft fractures occur in previously healthy children and young adults?

A

High-Velocity trauma

  • falls from height
  • road traffic accident

Child abuse in young children should be considered

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2
Q

Femoral Shaft Fractures

Why may femoral shaft fractures occur in the elderly?

A
  • osteoporotic bone
  • bone metastases
  • bone cysts

Occurs following a low-velocity injury
- falling over from a standing position

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3
Q

Femoral Shaft Fractures

Why is the proximal fragment abducted?

A

Due to pull of the gluteus medium and minimus on the greater trochanter

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4
Q

Femoral Shaft Fractures

Why is the proximal fragment flexed?

A

Due to the action of Iliopsoas on the lesser trochanter

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5
Q

Femoral Shaft Fractures

Why is the distal fragment adducted into a varus(medial) deformity?

A

Due to the actions of the adducted muscles (Adductor Magnus, gracilis)

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6
Q

Femoral Shaft Fractures

Why is the distal fragment extended?

A

Due to the pull of gastrocnemius on the posterior femur

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7
Q

Femoral Shaft Fractures

What does the patient present with, with this condition?

A

Tense swollen thigh

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8
Q

Femoral Shaft Fractures

Compare the blood loss in a closed femoral shaft fracture compared to an open one

A

Closed femoral shaft fracture

  • 1000-1500mL
  • may develop hypovolaemic shock

Open femoral shaft fracture

  • Double the amount
  • will develop hypovolemic shock
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9
Q

Femoral Shaft Fractures

How is this condition treated?

A

Surgical fixation

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10
Q

Distal femoral fractures

Why may this occur in younger patients?

A

High energy sporting injury

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11
Q

Distal femoral fractures

What will be seen on an x-ray of distal femoral fractures in younger patients?

A

Significant displacement of the fracture fragments

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12
Q

Distal femoral fractures

Why may this occur in an elderly?

A
  • osteoporotic bine

- fall from standing

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13
Q

Distal femoral fractures

Which vascular structure in the popliteal fossa may be damaged if there is significant displacement of the fracture?

A

Popliteal artery

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14
Q

Distal femoral fractures

Careful assessment of what structure in the limb before and after reduction of the fracture is essential?

A

Neurovascular

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15
Q

Tibial plateau fractures

In what type of injuries can Tibial plateau fractures occur?

A

High energy injuries

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16
Q

Tibial plateau fractures

What is the usual mechanism in this type of fracture?

A

axial (top to bottom) loading with varus or valgus angulation

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17
Q

Tibial plateau fractures

When these fractures are described as either unicondylar or bicondylar, what does it mean?

A

Unicondylar
- affecting one tibial condyle articulating surface within the knee joint

Bicondylar
- affecting both tibial condyles articulating surface within the knee joint

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18
Q

Tibial plateau fractures

Fractures affecting which tibial condyle are the most common?

A

Lateral tibial condyle

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19
Q

Tibial plateau fractures

Which condition will most patients develop in the affected joint despite careful approximation of the fracture fragments? why?

A
  • Post-traumatic Osteoarthritis

- Articular cartilage is always damaged

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20
Q

Tibial plateau fractures

Name 2 other injuries with the ligaments that Tibial plateau fractures can be associated with?

A
  • Meniscal tears

- Anterior cruciate ligaments injuries

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21
Q

Patellar fractures

Why may a patellar fracture occur?

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A
  • direct impact injury (knee against dashboard)

- eccentric contraction of the quadriceps

22
Q

Patellar fractures

In what age groups are these fractures common in?

23
Q

Patellar fractures

What can be seen/felt upon clinical examination?

Study These Flashcards
A
  • palpable defect in the patella

- haemarthrosis (blood in joint)

24
Q

Patellar fractures

Why may the patient be unable to perform a straight leg raise in some instances?

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A

The extensor mechanism is disrupted

- fracture completely splits patella distal to the insertion of the quadriceps tendon

25
Patellar fractures What is the treatment for displaced patellar fractures?
- reduction | - surgical fixation
26
Patellar fractures What is the treatment for undisplaced patellar fractures?
- do not usually require surgical fixation | - protected via splinting and using crutches whilst healing takes place
27
Patellar fractures What may be mistaken for a patella fracture on an X-ray?
Bipartite (in two parts) patella
28
Patellar fractures Why does a bipartite patella develop?
There is a failure of union of a secondary ossification centre with the main body of patella
29
Patella dislocation What is the term given to the partial displacement of the patella?
Subluxation
30
Patella dislocation What is the most common direction for the patella to dislocate? Why?
Lateral dislocation - (the Q angle ) the angle between the line of pull of the quadriceps muscles and patellar ligament means that during extension of the knee, the patella naturally tries to be displaced laterally
31
Patella dislocation What are the common causes of this condition?
- trauma - a twisting injury in a slight flexion - direct blow to the knee
32
Patella dislocation Which age group is most commonly affected?
Athletic teenagers
33
Patella dislocation What is the usual mechanism of injury?
internal rotation of the femur on a planted foot whilst flexing the knee (e.g sudden change of direction during sports)
34
Patella dislocation Give 4 factors that can predispose to a patellar dislocation
- Weakness of the quadriceps muscles, especially the VMO - Shallow trochlea(patellofemoral) groove with a flat lateral lip - Long patellar ligament - Previous dislocations
35
Patella dislocation What is the treatment for this condition ?
- extending knee then manually reducing patella (put it in correct alignment) - immobilisation is used whilst healing takes place - physiotherapy to strengthen the VMO
36
Meniscal injuries When do these injuries occur?
Sudden twisting motion on a weight-bearing knee in a high degree of flexion
37
Meniscal injuries What are the symptoms patients present with?
- intermittent pain, localised to the joint line - knee clicking, catching and locking - the sensation of the knee giving away
38
Meniscal injuries Why may swelling occur?
- delayed symptom - due to a reactive effusion or not at all - menisci are largely avascular (except at peripheries)
39
Meniscal injuries Why is acute haemarthrosis rare in Meniscal injuries?
Menisci are largely avascular
40
Meniscal injuries What does acute haemarthrosis indicate if present in Meniscal injuries?
- A tear in the peripheral vascular aspect on the meniscus | - an associated injury to the anterior cruciate ligament
41
Meniscal injuries Why may chronic effusion (increased synovial fluid) occur?
Synovitis ( inflammation of the synovial membrane)
42
Meniscal injuries What can be seen upon examination of the patient?
- joint line tenderness | - restricted motion due to pain or swelling
43
Meniscal injuries How is acute traumatic meniscal tears treated?
Treated surgically by either meniscectomy or meniscal repair
44
Meniscal injuries How are chronic degenerative meniscal tears treated?
Conservative management
45
Collateral ligament injury Why does this injury occur?
They usually result from acute varus or valgus angulation of the knee. - common sporting injury, particularly in direct contact sports
46
Collateral ligament injury In acute valgus strain, which collateral ligament is at risk?
medial collateral ligament (MCL)
47
Collateral ligament injury In acute varus strain, which collateral ligament is at risk?
lateral collateral ligament (LCL)
48
Collateral ligament injury Which collateral ligament is injured more commonly?
Medial collateral ligament
49
Collateral ligament injury Why does the lateral collateral ligament have a higher chance of causing knee instability?
- the medial tibial plateau forms a deeper and more stable socket for the femoral condyle than the lateral tibial plateau. - Hence, an intact LCL plays a more critical role in maintaining the stability of the knee
50
Collateral ligament injury What are the symptoms the patient present?
- pain and swelling of the knee. | - complain of it giving way or not supporting their body weight
51
Collateral ligament injury What is the unhappy triad?
injury to the anterior cruciate ligament, medial collateral ligament and medial meniscus
52
Collateral ligament injury How does the unhappy triad occur?
A strong force applied to the lateral aspect of the knee

Clinical conditions for MSK (6 decks)

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