E2 Ortho- Topic list & Emphasized

What is Compartment syndrome?

Elevation of intracompartmental pressure to a degree that compromises blood flow to involved muscles and nerves

Compartment syndrome most commonly occurs after which fx?

Tibia

What part of the gastrocnemius is affected in a gastroc tear?

medial head MC

Who are gastroc tears MC in?

athletes > 30 yo

What is the MOA of a gastroc tear?

happens quickly during ballistic movements involving eccentric loading; hear a pop

ex: sudden push-off, sudden direction change, tennis (tennis leg), running on a hill, jump

How does a gastroc tear present?

diffuse calf pain, tearing sensation, unable to perform a calf raise, ankle will be in plantarflexion, ecchymosis, tenderness/swelling; imaging not needed

What is the tx for a gastroc tear?

NSAIDs, RICE, calve sleeve/compression hose, .5 inch heel lift/boot

What is a below knee amputation?

Transtibial amputation

What is the most common involved compartment in compartment syndrome?

Anterior compartment

What is normal compartment pressure?

< 10 mmHg

What are the 6Ps of Compartment Syndrome?

Pain, Paresthesia, Pallor, Paralysis, Pulselessness, Poikilothermia

True or False: Compartment syndrome can be due to prolonged running/walking and symptoms resolve after 30 minutes of stopped activity

True (exertional compartment syndrome)

What do you use to test for compartment syndrome?

Indwelling catheter or needle with a pressure monitor

What is considered a clinically significant pressure in compartment syndrome?

> 30 mmHg

What is considered a dangerous pressure in compartment syndrome?

> 40 mmHg

What is the tx for acute compartment syndrome?

EMERGENCY -Fasciotomy

What are Shin splints?

Gradual onset of pain in the anteromedial aspect of the distal 1/3 of leg after inc in running activity; associated w/ running on hard, uneven surfaces

What is the medical term for Shin splints?

Medial tibia stress syndrome

What is the tx for shin splints?

Rest, ice, NSAIDs, PT

What is a Stress fracture?

Hairline/microscopic break in bone d/t microtraumatic, cumulative overload on bone (overtraining, incorrect biomechanics, fatigue, poor nutrition and osteoporosis)

What testing is done to confirm the diagnosis of a stress fracture?

MRI

What is the reasons for 70% of amputations?

DM, Infections, PVD

What is the reason for 20% of amputations?

Trauma

What leg amputation is the better one to have due to increased knee function?

*gives best quality of life, pts do better after

Below Knee Amputations (transtibial)

What test is good for diagnosing proximal DVT/clot formation?

Duplex US

What is the gold standard to confirm DVT?

Venography

What is the gold standard to confirm PE?

Pulmonary angiography

How does a DVT present?

Virchow’s triad; + Homan’s, unilateral swelling and tenderness

What is Valgus?

"Knocked knee"

What is Varus?

"Bowed leg"

Valgus or Varus: pushing on knees laterally

Valgus

Valgus or Varus: pushing on knees medially

Varus

+ Valgus stress test = (MCL/LCL) injury

MCL

+ Varus stress test = (MCL/LCL) injury

LCL

What special test:

Patient supine, hip flexed, knee flexed at 90 degrees. Patient foot stabilized by examiner sitting on foot. Examiner "pulls" tibia forward/anterior

Anterior drawer test

What special test:

Patient supine, with knee flexed at 30 degrees. Femur stabilized with one hand and tibia is pulled anterior with the other hand. Tests for ACL tears/injuries.

Lachman test

What diagnostic study is used to diagnose meniscal injuries?

MRI

How does a Meniscal tear present?

+ McMurray and + Apley's Compression test

locking of knee d/t unstable fragments, swelling, pain

What is the MOA of a meniscus tear?

pt attempts to turn, twist or change direction during wt bear OR contact to the lat/medial aspect oh knee while LE is planted

What is “Jumper's knee"?

Patellar tendinitis

How does Patellar tendinitis (jumper’s knee) clinically present?

mostly basketball & volleyball players; tenderness along patella tendon

What is the most sensitive physical exam test for an ACL injury?

Lachman test

What diagnostic study is used for ACL/PCL/MCL/LCL injuries?

MRI

+ Lachman test and + Anterior drawer test

ACL injury

What is the "Terrible"/"Unhappy" triad?

ACL, MCL & Meniscal tears

+ Posterior drawer test

PCL injury

What is the MOA of a PCL tear?

knee is pushed backward

What is the MOA of a MCL tear?

lateral trauma; usually hear a pop or snap

What is the MOA of a LCL tear?

medial trauma; usually hear a pop or snap

What is the MOA of a ACL tear?

usually non-contact, complete tear; hear a popping sound

What diagnostic study would you order for a patellar fracture?

Plain film: AP, Lateral, & Sunrise view

What causes a patellar fx?

fell right on their knee; long recovery ~ 1 yr

What is the most common patellar dislocation?

Lateral dislocation

Are patellar dislocations more common in females or males? Why?

Females due to excessive Q angle

+ Apprehensive test

Patellar dislocation

What is the tx for patella dislocation?

reduction, immobilization, PT, NSAIDs

*get pre and post reduction imaging

What does an XR of Patella tendon rupture show?

+ patella alta (superior appearing)

On exam patient cannot actively extend their knee and there is a palpable defect inferior to the patella. Possible dx?

Patella tendon rupture

What is a "true" knee dislocation?

Tibiofemoral dislocation

What should you check in a tibiofemoral dislocation?

Pulses for vascular compromise

What causes a knee dislocation?

high energy trauma (fall or MVA) w/ injury to multiple knee ligaments

What is the most dangerous potential complication of a knee dislocation?

popliteal artery injury

What is the tx for a knee dislocation?

ortho consult STAT, immediate reduction; vascular compromise → consult vascular surgery STAT (life-threatening)

What demographic does Osgood-Schlatter disease most commonly affect?

Adolescent athletes, M > F

Pain and swelling in the anterior knee over the tibial tuberosity commonly seen in adolescent athletes. Possible dx?

Osgood-Schlatter disease

What is the most common form of knee arthritis?

Osteoarthritis

Who does OA affect more?

> 55 yo, obese, FMH

What knee compartment is MC involved in OA?

medial

+ Homan's sign = _____

DVT

+ Thompson's test = _____

Achille's tendon rupture

+ Thompson's test (Achille's tendon rupture)

Absence of plantar flexion when calf is squeezed

What is the tx for an Achilles tendon rupture?

ortho: surgical repair

The medial clear space of the ankle should not exceed _____ mm on XR

4 mm

What is the most commonly injured ligament in an ankle sprain?

Anterior talofibular ligament

90% of all ankle injuries are due to what MOA?

Inversion injuries- sprains

What is the MC injury in sports?

ankle sprain

How does an ankle sprain present?

pain, tenderness, swelling

What breaks in a trimalleolar ankle fracture?

Medial, lateral, and posterior malleolus

What breaks in a bimalleolar ankle fracture?

Medial and lateral malleolus

What is Pes planus?

Flat foot arch

What is Pes cavus?

Elevated longitudinal arch of foot

What is the MOA of a Maisonneuve fx?

d/t pronation and external rotation of the ankle

What would you see on an XR of Maisonneuve fx?

widening of ankle mortise medially, fx of medial malleolus, spiral fx of the proximal fibula

Who has a bigger Q angle?

Women

What is “housemaid’s knee”?

prepatellar bursitis -d/t trauma or chronic irritation to the ant. knee

What causes a tibial plateau fx?

trauma: fall from heights, MVA, MVA vs Pedestrian accidents

How does a torn Patellar tendon present?

floating knee cap

How does a torn Quad tendon present?

hold leg up and it drops immediately when you let go

What is vascular claudication?

PVD

What is neurogenic claudication?

spinal stenosis

What imaging needs to be ordered for a tibial plateau fx?

XR or CT w/ scout view

What can be affected by a knee dislocation or multi-ligamentous injury (unhappy TRIAD)?

injured popliteal artery = EMERGENCY

What is the forefoot?

includes the 5 phalanges, metatarsal bones, great toe

What is the midfoot?

connects to fore & rear foot, consists of 5 bones: 3 cuneiform, navicular, and cuboid

What is the hindfoot?

connects the midfoot and ankle, consists of the bony architecture of the calcaneus and talus

What is a Lisfranc injury?

injury of the mid/hindfoot (twisting/fx/dislocation)

What is hallux valgus?

bunion

How does Plantar fascitis present?

Pain in the morning with 1st step, + heel pain, tenderness w/ palpation

*common in runners and jumping sports

What is the tx for Plantar fasciitis?

NSAIDs, ice, PT, steroid injections, wt loss may help

What is a Pilon fracture?

Oblique, comminuted fracture of distal tibia that extends through the tibiotalar articular surface d/t trauma