LE Orthopedic Conditions

Bleeding

most common complication of pelvic fracture.

Sartorius

muscle responsible for avulsion fracture of ASIS.

Rectus Femoris

muscle responsible for avulsion fracture of AIIS.

Avascular Necrosis

most common complication of femoral neck fracture.

Duverney’s Fracture

- isolated iliac wing fracture

- stable fracture

Malgaigne Fracture

- double vertical fracture of anterior and posterior pelvic ring

- unstable fracture

Hamstrings

muscle responsible for avulsion fracture of ischial tuberosity.

Avulsion Fracture

traction apophysitis secondary to forceful muscle contraction.

Osteitis Pubis

- inflammation of symphysis pubis

- causes:

• pregnancy

• overactivity of hip adductors

• motor bikers

• gymnast

- signs and symptoms

• burning groin pain

• dull, aching pain to sharp stabbing pain

• (+) moth eaten appearance in x-ray

• tightness of hip adductors

• weakness of hip abductors

Symphysis Pubis Dysfunction

- lax ligament

- pain in the pubic area aggravated by stepping fown from a curb

- poor spinal stabilizing muscles

- overactive adductors; underactive abductors

Diastasis Symphysis Pubis

widening or separation of the pubic symphysis due to a ruptured ligament.

Multiple Myeloma

- cancer that started in the bone marrow

- overproduction of abnormal plasma cells

- signs and symptoms:

• noctural nagging pain

• (+) mickey mouse lesion

Innominate

most common site of metastasis of multiple myeloma.

Hip Pointer

contusion to ASIS due to direct trauma.

Anterior Innominate Syndrome

- one innominate rotates anteriorly in relation to the other

- etiology: attributed to tight quadriceps or illiopsoas muscles

- supine: affected leg longer

- sitting: affected leg shorter

Posterior Innominate Syndrome

- one innominate rotates posteriorly in relation to the other

- etiology: attributed to tight hamstrings

- supine: affected leg shorter

- sitting: affected leg longer

Supine to sit test

special test for innominate syndrome.

Ischiogluteal Bursitis

- direct trauma to buttocks

- prolonged sitting on hard surface

- “boatman’s/tailor’s/weaver’s bottom

Slipped Capital Femoral Epiphysis

- downard slippage of femoral head from growth plate

- most common hip pathology in adolescents

- tall and obese; M > F

- signs and symptoms:

• abduction with IR

• presents with hip flexion and ER

• pain on lateral hip

• trendelenburg/waddling gait

- management: fixation using pins/screw

Legg Calve Perthes Disease

- avascular necrosis of the femoral head in children (coxa plana)

- short and thin, 7 y/o ; M > F

- signs and symptoms:

• abduction and IR

• pain on groin or thigh

• psoatic gait

• Toronto (ABIR)

• Trilateral (ABIR)

• Scottish Rite (FAB) - most commonly used

orthosis for LCPD.

I - necrosis

II - fragmentation

III - reossification

IV - healing

waldenstrom stages of LCPD.

Coxa Magna

enlarged femoral head.

Coxa Breva

short broad femoral neck.

Congenital Hip Dislocation

- dislocated at birth

- special test: Ortolani’s Test

Congenital Dislocatable Hip

- intact at birth, but unstable or dislocatable

- special test: Barlow’s Test

Congenital Subluxable Hip

- intact at birth but subluxable

- partial hip dislocation due to lax ligaments

Teratologic Hip Dislocation

- fixed hip dislocation prenatally

- arthrogryposis multiplex congenital

Acetabular Dysplasia

- absent condyloid ligament

- shallow hip socket

• Von Rosen (FAB)

• Ilfeld (FAB)

• Pavlik Harness (FABER) - most common

orthosis for congenital hip dislocation.

Falls

cause of acquired hip dislocation in elderly.

Motor Vehicular Accident

cause of aacquired hip dislocation in young people.

Cemented Fixation

- fixation used for the elderly and sedentary

- made up of polymethylmethacrylate

- weight bearing is tolerated <24 hrs

Non-cemented Fixation

- fixation used for young, active patients

- made up of porous coating

- weight bearing is limited up to 3 months

• Hip flexion >90°

• Adduction over the midline

• Internal rotation beyond neutral

THR posterolateral approach precautions.

• Hip flexion >90°

• Combined FABER

• Hip extension, adduction, ER beyoud neutral

THR anterolateral approach precaution.

• Adduction past neutral

• No active antigravity abduction for at least 6-8 weeks

THR trangluteal approach precaution.

• Pronated foot

• IR of hip

• Shorter leg

• Anterior pelvic tilt

components of coxa vara.

• Posterior pelvic tilt

• I/L leg is longer

• ER of hip

• Supinated foot

components of coxa valga.

• Increase Q angle

• Patella alta

• Genu valgum

• External tibial torsion

• Subtalar pronation

• In-toeing

components of anteversion.

• Decreased Q angle

• Patella baja

• Genu varum

• Internal tibial torsion

• Subtalar supination

• Out-toeing

components of retroversion.

Snapping Hip Syndrome

coxa saltans.

Internal Snapping Hip

characterized by a tight iliopsoas or iliofemoral ligament, which hits the iliopectineal line/hip joint capsule resulting to a snapping sound.

External Snapping Hip

- characterized by a tight ITB that hits the greater tubercle, resulting in a snapping sound
- most common

Intracapsular

sound is caused by loose bodies due to trauma or arthritis.

Meralgia Paresthetica

- impingement of the lateral femoral cutaneous nerve at the inguinal ligament

- burning pain at anterolateral thigh

- causes:

• pregnancy

• tight belt

• tight pants

Hamstrings

- most commonly strained muscle

- sprinting and jumping on hurdles are one of the causes

Quadriceps (Rectus Femoris)

can be strained due to forceful knee extension.

Adductors (Adductor Longus)

can be strained due to forceful abduction.

Charley Horse

- contusion to the quadriceps (rectus femoris)
- most commonly contusion

Heterotrophic Ossification

- abnormal bone growth in joint that is caused by prolonged immobilization

- signs and symptoms:

• pain

• hard end feel

• increased alkaline phosphate

• LOM

- management:

• early mobilization

• prolonged stretching

• CVA/SCI: shoulder

• SCI: hip

• burns: posterior elbow

common sites for heterotrophic ossification.

Disodium Etidronate

medication for heterotrophic ossification.

- abnormal bone growth in muscle caused by trauma leading to contusion

- signs and symptoms:

• pain

• palpable mass

• flexion contracture

- management:

• gentle active ROM

• Passive ROM and stretching

• Massage

contraindicated management for myositis ossificans.

• UE: Brachialis

• LE: Quadriceps

common sites for myositiis ossificans.

Osgood Schlatter Disease

- inflammation of patellar tendon at the tibial tuberosity

- bilateral enlargement of tibial tuberosity

- M>F; Adolescents

Ultrasound

contraindicated management for Osgood-Schlatter Disease.

Osteochondritis Dissecans

- lesion at the subchondral part of the femur

- common: lateral aspect of medial femoral condyle

Sinding Larsen Johansson Disease

lesion at the inferior pole of the patella.

Hoffa’s Disease

impingement of infrapatellar fat pad between femur and tibia.

Chondromalacia Patella

- degeneration of the articulating surface of patella

- other names: PFPS, patellofemoral arthralgia, runner’s knee

• Clarke’s Test

• Waldron’s test

special tests for chondromalacia patella.

• VMO weakness

• Increased Q angle

• Tight ITB

characteristics of chondromalacia patella.

Osteoarthritis

weight bearing condition due to wear and tear.

Genu Varum

most common deformity seen in osteoarthritis of the knee.

• Knee: CARS-UBC

• Ankle: Lateral heel wedge

orthosis for osteoarthritis.

Pellegrini Steida Disease

ossification of MCL.

MCL

injury to this knee ligament is caused by valgus stress.

LCL

injury to this knee ligament is caused by varus stress.

ACL

injury to this knee ligament is caused by a hyperextension injury or an excessive anterior translation of the tibia and is characterized by an audible pop and knee buckling.

Lachman Test

special test for ACL tear.

PCL

injury to this ligament is caused by hyperflexion injury or an excessive translation of the tibia from the femur and characterized with difficulty in knee extension.

• Posterior drawer sign

• Posterior sag sign

special tests for PCL.

Hamstrings > Quadriceps

strengthening protocol for ACL.

Quadriceps > Hamstrings

strengthening protocol for PCL.

18-19 months

genu varum is normal until this age.

3-4 years old

genu valgum is normal until this age.

• Weak or paralyzed quadriceps

• Spastic quadriceps

• Plantarflexor spasticity

causes of genu recurvatum.

Prepatellar Bursitis

- housemaid’s knee

- most common

Superficial Infrapatellar Bursitis

• nun’s knee

• clergyman’s knee

• vicar’s knee

Pes Anserine Bursitis

characterized by pain at inferomedial aspect of knee.

Popliteal Bursitis

baker’s cyst.

• Increased Q angle

• Patella Alta

• Genu Valgum

• Extenral tibial torsion

• Subtalar Pronation

• In toeing

compensatory movements of femoral anteversion.

• Decreased Q angle

• Patella Baja

• Genu Varum

• Internal tibial tosion

• Subtalar Supination

• Out toeing

compensatory movements of femoral retroversion.

Blount’s Disease

- growth arrest at the medial tibial physis or medial tibial shaft

- tibia vara

Anterior Compartment Syndrome

- impingement of the anterior compartment of the leg due to increased pressure

- management: fasciotomy

Deep peroneal nerve

most commonly affected nerve in anterior compartment syndrome.

Stress Fracture of the Tibia

- hairline fracture at the distal tibial shaft due to increased stress to the bone

- x-ray: (-) dreaded black line

Medial Tibial Stress Syndrome

- pain at the posteromedial leg due to overactivity of the tibialis posterior

- caused by toe running

- “shin splints” '“tibialis posterior overload”

Haglund’s Disease

- bony prominence at the posterior heel caused by shoes

- “pump bump”

Sever’s Disease

- inflammation of the growth plate at the insertion of achilles tendon on the calcaneus

- “calcaneal apophysitis”

• Pregnancy

• Obesity

• Prolonged standing

• Shoes

causes of plantar fasciitis.

• 1st step pain

• Pain at medial calcaneus

• Tight heel cords

signs and symptoms of plantar fasciitis.

• Stretching towards DF and toe extension

• Orthosis (resting splint)

• Analgesics

• Surgery

management of plantar fasciitis.

• Plantar flexed

• Adducted

• Inverted

position of ankle and foot during talipes equinovarus.

Plantar Calcaneonavicular Ligament

affected/collapsed ligament in pes planus.

Charcot Marie Tooth Disease

condition in which pes cavus is common.

Abduction > Evert > DF

serial casting of talipes equinovarus: order of motion or position to correct.

Splay Foot

collapsed of transverse arch causing foot widening due to the weakness of intrinsic muscle of the foot.