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35 Cards in this Set
- Front
- Back
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Hip Fractures Risk Factors, Most Common Cause, Treatment
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Most common Cause - Trauma
Risk Factors: Female>Male, over 75 (60%), osteopenia, osteoporosis, malnutrition, white (more than AA), excess alcohol or caffeine, drugs leading to orthostasis, impaired motor control or mental status (IMPAIRED MENTAL STATUS MAY NOT REMEMBER FALL) Treatment: Hospitalization, ORIF or hip replacement based on optimizing best function. Elderly need to hydrate, monitor CV, control pain, HIGH RISK FOR DEEP VEIN THROMBOSIS Rehab must be aggressive to prevent DVT or pneumonia |
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Secondary complications from Hip Fractures
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At risk of more CV, pulmonary, GI, renal, UTIs that can lead to death
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Morbidity and Mortality of Hip Fractures
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Morbidity - only 50% return to prior level of fxn, may lead to nursing home, expensive
Mortality - 20-30% after 1 year, 40% after 2, harbinger but not cause of death |
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Stress Fractures Risk group, most common cause,
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Most common cause: Overuse injuries of repetitive stress, microfractures leading into major fxn loss
Affects weight bearing bones. Most commonly in Lower extremity (head of femur), LEADS TO ANTERIOR-LATERAL HIP PAIN Risk groups: Athletes (endurance), military, osteoperosis, elderly |
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Female athlete triad
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Anorexia, amenorrhea, osteoporosis
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Pathologic Fractures due to tumors most common kind
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Usually metastatic tumors to femur and hip leading to fracture
In primary more primary tumors but still likely metastatic |
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Hip Joint Dislocations Most common cause, Symptoms, Treatment, Danger of damaging
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Most common cause: MVC or falling onto knee from height
Symptoms: Posterior (90%), dislocation Tx: urgent relocation or surgery Can be damaged: Posterior sciatic nerve (make sure can dorsiflex foot), Anterior (femoral nerve, artery, vein) |
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What to check with Hip Dislocation
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Sciatic nerve integrity (ask to dorsiflex foot)
Injury to femoral N/A/V |
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Avascular Necrosis Risk Factors Adults vs Children, Tx
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Loss of blood supply to head of the femur often via artery to head of femur
Risk Factors Adult: Trauma, corticosteroid use (COPD, RA, inflammatory bowel disease), alcohol abuse Child: trauma, Legg-Calve-Perthes disease (4/100,000) - males>femalse Tx: surgery, arthroplasty, splints |
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Developmental Dysplasia of Hip, Risk Factors and Tx, How to test for?
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Hip dislocation, subluxation, or acetabular dysplasia in a child
1/1000 births, female>male Early diagnosis necessary or can get deformity, growth failure, arthritis Tx: harness or casting Test: flex hip, abduct, externally rotate to feel for a click |
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Slipped Capital Femoral Epiphysis (SCFE), Risk Factors, Dx
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Rare disease M>F, AA and Hispanic,
Older children, femur head slips away from neck b/c weak epiphysial plate. Acute trauma or degenerative with abduction and lateral rotation. Progressive coxa vara. Discomfort referred to the knee. Older Dx age (10-16) Risk: Trauma, obesity, hormonal abnormalities, down syndrome Tx: Surgery to pin head of femur |
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Osteoarthritis Signs, Causes Young vs Old, Symptoms, Tx
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Most common hip arthritis cause
Signs: deep aching ANTERIOR (groin) hip pain referred to ANTERIOR thigh and knee Sx: loss of internal rotation, trendelenberg gait Young: trauma, AVN, LCP, DDH, SCFE Old: degenerative wear and tear Tx: conservative care of cane to opposite hand, stretch and strengthen, meds for pain, consider arthroplasty |
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Muscle Strain Signs and Tx
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Pain in region or muscle belly after forceful contraction (often eccentric contraction, hip flexion and knee extension)
Local tenderness, ecchymosis, edema, loss of fxn and recurrence common Tx: PRICEMM, lengthen (stretch), strengthen and lengthen (eccentric) |
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Greater Trochanteric Bursitis Signs, Risk Factors, Causes, Tx
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Most common LE bursitis near glut max
Signs: Lateral hip pain with movement/pressure, night pain, pain on touch, swelling, effusion, SNAPPING Risk: sciatica, gout, OA, RA) Causes: trauma/contusion, overuse of hip abductors and TFL, abnormal gait (from imbalance (medius weak), low flexibility, obese, coxa valga, hemiparesis (stroke, MS, etc). Tx: stretching, strengthen ab and adductors, NSAID or steroid |
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Knee Joint Region Fractures, most common cause, location, Tx
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Location: distal femur, tibial plateau
Causes: Trauma > Stress fractures and tumors Young, active individuals trauma, MVC Tx: alignment of articular surfaces, check nerve status |
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Meniscus Injuries Young Patient vs Old Pt type and Cause
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Most common knee injury
Young: Acute tears, traumatic pop with effusion, LOCKING b/c meniscus flap folds into knee Old: Degenerative tears, minimla trauma, intermittent effusion, RARELY LOCKING Tx: conservative in degenerative, rehab or surgery in acute |
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MCL Sprains, Mechanism, Signs
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Most common ligament knee injury
Mechanism: impact to lateral knee stretches other side or sustained valgus force Signs: Pop and medial knee pain NO LOCKING, swelling later Tx: rehab or surgery (esp if meniscus injury present) |
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Locking in knee joint
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suggests meniscus tear vs just a sprain or tear of ligament
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ACL Injury, Signs, Mechanism, Tx
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Most common sports ligament injury
Mechanism: cutting, deceleration, hyperextension Signs: Pop, diffuse pain, 1-2 hr LARGE BLOODY EFFUSION Tx: reconstruction in athletes, can just do rehab |
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PCL Injury Mechanism, Signs, Tx
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More rare than MCL, MM, ACL
Mechanism: MVC - knee hits dash, fall onto knee, hyperextension Signs: Pop (maybe), gradual swelling Tx: rehab/surgery |
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Terrible Triad
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ACL, MCL, medial meniscus tear, requires surgical reconstruction
Due to foot external rotation, valgus stress at knee and rotational force |
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Patellofemoral Pain Syndrome (PFPS) Sign, risk Factor, Tx
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Overuse injury with inflammation in patellofemoral joint. Can be acute or insidious
Sign: ANTERIOR knee pain, "moviegoers sign" - aggravated by prolonged sitting, stairs, hills, clicking, grinding, popping, crepitus with range of motion Risk: high Q angle (F>M), improper patella track) Tx: conservative (cross train), Ice, NSAID, strengthen Vastus Medialis |
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Patellar Tendonitis Signs, Tx
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Jumper's Knee, Overuse of patellar tendon. Young athletes with high quad load (jumping, squatting, kneeling)
Tx: conservative (cross train), ice, NSAID, |
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Knee bursitis potential locations
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Prepatellar - Housemaid's knee
Suprapatellar Deep infrapatellar Superficial infrapatellar - Vicar's knee Caused by direct trauma and have some effusion |
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Baker's Cyst Location, Sign, Tx
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Synovial cyst between medial head of gastrocnemius and joint capsule under semitendinosus
Associated with degenerative joint disease Sign: cyst on back of knee Tx: surgical excision |
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Stress Fractures, Risk Factors, Signs, Sx, Tx
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Repetitive stress causing bone deformation and microfractures with gradual or abrupt onset of pain
Risk: low bone mineral density (females late onset menses), low body weight, poor nutrition (low Ca), tobacco, alcohol Over-pronation, leg discrepancies (coxa valga, vara, genu valgum, verum) Training error, running on hard surfaces Sx: Pain and tenderness to site (can be diffuse), deep aching pain worse with activity, night pain, swelling redness Tx: boot, crosstraining, conservative |
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Most common stress fracture locations
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Tibia (middle), Fibula and metatarsals
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Medial Tibial Stress Syndrome (MTSS), Signs, Risk Factor, Tx
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"Shin Splints" - commonly due to exercise, overuse stress, usually at soleus attachment on medial tibia causing chronic traction at periosteal-fascial jxn
Signs: Pain decrease with exercise and increase after, local tenderness Risk: HYPERpronation of foot, hard surface running, bad warmup or shoes Tx: rest, rarely crutches, stretching, orthotics to prevent over pronation |
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Compartment Syndrome Signs, Acute vs Chronic, Dx, Tx
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HIGH pressure in compartment can lead to decreased blood flow. Pressure worse DURING EXERCISE
Chronic - buildup over time Acute - TRAUMA to leg anterolateral compartment (watch for damage to fibular nerve-footdrop), Must catch b/c death of muscle and nerve can occur in 4-8 hours) Dx: Pressure before and after exercise Tx: fasciotomy |
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Ankle Sprains, Most common, Mechanism
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Most commonly lateral ankle sprain to anterior tibiofibular ligament > calcanofibular ligament > posterior tibial fibular ligament
Mechanism: inversion plantar flexion or "roll over" Tx: conservative to surgery based on damage |
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Achilles Tendinopathy signs, tx, what to avoid, rupture risks
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Signs: POSTERIOR ankle pain and swelling, especially wit push off. Due to repetitive eccentric (lengthening) overload and overuse, tight hamstrings, soleus, gastroc, high arch, genu varum (bow leg), QUINOLONE drugs
Tx: rest, ice, NSAID, rehab, may need boot AVOID STEROIDS B/C RUPTURE RISK Rupture risks: chronic inflammation, poor nutrition, sudden push off or landing, STEROIDS to area |
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Plantar Fasciitis Signs, Cause, Risk Factors, Tx
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Sign: Medial Plantar heel pain worse in morning and decreases with activity
Cause: overuse injury leads to inflammation Risk: female>male, high arch or flat foot, obesity, tight achilles, seronegative spondyloarthropathies Tx: conservative cushion, stretching, splints, NSAIDs |
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Lower Extremity Amputation Causes Childhood vs Adults
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Childhood - Trauma (auto, burns) > cancer, congenital
Adult - Trauma, vascular disease, Infection, diabetes |
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Club Feet Cause, Tx
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Deformed talus and inverted calcaneus with tight ligaments and tendons lead to club foot (Talipes equinovarus)
Tx: Serial casting or surgery |
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Femur Fractures most common location elderly vs youth
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At neck is most frequent b/c weakest. Esp. with osteoporosis
Youth also at neck but can get direct blow to shaft or greater trochanter if play sports |
