Extracapsular or trochanteric

Femoral neck or subcapital areas

Proximal femoral shaft or subtrochanteric areas

Secondary to location

Secondary to severity of hip fracture

significant for loss of blood supply to femoral head

Most common Jt fractured in the body

can be many places

Extracapsular, Intracapsular etc

Main complication with hip fracture?

Patient with ted hoes- strangles leg and occludes blood supply

Not very common?

Can be:

Anterior or Posterior

Avoid EXTREME:

abduction,

flexion,

 internal rotation

removal of bone to change angle of neck of femor

reduces symptoms related to advanced OA (DJD)

eliminates pn and improves function

replaces the damaged femoral head with a bipolar (2 seperate snap fit components of one femoral prothetic unit) prostesis

Considered conservative procedure

Replaces both head and acetabulum

indications:

RA

OA

ON

Juvenile RA

Pain

reduced ambulation

avoid hip addution - with pillow wedge

Avoid hip internal rotation-supported medially with pillows

Avoid hip flexion > 90 degrees

Avoid the combination of hip flexion, internal rot, and adduction for up to 4m post sx

Most common

Bursa may become irritated and inflamed due to excessive compression and repeated friction

Iliotibial band snaps over the bursa while lying superior to the greater trochanter

soft-tissue injury affecting the hip

pain over ischial tuberosity underlying gluteous Max

Direct contusion

Prolonged sitting

local tenderness over the iliopsoas muscle and tendon

diffuse radiating pain into the anterior thigh

bursa lies deep to the tendon of iliopsoas mus, tightness of iliopsoas alone causes compression and frictional wear

refered to as

Stable or unstable

Avulsions-type to:

ASIS

AIIS

Ischial tuberosity

Iliac crest

rotationally unstable but vertically stable

or rotationally and vertically unstable

Slipped Capital Femoral Epiphysis

(SCFE)

high risk -tall, thin, rapidly growing adolescents

Seen also in

Male, overweight, sexually underdeveloped (imbalance inhormones, growth and sexual)

edocrine problem

3 ligaments

Inversion Ankle Sprain

most common sports injury

Anterior Talofibular

Fibulocalcaneal

Posterior Talofibular

Caused by plantar flexion

inversion

and adduction of ankle and foot

ex: stepping in a small hole, on a rock.

single ligament rupture

lateral ankle

anterior talofibular

2nd degree sprain

double ligament rupture

anterior talofibular and fibulocalcaneal ligaments

test

anterior talofibular ligament

Patient sitting with leg flexed in 90 degrees at knee

and involved ankle in slight plantar flexion

distal tibia stabilized

other hand on calcaneus pulling ankle forward

Test for ankle

maximal inversion stress.

Patient sitting knee flexed at about 90 degrees

slight plantar flexion

stressed by exertion of constant pressure over the lateral aspect of the foot and ankle while counter pressure is applied over the inner aspect of the lower leg until maximal inversion reached

medial ligament of ankle

not commonly torn

laxity of the ankle ligaments

surgery maybe necessary to stabilize the ankle joint

reconstruction procedures

subjective feeling of giving way without affecting ligament laxity

Host of factors: strenght, proprioception, and lig stability

overused injury

repetitive microtrauma and accumulative overloading of the tendon

localized pn at the midportion, distal third, and insertion on calcaneus

Excessive sudden plantar flexion

occurs in area of decreased vascularity

assesses the integrity of the Achilles tendon

pt lies prone with feet extending off the end

the belly of the calf is squeezed so it plantar flexes

if tendon ruptured no plantar flexion will occur

most commonly fixed with and ORIF & or external fixator

in a semirigid splint for 2 weeks

proforms plantar and dorsiflexion ROM exercises

Also known as Pilon fracture

Due to Vertical or axial loads that "drive" or compress the tibia into the talus

ORIF, External fixator, skeletal traction, or calcaneal pin

intraarticular depression fractures usually caused by falls from a height and resulting in compression of the calcaneus from the talus:

Central Crushing

lateral displacement

Body

anterior

fracture

falling from a height and landing on the foot in a crouched position

axial compression load between talus and calcaneus

OA is a common long-term complication because of immobilization and non WB status

partial or complete fracture

caused by unrelenting stress and force that does not allow osteoblastic repari and cause accelerated bone resorption

common: metatarsals, lateral malleolus, Os calcis, navicular, and sesamoid

chronic inflammation of the plantar aponeurosis

repetitive microtrauma leading to injury and c. inflam.

pn along medial boder of calcaneus

pn worse in morning when foot contacts the floor getting out of bed

 tender to touch

flat foot

congenital or aquired deformity

medial longitudinal arch is reduced

muscular weakness, lax of lig, paralysis, or pronated foot

mild, moderate, severe

Valgus

head of talus drops

Rigid- can see lowered arch in Non-WB and WB

Flexible- on in WB

abnormally high arch

results of neurogenic pathologic processes, mus imbalances and congenital abnormalities

Medial and lateral arch are affected

Painful calluses beneath metatarsal heads

Severe

Foot pronated, Adducted, and flexed

feet pointing to each other

can be reversed if detected early

Wont get back neutral w/o intervention

Most common

extremely dorsi flexed foot 

points up and out (sharp angle at heel)

Most mild

Foot turned inward

Might not notice at birth but is present

force foot gently back into position

casting, exercise, splinting, and surgery

diffuse

occasional radiating pn into the toes and proximally to the dorsal or plantar surface

Feels burning, cramping, or catching sensation

usually between 3-4 interspace

mass maybe palpated

lateral or valgus deviation of the great toe with soft tissue and bony deformity

worsened with improper footwear

pn relieved by removing shoes

Worsened by wearing improper shoes

deformity of:

 MTP jt- in either neutral or extension

PIP jt- held in flexion

DIP jt- in flexion or extension

worsened by wearing improper shoes
Neutral MTP jt

Neutral PIP jt

Flexed DIP jt

often associated with neuromuscular disease

similar to hammer toe

MTP hyperextension

PIP flexion

DIP flexion

result of simultaneous contraction of extensors and flexors

Grade I ligament sprain

Knee

incomplete stretching of collagen ligament fibers resulting in minimal pn

minimal or no swelling

no loss of motion

no functional instability

Grade II Ligament sprain

Knee

partial loss of ligament fiber continuity

few collagen ligament fibers may be completely torn

mod pn

mod swelling

some loss of fnx and stability

Grade III Ligament Sprain

Knee

Rupture

entire collagen ligament fiber bundles are completely torn

no continuity within the body of lig.

profound pn, intense swelling, loss of jt fnx and instability

ACL

Anterior Cruciate Ligament

connects to tibia in front and femur in the back

Intracapsular ligament

External rot, valgus stress, and int. tibial rot

or knee hyper ext. with foot planted

Primarily no contact

deceleration

Closed kinetic chain (CKC)

Can develope hemarthrosis

blood w/in jt capsule

requiring an arthrocentesis (aspiration of fluid)

pt supine w/ knee flexed at 25-30 degrees

one hand stabilizes distal femur and other stabilizes proximal tibia

knee is moved anterior to posterior

gap will appear if +

Anterior Drawer Test

Knee

pt supine w/ knee flexed to 80-90 degrees

creates slack of the ACL

problem w/ test is at this angle meniscotibial ligaments are really being tested not ACL

Autograft

ACL reconstruction

uses tis. from the body of the pt

ACL repair

Often use of gracilis tendon, fascia lata, semitendonosis, and quad mus tendon
BONE PATELLAR TENDON IS THE STRONGEST FOR ACL RECONSTRUCTIONS

Allograft

ACL Reconstruction

tissue from another human body

major risk of HIV trasmission

problem with effective sterilization procedures

Ligament-augmentation devices

(LAD)

artificial ligaments used for repair

problem w/ is material tends to deteriorate over time and cannot repair itself

attaches to femur in front and tibia in back

Posteriorly directed force on the anterior aspect of the flexed knee

pt falls on knee (contact with tibial tuberosity)

hyperflexion of knee w/o a resultant force on the tibia

Hyperextension with foot planted

30 degrees of knee flexion

tibia sags or subluxs posteriorly

problem when you bring tibia back to neutral it seems if ACL is laxed too

Godfrey posterior tibial sag test

PCL

Test

Pt supin w/ the hip and knee flexed at 90 degrees

hold heel and allow tibia to translate, sublux, or sag posteriorly by gravity

most common knee injury

extracapsular

direct external force

noncontact abduction- fixed leg and tibia rotated externally

rotational force

Often, injured by a valgus-direction force to lateral side of knee

Less common more severe sprain

MCL, ACL, and medial menicus

more common sprain

MCL, ACL, and Lateral Meniscus

determines if a torn meniscus is preventing knee extension

Pt supin with the affected knee flexed and supported by the examiner's hand.

knee is passively extended to full extension

if torn knee may not fully extend

Torn tissue blocks extension and creates a rubbery, springy end-feel

Subtotal meniscectomy

partial

higher than normal

patella

Position of the patella

lower than normal

anatomic alignment

characterized by femoral anteversion "squinting patellae," external tibial tornsion

foot pronation

a compression?

excessive hamstring tightness

sacrifice the cruciate ligaments (acl, pcl, or both)

relies on the complete conformity between the components for stability

Nonconstrained

cruciate sparing

resurfacing implants

retain the soft-tissue stabilizing restraints

acl and pcl

wedged removed to change the angle of joint

pt with advanced DJD

characterized by varus deformity 

unicompartmental degerative arthritis

desgned to transfew loads to uninvolved tibiofemoral jt

most common with varus deformity

approximately 13 weeks after surgery until return to activity

phase