Page 971 - TNFlipTest

Toronto Notes 2019 Tibia
Patellofemoral Syndrome (Chondromalacia Patellae)
• syndromeofanteriorkneepainassociatedwithidiopathicarticularchangesofpatella
Risk Factors
• malalignmentcausingpatellarmaltracking(Qangle≥20°,genuvalgus) • post-trauma
• deformityofpatellaorfemoralgroove
• recurrentpatellardislocation,ligamentouslaxity
• excessivekneestrain(athletes)
Mechanism
• softening,erosion,andfragmentationofarticularcartilage,predominantlymedialaspectofpatella • commonlyseeninactiveyoungfemales
Clinical Features
• deep,achinganteriorkneepain
■ exacerbated by prolonged sitting (theatre sign), strenuous athletic activities, stair climbing,
squatting, or kneeling
• insidiousonsetandvagueinnature
• sensationofinstability,pseudolocking
• painwithextensionagainstresistancethroughterminal30-40°
• painwithcompressionofpatellawithkneeROMorresistedkneeextension • swellingrare,minimalifpresent
• palpablecrepitus
Investigations
• X-ray:AP,lateral,skyline–mayfindchondrosis,lateralpatellartilt,patellaalta/baja,orshallowsulcus • CT-scan
• MRI–besttoassessarticularcartilage
Treatment
• non-operative
■ continue non-impact activities; rest and rehabilitation ■ NSAIDs
■ physiotherapy: vastus medialis and core strengthening
• operative
■ indication: failed non-operative treatment ■ tibial tubercle elevation
■ arthroscopic shaving/debridement
■ lateral release of retinaculum
Tibia
Tibial Plateau Fracture
Mechanism
• varus/valgusload±axialloading(e.g.fallfromheight)
• femoralcondylesdrivenintoproximaltibia
• canresultfromminortraumainthosewithosteoporosis
Clinical Features
• frequency:lateral>bicondylar>medial
• medialfracturesrequirehigherenergy–oftenhaveconcomitantvascularinjuries • kneeeffusion
• inabilitytobearweight
• swelling
• associatedwithcompartmentsyndrome,ACLinjury,andmeniscaltears
• Schatzkerclassification
Investigations
• X-ray: AP, lateral, oblique
• CT:pre-operativeplanning,identifyarticulardepressionandcomminution • ABIifanydifferencesinpulsesbetweenextremities
Orthopedics OR37
Pain with firm compression of patella into medial femoral groove is pathognomonic of patellofemoral syndrome
SchatzkerClassification
Type Description
I Involvement of lateral plateau split fracture II Lateral split-depressed fracture
III Involvement of lateral plateau: pure
depressionfracture
IV Medial plateau fracture
V Bicondylar plateau fracture
VI Bicondylar with metaphyseal/diaphyseal
involvement