Lower Limb Disorders

Hip Fracture

This presents with:

• Shortened, abducted, and externally rotated leg

• Pain

• Inability to weight bear

Risk factors - Increasing age, Osteoporosis

It's classified into whether the fracture is Intracapsular and Extracapsular. Intracapsular requires more urgent surgery as it carries a higher risk of avascular necrosis.

Total hip replacement is a common management option, however a complication of this is Posterior hip dislocation. Here, patients will have a shortened, but internally rotated leg.

N.B. For hip -> External rotation = Fracture. Internal rotation = Dislocation.

Meniscal Tears

This often occurs during twisting movements. It presents with:

• Pop sound during initial injury

• Pain, Swelling, Stiffness

• Reduced range of motion

• Locking of knee

• Knee instability

Investigations:

• McMurray’s and Apley Grind tests

• MRI

• Arthroscopy

ACL Injury

The ACL functions to stop the tibia from sliding forwards. An injury of this often occurs during sudden deceleration or twisting of the knee. It presents with:

• Pop sound during initial injury

• Pain, Swelling, Stiffness

• Reduced range of motion

  
  

• Knee instability

  
  

Investigations:

• Anterior Drawer test

• MRI

• Arthroscopy

Achilles Tendinopathy

Inflammation of the achilles at the mid-point or insertion point. It's caused by tearing/straining of the tendon fibres over a long period of time. It presents with pain, stiffness, tenderness, swelling, and thickening of the tendon.

Risk factors - Sport, Inflammatory conditions, DM

An Achilles tendon rupture always needs to be ruled out by doing a Simmonds’s calf squeeze test.

Achilles Tendon Rupture

This presents with:

• Sudden onset pain

• Snapping sound during initial injury

• Feeling of something hitting them at the back of the leg

• Weakness of plantarflexion

Investigations:

• Simmond’s calf squeeze test

• US

Plantar Fasciitis

This presents with a gradual onset of pain, which is worse with pressure e.g. walking or standing for long periods.

Ankle Fracture

This is sub-divided using the Weber Classification. This helps us know how unstable the fracture is and guides how we manage it:

• Type A - Below syndesmosis

• Type B - At level of syndesmosis

• Type C - Above syndesmosis

Management:

• Stable - Type A - Managed with Plaster of Paris (POP) cast

• Unstable - Type B and C - Managed with Surgery