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Orthopedics

February 2008 Radiology Quiz

This patient is a 45 year old male who presents to the ED right knee pain after falling. The following x rays are shown.

Questions:

1. Describe what you see?

• AP and Lateral view shows inferiorly displaced patella. No fracture.

  Diagnosis: Quadriceps Tendon Rupture.

2. What would you find on physical exam?

- large hemarthrosis
- freely mobile patella and an impressive loss of extensor function with intact knee flexion;
- patient is unable to walk;
- look for palpable defect(suprapatellar gap) swelling 2nd to hemarthrosis, pt unable to extend the knee;

 

3. What would be your management for this patient?

  Immobilize the knee in full extension.             

  Immediate Ortho consult

  Pain management

4. Although the joint between the fibula and tibia are not overtly considered a part of    the knee joint, the proximity of the fibular head to the knee joint and the similar symptoms associated with dysfunction warrant evaluation and treatment.  Assuming a patient has an anterior fibular head dysfunction, describe an osteopathic manipulative treatment involving HVLA, which might be useful in relieving pain and dysfunction.

• 1. Patient supine
• 2. Physician standing beside the patient on the same side as the dysfunction
• 3. Technique:
• a. the physician grasps the patient’s foot on the side of the somatic dysfunction with the nonthrusting hand.
• b. the physician places the thenar eminence of his thrusting hand over the superolateral aspect of the fibular head
• c. the patient’s knee is placed in the close-packed position, and then mildly flexed.
• d. the physician exerts a rapid knee extension while simultaneously introducing a downward and medial thrust through the fibular head.
• e. slight external rotation of the tibia facilitates the motion.

 

Trivia:   1. The group was named after Leonard Skinner; however, what relation did he have with the members of this group? 

A: Their Gym Coach

 (Leonard Skinner was Rossington and Burns' gym coach, at Robert E. Lee High School. He was a disciplinarian who enforced the school's dress code. Burns was expelled for having his hair too long; males weren't allowed to have hair touching the collar or sideburns below the ear. Legend has it that while still going under the moniker "One Percent" Ronnie Van Zant joked, while performing on stage, that they were now called "Leonard Skinner." This name would stick, only with a different spelling.)

 

  2. “Free Bird" was a tribute to who?

A. In 1973, the band released their signature song, "Free Bird," which was a tribute to Duane Allman, of The Allman Brothers Band. Duane was killed in a motorcycle accident while in Macon on October 29, 1973. "Free Bird," initially wrote for a wedding, was dedicated to the memory of Duane Allman.

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