Disorders of the Lower Extremity

  • Kenneth M. Bielak

Abstract

The lower extremities facilitate the maintenance of stature and balance, have intimate contact with the ground, and are responsible for movement over that ground. Thus injuries to the lower extremities are more frequent than those to the upper extremities. The bones and muscles of the lower extremity are relatively longer and stronger, and greater forces are required to disrupt the connections between them. This chapter provides basic information on the history, mechanism of injury, and testing procedures necessary to make an accurate diagnosis and formulate a specific management plan for injuries to the lower extremity. The common injuries are described in detail. Reference is made to uncommon and high impact injuries that should not be missed. Other systemic disorders and sports-related and pediatric injuries are covered in other chapters, though there is some degree of overlap.

Keywords

Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Collateral Ligament Ankle Sprain Patellar Dislocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cummings SR, Browner WS, Stone K, et al. Risk factors for hip fracture in white women. N Engl J Med 1995;332:767–73.PubMedCrossRefGoogle Scholar
  2. 2.
    Peacock M, Liu G, Manatunga AK, Timmerman L, Johnston CC Jr. Better discrimination of hip fracture using bone density, geometry, and architecture. Osteoporos Int 1995;5:167–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Gluer CC, Pressman A, Li J, et al. Prediction of hip fractures from pelvic radiographs: the study of osteoporotic fractures: the study of Osteoporotic Fractures Research Group. J Bone Miner Res 1994;9:671–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Kanis JA, Gullberg B, Allander E, et al. Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture. BMJ 1992;305:1124–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Bean N, Lehman AB. Habitus and hip fracture revisited: skeletal size, strength and cognition rather than thinness? Age Ageing 1995;24:481–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Robinovitch SN, Hayes WC. Force attenuation in trochanteric soft tissues during impact from a fall. J Orthop Res 1995;13:959–62.CrossRefGoogle Scholar
  7. 7.
    Jaglal SB, Darlinton GA. Lifetime occupational physical activity and risk of hip fracture in women. Ann Epidemiol 1995;5:321–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Hemenway D, Colditz GA. Body height and hip fracture: a cohort study of 90,000 women. Int J Epidemiol 1995;24: 783–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Greenspan SL, Maitland LA, Kido TH, Krasnow MB, Hayes WC. Trochanteric bone mineral density is associated with type of hip fracture in the elderly. J Bone Miner Res 1994; 9:1889–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Bogost GA, Cures JV III. MR imaging in evaluation of suspected hip fracture: frequency of unsuspected bone and soft-tissue injury. Radiology 1995;197:263–7.PubMedGoogle Scholar
  11. 11.
    Guanche CA, Kozin SH, Levy AS, Brody LA. The use of MRI in the diagnosis of occult hip fractures in the elderly: a preliminary review. Orthopedics 1994;17:327–30.PubMedGoogle Scholar
  12. 12.
    Norris MA. Fractures and dislocations of the hip and femur. Semin Roentgenol 1994;29:100–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Mitchell MJ, Resnick D. Diagnostic imaging of lower extremity trauma. Radiol Clin North Am 1989;27:909–28.PubMedGoogle Scholar
  14. 14.
    Frick SL. Is computed tomography useful after simple posterior hip dislocation? J Orthop Trauma 1995;9:388–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Fairbairn KJ, Murphey MD, Resnik CS. Gas bubbles in the hip joint on CT: an indication of recent dislocation. AJR 1995;164:931–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Poggi JJ, Spritzer CE, Roark T, Goldner RD. Changes on magnetic resonance images after traumatic hip dislocation. Clin Orthop Relat Res 1995;319:249–59.PubMedGoogle Scholar
  17. 17.
    Erb RE, Nance EP Jr, Edwards JR. Traumatic anterior dislocation of the hip: spectrum of plain film and CT findings. AJR 1995;165:1215–19.PubMedCrossRefGoogle Scholar
  18. 18.
    Rogers LF, editor. The hip and femoral shaft. In: Radiology in skeletal trauma, vol. 2. New York: Churchill Livingstone, 1992:653–712.Google Scholar
  19. 19.
    Burgos J, Ocete G. Traumatic hip dislocation with incomplete reduction due to soft-tissue interposition in a 4-year-old boy. J Pediatr Orthop 1995;4:216–18.CrossRefGoogle Scholar
  20. 20.
    Zarins B. Acute muscle and tendon injuries in athletes. Clin Sports Med 1983;2:167–82.PubMedGoogle Scholar
  21. 21.
    Lipscomb AB, Johnston RK. Treatment of myositis ossificans traumatica in athletes. Am J Sports Med 1976;4:111–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Young LY, Rock MG. Thigh injuries in athletes. Mayo Clin Proc 1993;68:1099–106.PubMedCrossRefGoogle Scholar
  23. 23.
    Ryan JB, Hopkinson WJ, Arciero RA, Kolakowski KR. Quadriceps contusions. Am J Sports Med 1991;19:299–304.PubMedCrossRefGoogle Scholar
  24. 24.
    Arrington ED. Skeletal muscle injuries. Orthop Clin North Am 1995;26:411–22.PubMedGoogle Scholar
  25. 25.
    Butcher JD, Lillegard WA. Lower extremity bursitis. Am Fam Physician 1996;53:2317–24.PubMedGoogle Scholar
  26. 26.
    Forbes JR, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology 1995;104:525–7.Google Scholar
  27. 27.
    Johnson DL. Diagnosis for anterior cruciate ligament surgery. Clin Sport Med 1993;12:671–84.Google Scholar
  28. 28.
    Lintner DM, Moseley JB, Noble PC. Partial tears of the anterior cruciate ligament. Am J Sports Med 1995;23:111–16.PubMedCrossRefGoogle Scholar
  29. 29.
    Speer KP, Bassett FH, Feagin JA, Garrett WE. Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med 1992;20:382–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Buss DD, Skyhar M, Galinat B, Warren RF, Wickiewicz TL. Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med 1995;23:160–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwietzer ME, Deely DM, Hume EL. Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology 1995;194:825–9.Google Scholar
  32. 32.
    Geissler WB, Caspari RB. Isolated rupture of the popliteus with posterior tibial nerve palsy. J Bone Joint Surg 1992; 74:811–13.Google Scholar
  33. 33.
    Ralston BM, Bach BR, Bush-Joseph CA, Knopp WD. Osteochondritis dissecans of the knee. Physician Sport Med 1996; 24:73–84.Google Scholar
  34. 34.
    Hawkins RJ, Anisette G. Acute patellar dislocations: the natural history. Am J Sports Med 1986;14:117–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Helms CA, Garvin GJ. Plantaris muscle injury: evaluation with MR imaging. Radiology 1995;195:201–3.PubMedGoogle Scholar
  36. 36.
    Johnson AW, Wheeler DL. Stress fractures of the femoral shaft in athletes—more common than expected. Am J Sports Med 1994;22:248–56.PubMedCrossRefGoogle Scholar
  37. 37.
    Regis D, Magnan B, Spagnol S, Bragantini A. Dynamic orthopaedic brace in the treatment of ankle sprains. Foot Ankle Int 1995;16:422–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med 1994;22:83–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Cetti R. Roentgenographic diagnoses of ruptured achilles tendons. Clin Orthop 1993;286:215–21.PubMedGoogle Scholar
  40. 40.
    Soma CA. Repair of acute achilles tendon injuries. Orthop Clin North Am 1995;26:239–47.PubMedGoogle Scholar
  41. 41.
    Howard CB, Winston I, Bell W, et al. Late repair of calcaneal tendon with carbon fiber. J Bone Joint Surg [Br] 1984;66:206–208.Google Scholar
  42. 42.
    McFerran MA, Boulas HJ. Complications encountered in the treatment of pilon fractures. J Orthop Trauma 1992;6:195–200.PubMedCrossRefGoogle Scholar
  43. 43.
    Brumback RJ. Fractures of the tibial plafond. Orthop Clin North Am 1995;26:273–85.PubMedGoogle Scholar
  44. 44.
    Berndt AL. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg 1959;41A:988–1020.Google Scholar
  45. 45.
    Miller RA, McGuire M. Efficacy of first time steroid injection for painful heel syndrome. Foot Ankle Int 1995;16:610–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Nesse E. Poor results after resection of Haglund’s heel: analysis of 35 heels in 23 patients after 3 years. Acta Orthop Scand 1994;65:107–9.PubMedGoogle Scholar
  47. 47.
    Pfeiffer WH. Clinical results after tarsal tunnel decompression. J Bone Joint Surg [Am] 1994;76:1222–30.Google Scholar
  48. 48.
    Frey C. Magnetic resonance imaging and the evaluation of tarsal tunnel syndrome. Foot Ankle 1993;14:159–64.PubMedCrossRefGoogle Scholar
  49. 49.
    Schon LC. Nerve entrapment, neuropathy, and nerve dysfunction in athletes. Orthop Clin North Am 1994;25:47–59.PubMedGoogle Scholar
  50. 50.
    Shapiro MS, Finerman GAM. Rupture of Lisfranc’s ligament in athletes. Am J Sports Med 1994;22:687–91.PubMedCrossRefGoogle Scholar
  51. 51.
    Trevino SG. Controversies in tarsometatarsal injuries. Orthop Clin North Am 1995;26:229–38.PubMedGoogle Scholar
  52. 52.
    Meyer SA, Albright JP, Crowley ET, et al. Midfoot sprains in collegiate football players. Am J Sports Med 1994;22:392–401.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Kenneth M. Bielak

There are no affiliations available

Personalised recommendations