2010 SAQ Flashcards
List the 4 Stages of Perilunate Instability
- scapholunate dissociation or scaphoid fracture
- capitolunate dislocation
- lunotriquetrial dissociation or triquetral fracture
- lunate dislocation
List the 7 CanMeds Components
“Please Help Me Memorize Stupid Canmeds Crap”
- professional
- health advocate
- medical expert
- manager
- scholar
- communicator
- collaborator
List the 4 Types of Neural Tube Defects
- spina bifida occulta
- spina bifida cystica:
- meningeocele
- myelomeningeocele
- myeloschisis
List stages of Keinboch’s
- I: changes evident only on MRI
- II: sclerosis on plain radiographs
- IIIA: lunate collapse and/or fragmentation w/o carpal instability
- i.e. normal radioscahpoid angle / no fixed rotation of schapoid
- IIIB: lunate collapse and fragmentation with carpal instability
- radioscaphoid angle > 60° = fixed roration of scaphoid
- IV: pancarpal arthritis
Most reliable sign of DDH in 8 month old
- leg length discrepancy (+ve Galezzi / Allis)
- decrease ABduction
4 Blocks to reduction of DDH
- extra-articular: iliopsoas, Adductor longus
- intra-articular: capsule, inverted labrum, ligamentum teres, pulvinar, transverse acetabular ligament
70 yr old male with CR TKA (120 Degrees pre-op) now with NO pain, Flexion of 75 degrees and full extension. Infection ruled out. List 4 causes for this.
- femoral component too big
- insufficient tibial posterior slope
- non-compliant w/ post op rehab
- inappropriate balancing (PCL too tight)
- lack of posterior condyle resection
List Common causes of AVN (three) - You were given an obvious xray with AVN in 45 yr old.
direct causes
- trauma
- irradiation
- hematologic d/c (leukemia, lymphoma)
- cytotoxins
- dysbaric ON (Caisson disease)
- Gaucher disease
- Sickle cell disease / trait
indirect causes
- EtOH abuse
- “immune deficiency” conditions
- corticosteroids
- organ transplant
- HIV
systemic conditions
- renal failure
- systemic lupus erythematosus
blood conditions
- thrombophilia
70 yr old with cemented THA, 1 yr history of thigh pain and periprosthetic fracture. List 3 factors important in the surgical management
- work up for infection
- Vancouver classification!
- location of fracture
- implant stability
- remaining bone stock
- pre-op medical optimization
List 4 Indications for percutaneous pinning of distal radius in a child
- inability to obtain a reduction
- inability to maintain a reduction (i.e. loss of reduction)
- ipsilateral radius and elbow fracture / multi-trauma
- displaced intra-articular fractures (SH III/VI)
- soft tissue compromised
50 yr old female with 2 week history of inability to extend 4th and 5th fingers. List 3 common causes in a Rheumatoid patient
- extensor tendon rupture (Vaughn Jackson syndrome)
- sagittal band rupture with subluxation of extensor tendon at MCP joint
- PIN palsy (compression at the RC joint)
- MCP dislocation (volar, volar plate atteniuation)
Describe the Leadbetter manoeuvre.
- flex the hip to 90 deg, w/ slight adduction, and apply traction in line with the femur;
- maintaining traction, apply internal rotation to 45
- slight abduction and full extension, while maintaining traction and internal rotation
3 sites of compression in radial tunnel syndrome
“FREAS’D”
- fibrous bands from radiocapitellar joint
- recurrent leash of henry
- ECRB
- Arcade of Frohse
- Supinator
- Distal edge of supinator
Name 3 main lateral elbow stabilizers
- static stabilizers:
- LUCL
- radiocapitellar joint
- common extensor tendon origin
- dynamic stabilizers
- Anconius
- brachialis
- biceps
- triceps
remember:
- 1° stabilizers of elbow: UH articulation, ant band of MCL, LUCL
- 2° stabilizers of elbow: RC articulation, flexor pronator origin, common extensor origin
What is the most important of these lateral structures
LUCL
45 yr old male with pure ligamentous instability after dislocation on lateral side. What is the management of this ?
- anatomic reconstruction of the LUCL with autograft
There are static and dynamic stabilizers of the DRUJ - List 5 soft-tissue stabilizers
- ECU tendon sheath
- IOM
- TFCC
- pronator quadratus
- DRUJ capsule
components of TFCC
- volar and dorsal radio-ulnar ligaments
- two disc-carpal ligaments: disc-lunate, disc-triquetral
- central articular disc
10 yr old male with X-ray of foot with medial pain. Obvious accessory navicular. List 2 initial treatments
- immobilization (brace/cast)
- activity modification
- anti-inflammatories
10 year old with tarsal coalition with ankle sprains and problems running. List 2 initial treatments.
- immobilization (accommodative orthosis / brace / AFO / cast)
- activity modification
- NSAIDs
Ottawa ankle rules
- inability to bear weight
- medial or lateral malleolus point tenderness
- 5MT base tenderness
- navicular tenderness
prevention techniques in athletes with prior sprains includes
- semirigid orthosis
- evertor muscle (peroneals) strengthening
- proprioception exercises
- season long prevention program
Radiographic finding in PTTI
AP foot
- increased talonavicular uncoverage
- increased talo-first metatarsal angle (Simmon angle)
seen in stages II-IV
weight bearing lateral foot
increased talo-first metatarsal angle (Meary angle)
- angles >4° indicate pes planus
seen in stages II-IV
decreased calcaneal pitch
- normal angle is between 17-32°
- indicates loss of arch height
decreased medial cuneiform-floor height
- indicates loss of arch height
subtalar arthritis
- seen in stages III and IV
ankle mortise
talar tilt due to deltoid insufficiency
- seen in stage IV
