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Orthobullets/ FRCSC Canadian Board > 2010 SAQ > Flashcards

2010 SAQ Flashcards

1
Q

) List the 4 Stages of Perilunate Instability

A
  1. scapholunate dissociation or scaphoid fracture
  2. capitolunate dislocation
  3. lunotriquetrial dissociation or triquetral fracture
  4. lunate dislocation
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2
Q

List the 7 CanMeds Components

A

“Please Help Me Memorize Stupid Canmeds Crap”

  1. professional
  2. health advocate
  3. medical expert
  4. manager
  5. scholar
  6. communicator
  7. collaborator
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3
Q

List the 4 Types of Neural Tube Defects

A

Forms of myelodysplasia

spinal bifida oculta

  • defect in vertebral arch with confined cord and meninges

meningocele

  • protruding sac without neural elements

myelomeningocele

  • protruding sac with neural elements

rachischisis

  • neural elements exposed with no covering
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4
Q

List stages of Keinboch’s

A

I: changes evident only on MRI

II: ­ sclerosis on plain radiographs

IIIA: lunate collapse and/or fragmentation w/o carpal instability

    • No DISI deformity=no ­ increase in radioscahpoid angle / no fixed rotation of schapoid

IIIB: lunate collapse and fragmentation with carpal instability

    • DISI deformity = radioscaphoid angle > 60° = fixed roration of scaphoid

IV: pancarpal arthritis

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5
Q

Most reliable sign of DDH in 8 month old

A
  • leg length discrepancy (+ve Galezzi / Allis)
  • decrease ABduction
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6
Q

4 Blocks to reduction of DDH

A
  • extra-articular: iliopsoas, Adductor longus
  • intra-articular: capsule, inverted labrum, ligamentum teres, pulvinar, transverse acetabular ligament
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7
Q

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

A
  • femoral component too big
  • insufficient tibial posterior slope
  • poor preoperative ROM
  • non-compliant w/ post op rehab
  • inappropriate balancing (PCL too tight)
  • lack of posterior condyle resection
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8
Q

List Common causes of AVN (three) - You were given an obvious xray with AVN in 45 yr old

A

• 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
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9
Q

70 yr old with cemented THA, 1 yr history of thigh pain and periprosthetic fracture. List 3 factors important in the surgical management.

A
  1. work up for infection
  2. location of fracture
  3. implant stability
  4. remaining bone stock
  5. pre-op medical optimization
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10
Q

) List 4 Indications for percutaneous pinning of distal radius in a child

A
  • 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 / IV)
  • soft tissue compromised
  • compartment syndrome
  • vascular injury
  • open fracture
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11
Q

50 yr old female with 2 week history of inability to extend 4th and 5th fingers. List 3 common causes in a Rheumatoid patient.

A
  • 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 attenuation)
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12
Q

Describe the Leadbetter maneuver

A
  1. flex the hip to 90 deg, w/ slight adduction, and apply traction in line with the femur;
  2. next, while maintaining traction, apply internal rotation to 45 deg
  3. the leg is slowly brought into slight abduction and full extension, while maintaining traction and internal rotation
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13
Q

3 sites of compression in radial tunnel syndrome

A

“FREAS’D”

  1. fibrous bands from radiocapitellar joint
  2. recurrent leash of henry
  3. ECRB
  4. Arcade of Frohse
  5. Supinator
  6. Distal edge of supinator
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14
Q

Name 3 main lateral elbow stabilizers

A

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

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15
Q

What is the most important of these lateral structures

A

LUCL

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16
Q

45 yr old male with pure ligamentous instability after dislocation on lateral side. What is the management of this ?

A

assuming an elbow

  • anatomic reconstruction of the LUCL with autograft
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17
Q

There are static and dynamic stabilizers of the DRUJ - List 5 soft-tissue stabilizers

A
  • ECU tendon sheath
  • IOM
  • TFCC
  • pronator quadratus
  • DRUJ capsule and joint congrouncy

remember components of TFCC
- volar and dorsal radio-ulnar ligaments

  • two ulno-carpal ligaments complex: ulno- lunate, ulno-triquetral
  • central articular disc (homolog meniscal disc)
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18
Q

10 yr old male with X-ray of foot with medial pain. Obvious accessory navicular. List 2 initial treatments.

A
  • immobilization (brace/cast)
  • activity modification
  • anti-inflammatories
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19
Q

10 year old with tarsal coalition with ankle sprains and problems running. List 2 initial treatments.

A
  • immobilization (accommodative orthosis / brace / AFO / cast)
  • activity modification
  • NSAIDs
  • physical therapy
  • properiocepation board training
  • peroneal muscle strengtheining
20
Q

14 yr old female with Right Thoracic curve and Left lumbar curve. List 3 radiographic features that are suggestive that this is a structural curve.

A
  • curve with greatest magnitude (largest Cobb angle)
  • Cobb angle > 25 on correction
  • kyphosis > 20
21
Q

12 yr old female with a 30 degree thoracic curve. List 6 ways to determine her skeletal maturity

A
  • Tanner stage
  • Risser grade
  • age of menarche
  • presence of open tri-radiate cartilage
  • presence of open physis in other bones  e.g. olecranon apophyseal closure right before peak growth velocity
  • peak growth velocity
22
Q

) 3 Causes of a superior labral tear

A
  1. peel back model (posterior superior shift of humeral head during cocking phase of throwing  sheer forces on superior labrum)
  2. impingement (abnormal contact btwn the posterior RC and posterior margin of glenoid labrum)
  3. trauma (FOOSH, sudden pull of arm)
23
Q

CT Scan of Reverse Hill-Sachs in a posterior dislocator. List 3 surgical options to treat this.

A
    • disimpact and bone graft (if acute)
    • modified McLaughlin (LT + subscap transfer into defect)
    • allograft
    • proximal rotational osteotomy
    • resurfacing
    • hemiarthroplasty
    • total shoulder arthroplasty
24
Q

45 yr old male going for a TKA. What level should their factor VIII level be pre-op ?

How long should these levels be maintained post-op ?

Exact wording “How would this patient’s outcome compare with an unaffected person with Hemophilia” ?

A
  • 100% for factor VIII (hemophilia A), fact100% for factor VIII (hemophilia A), factor lX (hemophilia B)or lX (hemophilia B)
    • 3-4 weeks post op for bony procedures
  • remember: 3-5 days for soft tissue procedures
  • higher rate of infection and higher post op hemarthrosis otherwise equivalent outcomes
25
Q

List 3 factors to consider when thinking about doing a hemi-epiphysiodesis

A
  • amount of LLD and required length correction
  • amount of growth remaining
  • amount of angular deformity
  • location of physis
26
Q

List 5 factors that would lead to a poor outcome in a patient with a Type II Odontoid

A
  • displacement > 5 mm
  • angulation > 10°
  • posterior displacement
  • > 2mm gap
  • oblique unstable fracture
  • elderly age (> 60 y/o)
  • smoker
  • medical co-morbidities
27
Q

8 Parameters to consider in a trauma patient for DCO vs Early total care

A
  • lactate > 2.5
  • BE > 5
  • hypotension (SBP < 90 mm Hg)
  • requirement of vasopressors
  • coagulopathy
  • temp < 35°C
  • PaO2/FiO2 < 300
  • massive transfusion (> 10 U PRBC)
  • extreme chest / abdo trauma as identified on severity scores
  • ISS>40
  • ISS>20 with severe chest, and abdominal injuries
28
Q

4-Year-old male with hip pain. List 4 clinical or laboratory finding to differentiate from Transient Synovitis.

A
  • ESR > 40
  • CRP > 20
  • WBC > 12
  • temperature > 38.5
  • unable to move the joint or touch the floor
29
Q

16 yr old with Gr II open tibia with zero tetanus vaccinations and an anaphylactic reaction to penicillin:

a) What antibiotic to use ?
b) What Immunization protocol to implement

A
  • clindamycin

tetanus toxoid + TIG

HISTORY OF PREV TET IMMUNIZATION CLEAN, MINOR WOUNDS ALL OTHER WOUNDS

Uncertain or < 3 doses give vaccine give vaccine + TIG

> 3 more previous doses no need to vaccinate no need to vaccinate

(unless > 10 yrs since last dose) (unless > 5 years since last dose)

c) What surgical treatment to implement ?
- I&D and definitive fixation

30
Q

23 yr old with lytic lesion in proximal phalanx - Radiologist says it benign. List 5 possible causes

A
  • enchondroma
  • GCT
  • ABC
  • UBC
  • NOF
  • Langerhans histiocytosis
31
Q

31) 70-year-old male with pathologic fracture of diaphyseal femur. Has 3 other skeletal lesions and thyroid lesion

What would be the appropriate surgical treatment ?

What systemic skeletal intervention would be appropriate (medical)?

What local treatment would assist your surgery?

A
  • cephalomedullary nail
  • bisphosphonates
  • radiation
32
Q

List 4 risk factors for neurological deterioration in vertebral osteomyelitis

A
  • aggressive bacteriology (e.g. MRSA)
  • medical co-morbidities (e.g. immunocompromised patient, Dm)
  • elderly age
  • higher vertebral involvement (i.e. cervical)
  • associated epidural or paraspinal abscess
  • failure to initiate treatment / late diagnosis
33
Q

List 6 principles of tendon transfers

A

“SEACOAST”

  1. synergistic transfer
  2. expendable donor
  3. adequate motor power of transffered tendon
  4. contractures need releasing (supple joint)
  5. one tendon, one function
  6. adequate excursion (length)
  7. straight line of pull
  8. tissue equilibrium: scar free bed, stable joint, well healed wound
34
Q

List 6 risk factors for Radio-ulnar synostosis after surgery?

A
    • radius-ulna # at same level
    • use of one incision to ORIF both radius and ulna
    • delayed surgery > 2 weeks
    • high energy
    • closed head injury
    • SCI
    • history of HO
    • infection
    • screws that penetrate IOM
    • bone grafting into IOM
    • ankylosing spondylitis
    • prolonged immobilization
    • two incision approach for biceps repair
35
Q

50 yr old female tennis player with pain while playing, pain preventing ADLs, and sports. Tender at distal ulna, DRUJ, and triqretrum

List 3 possible causes

MRI now shows ulno-carpal impaction - you decide to scope the wrist. What are the anatomic landmarks for the dorsoradial and dorsoulnar portals ?

A
  • ulno-capral impaction (Ulnocarpal abutment syndrome)
  • TFCC tear
  • ECU subluxation
  • keinbock’ disese
  • VISI
  • dorsoradial (3-4): just distal to lister’s tubercle, btwn 3rd and 4th compartments
  • dorsoulnar: 6R ® just radial to ECU tendon; 4-5 btwn 4th/5th compartments just radial to 6R

• remember:

  • radial midcarpal ® 1 cm distal to 3-4 portal, radial border of 3rd MC
  • ulnar midcarpal ® 1 cm distal to 4-5 portal, in line w/ 4th MC
36
Q

25 yr old female with a severe bunionette and and high 4-5 angle ? What are 3 surgical treatment components?

A
  • oblique diaphyseal rotational osteotomy + screw fixation
  • distal 5th MT osteotomy
  • lateral condylectomy w/ reefing of lateral MTP joint capsule
37
Q

Ankle fracture in a diabetic that you treat surgically - what are the complications are at higher risk?

A
  • infection
  • amputation
  • mal/non-union
  • wound dehiscence
  • cardiopulmonary complications
38
Q

Patient with a lisfranc injury - what are 3 radiographic features to look for?

A
  • widened space btwn 1st and 2nd MT (widened interval between the 1st and 2nd RAY)
  • bony avulsion of lisfranc ligament (base of 2nd MT)
  • dorsal subluxation of 2nd MT base on lateral xray
  • incongruity of metatarsals with cuneiforms
  1. lateral cortex of 1st MT does not line up with medial cuneiform on AP
  2. medial aspect of 2nd MT does not line up with middle cuneiform on AP
  3. medial aspect of 3rd MT does not line up with lateral cuneiform on oblique
  4. medial aspect of 4th MT does not line up with cuboid
39
Q

X-ray with a Crowe 4 hip - What are four things to consider when considering performing a THA?

A
    • restoring hip center to true acetabulum
    • avoid overlengthening to avoid sciatic nerve injury—>® subtroch shortening osteotomy
    • ­ increase anteversion of femoral neck and small femoral diaphyseal shaft –>® modular femoral stem

approach

  1. contracted deficient ABductors
  2. ADductors, psoas, hamstrings, rectus femoris shortened tenotomy may be needed to correct deformity
  3. capsule elongated and redundant ® may need extensive capsulotomy
  4. sciatic nerve assumed normal length ® susceptible to stretch during correction

acetabular side

acetabulum shallow / oblong / roof eroded

  • deficient anteriorly, laterally, superiorly
  • may need very small acetabular component (< 40 mm)

false acetabulum

  • usually not deep / wide for cup containment
  • cup should be implanted in true acetabulum
  1. medial and inferior location ¯ joint contact forces
  2. thickest bone
  3. facilitates limb lengthening
  4. improves ABductor function
  5. decrease risk of loosening
  • cup should be confined within bone if possible (see below)
  • medial wall should be left intact

femoral side

  • proximal migration of femur
  • femoral head small & deformed
  • femoral neck short and narrow with varying but ­increase anteversion
  1. may need osteotomy
  2. anteversion of implanted acetabular component will influence how much anteversion can be accepted on femoral side
  • valgus neck shaft angle
  • GT small and posterior (may need to be moved to more anatomic position)
  • femoral canal narrow (small diameter canal)
  1. exacerbated by ­ increasing ant bowing of proximal 1/3 of femur
40
Q

List 3 ways to monitor for a spinal cord injury when performing spinal deformity correction?

A
  • somatosensory evoked potentials
  • motor evoked potentials
  • wake up test (stagnara test)
41
Q

List 4 Principles of medical ethics (B-A-N-J)

A
  • beneficence
  • autonomy
  • non-maleficence
  • justice
42
Q

List 3 Non-skeletal manifestations of Marfan’s ?

A
    • ocular: ectopia lentis (superior lens dislocation)
    • cardiovascular: ascending aorta dilation / aortic regurgitation, ascending aorta dissection, mitral valve prolapse / regurgitation
    • pulmonary: spontaneous pneumothorax, apical blebs
    • dura: lumbosacral dura ectasia
43
Q

List three neurological features of Brown-Sequard?

A
  • ipsilateral corticospinal (motor) lost
  • ipsilateral dorsal column (proprioception, vibration) lost
  • contra-lateral spinothalamic (pain and temperature) lost
44
Q

What are 3 at risk signs for LCP?

A
    • V shaped radiolucency in lateral epiphysis (Gage’s sign)
    • calcification lateral to the epiphysis
    • horizontal physis
    • lateral subluxation of femoral head
    • metaphyseal cysts
45
Q

In a child with congenital hemi-vertebra. What are your consideration for hemi-ephysiodesis?

A
  • age < 5
  • smaller curve (< 40-50°)
  • type of hemivertebrae (fully segmented)
  • progressive curve
  • sagittal balance (no kyphosis)
  • concave growth potential < 5 years

Orthobullets/ FRCSC Canadian Board (121 decks)

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