2013 SAQ Flashcards
1
Q
List 3 XRAY findings of a Lisfranc injury
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
- lateral cortex of 1st MT does not line up with medial cuneiform on AP
- medial aspect of 2nd MT does not line up with middle cuneiform on AP
- medial aspect of 3rd MT does not line up with lateral cuneiform on oblique
- medial aspect of 4th MT does not line up with cuboid
2
Q
List 5 conditions to be considered if you are thinking about treating an Achilles tendon rupture operatively
A
- Diabetes
- Smoking
- Peripheral vascular disease
- Immunosuppression/immunocompromised state
- Local/systemic dermatologic disorders
- Obesity
- Neuropathy
3
Q
List 5 essential components of obtaining an informed consent.
A
- Competence of patient (capacity)
- Voluntary (not coerced)
- Aware of diagnosis
- Informed of pertinent and common risks / benefits
- Informed of alternative treatment options
- Informed of the expected outcome with all treatment options
4
Q
List 3 advantages of locking plates vs. a DCS for the treatment of distal femur fractures
A
- Better fixation in osteoporotic bone
- Multiple fixation options in articular segment
- Indirect reduction of articular segment to diaphysis
- Minimal invasive application
5
Q
List 4 different ACL reconstruction techniques for an active 11 year old
A
- All epiphyseal
- IT band over the top technique (combined intra / extra – articular)
- Partial transphyseal
- Transphyseal (with vertical tunnels, smaller diameter, soft tissue grafts and metaphyseal fixation)
- Anatomic adult style ACL reconstruction
6
Q
List 3 physical findings of sacral sparing in a spinal cord injury
A
- Preserved perianal sensation
- Voluntary anal contraction
- Great toe flexion
7
Q
A 50 year old female who enjoys playing tennis is complaining of wrist pain over the last few weeks. She now wears wrist splints and can’t play anymore tennis. Her wrist pain is localized over the DRUJ, Ulnar head, and triquetium
- List your top 3 differential diagnoses
Her MRI shows signal change of the lunate on T1. You decide to do a wrist scope.
- What are your anatomic markers for the radial and ulnar portals?
A
- TFCC tear
- DRUJ arthritis
- Ulnar impaction / abutment
- ECU tendonitis
- LT tear
- DRUJ instability
- Fracture
- Pisotriquetral arthritis
- Ganglion cyst
3-4 portal (1 cm distal and ulnar to Lister’s, between EPL and EDC)
4-5 portal (in line with the radial border of the 4th metacarpal, slightly proximal to 3-4 portal, between EDC and EDM)
8
Q
List 6 principles of tendon transfers
A
- Synergistic
- Expendible function
- Adequate power
- Contracture of joints released
- One tendon, one function
- Adequate aplitude
- Straight line of pull
- Tissue equilibrium
9
Q
List 5 radiographic “head at risk” signs in Perthes
A
- Lateral subluxation
- Horizontal physis
- Gage sign (V shaped lateral physis)
- Metaphyseal cysts
- Lateral calcification
10
Q
List 3 ways to judge your reduction of a femoral neck fracture in a young patient
A
- Reduction of medial calcar (restoration of shenton’s line)
- Double S shaped contour on lateral
- Neck shaft angle (No varus, up to 15 degrees valgus)
- Anterior / Posterior angulation within 10 degrees (on lateral)
- Alignment of compressive trabecular lines on AP and lateral (155 – 180 degree)
11
Q
List 3 contraindications for pelvic realignment in an adult
A
- Presence of arthritis (Tonnis grade 2 or worse)
- Asymptomatic
- Aspherical femoral head
- Incongruous joint
- Age >55
12
Q
List 5 features of a traumatic proximal Tibia fibula dislocation. (Don’t worry, none of us had heard of it either)
A
- Peroneal nerve injury
- Lateral knee pain / Palpable tenderness
- Instability on exam (LCL laxity)
- Associated tib/fib fracture
- Bruising / swelling
- Decreased ROM
13
Q
List 3 strategies to avoid AVN of the femoral neck when nailing a femoral shaft fracture in a pediatric patient
A
- Lateral entry point
- Smaller diameter nail
- Minimal proximal dissection
- +/- Minimal proximal reaming
- +/- Liberal use of fluoro
14
Q
List 8 XRAY findings of a traumatic aorta dissection
A
- Widened mediastinum
- Hemothorax
- Obliteration of AP window
- Apical cap
- Loss of Aortic knob
- Tracheal deviation to the right
- Deviation of NG tube to right
- Depression of left mainstem bronchus
- Fracture of 1st / 2nd rib or clavicle
15
Q
List 3 components of the Lenke classification
A
- Location of structural curves
- Coronal balance based on CSVL
- Sagittal balance based on Thoracic Sagittal profile (T5-T12 à <10, 10-40, >40)
16
Q
An old lady with confirmed diagnosis of RA has a 2 week history of loss of extension in her ring and little finger. List your top 3 differential diagnoses
A
17
Q
List the 4 structures of the ankle syndesmosis
A
- Anterior inferior tib-fib ligament
- Interosseous ligament
- Posterior inferior tib-fib ligament
- Inferior transverse ligament
18
Q
Thessaly test is a test to detect meniscal tears. List 3 conditions that would give a false positive.
A
- Osteoarthritis
- Ligament laxity
- OCD
- Loose body
19
Q
List the 4 stages of perilunate instability.
A
20
Q
List 3 components of the minimally invasive treatment of congenital vertical talus
A
- Reverse ponsetti casting
- Open / percutaneous pinning of TN joint
- Achilles tendon lengthening / tenotomy
21
Q
A question regarding traumatic proximal tibio-fibular dislocation
- List 2 mechanisms that would cause it (ie, the position of the leg)
- List 2 physical examination findings.
- List 2 important points for the closed reduction
A
- fall on flexed / adducted knee
- direct injury to fibula
List 2 physical examination findings.
- peroneal nerve injury
- pain / palpable tenderness
List 2 important points for the closed reduction.
- flex knee to 80 – 110 degrees
- direct pressure over fibular head opposite to direction of dislocation
- ankle dorsi-flexed and externally rotated
22
Q
List 3 mechanisms for a SLAP tear.
A
- Repetitive overhead activity (“peel–back”)
- Traction
- Fall on outstretched arm with tense biceps
23
Q
List 11 muscle groups that are important to test for the AISA classification and give their respective myotome level
A
- Elbow flexion – C5
- Wrist extension – C6
- Elbow extension – C7
- Finger flexion – C8
- Finger abduction – T1
- Hip flexion – L2
- Knee extension – L3
- Ankle DF – L4
- EHL – L5
- Ankle PF – S1
- Voluntary anal contraction – S4
24
Q
List 5 complications of a mal-positioned acetabular component
A
- Dislocation
- Accelerated wear
- Osteolysis / Aseptic loosening (polyethylene / metal debris)
- Component Impingement
- Liner fracture / cracking
- Increased metal ion / soft tissue reaction / pseudotumor
- Psoas impingment
- Squeaking
- Decreased offset and limping
25
List 3 non-skeletal manifestations of Marfan’s.
* Superior lens dislocation
* Aortic root dilatation (possible aortic dissection)
* Mitral valve prolapse
* Spontaneous pneumothorax
* Dural ectasia
26
List the 4 knee ligaments (ie, ACL, MCL, LCL, and PCL) in order from the weakest to the strongest
LCL (750 N) \< ACL (2200 N) \< PCL (2500 – 3000 N) \< MCL (4000 N)
27
List 6 factors that would contribute to synostosis following the surgical treatment of a forearm fracture
* Open fracture
* Head injury
* Large soft tissue disruption / high energy
* Exposure of both bones in single approach
* Hardware / bony fragments in IOM
* Both bone fracture at same level
* Acute bone grafting
* Prolonged immobilization
28
List 4 features of pediatric radial neck fractures that would lead to a poor outcome
* Open reduction
* \>30 degrees angulation
* \>3 mm displacement
* Associated forearm / elbow fracture
* Older patient
* Delayed treatment
29
List the 2 muscles that surround the radial nerve after it pierces the intramuscular septum
1. Brachialis
2. Brachioradialis
30
List 3 spinal conditions that will light up on a gadolinium enhanced MRI
* Infection / Abscess
* Post-surgical fibrosis
* Tumors
* AVN
* Ankylosing Spondylitis
31
List 4 dysplastic features seen in developmental spondylolisthesis that would indicate a risk for progression.
1. Dome shaped S1 superior endplate
2. Lumbosacral kyphosis
* Increased sacral slope / pelvic incidence (low pelvic tilt)
* Sagittal imbalance
3. Trapezoidal L5
4. Dysplastic posterior elements (facets, pedicles,posterior arch, Spina bifida occulta)
32
You smoke in a high offset femoral prosthesis in some old guy. List 4 benefits of using a high offset THA
* Increased stability
* Tensioning of abductors
* Decreased joint reaction force
* Decreased impingement (femoropelvic)
33
List 4 indications to percutaneously pin a distal radius fracture in a pediatric patient
* Ipsilateral supracondylar fracture
* Failure to maintain an acceptable closed reduction
* Compartment syndrome
* Salter Harris 3/4
* Open fracture
* Vascular injury requiring repair
* Soft tissue injury preventing casting / splinting
34
List 4 risk factors for developing a DVT in a pediatric patient with MRSA osteomyelitis
* Lower extremity location
* Surgical treatment
* Positive blood culture
* Age \>8
* Prolonged time to fever resolution
* Elevated CRP (\>6)
35
List 5 poor prognostic factors for an osteosarcoma
* Persistently elevated Alk Phos after treatment
* Metastasis
* large Size
* high Grade
* tumor necrosis in response to chemotherapy (\<90%)
* Axial location
36
List 3 endocrinopathies that are seen in SCFE
Hypothyroidism (40%)
Growth Hormone deficiency (25%)
Hyperparathyroidism
* May be secondary to CKD and renal osteodystrophy
Hypopituitarism
Growth Hormone excess
Hypogonadism
down syndrome
37
List 4 signs of post-tourniquet syndrome
* Motor weakness (without paralysis)
* Paresthesia (without numbness)
* Dysesthesia
* Edema
* Local pain
* Stiffness
* Skin irritation/burn
38
List 4 long-term complications of radial head fractures
* Radiocapitellar arthritis
* Elbow / forearm stiffness
* PIN palsy
* PLRI
* DRUJ instability
39
List 7 points of the WHO pre-operative check list
Patient identify: name, procedure, site
Site marked
Consent signed
Pulse oximeter applied working
Anesthetic concerns
Imaging displayed
Risk \>500 mL blood loss
Equipment concerns
Nursing concerns
Critical / unexpected steps
Difficult airway
Preop antibiotics
Introduce team,
Anesthetic concerns
Postop
* Procedure performed
* Anesthetic concerns for recovery
* Nursing issues
* Equipment issues
40
Not including aspiration, list 4 things to help you differentiate a septic arthritis from transient synovitis.
* Fever \>38.5
* CRP \> 20
* ESR \> 40
* Inability to WB
* WBC \>12
41
List 4 extraosseous manifestations of fibrous dysplasia
* Café-au-lait spots (coast of Maine)
* Endocrine abnormalities (ie. Precocious puberty, Hypothyroid, renal phosphate wasting)
* Renal Phosphate wasting
* Intramuscular myxomas (Mazzabraud)
* Cranial deformities with blindness
42
List 3 benefits of steroids in Duchene’s. Also, list 3 adverse effects of steroids in a Duchene’s
* Prolonged ambulation, improved respiratory function, Decreased scoliosis, Improved strength
* Cushingoid appearance, Osteonecrosis, Short stature, Weight gain, immunocompromise, glucose intolerance
43
List 3 techniques to avoid varus deformity when nailing a subtrochanteric femur fracture
* Avoid lateralizing start point with trochanteric entry nail
* Piriformis entry nail
* Open reduction and clamping
* Ream in reduced position
* Larger diameter nail
* Unicortical plate
* Lateral decubitus position
* Blocking screw
44
List 3 advantages to coning XRAY
* Less radiation to patient
* Less radiation scatters
* Improved image quality
45
Other than medical comorbidities or tear characteristics, list 4 patient factors that are predictive of poor healing of the rotator cuff tear following surgery
* Age \>65
* Female
* Duration of symptoms
* Inability to elevate \>100
* Weak elevation and external rotation
* Smoking
* Failure to comply with activity restrictions
* Malnutrition
46
List 8 reasons to do Damage Control Orthopedics
* ISS\>40
* ISS\>20 with chest injury (AIS\>2)
* Closed head injury (AIS \>3)
* Hypothermia (T\<35)
* Multiple injuries and hypotensive / hemodynamically unstable (BP\<90)
* Radiographic evidence of pulmonary contusions
* Bilateral femoral fractures (+/- chest injury)
* \>6 hours anticipated surgical time
* Lactate \>2.5
* Base excess \>6-8, Base deficit \>+/-2
* Coagulopathy (DIC, platelets \<70, etc)
47
List 4 anatomic features of a pincer type femoral acetabular impingement
* Acetabular retroversion (cross over sign, prominent ischial spine, posterior wall sign)
* Acetabular lateral overhang (CEA \>40)
* Acetabular Protrusio
* Coxa Profunda
* Global acetabular overcoverage
48
List 4 indications to fix a scaphoid fracture acutely
* Proximal pole
* Displacement \>1mm
* Comminuted
* Transcaphoid perilunate injury
* DISI deformity (radiolunate \>15)
* Intrascaphoid angle \>35 (Humpback deformity)
* Unstable vertical / oblique
