2016 (All) Flashcards
Definitions of Scheurman’s Kyphosis.
Treatment?
Criteria for ORIF of a pars defect (spondylolysis)
Where is EG most commonly found in the spine?
What is the most common painful pediatric malignancy in the spine?
Treatment?
Risk factors for Spinal Infection (10)
Treatment of spinal infections and indications to operate
Indications for fixation of a Humeral GT # (4)
- Displacement >5mm
- Displacement >3mm in an overhead worker
- Failure of nonop managment
- Open fracture
- GT radio >0.5
Three types of Humeral GT #s
Which flexor tendon zone has the worst prognosis for repair?
List the flexor tendon zones of the hand (6)
Where does FDP Bifurcate?
Complications of flexor tendon Repairs
- Wound Issues
- Tendonorraphy Rupture
- Bowstringing
- Intrinsict Tightness
- Nail sensitivity
- Intrinsic plus deformity
- DIP contracture
Sunderland Classification of Nerve Injury
Sneddon?
When do you explore the peroneal nerve after injury?
Name 4 medications that need to be regally dosed?
Hepatically Dosed (4)
What tendon transfer do you perform for peroneal n. Palsy?
What are grafting options fo peroneal nerve laceration?
Criteria for good risk prediction tool (5)
Preop consideration fo patient with renal failure (7)
What GI conviction is a contraindication to surgery?
DDx of osteochodnral lesion of talus (7)
Indications for fresh allograft in OCD lesions of talus (4)
1.
Increased risks associated with GA vs neuraxial technique for anesthesia in TKA.
When is it safe to admin LMHW after epidural catheter?
When would you not want a nerve block in the setting of TKA for a patient?
What does the literature say for arthroscopic debridement for OA in:
- Knee
- Shoulder
- Elbow
- Hip
Advantages of XLIF (lateral inter body fusion) over PLIF and TLIF (3)
Disadvantage to XLIF (lateral inter body fusion)
Contraindications to lateral lumbar Intra body fusion (4)
Indications for lumbar Interbody Fusion ( 5)
1.
Where is the “safe zone” of acces for a retroperitoneal approach to the lumbar spine?
Factors contributing to ankle arthritis (5)
Outcomes of total ankle vs arthrodesis
Contraindications to ankle arthroplasty (8)
Contraindication for arthroscopic assisted arthrodesis of the ankle
Patient presents with transphyseal fracture of the distal humerus <1 year of age. What do you need to rule out?
CHILD ABUSE.
Presentation of pediatric patients with injury.
Radiographic signs of transphyseal distal humerus fracture in a child
Treatment of transphyseal distal humerus fractures.
Complications of transphyseal distal humerus fractures.
Presentation of Metal Hypersensitity reaction following TKA
PRP use in F&A regarding: osseus healing, Achilles tendinopathy & plantar fasciitis
- Osseus
Factors influencing strength of soft-issue to bone fixation construct (4)
Which implant the ha sthe highest yeild and cyclic load tasting in soft tissue to bone healing constructs?
Mode of failure for:
Interference Screw
Cortical Button
Transfixation Pins
Suture Anchors
Staples
Which mode of distal biceps fixation has the lowest rate of complications?
Mangement of UCL injuries
Techniques that have improved outcome in UCL reconstruction in the elbow (3)
Most common complication following UCL reconstruction int he elbow
Figure of 8 vs docking technique in UCL reconstruction of the elbow
Describe thre foot strike patterns in running
- Forefoot strike
- Inistsially land over forefoot
- More cushioning, foot intrinsics contract cushions forefoot, gastrocs eccentrically contracts cushioning proximal joints
- Midfoot strike - whole foot on ground at once
- Rearfoot strike - land on heal and weigh rolls foreward
1.
Fractures of the forefoot and midfoot strike vs rearfoot strike in running.
Injuries in barefoot running
Indications for TTC Fusion (9)
Patient factors negatively affecting results of TTC fusion (9)
Bone grafting options in TTC arthrodesis
When can you use cannulated screw fixation in TTC arthrodesis?
TTC nail vs plate fixation in TTC fusion
Equivalent biomechanical outcomes
Benefits of TTC nail in TTC arthrodesis
- Load sharing, can weightbare earlier
- Decrease incision sizes.
Dont use when deformity of distal tibia
Outcomes of unplanned resection of soft tissue sarcomas (5)
- Greater
Greater Trochanter pain sydrome encompasses which 3 entities?
Imaging modalities to work up greater trochanteric pain syndrome
Indications and option for surgical management of greater trochanter pain syndrome
- 613 month
Independent predictors of in-hospital mortality and postop complicatiosn in primary TKA (5)
Consideration for Parkinson’s patients undergoing TKA
What is the Rosenberg View?
Xrays you should order for preop plannting of TKA, and what do they show.
- 3 ft standing
What is the result of raising the jointline in TKA?
Lowering it?
How do you avoid cam-post impingment in TKA?
Cause of increased Q angle in TKA (7)
- Internal rotation of femoral component
- Internal rotation of tibial component
- Medialiation of femoral component
- Medialization of tibial component
- lateralization of patellar implant
- >7 degree valgus femoral cuT
What size tibial defect can be filled with cement?
What degree of coronal deformity can be balanced in the knee using soft tissue releases?
Navigated vs non-nag TKA
Strength loss post patellectomy
Principles for ERTL transtibial amputation
- B
ERTL vs trantibial BKA
- ERTL
Gene related to ank spond
Features of ankle spond
When is an ank spond patient at high risk of iatrogenic nerve injuries?
Spinal changes in ank spond
Non orthopaedic and orthopaedic features of ank spond
Outcomes of operative intervention in spine fractures in ank spond
Complications of spine surgery specific to ank spond
Course and branches of axillary n.
3 technical difficulties of subscap sparing (subscap split) approach for arthropalsty
Ideal adjunct treatment for spinal cord injury would have which 3 components?
Name the meniscofemoral ligaments (2)
Which PCL bundle is larger? Stronger?
How do you grade PCL injury?
What would you see commonly with chronic PCL on long leg standing films?
Op vs nonop isolated PCL injury in an athlete
Fixation techniques PCL:
Single vs double bundle?
Fixation technique for avulsion?
Single vs double - no differec
What position do fuse:
MCP and PIP of second finger
as you go more ulnar?
thumb cmc?
Finger arthritis vs fusion in:
post traumatic OA?
Septic arthritis?
Psoriatic arthitis?
SLE?
RA?
Scleroderma?
Complication post finger fusion
Most common mutation in OI
Medical therapy for OI (3)
Meds not recommended for treatment of OI
Considerations for nailing in patients with OI (4)
What % of # are in the spine, for adult OI patients?
50%
Complications of hip scope for trauma
chondral injury
fluid extravasation -> abdo compartment syndrome, resp failure, death
transient traction neuropraxia (pudendal nerve > LFCN)
HO 1-6.3%
VTE 1.4%
Rates of AVN after hip dislocation with fracture
Rates of HO following open vs arthroscopic hip procedure
Definition of proximal junctional kyphosis
Risk factors for proximal junctional kyphosis
Strategies to decrease occurrence of Proximal junctional kyphosis
What anatomic changes are associated with glenoid dysplasia?
Management of glenoid dysplasia
What procedure shoudl you avoid in patients with glenoid dysplasia?
How much glenoid bone stock is required to put in a glenoid component in shoudler arthroplasty?
How much glenoid retroversion can be corrected with eccentric reaming?
What type of corrosion in implicated in trunnosis?
Factors associated with increased failure of MOM articulation and trunnion wear (7)
Things to check when revision for trunnosis
When would you do a femoral component revision in trunnionosis
What is the trajectory of a cortical pedicle screw?
Other fixation options for lumbar spine fusion (besides traditional pedicle screws).
When are they useful?
Complications after injection for tennis elbow
- PLRI
- Fat Atrophy (common)
- Skin hypopigmentatin (common)
When do you apply a halo postop for pediatric spine surgery?
- Age <8
- Unreliable patient
When inserting occipital screws- what do you do if you drill and cause a CSF leak?
Tamponade the hole with a screw.
Main blood supply to navicular?
Classification of navicular fractures
Risk factors for navicular stress # (3)
Conservative management of navicular #
Indications to fix navicular body fracture (6)
Complications of navicular fracture
Techniques to avoid anterior perforation of femur during nailing (4)
Long vs Short nail (when to use), complications
When is an elbow dislocation considered chronic?
Salvage procedures for chronic elbow dislocation
Indications for triceps lengthening in chronic elbow dislocation. (3)
Structures to release in chronic elbow dislocation.
Indications for ulnar nerve transposition in chronic elbow dislocation
Goals of supramalleolar osteotomy (4)
1.
Indications for supramalleolar osteotomy
- Assymetric varus
Contraindications to supramalleolar osteotomy (6)
When’d o you require a fibular osteotomy when performing a SMO?
Complications of a SMO
When do you do a dome osteotomy for SMO
Standard technique and alignment goal for varus and valgus SMO
- Varus- Medial opening wedge
- Valgus- medial closing wedge
- Aim for 2-4 degrees tibiotalar valgus
Can do lateral osteotomies, just more difficult with fibula there.
DDX of patient with lumbar pain postop decompression or fusion procedure
- Decompression
- Samelevel
- Infection
- Stenosis
- Farcture
- Instabilty/Deformity
- Ajacent Level
- Stenosis
- Instabily
- Deformity
- Samelevel
- F
Risk factors for postop infection in spine surgery
Indications for surgical management of postop spine infection (3)
What do you do with hardware when doing an I&D for spine infection postop.
What is the rate of recurrence of stenosis postop lumbar spine decompression?
Where do most postop lumbar spine fractures occur?
Treatment for postop # in lumbar spine six (op and nonop)
What is the benefit of S2-Alar-Illica Screws?
Factors increasing chance of fusion in lumbar spine surgery
Risk factors for pseudoarthrosis in spinal surgery
What can you do to optimize fusion rates in revision spine surgery for psuedoarthrsis?
What is flat back syndome?
Causes? (3)
Treatment?
Failure risk with vertical femoral tunnel in ACL surgery using transtibial techinque
Where do you put your femoral tunnel in a single bundle ACL reconstruction?
Landmarks for tibial tunnel during single bundle ACL reconstruction
Double bundle vs single bundle ACL
Theoretic risks of using independent femoral drilling compared to a transtibial approach
Potential advantages to IM clavicle fixation (4)
What kind of ossification does the clavicle undergo?
Comment on the blood supply to the femur during developement
- Early - epiphysis and metaphysis have separate blood supply
- Then becomes a vascular network around the proximal femur
- Epiphipseal vessesl cross the growth plate extraosseously and pierce the epiphysis becoming retinacular vessels
At risk structures around the clavicle (3)
- Brachial plexus - 1cm away
- Subclavian a. - 1.2 cm away
- Subclavian v. - 0.9mm away
General thought on wiring and kwire fixaton of the clavicle/
Too many hardware compliations. Wires can migrate to the heart and lungs and cause death. Newer generation IM nails/screws are preferred for IM fixation of clavicles
Branches of the profunda femoris a.
- MFCA
- LFCA
- Perforating A.
- Muscluar branches
- Desceding retinacular a.
Componenets of the cruciate anastamosis.
- Inferior gluteal a.
- Transverse MFCA
- Transverse LFCA
- Profuda femoris a.
On field management of athletet with a suspected c-spine injury
- Immobilize in rigid collar
- Rigid backbone
- Leave helmet in place. Defer removal until i a controlled environment.
When do you surgically fix a facet fracture?
burst fracture?
- Fix all injuries with injured PLC
- Neurological injuries
- Unstable
- Facet
- Displaced >1 cm
- Involve > 40% lateral mass
- Burst: same as above
- Relative contradincicaiton for C7 burst to be treated nonop, mointor for risk of substantial kyphosis
Contraindications to participation in intense athletic activty after cspine fracture (9)
Reletive contraindications (4)
- Occipital-cervical arthrodesis
- AA instability
- Residual subaxial arthrodesis
- Substantial sagital malalignment
- Narrowing of spinal canal as result of retropulsed fragment
- Residual new deficits
- Loss of cervical ROM
- Spear tackler’s spine
- Canal vertebral body ration (pavlov) <0.8
- Straight or kyphotic alignement
- Post traumatic radiographic abnormality
- Documation of spear tackling technique
Relative
- Upper c-spien fracture malunion
- C1 ring fracture nonunion
- Two level cervical arthrodesis
- Congential abnormality (ie os sodentiodum)
Torg-Pavlov Ratio
Diameter cervical canal/diameter of cervical body.
<0.8 = stenosis
Which appraoch ot the hip puts the inferior gluteal a. and n. at risk?
Split of glut max in kocher langenbeck
Which vessels are damaged during a piriformis start nail?
Superior retinacular vessels of ascending cervical braches
Which artery does teh artyer of ligmentum teres arise from ?
Mostly obtuartor (some from MFCA, some have contributions from both)
How much supracetbaularu distace should you leave when doing a PAO? Why?
2- 2.5 cm
to allow sufficien profusion of the acetabulum (where all the acetabular vessels are)
Bloody supply to the acetabulum
- Central axis
- Acetabular a. (from obturator)
- Supplies 3 main ossification centres of the triradiate
- Acetabular a. (from obturator)
- Peripheral Ring
- SGA
- IGA
- Ischial A. (internal pudendal)
Imbalances seen in swimmer’s shoulder (2)
- Overdeveloped lat dorsi and Pec Major
- Increased adduciton and internal rotation force
- Scapular dyskinesia
Pathologies seen in swimmer’s shoulder
- Os acromilae
- Labral pathology
- Surpascapuarl Neuropathy
- GIRD
- Subacromial Impingment
- Hyperlaxity
- Scapular dyskinesia
- Overdeveloped Pec Major and Lat Dorsi
- Overpowers serratus and subscap
- Asynchronous trap firing = superior migration of hte humeral head
Which one surgery, when done for the appropriate pathology, has swimmers most constatily abck at pre-injury level of performance?
Decompression of suprascapular n.
Nonop management of swimmer’s shoulder
- Sleeper stretches
- Strengthening of serratus, RTC, straps and rhomboids
- Proper stroke form and slow return to sports
Tissue densities in ultrasound
- Tendons/bones = hyperechoic (white)
- Muscles - hypoechoic (grey)
- Fluid/cysts - anechoic (black)
- Peripheal n, ligments - mixed
What can you use to reliabely diagnose a stener’s lesion of the thumb?
Ultrasound! 100p acurate
and I guess an MRI
How do you assess integrety of pulleys in the finger using ultrasound?
Look at degree of bowstringing.
3mm in extension or 5mm in flexion = complete pulley disruption
Benefit of ultrasound use in the hand and wrist.
- Usesfl preop for identifying extent of retraction of tendons
- Can dynamically evaluate structures (ie ECU subluxation
Evidence of ultrasound guided vs blind injection in the hand and wrist.
- Minimal evidence of improved outcomes
- Studies aren’t great
Success rates of bracing for AIS
- Worn >13hrs/day = 90-93% successful
- <6 horus - 41% sucessful
- NNT for bracing =3 (BRAIST Study)
- No effect on QOL
Mechanicsm of action of bracing in AIS
- 3 point mould
- Elongation
- Push
- Movement
Which AIS patients can you brace?
Goal of brace correction?
How long to wear?
- Can brace
- 20-40 degree curve
- Risser 0-3
- Goal : correction of 30-70% (roughly 50%)
- Weak at least 12 hr/day (16-18 ideal)
Overall evidence for physio for coruve correction in scoliosis.
Some evidence for Schroth method specifically, everything else has no evidence.
Principles of skill acquisition through simulation training (4)
- Transferability
- Retention - higher retention = better performance on gameday
- Repeated practice (multiple repetitions better than one long intensive session)
- Prevent Decay (manual practice influences cognitive knowledge)
Which patients have worse outcomes for primary TKA?
- Obese
- DM
- Cirrhosis
- Hep C
- Chronic pain, anxity, depression
No difference found in delaying patients for surgery, so go ahead and optimize them.
No evidence supporting these in TKA (6)
- Patient specific implants
- PS over CR or otherwise
- Navigation
- ABx cement
- Drains
- CPM machine (early mobilization)
Most common sports with cervical spine injuries
- US
- Football
- Wrestling
- Gymnastics
- Canada - hockey
- Europe - rugby
motorcross didn’t make the cut.
Fixation indication for odontoid #
- >5mm displacement
- >10 degrees angulation
- Comminuted
What must be ruled out in an athlete with a stinger, who has neurosymptoms worse in one extremity or that do not rapidly resolve?
rule out transient cervical cord neuropraxia
What threshold of midsagittal intervertebral disc space is associated with increased risk of SCI
greater than or equal to 8mm
Which levels do disc herniations occur more commonly in NFL players
C3-4, C5-6
(C6-7 most common in general population)
Is it safe to return to sports after single level ACDF?
What changes are seen in a spear-tackler’s spine?
What is the most common primary bone tumour of the hand?
Ejc0
What shoudl you see on xrays of an enchrondroma?
Well
Tagkigawa classification of Enchondromas
Associations with Mafucci Syndrome
DDx of benign hand tumours
- Enchondroma
- Chondroblastoma
- Osteoblastoma
- Hemmorhagic epitheliod and spindle cell hemangioma
DDx of malignant hand tumours (6)
DDx of non-tumour, but tumour-like lesions of the hand (7)
Most frequent site of metastasis in the hand
Which cancers most commonly metastasize to the hand?
How do you treat low grade chondrosarcoma vs enchondroma of the hand?
Treatment of pathologic fracture of an enchrondroma of the hand
Adjunctive treatments in Enchondroma currettage
Complications post-curretage of an enchondroma
Rate of HO in traumatic amputation
Causative organism of septic arthritis in children <1 year of age
Most common organism for septic arthritis and abcess in sickle cell patients
Complications increased with MRSA infection
What should be monitored as an indicator of a pediatric patient’s response to antibiotics
What pathogens do you need to consider as a source of infection in pediatric patient who are immunocompromised or from endemic regions?
New marker we can monitor in the serum for pediatric infections
DDx of limp and pain/fever in a kid (6)
Kocher Criteria
What is a common triad seen in JIA?
Surgical indications of pediatric osteomyelitis (3)
Goals of treatment for adults with neuromuscular conditions (Parkinson’s, MS, CP, myopathies)
Name and describe 4 deformities seen in Parkinson’s patients
Surgical consideratiosn in a spinal surger for a patient with Parkinsons
Common causes for revision of spinal surgery in Parkinson’s patients
Targets for spinopelvic correction in Parkinsons
Postop considerations for spinal surgery in Parkinson’s Patients
Factors affecting delivery of care to inmates
- Saftey takes priority over health issues
- Inmate transfers
- noncomplicance and lack of cooperation from patient
- delay + interruption in care
- lack of services ie rehab
Indications for a distal femoral traction pin
Contraindications to femoral traction pin
Indications for proximal tibia traction pin
contraindications?
- Distal 2/3 femoral shaft fracture.
*
Optimal position of calc pin
5 factors associated with successfully closed reduction of a pediatric dislocated hip
Safe zone for closed reduction in Paeds DDH
3 risk factors for AVN in a closed reduction DDH
Incidence of AVN after open reduction via a medial approach
Surviourship of a salter osteotomy
Which have fastest onset of growth modulation, staples or plates?
Indications fo hemiepiphyseodeiss in blounts
How much angular correction can you expect in guided growth of the femur? Tibia? With tension band plating.
Indications for tension band plating for crouched gait (CP
Contraindications to tension band plating
Which patiens are tension band plating ideal for>
Complications of tension band plating
Risk factors for failure of tension band plates
Causes of perioperative vision loss
What kind of ischemic optic neuropathy is most associated with spine surgery, anterior or posterior?
Risk factors for POVL
Treatment of perioperative vision loss
What is the threshold for strain before you get a fibrous nonunion?
factors affecting implant stiffness
1.
Factors associated with risk of nonunion
Guidelines for bridge plating
Downside to using titanium plates
What layers separate in morel-lavalee lesion?
Stagesof a morel-lavalee lesion evolution
- Dermis separates from underlying fasci
- Exanguination from lymphatic and vasculature produces collection of blood, lymph and fatty debris
- Lesion enlarges as serosang fluid replaces above
- if left untreated, inflammation leads to pseudocapsule
Indications for debridement of a morel-lavalee lesion
Arthroplasty in patients >80 vs <80
Risk that increase in arthroplasty for patients >80
Hospitalist involvement in elderly total joint patients has shown to:
Indications for cortical bone trajectory pedicle screws
Contraindications to cortical trajectory pedicle screws
Benefit of cortical based trajectory screws
Which side of the knee has the more robust profusion
Contraindicatiosn to VAC dressings in open knee wounds
Main risk associated with partia thickness skin graft
Flap options for knee coverage
Downside of using a free flap
Ways to gauge rotation off forearm xrays
Acceptable reduction parameters for forearm fractures in peds
Surgical for BBFF in Paeds (6)
Advantages of flexible nails in pediatric BBFF
Disadvantages of flexible nails in pediatric BBFF
ORIF vs flexibel nailing BBFF
Single vs double bone nailing Paeds BBFF
Complications of flexible nailing
Risk factors for increased complication in nailing of BBFF
General approach to treatment by by age BBFF
Failure rate for massive RTC repair
Synthetic grafts vs biologic graft in RTCR
Concerns with synthetic grafts in RTCR
Teatime of lumbar facet cysts
Surgical indication for treatment of lumbar facet cyst
What is the most common location for lumbar facet cysts?
3 stages of lumbar facet cyst pathogenesis
Symptoms of lumbar facet cysts
Shoudl you fuse after surgical decompression of lumbar facet cysts?
Complications of surgical management of lumbar facet cysts
Ethology of spinal stenosis
- Degenerative
- congential
What is the best measure of symptoms for spinal pathology
Clause of spinal stenosis by location
Jersey finger
Treatment of jersey finger
Indications for repair of multiple pulley ruptures of fingers
Which pulley sdo climbers injure?
baseball pitchers?
3 types of ECU instabilty
What position is ECU unstable in?
Treatment of ECU subluxation
What position do you test for UCL injury of the thumb
Classification of UCL thumb injuries
Indication fo operative mangement of thumb UCL injury
Risk factors for patellar tendonopathy
Treatment of patellar tendonopathy
Nonop - only good evidence of eccentric exercises. Everything else has no evidence
Op - tenotomy patellar tendon, debride and re-repair. (Same as insertional Achilles tendonopathy)
