2016 only Q's with A's - answers may be truncated Flashcards
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
DDx of benign hand tumours
- Enchondroma
- Chondroblastoma
- Osteoblastoma
- Hemmorhagic epitheliod and spindle cell hemangioma
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
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
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
- Narrowingof 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)
No evidence supporting these in TKA (6)
- Patient specific implants
- PS overCR or otherwise
- Navigation
- ABx cement
- Drains
- CPM machine (early mobilization)
Complications after injection for tennis elbow
- PLRI
- Fat Atrophy (common)
- Skin hypopigmentatin (common)
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
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)
Complications of flexor tendon Repairs
- Wound Issues
- Tendonorraphy Rupture
- Bowstringing
- Intrinsict Tightness
- Nail sensitivity
- Intrinsic plus deformity
- DIP contracture
How much supracetbaularu distace should you leave when doing a PAO? Why?
2- 2.5 cmto allow sufficien profusion of the acetabulum (where all the acetabular vessels are)
What % of # are in the spine, for adult OI patients?
50%
Which levels do disc herniations occur more commonly in NFL players
C3-4, C5-6(C6-7most common in general population)
Patient presents with transphyseal fracture of the distal humerus <1 year of age. What do you need to rule out?
CHILD ABUSE.
Complications of hip scope for trauma
chondral injuryfluid extravasation -> abdo compartment syndrome, resp failure, deathtransient traction neuropraxia (pudendal nerve > LFCN)HO 1-6.3%VTE 1.4%
Which one surgery, when done for the appropriate pathology, has swimmers most constatily abck at pre-injury level of performance?
Decompression of suprascapular n.
Torg-Pavlov Ratio
Diameter cervical canal/diameter of cervical body.<0.8 = stenosis
TTC nail vs plate fixation in TTC fusion
Equivalent biomechanical outcomes
What threshold of midsagittal intervertebral disc space is associated with increased risk of SCI
less than or equal to 8mm
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
Which artery does teh artyer of ligmentum teres arise from ?
Mostly obtuartor (some from MFCA, some have contributions from both)
Treatment of patellar tendonopathy
Nonop - only good evidence of eccentric exercises. Everything else has no evidenceOp - tenotomy patellar tendon, debride and re-repair. (Same as insertional Achilles tendonopathy)
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
Fixation techniques PCL:Single vs double bundle?Fixation technique for avulsion?
Single vs double - no differec
Overall evidence for physio for coruve correction in scoliosis.
Some evidence for Schroth method specifically, everything else has no evidence.
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
When inserting occipital screws- what do you do if you drill and cause a CSF leak?
Tamponade the hole with a screw.
Generalthought 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
What can you useto reliabely diagnose a stener’s lesion of the thumb?
Ultrasound! 100p acurateand Iguess an MRI
Fixationindication for odontoid #
- > 5mm displacement
- > 10 degrees angulation
- Comminuted
Xrays you should order for preop plannting of TKA, and what do they show.
- 3 ft standing
Mechanicsm of action of bracing in AIS
- 3 point mould
- Elongation
- Push
- Movement
When do you apply a halo postop for pediatric spine surgery?
- Age <8
* Unreliable patient
At risk structures around the clavicle (3)
- Brachial plexus - 1cm away
- Subclavian a. - 1.2 cm away
- Subclavian v. - 0.9mm away
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)
Bloody supply to the acetabulum
Central axis Acetabular a. (from obturator)
- Supplies 3 main ossification centres of the triradiate Peripheral Ring
- SGA
- IGA
- Ischial A. (internal pudendal)
DDX of patient with lumbar pain postop decompression or fusion procedure
Decompression Samelevel
- Infection
- Stenosis
- Farcture
- Instabilty/Deformity Ajacent Level
- Stenosis
- Instabily
- Deformity
- F
Ethology of spinal stenosis
- Degenerative
* congential
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
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 plateextraosseouslyand pierce the epiphysis becomingretinacular vessels
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
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.
Componenets of the cruciate anastamosis.
- Inferior gluteal a.
- Transverse MFCA
- Transverse LFCA
- Profuda femoris a.
Benefits of TTC nail in TTC arthrodesis
- Load sharing, can weightbare earlier
- Decrease incision sizes.
Dont use when deformity of distal tibia
Branches of the profunda femoris a.
- MFCA
- LFCA
- Perforating A.
- Muscluar branches
- Desceding retinacular a.
Evidence of ultrasound guided vs blind injectionin the hand and wrist.
- Minimal evidence of improved outcomes
* Studies aren’t great
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.
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
Imbalances seen in swimmer’s shoulder (2)
Overdeveloped lat dorsi and Pec Major
- Increased adduciton and internal rotation force
- Scapular dyskinesia
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
Most common sports with cervical spine injuries
US * Football * Wrestling * Gymnastics * Canada - hockey * Europe - rugby motorcross didn't make the cut.
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
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.
Success ratesof bracing for AIS
- Worn >13hrs/day = 90-93% successful
- <6 horus - 41% sucessful
- NNT for bracing =3 (BRAIST Study)
- No effect on QOL
