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JAAOS Summaries > 2016 only Q's with A's - answers may be truncated > Flashcards

2016 only Q's with A's - answers may be truncated Flashcards

1
Q

Stagesof a morel-lavalee lesion evolution

A
  • 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
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2
Q

DDx of benign hand tumours

A
  • Enchondroma
  • Chondroblastoma
  • Osteoblastoma
  • Hemmorhagic epitheliod and spindle cell hemangioma
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3
Q

Describe thre foot strike patterns in running

A

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
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4
Q

Cause of increased Q angle in TKA (7)

A
  • 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
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5
Q

Contraindications to participation in intense athletic activty after cspine fracture (9)Reletive contraindications (4)

A
  • 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)
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6
Q

No evidence supporting these in TKA (6)

A
  • Patient specific implants
  • PS overCR or otherwise
  • Navigation
  • ABx cement
  • Drains
  • CPM machine (early mobilization)
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7
Q

Complications after injection for tennis elbow

A
  • PLRI
  • Fat Atrophy (common)
  • Skin hypopigmentatin (common)
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8
Q

Factors affecting delivery of care to inmates

A
  • Saftey takes priority over health issues
  • Inmate transfers
  • noncomplicance and lack of cooperation from patient
  • delay + interruption in care
  • lack of services ie rehab
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9
Q

Principles of skill acquisition through simulation training (4)

A
  • 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)
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10
Q

Complications of flexor tendon Repairs

A
  • Wound Issues
  • Tendonorraphy Rupture
  • Bowstringing
  • Intrinsict Tightness
  • Nail sensitivity
  • Intrinsic plus deformity
  • DIP contracture
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11
Q

How much supracetbaularu distace should you leave when doing a PAO? Why?

A

2- 2.5 cmto allow sufficien profusion of the acetabulum (where all the acetabular vessels are)

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12
Q

What % of # are in the spine, for adult OI patients?

A

50%

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13
Q

Which levels do disc herniations occur more commonly in NFL players

A

C3-4, C5-6(C6-7most common in general population)

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14
Q

Patient presents with transphyseal fracture of the distal humerus <1 year of age. What do you need to rule out?

A

CHILD ABUSE.

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15
Q

Complications of hip scope for trauma

A

chondral injuryfluid extravasation -> abdo compartment syndrome, resp failure, deathtransient traction neuropraxia (pudendal nerve > LFCN)HO 1-6.3%VTE 1.4%

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16
Q

Which one surgery, when done for the appropriate pathology, has swimmers most constatily abck at pre-injury level of performance?

A

Decompression of suprascapular n.

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17
Q

Torg-Pavlov Ratio

A

Diameter cervical canal/diameter of cervical body.<0.8 = stenosis

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18
Q

TTC nail vs plate fixation in TTC fusion

A

Equivalent biomechanical outcomes

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19
Q

What threshold of midsagittal intervertebral disc space is associated with increased risk of SCI

A

less than or equal to 8mm

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20
Q

How do you assess integrety of pulleys in the finger using ultrasound?

A

Look at degree of bowstringing.3mm in extension or 5mm in flexion = complete pulley disruption

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21
Q

Which artery does teh artyer of ligmentum teres arise from ?

A

Mostly obtuartor (some from MFCA, some have contributions from both)

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22
Q

Treatment of patellar tendonopathy

A

Nonop - only good evidence of eccentric exercises. Everything else has no evidenceOp - tenotomy patellar tendon, debride and re-repair. (Same as insertional Achilles tendonopathy)

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23
Q

What must be ruled out in an athlete with a stinger, who has neurosymptoms worse in one extremity or that do not rapidly resolve?

A

rule out transient cervical cord neuropraxia

24
Q

Fixation techniques PCL:Single vs double bundle?Fixation technique for avulsion?

A

Single vs double - no differec

25
Q

Overall evidence for physio for coruve correction in scoliosis.

A

Some evidence for Schroth method specifically, everything else has no evidence.

26
Q

Which appraoch ot the hip puts the inferior gluteal a. and n. at risk?

A

Split of glut max in kocher langenbeck

27
Q

Which vessels are damaged during a piriformis start nail?

A

Superior retinacular vessels of ascending cervical braches

28
Q

When inserting occipital screws- what do you do if you drill and cause a CSF leak?

A

Tamponade the hole with a screw.

29
Q

Generalthought on wiring and kwire fixaton of the clavicle/

A

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

30
Q

What can you useto reliabely diagnose a stener’s lesion of the thumb?

A

Ultrasound! 100p acurateand Iguess an MRI

31
Q

Fixationindication for odontoid #

A
  • > 5mm displacement
  • > 10 degrees angulation
  • Comminuted
32
Q

Xrays you should order for preop plannting of TKA, and what do they show.

A
  • 3 ft standing
33
Q

Mechanicsm of action of bracing in AIS

A
  • 3 point mould
  • Elongation
  • Push
  • Movement
34
Q

When do you apply a halo postop for pediatric spine surgery?

A
  • Age <8

* Unreliable patient

35
Q

At risk structures around the clavicle (3)

A
  • Brachial plexus - 1cm away
  • Subclavian a. - 1.2 cm away
  • Subclavian v. - 0.9mm away
36
Q

Which AIS patients can you brace?Goal of brace correction?How long to wear?

A

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)
37
Q

Bloody supply to the acetabulum

A

Central axis Acetabular a. (from obturator)

  • Supplies 3 main ossification centres of the triradiate Peripheral Ring
  • SGA
  • IGA
  • Ischial A. (internal pudendal)
38
Q

DDX of patient with lumbar pain postop decompression or fusion procedure

A

Decompression Samelevel

  • Infection
  • Stenosis
  • Farcture
  • Instabilty/Deformity Ajacent Level
  • Stenosis
  • Instabily
  • Deformity
  • F
39
Q

Ethology of spinal stenosis

A
  • Degenerative

* congential

40
Q

Indications for fixation of a Humeral GT # (4)

A
  • Displacement >5mm
  • Displacement >3mm in an overhead worker
  • Failure of nonop managment
  • Open fracture
  • GT radio >0.5
41
Q

Comment on the blood supply to the femur during developement

A
  • 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
42
Q

When do you surgically fix a facet fracture?burst fracture?

A
  • 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
43
Q

On field management of athletet with a suspected c-spine injury

A
  • Immobilize in rigid collar
  • Rigid backbone
  • Leave helmet in place. Defer removal until i a controlled environment.
44
Q

Componenets of the cruciate anastamosis.

A
  • Inferior gluteal a.
  • Transverse MFCA
  • Transverse LFCA
  • Profuda femoris a.
45
Q

Benefits of TTC nail in TTC arthrodesis

A
  • Load sharing, can weightbare earlier
  • Decrease incision sizes.
    Dont use when deformity of distal tibia
46
Q

Branches of the profunda femoris a.

A
  • MFCA
  • LFCA
  • Perforating A.
  • Muscluar branches
  • Desceding retinacular a.
47
Q

Evidence of ultrasound guided vs blind injectionin the hand and wrist.

A
  • Minimal evidence of improved outcomes

* Studies aren’t great

48
Q

Which patients have worse outcomes for primary TKA?

A
  • Obese
  • DM
  • Cirrhosis
  • Hep C
  • Chronic pain, anxity, depression
    No difference found in delaying patients for surgery, so go ahead and optimize them.
49
Q

Pathologies seen in swimmer’s shoulder

A
  • 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
50
Q

Imbalances seen in swimmer’s shoulder (2)

A

Overdeveloped lat dorsi and Pec Major

  • Increased adduciton and internal rotation force
  • Scapular dyskinesia
51
Q

Nonop management of swimmer’s shoulder

A
  • Sleeper stretches
  • Strengthening of serratus, RTC, straps and rhomboids
  • Proper stroke form and slow return to sports
52
Q

Tissue densities in ultrasound

A
  • Tendons/bones = hyperechoic (white)
  • Muscles - hypoechoic (grey)
  • Fluid/cysts - anechoic (black)
  • Peripheal n, ligments - mixed
53
Q

Most common sports with cervical spine injuries

A 
US			
* Football		
* Wrestling		
* Gymnastics			
* Canada - hockey	
* Europe - rugby
motorcross didn't make the cut.
54
Q

Benefit of ultrasound use in the hand and wrist.

A
  • Usesfl preop for identifying extent of retraction of tendons
  • Can dynamically evaluate structures (ie ECU subluxation
55
Q

Standard technique and alignment goal for varus and valgus SMO

A
  • 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.
56
Q

Success ratesof bracing for AIS

A
  • Worn >13hrs/day = 90-93% successful
  • <6 horus - 41% sucessful
  • NNT for bracing =3 (BRAIST Study)
  • No effect on QOL

JAAOS Summaries (8 decks)

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