2017 SAQ Flashcards
1
Q
List 6 etiologies associated with sclerosing periosteal reaction and cortical thickening in infancy and young children
A
- Chronic infection – osteomyelitis
- osteoid osteoma
- chronic stress reaction/fracture
- other tumours – osteosarcoma, Ewing’s sarcoma
2
Q
Define the following: complete, complex, synonychia
A
- Synonychia – fingers share a common nail
- Complete – fusion of digits from webspace to fingertips (simple or complex)
- Complex – involves fusion of bone or finger nails to adjacent fingers
3
Q
When treating a transverse femoral fracture in a child, what are 4 surgical technique considerations to prevent failure of implant fixation and loss of reduction
A
- Flexible nails – nail size – multiply width of canal by 0.4 for diameter of each nail; use only if fracture is midshaft (not as good proximal or distal); don’t use in patients >11 years old or over 50 kg
- Submuscular bridge plating – long 12-16 hole 4.5mm narrow LCDC plate, restrict WB until callus formation
- Antegrade nail – lateral entry (if GT entry used – can get narrowing of femoral neck, premature fusion of GT apophysis, coxa valga, hip subluxation)
4
Q
List 4 indications for operating on the cervical spine in a RA patient
A
- Progressive neurological deficit/myelopathy
- PADI <14mm
- Basilar invagination/ atlantoaxial impaction 5mm above McGregor’s line (hard palate to opisthion)
- Subaxial sagittal canal diameter <14mm
- Chronic neck pain unresponsive to non – narcotic treatment invagination/instability
- ADI >10 mm
- ADI motion >3.5mm on flex-ex
- >7mm with neurological impairment
5
Q
- List the 4 deformities IN ORDER that need to be corrected in clubfoot
A
- CAVE
o Cavus
o Adductus
o Varus
o Equinus
6
Q
- List 8 radiographic findings in aortic dissection
A
- Widened mediastinum
- Hemothorax (left)
- Apical Cap
- Loss of AP window
- Loss of aortic contour/knob
- Tracheal deviation to right
- Deviation of NG to right
- Depression of left bronchus
- Fractured 1st/2nd rib or clavicle
7
Q
- List 6 principles of tendon transfer
A
- Synergistic transfer
- Expandable donor
- Adequate power (lose 1 grade)
- Contractures need releasing
- One tendon, one function
- Adequate amplitude (length/excursion)
- Straight line of pull
- Tissue equilibrium
8
Q
- List 6 orthopedic manifestations that helps in diagnosis of Marfan’s syndrome
A
- Dolichostenomelia (arm span > height >1.05 ratio)
- Arachnodactyly (long, thin toes and fingers)
- Thumb sign (tip of thumb extends beyond small finger when thumb clasped in palm under four fingers)
- Wrist sign (distal phalanges of thumb and index fingers overlap when wrapped around opposite wrist)
- Ligamentous hyperlaxity
- Scoliosis
- Pes planus
- Protrusio acetabuli
- Recurrent dislocations
- Dural ectasia
- Meningocele
- Pectus excavatum or carinatum
9
Q
- List 6 neurologic causes of cavus foot
A
- Charcot-Marie-Tooth
- Stroke
- Spinal cord injury/tumours
- Fredrichs ataxia
- Polio
- Spinal dysraphism
- CP
- Muscular dystrophy
10
Q
- List 5 reduction techniques to use in proximal tibia fractures
A
- Poller screw (blocking screw)
- Suprapatellar approach, semi – extended knee position
- Unicortical plate
- Reduction clamp
- Universal distractor
- Ream reduced
- Avoid anterior start point
11
Q
- List 3 techniques to check for proper femoral rotation during femoral nailing
A
- Match cortices on lateral view
- Lesser trochanter profile
- Clinical assessment
- Fracture fragment reduction
- Tornetta method (CT study for torsion assessment)
12
Q
- List 3 criteria for an acceptable reduction of femoral neck fractures
A
- Restoration of double “s” shape curves on lateral view
- No varus (up to 15 degrees of valgus)
- Reduction of medial calcar with no displacement
- AP angulation < 10 degrees
- Garden alignment index = trabecular liens on AP/lateral (aim for 160/180)
13
Q
- List the 3 findings in sacral sparing
A
- Voluntary anal contraction
- Perianal sensation
- Deep anal pressure
14
Q
- What are 6 relative indications for doing an MRI in scoliosis
A
- Associated back pain
- sign and symptoms of Neurological impairment
- Left sided curve (concave to right)
- Double curves or high thoracic curves
- Spinal X-ray abnormalities aside from curve
- Midline spinal cutaneous markers = dermal tracts, tufts of skin tags, hairy patch
- Abnormal number of café-au-lait spots
- Rapid progression
- Excessive kyphosis
- Foot deformities
15
Q
- List 3 local adverse effects of metal-on-metal hip arthroplasty
A
- Pseudotumour
- Aseptic lymphocyte = dominated vasculitis associated lesion (ALVAL)
- Abductor destruction
- Periprosthetic fracture
- Aseptic loosening
16
Q
- List 4 surgical considerations to take into account when doing a total shoulder arthroplasty in a B2 glenoid (biconcavity)
A
- Patient specific instrumentation = significant bone loss and retroversion
- Preopreative planning with 3D CT = important predictor of appropriate glenoid placement
- asymmetric reaming = can address posterior bone loss up to 5 to 8mm from joint line and correct 10 to 15 degrees of version
- TSA with bone grafting
- TSA with augmented glenoid components
17
Q
- List 3 risk factors to developing metastasis in soft tissue sarcoma
A
- Delay in diagnosis
- Local failure of complete excision
- Intermediate/high grade
- Lack of secondary re-excision
18
Q
List 6 complications associated with valgus medial opening HTO
A
- Hinge fracture
- Non union
- Infection
- Failure fixation/loss of correction
- DVT/PE
- Compartment syndrome
19
Q
- List 4 patient related risk factors associated with increased infection in total joint replacement
A
- DM
- Elevated BMI (especially >40)
- Smoking
- Immunocompromised (RA etc)
- Previous history of septic arthritis
20
Q
- List the 3 most common indications for reoperation after a terrible triad fixation
A
- Continued instability
- Failure of internal fixation = radial head/neck fractures
- Post traumatic stiffness
21
Q
List 6 indications to fix a humeral shaft fracture
A
- open fracture
- pathological fracture
- polytrauma
- inability to obtain/maintain adequate closed reduction
- vascular injury requiring repair
- compartment syndrome
22
Q
- List 4 glenohumeral ligaments
A
- SGHL
- MGHL
- IGHL
- Coracohumeral ligament
23
Q
- List 4 stabilizers of the AC joint
A
- Acromioclavicular ligament
- Coracoclavicular ligaments (trapezoid, conoid)
- Capsule
- Deltoid
- Trapezius
24
Q
- List 4 indications for a hemiresection-interposition arthroplasty of the DRUJ
A
- Degenerative arthritis of distal radioulnar joint
- Painful instability
- Post-traumatic arthritis
- RA with synovitis
- Ulnocarpal impaction
- Chronic dislocation
- Ulnar malunion
25
List 4 risk factors for neurological progression in vertebral osteomyelitis
- Delay in diagnosis
- Spread to spinal canal = epidural abscess
- Destruction of vertebrae/disc --\>instability--\> Pathological fracture
- Inappropriate antibiotic treatment
26
1. List three endocrinopathies associated with SCFE
- Hypothyroidism
- Renal osteodystrophy
- Growth hormone deficiency
- Panhypopituitarism
- Hypogonadism
- down syndrome
27
2. List 5 reconstruction options with a type II periacetabular primary bone tumor
- Curettage, cement
- THR
- THR with reinforcement ring
- THR with defect filling with cement or allograft
- Megaprosthesis
- Massive allograft with THR
- Harrington procedure
28
3. Patient with a type II anterior tibial eminence fracture
a) What is the main block to reduction
b) What are the associated complications
**main block to reduction:**
- Entrapped meniscus or intermeniscal ligament (medial meniscus most common)
**The associated complications:**
- Compartment syndrome
- Loss of motion (particularly extension)
- Arthrofibrosis
- Growth arrest
- ACL laxity
- NV injury
29
4. List 6 risks during spine or other orthopedic procedures that can lead to postop vision loss
**Ricks can lead to the following:**
- Corneal abrasion
- Postop posterior ischemic optic neuropathy
- Post op anterior ischemic optic neuropathy
- Cerebral visual loss
- Central retinal artery occlusion
- Branch retinal artery occlusion
**Risks**
1. Eye lids not closed, not lubricated
2. Prone position
3. Long duration
4. High blood loss
5. Large fluid resuscitation
6. Head pieces that put pressure on the globe
30
6. You are treating a 8 year old patient with open reduction of the lateral condyle fracture. List 3 surgical considerations
- Posterior dissection can result in lateral condyle osteonecrosis
- Visualize joint reduction as metaphyseal component may have plastic deformation
- Prevent non union by preserving soft tissue attachments and stable fixation
31
What are 6 factors that are associated with failure of treatment of DDH with a brace
1. Delay in diagnosis
2. Irreducible hip
3. Teratologic hip dislocations
4. Abnormal muscle function (spina bifida or spasticity)
5. Extremes of position (**AVN** – with extreme abduction – impingement of posterosuperior retinacular branch of medial femoral circumflex artery); Transient femoral **nerve palsy** (hyperflexion)
6. Not worn for at least 23 hours/day for 6 weeks then wean 6-8 weeks
7. Wearing brace when hip not reduced after 3-4 weeks – prevents development of posterior wall of acetabulum
32
List six principles in the management of severe hallux valgus
1. Correct the HVA and IMA
2. Achieve a congruent joint
3. Double osteotomy or Fusion procedure needed to correct severe deformity
4. Arthrodesis - failed procedure, OA or high risk of failure (OP, neuromuscular spasticity, involvement of lesser joints)
5. Be mindful of capsular release – AVN
6. Do not shorten the hallux – transfer metatarsalgia
7. Be mindful of medial branch of dorsal cuntaneous nerve of SPN – lower risk of neuropraxia
33
What is the etiology and radiographic findings in weightlifter shoulder disease?
* Repetitive microfracture –-\> distal clavicle osteolysis
* XR – cysts at distal end of clavicle, osteopenia, resorption and erosion, tapering distal clavicle
34
What are 6 radiographic findings associated with non accidental trauma in pediatric patients with no metabolic bone disease
**_High specificity_**
* Fracture at the junction of metaphysis/physis
* Corner fracture
* Bucket handle fracture
* Rib fractures (esp. posteromedial)
* Scapula, sternal, spinous process #’s
**_Moderate specificity_**
* Epiphyseal separation
* Multiple fractures, various healing stages
* Vertebral body Fractures/subluxations
* Digital fractures
* Complex skull fractures
35
Patient presenting with a tibial open fracture, fill in the Tetanus table below
Clean wound
Dirty wound
Unknown immunization history
Give Td but no TIG
Yes Td and TIG
Immunization done \>10y ears ago
Give Td but no TIG
Yes Td, no TIG
Immunization done \< 10 years ago
*
Yes Td (if \>5 years), no TIG
36
List three deformities associated with a subtrochanteric femur fractures and list two surgical techniques/aids to help you in reduction for each of them
1. Abduction – gluteus medius
2. Flexion – iliopsoas
3. External rotation – short external rotators
37
List 6 factors associated with Dupuytren’s disease
1. Hereditary
2. EtOH
3. Epilepsy
4. Trauma
5. DM
6. HIV
7. Peyrone’s disease
38
What is the difference between concealment of allocation and blinding
**_Concealment of allocation_**
* person randomizing patient does not know what the next treatment allocation will be.
**_blinding_**
* involves not disclosing to patients and outcome assessors the treatment allocations after random allocation
39
List 5 reamer characteristics to decrease intramedullary pressure while reaming
1. Deep flutes
2. Narrow reamer shaft
3. Sharp flutes
4. Cannulated
5. Conical shape
40
List 4 major criteria to diagnose fat embolism
1. Hypoxemia (PaO2\<60)
2. CNS depression (changes in mental status)
3. Petechial rash
4. Pulmonary edema
41
List 4 minor criteria to diagnose fat embolism
1. Tachycardia
2. Pyrexia
3. Retinal emboli
4. Fat in urine or sputum
5. Thrombocytopenia
6. Decreased HCT
Other – PCO2\>55, pH \<7.3, RR \>35, dyspnea, anxiety
42
List 6 radiographic findings associated with FAI
1. Coxa profunda
2. Protrusio acetabuli
3. Femoral neck retroversion
4. Acetabular retroversion
5. Anterior superior acetabular rim overhang
6. Pistol grip deformity (Cam impingement)
7. Crossover sign (Pincer impingement)
8. Alpha angle \>42 degrees – head/neck offset deformity
9. Head neck offset ratio \<0.17 – cam deformity present