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
Q
List 4 risk factors for neurological progression in vertebral osteomyelitis
A
- Delay in diagnosis
- Spread to spinal canal = epidural abscess
- Destruction of vertebrae/disc –>instability–> Pathological fracture
- Inappropriate antibiotic treatment
26
Q
- List three endocrinopathies associated with SCFE
A
- Hypothyroidism
- Renal osteodystrophy
- Growth hormone deficiency
- Panhypopituitarism
- Hypogonadism
- down syndrome
27
Q
- List 5 reconstruction options with a type II periacetabular primary bone tumor
A
- Curettage, cement
- THR
- THR with reinforcement ring
- THR with defect filling with cement or allograft
- Megaprosthesis
- Massive allograft with THR
- Harrington procedure
28
Q
- Patient with a type II anterior tibial eminence fracture
a) What is the main block to reduction
b) What are the associated complications
A
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
Q
- List 6 risks during spine or other orthopedic procedures that can lead to postop vision loss
A
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
- Eye lids not closed, not lubricated
- Prone position
- Long duration
- High blood loss
- Large fluid resuscitation
- Head pieces that put pressure on the globe
30
Q
- You are treating a 8 year old patient with open reduction of the lateral condyle fracture. List 3 surgical considerations
A
- 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
Q
What are 6 factors that are associated with failure of treatment of DDH with a brace
A
- Delay in diagnosis
- Irreducible hip
- Teratologic hip dislocations
- Abnormal muscle function (spina bifida or spasticity)
- Extremes of position (AVN – with extreme abduction – impingement of posterosuperior retinacular branch of medial femoral circumflex artery); Transient femoral nerve palsy (hyperflexion)
- Not worn for at least 23 hours/day for 6 weeks then wean 6-8 weeks
- Wearing brace when hip not reduced after 3-4 weeks – prevents development of posterior wall of acetabulum
32
Q
List six principles in the management of severe hallux valgus
A
- Correct the HVA and IMA
- Achieve a congruent joint
- Double osteotomy or Fusion procedure needed to correct severe deformity
- Arthrodesis - failed procedure, OA or high risk of failure (OP, neuromuscular spasticity, involvement of lesser joints)
- Be mindful of capsular release – AVN
- Do not shorten the hallux – transfer metatarsalgia
- Be mindful of medial branch of dorsal cuntaneous nerve of SPN – lower risk of neuropraxia
33
Q
What is the etiology and radiographic findings in weightlifter shoulder disease?
A
- Repetitive microfracture –-> distal clavicle osteolysis
- XR – cysts at distal end of clavicle, osteopenia, resorption and erosion, tapering distal clavicle
34
Q
What are 6 radiographic findings associated with non accidental trauma in pediatric patients with no metabolic bone disease
A
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
Q
Patient presenting with a tibial open fracture, fill in the Tetanus table below
A
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
Q
List three deformities associated with a subtrochanteric femur fractures and list two surgical techniques/aids to help you in reduction for each of them
A
- Abduction – gluteus medius
- Flexion – iliopsoas
- External rotation – short external rotators
37
Q
List 6 factors associated with Dupuytren’s disease
A
- Hereditary
- EtOH
- Epilepsy
- Trauma
- DM
- HIV
- Peyrone’s disease
38
Q
What is the difference between concealment of allocation and blinding
A
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
Q
List 5 reamer characteristics to decrease intramedullary pressure while reaming
A
- Deep flutes
- Narrow reamer shaft
- Sharp flutes
- Cannulated
- Conical shape
40
Q
List 4 major criteria to diagnose fat embolism
A
- Hypoxemia (PaO2<60)
- CNS depression (changes in mental status)
- Petechial rash
- Pulmonary edema
41
Q
List 4 minor criteria to diagnose fat embolism
A
- Tachycardia
- Pyrexia
- Retinal emboli
- Fat in urine or sputum
- Thrombocytopenia
- Decreased HCT
Other – PCO2>55, pH <7.3, RR >35, dyspnea, anxiety
42
Q
List 6 radiographic findings associated with FAI
A
- Coxa profunda
- Protrusio acetabuli
- Femoral neck retroversion
- Acetabular retroversion
- Anterior superior acetabular rim overhang
- Pistol grip deformity (Cam impingement)
- Crossover sign (Pincer impingement)
- Alpha angle >42 degrees – head/neck offset deformity
- Head neck offset ratio <0.17 – cam deformity present
