2021 Exam Flashcards
“Question about distal humerus fracture in low demand elderly patient, medically sick, what is true regarding non-operative treatment (repeat)<br></br><br></br><b><div><b><span>1. ⅔ have good to excellent subjective function, average rom 25-125</span></b><br></br></div><div><span>2. ⅓ with good to excellent subjective function, average ROM 45-90</span></div><div><span>3. Do poorly as above elbow splint is poorly tolerated</span></div><div><span>4. 80% nonunion</span></div></b><br></br>”
“<b><span>⅔ have good to excellent subjective function, average rom 25-125</span></b>”
“<b><div>Anatomical landmark used for acetabular version in THA<br></br><br></br></div><div><span>1. labrum</span></div><div><span>2. Posterior wall</span></div><div><span>3. Ligamentum teres<br></br>4. TAL</span></div></b><br></br>”
“<b><div><span>TAL</span></div><div><a><span>https://journals.sagepub.com/doi/pdf/10.1177/230949901302100215</span></a></div><div><span>AO Recon:</span></div><div><span>Bassam Masri, MD, and Head of Orthopaedics at the University of British Columbia, Canada, shared his preferred approach to determining cup version:</span></div><div><span>“The most important landmark for determining the cup ante-version if the transverse acetabular ligament (TAL). In most hips, the TAL is well-preserved and if the inferior aspect of the cup is placed parallel to the TAL, the correct anteversion is typically selected. In the absence of a TAL, I estimate its position by drawing a liner along the axis of the fovea centralis, which would be perpendicular to the position of the TAL.”</span></div></b><br></br>”
“<b><div>Patient with Open TIbia fx. What is true regarding open tibia fracture<br></br><br></br></div><div><span>1. Vanco powder has been assiociated with nephrotoxicity</span></div><div><span>2. No difference in outcome as long as get antibiotic withini 6 hours</span></div><div><span>3. No diff in outcome as long as I&D done within 24h</span></div><div><span>4. Abx for 5 days after wound closure is required to improve outcome</span></div></b><br></br>”
“<b><div><span>3. No diff in outcome as long as I&D done within 24h<br></br><br></br></span></div><div><span>Historically, dogma has led orthopaedists to treat open fractures with surgical irrigation and debridement within six hours of the injury or risk increased rates of infection. This practice has come to be known as the “six hour rule” in orthopaedic surgery. However, it has been disproven in recent years by several high quality studies demonstrating that delaying surgical irrigation and debridement up to 24 hours does not increase infectious complications for open fractures. Based on the best available evidence, the panel does not endorse the “six hour rule. Taking these issues into consideration, the panel recommends that patients with open fractures should be taken to the operating room </span><span>for surgical irrigation and debridement within 24 hours of presentation to the emergency department whenever possible (AAOS)<br></br><br></br></span></div><div><span>Antibiotic Prophylaxis in </span><span>Open</span><span> Fractures: Evidence, Evolving Issues, and Recommendations</span></div><div>Journal of the American Academy of Orthopaedic Surgeons<span>: </span><a><span>April 15, 2020 - Volume 28 - Issue 8 - p 309-315</span></a></div><div><span>- First dose antibiotics most important</span></div><div><span>- Topical Vanco reduces infection rates but has to be given in OR within 24hrs from injury (rat model, no human evidence)</span></div><div><span>- Delayed OR does not change risk of infection</span></div><div><span>- Stop antibiotics 24 hours after definitive fixation (no role for prolonged Abx therapy)<br></br><br></br></span></div><div><span>Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subject. Study from EDMONTON.<br></br><br></br></span></div><span>Multivariate regression found no association between infection and time to surgery [odds ratio (OR)</span><span>,</span></b>”
“<b>Elderly lady gets a distal humerus fracture, low demand, unfit for surgery, what is true?<br></br></b><b><ol><li><div><span>⅔ have good to excellent outcome with ROM 20-125 degree</span></div></li><li><div><span>⅓ has good to excellent outcome with ROM 45-90</span></div></li><li><div><span>Universally poorly because they cannot tolerate sling</span></div></li><li><div><span>80% non-union</span></div></li></ol></b>”
“2/3 have good outcomes and ROM 20-125<br></br><br></br><b><div><span><img></img></span></div><br></br><div><span><span>At a mean of 27 14 months of follow-up, 68% (13 of 19) of patients reported good to excellent subjective outcomes. Outcomes in 2 patients were classified as poor, one of whom underwent total elbow arthroplasty as a result. <br></br><br></br>Overall, the mean score on the Patient Rated Elbow Evaluation was 16 23 and the Mayo Elbow Performance Index was 90 11. <br></br><br></br>When the injured was compared with the uninjured side, extension (22</span><span> </span><span>11</span><span> </span><span>vs 8</span><span> </span><span>12; P 1⁄4 .025) and flexion (128</span><span> </span><span>16</span><span> </span><span>vs 142</span><span> </span><span><span>7; P 1⁄4 .002) were significantly worse in the injured elbows. </span><br></br><br></br>–> ROM 22 - 128 in the non op group<br></br><br></br><span>The fracture union rate was 81% (22 of 27) at a mean radiographic follow-up of 12 months.</span></span></span></div><div><span><br></br>Conclusions: Satisfactory outcomes were observed after the nonoperative management of selected distal humeral fractures in lower-demand, medically unwell, or older patients. Fracture union can be expected in most patients.</span></div></b><br></br>”
“<b><div>Based on the following stress-strain curve, what is true:</div><ol><li><div><span>Have the same yield point but different modulus of elasticity</span></div></li><li><div><span>Have the same modulus of elasticity but different yield points</span></div></li><li><div><span>The toughness of bone is more than the toughness of tendon</span></div></li><li><div><span>The toughness of tendon is more than the toughness of bone</span></div></li></ol></b>”
“<b><div><span>– toughness of tendon is more than bone</span></div><div><span><br></br>Modulous of elasticity = stress/strain</span></div><div><span>Toughness = area under stress-strain curve</span></div><div><span>Yield = limit of elastic behaviour and start of plastic behaviour</span></div></b><br></br>”
“<b><div>What is associated with failure of a Halo application (repeat)?</div><ol><li><div><span>6 pins instead 4 pins</span></div></li><li><div><span>Ring 2cm above pinna</span></div></li><li><div><span>Decreasing distance between ring and skull</span></div></li><li><div><span>Retightening the pins at appropriate intervals</span></div></li></ol></b>”
“B. Ring above pinna<br></br><br></br><b><div><span>More pins = more stable</span></div><div><span>Decreased ring to skull distance is stronger</span></div><div><span>Retightning pins reduces loosening/failure</span></div><div><span>1cm above pinna</span></div></b><br></br>”
“<b><div><span>Mechanism of action of bone morphogenetic proteins (repeat)</span></div><ol><li><div><span>Recruits Mesenchymal stem cells</span></div></li><li><div><span>Induces differentiation of Osteoblast precursors into osteoblast</span></div></li><li><div><span>RANKL</span></div></li><li><div><span>Something that was blatantly wrong</span></div></li></ol></b>”
“Shit question, repeat<br></br><br></br><div><span>OKU 10</span></div> <div><span>○ </span><span>Induces differentiation of mesenchymal stem cells into osteoproginator cells</span></div> <div><span>○ </span><span>Recruitment of mesenchymal stem cells</span></div> <div>○ Stimulation of angiogenesis<br></br><br></br></div><div>Orthobullets:</div> <div>● RANKL is secreted by osteoblasts and binds to the RANK receptor on osteoclast precursor and mature osteoclast cells</div> <div>● RANKL binds RANK and stimulates osteoclastic bone resorption<br></br><br></br></div> <div><span>● </span><span>BMP stimulates undifferentiated perivascular mesenchymal cells to differentiate into osteoblasts through serine-threonine kinase receptors</span></div><br></br>”
“<b><div><span>Atypical femur fracture - what is true?</span></div><ol><li><div><span>Malunion is common with IM nail fixation</span></div></li><li><div><span>Prophylactic nailing of the contralateral side only if they have symptoms</span></div></li><li><div><span>Need continuous bisphosphonate use for 10 years</span></div></li><li><div><span>Fracture line starts medial, and if complete, ends lateral</span></div></li></ol></b>”
“<b><div><span>A. Consensus<br></br><br></br>B is debated, since it says ““only”“<br></br><br></br>Surgical Management of </span><span>Atypical</span><span> </span><span>Femur</span><span> </span><span>Fractures</span><span> Associated With Bisphosphonate Therapy<br></br><br></br></span></div><div><span>Journal of the American Academy of Orthopaedic Surgeons: </span><a><span>December 15, 2018 - Volume 26 - Issue 24 - p 864-871</span></a></div><div><span>doi: 10.5435/JAAOS-D-16-00717</span></div><br></br><div><span>A – often translational defect with nail if you eccentrically ream because the pedestal (beak) pushes the reamer medially. But perhaps this is more malreduction and not malunion.<br></br><br></br></span></div><div><span>B – if asymptomatic then surveil</span></div><div><span>AFF risk linked to bisphosphonate use for 3 or more years</span></div></b><br></br>”
“<b><div>Treatment of high grade undifferentiated pleomorphic sarcoma (MFH) of bone</div><ol><li><div><span>Surgery</span></div></li><li><div><span>Surgery, chemo, and rads</span></div></li><li><div><span>Surgery and rads</span></div></li><li><div><span>Surgery and chem</span></div></li></ol></b>”
“<b><ol><li><div><span>Surgery and chemo</span></div></li></ol><div>Management (similar to osteosarcoma)</div><ul><li><div><span>Neo-adjunctive chemotherapy, wide resection, postoperative chemotherapy +/- radiation</span></div></li><li><div><span>standard of care</span></div></li></ul><ul><li><div><span>chemotherapy</span></div></li><ul><li><div><span>preoperative chemotherapy given for 8-12 weeks followed by maintenance chemotherapy for 6-12 months after surgical resection</span></div></li></ul><li><div><span>surgical resection</span></div></li><ul><li><div><span>wide excision or amputation have been found to have a higher 5-year survival rate than those who received intralesional or marginal excision</span></div></li><li><div><span>trend towards limb salvage whenever possible</span></div></li><li><div><span>options include arthroplasty, resection arthrodesis, allograft reconstruction and rotationplasty</span></div></li></ul><li><div><span>radiation</span></div></li><ul><li><div><span>incomplete or questionable margins in order to reduce risk of local recurrence</span></div></li><li><div><span>adjunct to traditional chemotherapy and surgical regimens</span></div></li></ul></ul></b>”
“<b><div>What is true of plate-pretensioning</div><ol><li><div><span>Center of plate on bone and distal and proximal edges of the plate off bone</span></div></li><li><div><span>Center of the plate off of bone and distal and proximal edges on bone</span></div></li><li><div><span>Use a hinged tensioning device</span></div></li></ol></b>”
“<b><span>2. Off bone in center<br></br><img></img><br></br><br></br><br></br><br></br><br></br></span></b>”
“<b><div>Most common cause for early failure in a mobile bearing medial UKA</div><ol><li><div><span>Progression of arthritis to tricompartmental arthritis</span></div></li><li><div><span>Infection</span></div></li><li><div><span>Loosening of implants</span></div></li><li><div><span>Bearing dislocation</span></div></li></ol></b>”
“<b><div><span>Medial </span><span>Unicompartmental</span><span> Arthroplasty of the Knee<br></br><br></br></span></div><div><span>Jennings, Jason M. MD, DPT; Kleeman-Forsthuber, Lindsay T. MD; Bolognesi, Michael P. MD</span></div><div><span>Journal of the American Academy of Orthopaedic Surgeons: </span><a><span>March 1, 2019 - Volume 27 - Issue 5 - p 166-17</span></a></div><span><br></br>A recent systematic review found that the most common reasons for UKA failure were aseptic loosening (36%), progression of osteoarthritis (20%), unexplained pain (11%), instability (6%), infection (5%), and polyethylene wear (4%).<span><br></br></span></span><span><span><br></br></span><span>The majority of early failures (<5 years) were from aseptic loosening (25%), osteoarthritis progression (20%), and bearing dislocation (17%)</span></span><span>, whereas </span><u>midterm and later revisions were performed primarily for osteoarthritis progression (38 to 40%),</u><span> aseptic loosening (29%), and polyethylene wear (10%)</span><span><br></br><br></br>Early: < 5years<br></br>1. Aseptic loosening<br></br>2. intability<br></br>3. infection<br></br>4. poly wear<br></br><br></br>Mid - late<br></br>1. Progression of arthritis<br></br>2. Aseptic loosening<br></br>3. Polywear<br></br><br></br><br></br></span></b>”
“<b><div>62 yo guy falls off a ladder, X-ray shows a comminuted radial head fracture, and 25% coronoid fracture. What is the best treatment?</div><ol><li><span>Radial head replacement, ORIF coronoid, LUCL repair</span><br></br></li><li><div><span>ORIF radial head, ORIF coronoid, LUCL repair</span></div></li><li><div><span>ORIF coronoid, ORIF radial head, hinged ex-fix</span></div></li><li><div><span>Radial head replacement, ORIF coronoid, MCL repair</span></div></li></ol></b>”
- Radial head replacement, ORIF and LUCL<br></br><br></br>CORR Trauma will beat this into you
“<div style=""><span></span><b>What is the most common cause of early failure in a </b><u><b>medial mobile-bearing</b></u><b> unicondylar knee arthroplasty?</b></div><ol style=""><li><div><span>Polyethylene wear</span></div></li><li><div><span>Bearing dislocation</span></div></li><li><div><span>Aseptic loosening</span></div></li><li><div><span>Progressive degenerative changes in the lateral compartment</span></div></li></ol>”
“3. Aseptic loosening<br></br><br></br><b><div><span>Medial </span><span>Unicompartmental</span><span> Arthroplasty of the Knee</span></div><div><span>Jennings, Jason M. MD, DPT; Kleeman-Forsthuber, Lindsay T. MD; Bolognesi, Michael P. MD</span></div><div><a><span>Author Information</span></a></div><div><span>Journal of the American Academy of Orthopaedic Surgeons: </span><a><span>March 1, 2019 - Volume 27 - Issue 5 - p 166-176</span></a></div><div><span>doi: 10.5435/JAAOS-D-17-00690</span></div><br></br><span>A recent systematic review found that the most common reasons for UKA failure were </span><span>aseptic loosening (36%)</span><span>, progression of osteoarthritis (20%), unexplained pain (11%), instability (6%), infection (5%), and polyethylene wear (4%).</span><span>25</span><span> T</span><span>he majority of early failures (<5 years) were from aseptic loosening (25%)</span><span>, osteoarthritis progression (20%), and bearing dislocation (17%), whereas midterm and later revisions were performed primarily for osteoarthritis progression (38 to 40%), aseptic loosening (29%), and polyethylene wear (10%).</span><span>25</span></b>”
“<b><div>3-year-old male, rhizomelic, bilateral genu varum and varus ankles with frontal bossing and midface hypoplasia. Both parents of normal stature, want to know more about the etiology?</div><ol><li><div><span>COL2A1 deficiency</span></div></li><li><div><span>FGFR3 defciency</span></div></li><li><div><span>Cartilage oligomeric matrix protein deficiency</span></div></li><li><div><span>Diastrophic dysplasia sulfate transporter deficiency</span></div></li></ol></b>”
“2. FGFR3<br></br><br></br><div style=""><span>Mutations in the </span><a><span>FGFR3</span></a><span> </span><span><b><u>gene</u></b></span><span> cause </span><span>achondroplasia</span><span>. The </span><span>FGFR3</span><span> gene provide instructions for making a protein that is involved in the development and maintenance of bone and brain tissue. Two specific mutations in the </span><span>FGFR3</span><span> gene are responsible for almost all cases of achondroplasia. 80</span><span><b>PERCENT are sporatic. <br></br><br></br>Affects proliferative zone.</b></span><span><br></br><br></br></span></div><div style=""><span>Achondroplasia</span><span> is characterized by small stature with rhizomelia <br></br><br></br>- Foramen magnum stenosis - need MRI when young so they don’t die. Central sleep apnea, drooling etc<br></br>- Thoracolumbar kyphosis - gets better as starts to walk. Non op<br></br>- genu varum - no evidence has higher risk of arthritis, but we still operate on them.<br></br>- lumbar stenosis - short pedicles, get closer together as move down spine - stenosis in later years<br></br>- trident configuration of the hands<br></br>- recurrent ear infections<br></br><br></br><br></br></span></div><br></br>”
<div><b>Worst risk factor for periprosthetic joint infection?<br></br><br></br></b></div>
<div>a. HIV</div>
<div>b. Obesity</div>
<div>c. Autoimmune disease</div>
<div>d. Dementia (McGill/UofC/A/Mac)</div>
“Who knows, recent JAAOS has only a strong recommendation for obesity, less strong for others such as inflammation<br></br><br></br><div><span>JAAOS. 2020. Diagnosis and Prevention of Periprosthetic Joint Infections</span></div> <div>(1) Moderate strength evidence supports that obesity is associated with increased risk of periprosthetic joint infection (PJI).</div> <div><br></br>Much has been written, but few studies provide the quality of evidence to draw firm conclusions with possibly the exception of obesity which moderate quality evidence does suggest increases PJI risk in hip and knee arthroplasty.</div><br></br>However, RA is the strongest in this study.<br></br><img></img><br></br><br></br><br></br>”
“<b><div><span>Which of the following is TRUE regarding the treatment of trigger digits:<br></br><br></br></span><span>Percutaneous release of the trigger thumb</span><span>should be avoided</span><span><br></br></span></div><div><span>Complication rate of 20% after surgery<br></br></span><span>Pathology is at proximal edge of A2 pulley</span><span><i><br></br></i></span><span>Primary trigger digit and RA have similar prognosis</span></div></b><br></br>”
“<span><span>Percutaneous release of the trigger thumb</span><span>should be avoided<br></br><br></br></span><b><div style=""><span>Green’s Chapter 56 Tendinopathy<br></br><br></br></span></div><div style=""><span>A = TRUE<br></br></span><span></span><span>Percutaneous Trigger Finger Release.</span><span>Do not use for thumb or index finger due to proximity of crossing nerves</span></div><div style=""><span><br></br></span></div><div style=""><span>B = FALSE</span></div><div style=""><span>■</span><span> </span><span>Reported rates of complication following open trigger release range widely from 3 to 31%, depending in large part on the definition of “complication” and the severity of the adverse events noted.</span></div><div style=""><span>■</span><span> </span><span>This is the one I am least confident on, but I think A is defs true and C and D are defs false so this probably false too<br></br><br></br></span></div><div style=""><span>C = FALSE</span></div><div style=""><span>■</span><span> </span><span>Proximal phalangeal flexion, particularly with power grip, causes high angular loads at the distal edge of the first annular (A1) pulley<br></br><br></br></span></div><div style=""><span>D = FALSE</span></div><div style=""><span>Secondary trigger finger can be seen in patients with diabetes, gout, renal disease, RA, and other rheumatic diseases and is associated with a worse prognosis after conservative or surgical management<br></br><br></br></span><div> <div> <div><img></img><br></br><br></br><div>Always look for carpel tunnel (60% on EMGs)</div></div> </div></div></div></b><br></br></span>”
“<b><div>Which is the best intra-operative correction for a total knee replacement with a loose flexion gap and stable extension gap?<br></br><br></br></div><div><span>A. Upsize the femoral component</span></div><div><span>B. Re-cut tibia with increased slope</span></div><div><span>C. Increase tibial poly size and release posterior capsule</span></div><div><span>D. Increase tibial poly size and resect more distal fem</span></div></b><br></br>”
“Upsize the femoral component<br></br><br></br><div>Flexion Instability After Total Knee Arthroplasty JAAOS 2019<br></br>Step 1. Recut tibia with LESS slope if feel slope off<br></br>Step 2. Upsize femur<br></br><br></br>Using a bigger poly to make up for a flexion gap is BAD. This overstuffs the extension gap, and has lead to a flexion contracture in studies.<br></br><br></br><img></img><br></br></div>”
“<b><div><span>46yo patient with a distal radius fracture underwent distal radius ORIF and carpal tunnel release 8 months ago. Recovered well, but starting 6 months post-operatively had recurrence of paresthesias in the thumb, index and middle fingers. APB and opponens pollicis motor function are normal. No other sites of nerve compression are identified. What is the most appropriate management?<br></br><br></br></span></div><div><span>A. Neuroma excision and reconstruction of the injured palmar cutaneous nerve</span></div><div><span>B. Neurorrhaphy and nerve reconstruction</span></div><div><span>C. Revision neuroplasty and hypothenar fat flap</span></div><div><span>D. Reconstruction of the transverse carpal ligament</span></div></b><br></br>”
“<b><div><span>C. Revision neuroplasty and hypothenar fat flap</span><span><br></br><br></br><img></img></span></div><div><span>JAAOS 2019 <br></br><br></br>Note, new JAAOS on revision ulnar nerve that may come up. Same thing, revise with some sort of flap, often vein to prevent adhesions. Broken down into 1. Never got better. 2. Got better, but then came back. 3. Different symptoms</span></div></b><br></br>”
“<b><div>5yo girl presents with toe-walking. Which is a feature that would be MOST concerning?<br></br><br></br></div><div><span>A. Unilateral</span></div><div><span>B. Has been present for 3 years</span></div><div><span>C. Has not improved over time</span></div><div><span>D. Decreased passive ankle dorsiflexion</span></div></b><br></br>”
“A. Unilateral<br></br><br></br>JAAOS 2012<br></br><br></br>ITW is best described as bilateral persistent toe walking with or without a fixed equinus contracture without other discernible etiologic abnormalities in patients aged greater than 2<br></br><br></br>Toe walking before 2 is considered normal, and a normal progression of gait<br></br>Beware 5 year old who has recently begun to toe walk, especially unilatera<br></br><br></br>Idiopathic toe walking is a term used to define a gait in which a person walks with a toe‐toe gait pattern without any known correlated etiology<br></br><br></br>It is very important to make this a dx of exclusion as this can be due C<span>P, Duchannes, tethered cord, diastematomyelia, Autism, schizophrenia, global developmetal delay, CMT, spina bifida etc<br></br><br></br>Work up to consider<br></br></span><ol> <li>Spine xray/MRI depending on history and physical</li> <li>Gait analysis</li> <li>EMG - may or may not be helpful</li> <li>CK—> may lead to muscle bx if >5000</li></ol><b><u>Remember, RCT shows botox has no impact</u></b><br></br><br></br><div><div>Randomized Controlled Trial</div><div><div>J Bone Joint Surg Am<span>.</span>2013 Mar 6;95(5):400-7.</div></div><span>doi: 10.2106/JBJS.L.00889.</span></div><h1>Botulinum toxin A does not improve the results of cast treatment for idiopathic toe-walking: a randomized controlled trial</h1>”
“<b><div>What is true about pseudosubluxation of the cervical spine in pediatric patients? (REPEAT)<br></br><br></br></div><div><span>1. Posterior body will have some subluxation</span></div><div><span>2. Subluxation most common at C3/4</span></div><div><span>3. It is due to vertical facet orientation</span></div><div><span>4. To differentiate from pathologic pseudosubluxation, a line can be drawn between the</span></div><div><span>spinous processes</span></div></b><br></br>”
“<b><div><span>2. False, most common at c2/3</span></div><div><span>3. False, due to horizontal facts</span></div><span>4. False,can draw swischuk line from c1 - c2 posterior arch</span><span><br></br><br></br></span></b><img></img><br></br><b><span><br></br></span></b><b><span>Careful reading of wording. If it says spinous process for swischuk’s line = FALSE. If it says spinolaminar or posterior arch, may be TRUE.<br></br></span></b>”
“<b><div>Contracture seen with vascularized fibula harvest:</div><ol><li><div><span>FHL</span></div></li><li><div><span>Achilles</span></div></li><li><div><span>Tib post</span></div></li><li><div><span>Tib ant</span></div></li></ol></b>”
“Repeat<br></br><br></br>FHL<br></br><br></br><img></img>”
“<b><div><span>56M diabetic, comes in with complaint of thumb weakness (low median nerve), dropping objects, etc. On exam noted D4/5 MCP hyperextension and PIP flexion (high median neve). Most appropriate tendon transfer?</span></div><ol><li><div><span>FDS to Adductor Pollicis</span></div></li><li><div><span>FPL to APL</span></div></li><li><div><span>Something to EDM</span></div></li><li><div><span>FCU to radial lateral bands of 4/5</span></div></li></ol></b>”
“<b><div><span>Think it is describing low ulnar palsy with a positive froments sign. Therefore, tendon transfers</span></div><br></br><div><span>■</span><span> </span><span>FDS of long finger to adductor pollicis</span></div><br></br><div><span><img></img></span></div></b><br></br>”
“<b><div><span></span><span>25yo sustains galeazzi fracture, after anatomic reduction of distal radius, the druj is reducible but unstable and distal ulna dislocates dorsal. Very distal small tip of ulna is fractured. What is appropriate treatment? (repeat)<br></br><br></br></span></div><div><span>a) Pin radius to ulna in pronation for 6 weeks</span></div><div><span>b) repair TFCC (arthroscopically or open) then early motion at 1-2 weeks</span></div><div><span>c) fix styloid fracture with tension band construct and early motion at 1-2 weeks</span></div><div><span>d) cast in above elbow in supination for 6 weeks</span></div></b><br></br>”
“Repeat, nobody can agree on the answer. Likely B, but nobody is happy with the early ROM<br></br><br></br><b><div><span>●</span><span> </span><span>Orthobullets (via Giannoulis, 2007)<br></br><br></br></span></div><div><span>○</span><span> </span><span>A</span><span>lgorithm</span></div><div><span>■</span><span> </span><span>Stable DRUJ</span></div><div><span>●</span><span> </span><span>Cast in supination for 6 weeks<br></br><br></br></span></div><div><span>■</span><span> </span><span>Unstable DRUJ</span></div><div><span>●</span><span> </span><span>TFCC repair and DRUJ pinning with K-Wire in neutral rotation<br></br><br></br></span></div><div><span>■</span><span> </span><span>Unstable DRUJ with Ulnar Styloid Fracture</span></div><div><span>●</span><span> </span><span>ORIF of ulnar styloid with tension band wire or lag screw<br></br><br></br></span></div><div><span>■</span><span> </span><span>Irreducible DRUJ – likely due to tendon interposition (ECU, EDC or EDM)</span></div><span>●</span><span> </span><span>Open reduction and TFCC Repair<br></br></span></b><br></br>Chan / Badre say more people are moving away from pinning and if you are 100p the distal radus is ATF, open and fix the TFCC.<br></br>”
“<b><div>What is the MOST common reason for revision in a 3 component total ankle replacement, 10 years post replacement: (repeat)<br></br><br></br></div><div><span>A) sub clinical Infection</span></div><div><span>b) Poly wear and osteolysis</span></div><div><span>c) Medial malleolus stress fracture</span></div><div><span>d) Subtalar arthritis</span></div></b><br></br>”
b) Poly wear and osteolysis
“<b><div>Previous L3-S1 lumbar fusion, now with PI 50, LL 25, and 10cm SVA anterior to sacrum, what is LEAST invasive option to correct sagittal alignment?<br></br><br></br></div><div><span>a) L2-5 smith Pete osteotomies</span></div><div><span>b) L1-S1 laminectomy</span></div><div><span>c) L3 PSO</span></div><div><span>d) T10 VCR</span></div></b><br></br>”
“Debated. Consensus C. But, if xrays shows mobile disc segments, a may correct.<br></br><br></br><div><span>JAAOS. 2009. Sagittal Plane Deformity in the Adult Patient</span></div><ul style=""><li style=""><div><span>SPO - 10 degrees per level</span></div></li><ul style=""><li style=""><div><span>Posterior column is shortened and anterior column is lengthened</span></div></li><li style=""><div style=""><b>Requires mobile disc space or osteomized anterior fusion mass</b></div></li><li style=""><div><span>The osteotomy hinges on the posterior aspect of the disc</span></div></li><li style=""><div><span>Posterior pedicle screw instrumentation is required to maintain closure of the osteotomy</span></div></li><li style=""><div><span>Do if need 4 - 7 cm of sagital correction)</span></div></li></ul><li style=""><div><span>PSO - 30 degrees per level (do if need >10 cm)</span></div></li><ul style=""><li><div><span>Posterior column is shortened without lengthening the anterior column</span></div></li><ul><li><div><span>Pedicle subtraction osteotomy (PSO) provides greater sagittal correction than single-level opening wedge osteotomy and Smith-Petersen osteotomies, with the advantage of working at a single level and not having to resect the intevertebral disc.</span></div></li></ul><li><div><span>Hinges on anterior cortex</span></div></li><li><div><span>Posterior pedicle screws are required 3 levels above and below</span></div></li><li><div><span>Indications</span></div></li><ul><li><div><span>Sagittal balance greater than 10 cm</span></div></li><li><div><span>Shape, angular kyphosis</span></div></li><li><div><span>360 fusion along multiple segments</span></div></li></ul></ul><li style=""><div><span>VCR (vertebral column resection) - 45 degrees per level</span></div></li><ul style=""><li><div><span>One or more vertebral segments is removed</span></div></li><ul><li><div><span>Includes posterior elements, pedicles and entire vertebral body as well as disc above and below</span></div></li></ul><li><div><span>Indications</span></div></li><ul><li><div><span>Congenital kyphosis, severe sagittal plane deformity plus coronal plane deformity, spondyloptosis, resectable spine tumor</span></div></li></ul><li><div><span>Vertebral column resection is a technically challenging procedure with significant complication rates, and should be reserved for patients requiring >45° of sagittal plane correction for sharp angular deformities.</span></div></li><li><div><span>VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs</span></div></li></ul></ul>”
“<b><div><span>Young female is poly trauma with spleen lac, head injury non op, segmental femur, LC displaced pelvic fracture, tibial plafond fracture. Initial vital signs: 95/45, 140HR, lactate 5.3, ph 7.18, resuscitated with crystalloids and 4U pRBC now 115/85, 110 HR, lactate 3.1, </span><span>ph 7.28</span><span>. Other than ongoing resuscitation and transfusions, what is best next orthopaedic step?<br></br><br></br></span></div><div><span>a) pelvic angiography and ex fix of all injuries</span></div><div><span>b) ex fix of all injuries and delayed (more than 48 hours) definitive fixation</span></div><div><span>c) definitive fixation of femur and pelvis (within 36 hours), delayed fixation of tib plafond (>48 hours)</span></div><div><span>d) definitive fixation of femur (within 36 hours), delayed fixation of pelvis and tib plafond (>48 hours)</span></div><br></br></b><br></br>”
“<b><span>C.</span></b>Meets Vallier EAC criteria and<span> trending in the correct direction. </span><span>Plafond is staged because its a plafond and we are not in Vancouver.<br></br><br></br>Remember Vallier’s paper states the bones, including pelvis AND spine can be treated within 36 hours if one of the thresholds are met.<br></br></span><div><b></b></div><b><span><img></img></span></b>”
“<b><div>7 month old with DDH presents to clinic – what is best test for dx<br></br><br></br></div><div><span>a)</span><span> </span><span>Ortolani</span></div><div><span>b)</span><span> </span><span>Barlow</span></div><div><span>c) </span><span> </span><span>Trendelenberg</span></div><span>d)</span><span> </span><span>Decreased abduction</span></b>”
“<b><span>D. Decreased abduction</span></b>”
“<b><div>Applying straps for Pavlik harness – you should not tension the posterior straps too much for the risk of:<br></br><br></br></div><div><span>a.</span><span></span><span>Posterior dislocation</span></div><div><span>b.</span><span></span><span>Femoral nerve palsy</span></div><div><span>c.</span><span>AVN</span></div><span>d.</span><span></span><span>Pavlik disease</span></b>”
“c. AVN<br></br><ul><li>Chest strap – at nipples and should fit 2 fingers under to let baby breath</li> <li>Shoulder strap - set level of strap</li> <li>Anterior leg strap – this <span>prevents extension</span> and child should be in 90 to 100 degrees of flexion</li> <li>Posterior leg strap – <span>this limits adduction a</span>nd should be 15 degrees back from max abduction → tensioned too much = risk of AVN</li></ul><b><br></br><br></br></b><br></br><br></br>”
“<b><div>Klippel-feil is associated with what anomaly:<br></br><br></br></div><div><span>a. </span><span> </span><span>Renal (1-4%)</span></div><div><span>b. </span><span> </span><span>Deafness (1-4%)</span></div><div><span>c. </span><span> </span><span>Scoliosis (30-80%)</span></div><span>d. </span><span> </span><span>Synkinesis (1-4%)</span></b>”
“<div style="">c. Scoliosis (30-80%)<br></br></div><ul style=""><li><div><span>orthopedic conditions</span></div></li><ul><li><div><span>congenital scoliosis</span></div></li><li><div><span>Sprengel’s deformity</span><span> (30%) </span><a><span></span></a><span></span></div></li></ul></ul><ul style=""><li><div><span>medical conditions & comorbidities</span></div></li><ul><li><div><span>renal disease </span><span>(aplasia in 33%)</span></div></li><li><div><span>auditory issues (deafness in 30%)</span></div></li><li><div><span>congenital heart disease/cardiovascular (15-30%)</span></div></li><li><div><span>brainstem abnormalities/basilar invagination</span></div></li><li><div><span>congenital cervical stenosis</span></div></li><ul><li><div><span>MRI to rule out intraspinal cord abnormalities</span></div></li></ul><li><div><span>atlantoaxial instability (~50%)</span></div></li><li><div><span>adjacent level disease (100%)</span></div></li><ul><li><div><span>degeneration of adjacent segments of cervical spine that has not fused is common due to increased stress</span></div></li></ul></ul></ul><br></br>”
“<b><div>Strongest tendon repair?<br></br><br></br></div><div><span>a. </span><span> </span><span>Pulvertaft</span></div><div><span>b. </span><span> </span><span>Kessler</span></div><div><span>c. </span><span> </span><span>Bunnell</span></div><span>d. </span><span> </span><span>Interrupted</span></b>”
“a. Pulvertaft<br></br><br></br>If it says ““repair”” you should pick kessler<br></br><br></br><b><span><img></img></span></b>”
“<b><div>60F nurse developing rapid progressive neck pain since 2 weeks and neuro symptoms. MRI Imaging shows abscess posteriorly to cord with cord compression from C3 to C6. (Alignment not kyphotic)<br></br><br></br></div><div><span>a. </span><span> </span><span>Posterior decompression + debridement</span></div><div><span>b. </span><span> </span><span>Anterior decompression + debridement</span></div><div><span>c. </span><span> </span><span>ABx</span></div><span>d. </span><span> </span><span>Tumour debulking and fusion</span></b>”
“<b><span>Posterior decompression + debridement</span></b>”
“<b><div>50F with 20% L4-5 degen spondy. 2 weeks leg pain. What is the likely future scenario (natural history of her condition)?</div><ol><li><div><span>Spondy continues to progress past 50%</span></div></li><li><div><span>Intermittent symptoms with no permanent deficits</span></div></li><li><div><span>Worsening leg pain and eventual leg weakness that is permananent</span></div></li><li><div><span>Something else wrong</span></div></li></ol></b>”
“<b><div>Intermittent symptoms with no permanent deficits<span> <br></br><br></br></span><span>JAAOS. 2009. Adult Isthmic Spondylolisthesis</span></div><span>○</span><span> </span><span>Most adults with axial or radicular pain related to lumbar spondylolisthesis will improve with nonsurgical treatment. The mainstay of early treatment of these symptomatic patients is the judicious use of nonsteroidal anti-inflammatory drugs, along with modification of pain provoking activities and relative rest for 1 to 2 weeks. Muscle relaxants are helpful in some patients with greater pain. Narcotic analgesics should be used sparingly and for short durations in cases of severe pain.<br></br><br></br></span>More than 75% of adults with back and leg pain resulting from a pars defect and grade I to II spondylolisthesis will have successful outcomes using antilordotic bracing and activity modification for 3 to 6 month<span>s.<br></br></span><span><br></br>Epidural steroid injections may provide some relief of radicular symptoms, but they are unlikely to help patients with axial pain. <br></br></span><br></br>Patients with persistent symptoms typically remain active and neurologically stable, even in the presence of high-grade spondylolisthesis</b>”
“<b><div>Type 2 bado Monteggia (post subluxation)… .treatment?</div><ol><li><div><span>Cast in sup/flex to 90</span></div></li><li><div><span>Cast in pro/flex 90</span></div></li><li><div><span>OR</span></div></li><li><div><span>Cast in full extension and in pronation</span></div></li></ol></b>”
Cast in full extension and in pronation
“<b><div><span>Young patient, Unilateral facet dislocation C5-6, neuro intact, closed reduced inhalo and looks good. What is treatment for best function in future?</span></div><ol><li><div><span>HALO x 6 weeks</span></div></li><li><div><span>Hard cervical collar x 6 weeks</span></div></li><li><div><span>Posterior fusion</span></div></li><li><div><span>Anterior fusion</span></div></li></ol></b>”
“4. Vancouver paper<br></br><br></br><b><div><span><img></img></span></div><ul><li><div>Treatment failure, neurological deterioration, and persistent pain occurred more frequently in patients treated nonoperatively versus patients treated with surgery.<span></span></div></li><li><div><span>Surgical patients experienced infections and surgical related complications not experience by those managed nonoperatively.</span></div></li><li><div><span>Patients treated surgically after failed nonoperative management also experienced better outcomes than those who continued to be managed nonoperatively.</span></div></li></ul></b>”
“<b><div>What incomplete spinal cord injury - most likely to least likely to recover (REPEAT)</div><ol><li><div><span>Brown Sequard, central cord, anterior cord</span></div></li><li><div><span>Central cord, posterior, anterior</span></div></li><li><div><span>Posterior cord, Brown, central</span></div></li><li><div><span>Brown, anterior, central</span></div></li></ol></b>”
“<b><span>Brown Sequard, central cord, anterior cord</span></b>”
“<b><div>7 year old girl presents with 1 month of insidious onset of pain in left thigh. There is no soft tissue mass or lympadenopathy. She has normal hip and knee ROM. She is afebrile and systemically well. Xrays similar to this but skeletally immature and showed whole femur with lesions in distal diaphysis. What is the most likely diagnosis?</div><ol><li><div><span>Lengerhans cell histiocysosis</span></div></li><li><div><span>Simple cyst</span></div></li><li><div><span>Fibrous dysplasia</span></div></li><li><div><span>osteosarcoma</span></div></li></ol></b><img></img>”
Fibrous dysplasia?
“<b><div>A study shows tibial reaming non-union is 5%, and tibial unreaming non-union is 10%. What is NNT? (REPEAT)</div><ol><li><div><span>Inverse of relative risk reduction</span></div></li><li><div><span>5</span></div></li><li><div><span>10</span></div></li><li><div><span>20</span></div></li></ol></b>”
“20<br></br><br></br><div><span>Absolute Risk Reduction:</span> Control Event Rate - Exposure Event Rate<br></br>= 0.1 - 0.5<br></br>= 0.05</div> <div></div> <div><span>NNT = 1/ARR<br></br>= 1/ 0.05<br></br>=20<br></br><br></br></span></div>”
“<b><div>Which one of the following decreases stiffness of plate construction (image showing bridging construct for periprosthetic TKA distal femur fracture)</div><ol><li><div><span>Plate stiffness can be decreased by far cortical locking</span></div></li><li><div><span>Working length can be decreased by putting larger screws</span></div></li><li><div><span>You can put more screws distally periarticular to increase working length</span></div></li><li><div><span>Stiffness and working length are directly proportional</span></div></li></ol></b>”
“Plate stiffness can be decreased by far cortical locking<br></br><br></br><div>■ <span>Far cortical locking (FCL) is an approach requiring specialized screws in a locking plate. <i><u>FCL aims to reduce stiffness whilst maintaining strength of a construct.</u></i> The screws have threads at the tip and the head that lock into the plate and far cortex respectively. The screws also have a shaft with a reduced diameter, allowing for movement at the near cortex due to an increased working length.</span></div>”
“<b><div><span></span>RCT finished, with randomization, but with unequal gender distribution between groups. What should you do? (REPEAT)<br></br><br></br></div><div><span>a) Continue study until equal</span></div><div><span>b) Continue study with predetermined number of patients</span></div><div><span>c) Present results as is</span></div><div><span>d) Eliminate patients to equalize group</span></div></b><br></br>”
c) Present results as is
“<b><div>Secondary chondrosarcoma<br></br><br></br></div><div><span>a) Ollier disease has more than multiple exostoses</span></div><div><span>b) Pelvic have higher recurrence</span></div><div><span>c) All are high grade</span></div><div><span>d) Can’t remember 4th option - cartilage cap thickness changes with age or something</span></div></b><br></br>”
“Pelvic have higher recurrence<br></br><br></br>However, loaded question<br></br><br></br><div>■ JAAOS 2021</div> <div>● The risk of malignant transformation of benign cartilage tumors has not been well established, and estimates vary widely. For solitary osteochondromas, the risk is most likely <1%,whereas patients with HME may have a 2% to 4% chance of developing chondrosarcoma.<span> Patients with Ollier disease and Maffucci syndrome appear to have an even higher risk, with estimates ranging from 10% to 40%</span>. One study suggested that malignancy is a near certainty in persons with Maffucci syndrome. Well-controlled, longitudinal, epidemiologic studies are needed to determine accurate estimates.<br></br><br></br>But,<span>JAAOS 2010 Secondary Chondrosarcoma</span><div>○ <span>Secondary chondrosarcoma is a distinctive type of tumor that originates from a preexisting cartilaginous lesion. <b><span>Most commonly, it is associated with solitary or multiple osteochondromas</span>. A <span>fraction</span> of cases arises from other conditions, such as Maffucci syndrome and <span>Ollier disease</span></b>. <b>A sudden increase in the size of the cartilaginous cap</b> of an osteochondroma is a sign of malignant transformation to secondarychondrosarcoma. However, there is no strict cutoff in terms of thickness of the cartilaginous cap that can be regarded as being pathognomonic of malignancy. <b>Most cases of secondary chondrosarcoma are low to intermediate grade</b>. Distant metastasis is uncommon, and the prognosis is good for most patients. Overall survival at 5 years is approximately 90%. Surgical resection with wide margins is the best treatment option, but local recurrence remains a significant problem in approximately 10% to 20% of patients.<span> <b>Patients with secondary chondrosarcoma of the pelvis are especially at risk for local recurrence.<br></br><br></br>Joe says stick with the JAAOS last sentence:</b></span></span><b>Patients with secondary chondrosarcoma of the pelvis are especially at risk for local recurrence.</b></div></div>”
“<b><div><span>Kienbock’s disease cause , all except</span></div><ol><li><div><span>skeletal variation</span></div></li><li><div><span>Clotting disorder</span></div></li><li><div><span>Venous obstruction</span></div></li><li><div><span>Arterial pattern</span></div></li></ol></b>”
“Repeat. Clotting<br></br><br></br><b><div><span>JBJS 2008 review Kienbock’s disease</span></div><ul><li><div><span>Precise etiology not known</span></div></li><li><div><span>Kienbock’s seen in sickle cell causing bone infarction</span></div></li><li><div><span>Necrosis might be consequence of impaired venous outflow or arterial interruption</span></div></li><li><div><span>"”Some lunates may be predisposed to collapse because of their particular anatomy causing an uneven internal distribution of the bone stresses””</span></div></li><li><div><span>Uncovering of the lunate by the distal radius, ulnar negative variants, midcarpal facet on the lunate, radial inclination</span></div></li></ul></b>”
“<b><div>Clubfoot recurrence despite previous successful treatment by another orthopaedic surgeon. Why did they recur? (REPE<span>AT)</span></div><ol><li><div><span>Inadequate casting by previous surgeon</span></div></li><li><div><span>Poor compliance with boots and bars</span></div></li><li><div><span>Started casting too late</span></div></li></ol></b><br></br>”
“2. Poor complianc<br></br><br></br><b><br></br><div><span>Loads of references including several different JAAOS reviews on the topic of clubfoot</span></div><div><span>Most if not all state that full time boots and bars required for three months followed by 12hrs/day until age 2-4 for maintenance of correction</span></div><div><span><br></br>Treatment of relapsed deformity in the older child begins with repeat ponseti casting</span></div></b>”
“<div style=""><span>Spinopelvic alignment (all except)</span></div><ol style=""><li style=""><div style=""><span>standing to sitting will cause anterior tilt of pelvis</span></div></li><li style=""><div><span>Sacral tilt is the best way to measure pelvic movement (yes, sacral tilt)</span></div></li><li style=""><div><span>Pelvic incidence is fixed</span></div></li><li style=""><div><span>Acetabulum opens with sitting</span></div></li></ol>”
“<span>standing to sitting will cause anterior tilt of pelvis = FALSE<br></br><br></br></span><b><span>PI=PT+SS</span></b><span><br></br><br></br></span><b><div><span>When the patient sits, </span><span>lumbar lordosis decreases </span><span>and the pelvis </span><span>“rolls back”</span></div><div><span>- Opens the acetabulum to accommodate flexion and internal rotation of the hip</span></div><div><span>- This protects from anterior impingement and posterior hip dislocation<br></br><br></br></span><b><span><img></img></span></b><span><br></br></span></div></b><br></br><br></br>”
“<b><div>Compartment syndrome in obtunded patient with comminuted radial fracture, which would lead you to diagnosis?</div><ol><li><div><span>History of being found down x 24 hours</span></div></li><li><div><span>Firm and tense volar compartment with circumferential bruising</span></div></li><li><div><span>Nurse extending finger to put on sat probe caused agitation</span></div></li><li><div><span>Compartment reading 40mm Hg, and diastolic BP 75mm Hg</span></div></li></ol></b>”
“Compartment reading 40mm Hg, and diastolic BP 75mm Hg. Delta is 35… We picked 4 as a consensus as there is evdience to support delta P greater than 30.<br></br><br></br><div><span>JAAOS 2020 - Management of Acute Compartment Syndrome (CPG Summary)</span></div> <div>- In obtunded patients, the workgroup found no evidence regarding the utility of the clinical examination in diagnosing ACS. Therefore, the workgroup’s consensus was that pressure-based methods of diagnosis be used.<br></br><br></br></div> <div><span>JAAOS 2021 - Diagnosis and Management of Acute Compartment Syndrome</span></div> <div>- No physical examination finding or diagnostic test has 100% specificity and sensitivity for ACS, and diagnostic criteria will likely vary based on patient factors (ie, intoxication or the obtunded patient).<br></br><span><br></br>JAAOS 2011 - Acute Compartment Syndrome of the Upper Extremity</span><br></br><b><span>- ACS is typically diagnosed clinically. However, it may be necessary to measure compartment pressure (</span><span>Figure 6</span><span>). Animal studies demonstrate that compartment syndrome is indicated in the presence of a difference between diastolic blood pressure and the compartment measuring ≤20 mm Hg</span><span>40</span><span> or a difference between mean arterial pressure and the compartment measuring ≤30 mm Hg</span><span><br></br><br></br></span><span>- Fasciotomy is often performed in patients with absolute pressure measuring >30 mm Hg.</span><span>6.</span><span>We consider a differential between diastolic pressure and the compartment of ≤20 mm Hg to be an absolute indication for emergent fasciotomy. In the patient with swollen compartments and nearly normal pressures (<30 mm Hg absolute pressure), we advocate waiting and performing serial examinations and pressure measurements. Increasing swelling and rising pressures warrant decompression even when the pressure differential is ≤20 mm Hg</span></b><br></br><br></br><div>- This is a tricky question because the compartment pressure of >40 is obviously concerning but in previous years it seems that the delta P of <30 is more important and in this question the delta P is 35</div></div><br></br><div>Old version (from 2003-2007 doc): <b>An adult with a head injury who is unconscious with multiple injuries with a T2 spinal fracture for which he is paraplegic. He also has a tibia fracture. The most appropriate criteria for diagnosing a compartment syndrome is:<br></br><br></br></b></div> <div>○ Calf swelling</div> <div>○ Pain on passive toe movement</div> <div>○ Compartment pressures of 40mmHg with a blood pressure of 120/80</div> <div>○ <span>Compartment pressures of 30mmHg with a blood pressure of 100/50</span><span> </span></div>”
“<div style=""><b>Regarding Tillaux fractures, all except:<br></br></b><br></br>a. Should not cross physis with screws<br></br>b. May lose reduction with below knee casting<br></br>c. External rotation avulses the fragment (ER causes AITFL to avulse bone McGill/UofC/A)<br></br>d. CT is good to assess intra-articular displacement</div><div style=""><span></span></div><br></br><br></br>”
“<div><span></span>a. Should not cross physis with screws<span><br></br></span><span><br></br>JAAOS 2013 - Pediatric Physeal Ankle Fractures<br></br><br></br></span></div> <div><div>○ A = FALSE</div> <div>■ Because there is minimal to no growth remaining, fixation that crosses the physis is unlikely to cause complications. Bioabsorbable implants also can be used.1 These patients are near the end of growth and physeal function, and thus, the risk of physeal damage with resultant deformity is low.17<br></br><br></br></div> <div>○ B = TRUE</div> <div>■ Patients with nondisplaced fractures are treated with 4 weeks in non-weight-bearing long leg casts applied in internal rotation, followed by non-weight-bearing in a boot for 2 weeks<br></br><br></br>C = TRUE ** (Don’t let JAAOS typo screw it up)<br></br><b><span>Wuerz et al 2013 JAAOS<br></br></span></b>Produced experimentally by everting a supinated foot - <span>ATFL</span> avulses with ER<span><br></br>–></span><span></span><span>So I think the issue here is they wrote anterior tibiofibular ligament instead of anterior inferior but they are the same thing because ATFL means “talofibular”</span><br></br><br></br></div> <div>○ D = TRUE<br></br></div> ■ CT is warranted in cases in which displacement >2 mm is suspected (Figure 6). CT better defines fracture displacement and can aid in surgical planning.displacement and can aid in surgical planning.</div>”
“<div style="">Advanced Spondylolisthesis in middle aged woman with mild pain for 12 years, no neurological symptoms or other complaints.<br></br><br></br>a. Come back if symptoms progress<br></br>b. Close follow-up in 3 months with XR<br></br>c. In situ fusion with bone graft with or without fixation (U of T)<br></br>d. Posterior reduction and fusion without instrumentation (Mac)<br></br>a. Anterior fusion with or without fixation (U of T/Mac)</div>”
“A or B<br></br><br></br>A = Consensus 2022 document<br></br><br></br><div><span>● </span><span>JAAOS 2008 - Degenerative Lumbar Spondylolisthesis: Trends in Management<br></br><br></br></span></div> <div>○ Non-op management for mild symptoms, not sure about the follow up time frame, but given that it’s a higher grade slip I suppose that’s why people settled on the 3 month follow up, I honestly feel like A is a better option, sigh<br></br><br></br><img></img><br></br></div><div><br></br></div> <div>○ Jen looked back further and found this repeated again in 2003-2007 doc, in that one they picked A and cited this paragraph from the same article<br></br><br></br></div> <div>■ Listhesis has been shown <b><i>to <u>progress in 25% to 30%</u></i></b> of patients, but it rarely progresses to >30% of the subjacent vertebra. In their study of the natural history of listhesis, Matsunaga et al reported that <b><i>back pain improved as the disk space was collapsed</i></b> and that progression of the slippage occurred in only 34% of patients. <b><i><u><span>76% percent of the patients who were initially neurologically intact did not deteriorate over time</span></u></i><span>. Such patients may be treated nonsurgically.</span></b><span> </span>Conversely, most patients (<b><i>83%) with a history of significant <u>neurogenic claudication</u></i></b> or vesicorectal symptoms deteriorated and had <b><i>a poor outcome</i></b>. These patients <b><i>should be <u>treated surgically</u></i></b>.<br></br><br></br></div> <div><span>● </span><span>JAAOS. 2009. Adult Isthmic Spondylolisthesis<br></br><br></br></span><span></span></div> <div>○ Most adults with axial or radicular pain related to lumbar spondylolisthesis will improve with nonsurgical treatment. The mainstay of early treatment of these symptomatic patients is the judicious use of nonsteroidal anti-inflammatory drugs, along with modification of pain provoking activities and relative rest for 1 to 2 weeks. Muscle relaxants are helpful in some patients with greater pain. Narcotic analgesics should be used sparingly and for short durations in cases of severe pain. <b>More than 75% of adults with back and leg pain resulting from a pars defect and grade I to II spondylolisthesis will have successful outcomes using antilordotic bracing and activity modification for 3 to 6 months.</b>27-29 Epidural steroid injections may provide some relief of radicular symptoms, but they are unlikely to help patients with axial pain. <b>Patients with persistent symptoms typically remain active and neurologically stable, even in the presence of high-grade spondylolisthesis</b><b></b></div><br></br><br></br>”
“<b><div><span></span>Botox mechanism of action (repeat)</div><ol><li><div><span>presynaptic ACH prevention</span></div></li><li><div><span>Post synaptic ACH receptor blockade</span></div></li><li><div><span>Something weird</span></div></li><li><div><span>decrease release calcium from endoplasmic reticulum</span></div></li></ol></b>”
“1. Presynaptic ACH prevention<br></br><br></br><img></img>”
“<b><div>All of the following are true regarding scoliosis with associated spondylolisthesis except: (REPEAT)</div><ol><li><div><span>⅔ of postural curves will correct with management of spondylolisthesis</span></div></li><li><div><span>20-50% of spondylolisthesis will develop scoliosis</span></div></li><li><div><span>Idiopathic curves will correct with lumbosacral arthrodesis</span></div></li><li><div><span>Idiopathic scoliosis is associated with spondylolisthesis in <10%</span></div></li></ol></b>”
“Idiopathic curves will correct with lumbosacral arthrodesis. Incorrect<br></br><br></br><div><span>● </span><span>BOTTOM LINE:</span></div> <div>○ Pts with idiopathic scoliosis have a LOW INCIDENCE of spondylolisthesis</div> <div>○ Pts with spondylolisthesis have a HIGH INCIDENCE of scoliosis</div><div><br></br><div>○ Idiopathic curves do not correct after fusion</div> <div>○ Postural curves do</div></div>”
“<b><div>Risk factors for intraoperative periprosthetic humerus fracture of total shoulder arthroplasty. All are true except:<span></span></div><ol><li><div><span>Osteonecrosis</span></div></li><li><div><span>Humeral version</span></div></li><li><div><span>Post traumatic arthritis</span></div></li><li><div><span>Press fit stem</span></div></li></ol></b>”
“<b><div><span>Humeral version</span><span><br></br><br></br>JBJS - periprosthetic humeral fractures during shoulder arthroplasty</span></div><div><span>Athwal et al (western)<br></br><br></br></span></div><div><span>a relative risk analysis- female patients were three times more likely to sustain fractures than male patients; patients undergoing revision surgery were three times more likely to sustain fractures than patients undergoing a primary TSA</span></div><div><span>press-fit humeral component three times more likely to lead to a fracture than cemented humeral component was, and patients with posttraumatic arthritis were two times more likely to sustain a fracture than patients with a diagnosis of rheumatoid arthritis, osteoarthritis, or osteonecrosis</span></div><div><span></span></div><div><span>Patients who were managed with a primary press-fit humeral component had a significantly higher likelihood of sustaining an intraoperative fracture than did patients who were managed with a cemented component (relative risk, 2.9; p = 0.046)</span></div><div><span></span></div><div><span>The fracture rate based on the primary diagnosis was 1.2% (relative risk, 0.8; p = 0.58) for osteoarthritis, 1.1% (relative risk, 0.7; p = 0.67) for rheumatoid arthritis, 2.5% (relative risk, 1.9; p = 0.11) for posttraumatic arthritis, and 1.6% (relative risk, 1.1; p = 0.75) for osteonecrosis</span></div></b><br></br>”
“<b><div>Addition of lateral extra articular tenodesis in acl reconstruction, compared to ACL reconstruction alone. all are true except:</div><ol><li><div><span>Increase lateral compartment pressure</span></div></li><li><div><span>Decrease graft failure</span></div></li><li><div><span>Decrease acl instability</span></div></li><li><div><span>Poorer 3 month patient outcomes</span></div></li></ol><div><span></span></div></b><br></br>”
“<div>1. Increase lateral compartment pressure<br></br><br></br>STABILITY study – Getgood et al (Western), American Journal of Sports Med</div> <div><br></br>Addition of LET to single-bundle hamstring autograft ACLR in young patients at high risk of failure decreased graft rupture and persistent laxity at 2 years (NNT 14). <br></br><br></br>Remember, worse 3 month outcomes as its a bigger surgery.<br></br><br></br></div> <div>Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy – <a><span>Tomoyuki Shimakawa</span></a> – Ortho J Sports Med, 2019</div>”
“<b><div>All are true about syndesmosis except<span>,</span></div><ol><li><div><span>All syndesmotic components have to be injured to result in internal rotation instability</span></div></li><li><div><span>AITFL most important for ER resistance</span></div></li><li><div><span>PITFL most important for IR resistance</span></div></li><li><div><span>AITFL no effect on posterior translation of fibula</span></div></li></ol></b>”
“AITFL no effect on posterior translation of fibula<br></br><br></br><b><div><span>Biomechanical analysis of the individual ligament contributions to syndesmotic stability</span></div><div><span>Clanton et al F&Ankle international 2017</span></div><div><span>AITFL provides clinically significant stability to the syndesmosis</span></div><div><span>resistance to posterior fibular translation and external rotation of the lateral malleolus when an external rotational force is applied</span></div><div><span>The PITFL also provides a significant, but smaller, contribution to stability, primarily providing resistance to internal rotation</span></div><div><span></span></div><div><span>JAAOS 2021 Diagnosis and treatment of syndesmotic unstable injuries</span></div><div><span>AITFL primarily limits external rotation of the fibula, and biomechanical studies suggest that isolated injuries to the AITFL result in approximately 24% reduction of resistance to external rotation</span></div><div><span>The IOL prevents coronal plane translation of the fibula, esp during ankle dorsiflexion</span></div><div><span>PITFL extends from the posterior tibial tubercle to the fibula and limits posterior translation of the fibula</span></div><div><span></span></div></b><br></br>”
“<b><div>All of the following are true except:</div><ol><li><div><span>Osteoporosis in post menopausal women is defined as a T score less than 1.5</span></div></li><li><div><span>Osteoporotic vertebral compression fractures occur twice as much as osteoporotic hip fractures</span></div></li><li><div><span>Estrogen is protective against osteoporosis by decreasing the cycles of bone remodelling.</span></div></li><li><div><span>Osteomalacia and rickets both have impaired mineralization of the osteoid.</span></div></li></ol></b><br></br>”
“<b><div><span>Osteoporosis in post menopausal women is defined as a T score less than 1.5. INCORRECT.</span><span><br></br><br></br>Osteoporosis defined as T-score below -2.5 per WHO. This means compared to the average 30 YEAR OLD.</span></div><div><span>50% of patients over the age of 80 will have osteoporotic vertebral compression fractures</span></div><div><span>Osteomalacia/rickets = metabolic bone dz where defective mineralization results in a large amount of unmineralized osteoid</span></div></b>”
“<b><div>With Regard to Langerhans cell histiocytosis. The following are true except:</div><ol><li><div><span>Monostotic has high recurrence rate</span></div></li><li><div><span>Many will resolve after a simple needle biopsy</span></div></li><li><div><span>The etiology is not well known</span></div></li><li><div><span>It can exist in monostotic, polyostotic, or multisystem disseminated forms</span></div></li></ol></b>”
“Monostotic has high recurrence rate<br></br><br></br><div style=""><span>JAAOS review - langerhans cell histiocytosis - the great</span><b>imitator<br></br><br></br></b>LCH has a wide spectrum of disease that can range from focal disease (eosinophilic granuloma) that can be benign or fatal depending on the involvement<br></br>- Localized form (EG) accounts for 70% of cases</div><div style=""><span>Unknown exactly what it is - neoplastic vs autoimmune</span></div><div style=""><span>Three forms with monostotic having the best prognosis<br></br></span><ol style=""> <li style=""><span>Single focus, single site (monostotic EG) - self limiting - 100% 10 year survival –></span><b>Lesions have been seen to resolve after simple needle biopsy; can inject steroid at the time of needle biopsy</b></li> <li style="">Single system, multisite (Polyostotic EG) - 90% 10 year survival - consider chemo</li> <li style="">Multisystem - 70% 10 years survival</li></ol></div><div style=""><span>After bone, skin is the second most common location for lesions; can also see solid organ inc lung involvement (more common in smokers)</span></div><div style=""><span>Radiologically appears as a lytic bony lesion that can be permeative or well define</span></div><br></br><br></br>”
“<b><div>75yo woman, had a THA 5 years ago. Back with THA loosening. (Xray1: they show you a xray of a cemented THA, properly implanted, not in varus, Xray2: I assume this is the followup xray where the stem subsided, cement mantle fractured, stress shielding on the GT but still no varus). All are visible causes of loosening on the xray EXCEPT:</div><ol><li><div><span>Stress shielding</span></div></li><li><div><span>Cement mantle fracture</span></div></li><li><div><span>Varus position of stem</span></div></li><li><div><span>Subsidence</span></div></li></ol></b>”
Stress shielding
“<b><div>Patient sustained a lesser arch injury. All are injured ligaments EXCEPT:<br></br><br></br></div><div><span>a)</span><span> </span><span>Scapholunate ligament</span></div><div><span>b)</span><span> </span><span>Lunocapitate ligament</span></div><div><span>c) </span><span> </span><span>Volar radiolunate ligament</span></div><span>d)</span><span> </span><span>Dorsal radiocarpal ligament</span></b>”
“C. Repeat<br></br><br></br><b><div><span>Hand Clin 31 (2015) 399–408. Perilunate Dislocations and Fracture Dislocations</span></div><div><span>JAAOS September 2011, Vol 19, No 9. Perilunate Dislocation and Perilunate Fracture-dislocation</span></div><div><span>Less arc injuries involve ligament injuries around the lunate, compared to greater arc injuries which involve bony injuries (trans-scaphoid, trans-radial etc).</span></div><div><span></span></div><div><span>Mayfield classification describes sequence of disruption during injuries around the lunate which progress from SL dissociation (</span>SL ligament disruption<span>), lunocapitate disruption (disruption through the space of Poirier) to lunotriquetral disruption which results in a perilunate dissociation (dorsal radiocarpal ligament fails, lunate rotates volar attached to the </span>intact volar radiolunate ligament<span>).</span></div><div><span></span></div><div></div><div><span></span><span><img></img></span><span><img></img></span></div><div></div><div></div><div><span>** The space of Poirier Is an area of weakness at the level of the proximal capitate between the volar radioscaphocapitate ligament and volar long radiolunate ligament where the lunate will escapes into.</span></div></b><br></br>”
“<div style=""><b>Middle aged man with ankle arthritis signs/symptoms, crepitus, but minimal pain (stem seemed to suggest neuropathy). All good measures to take except :<br></br><br></br></b></div><div style=""><span>a)</span><span> </span><span>AFO referral</span></div><div style=""><span>b)</span><span> </span><span>Counseling fusion</span></div><div style=""><span>c) </span><span> </span><span>Counseling TAA</span></div><span>d)</span><span> </span><span>Neuro referral</span><br></br>”
“<b><div><span></span><span>c)</span><span></span><span>Counseling TAA - WRONG</span><span><br></br><br></br> </span><span>Ideal candidate</span></div><div><span>o</span><span> </span><span>Lower BMI</span></div><div><span>o</span><span> </span><span>Female</span></div><div><span>o</span><span> </span><span>60</span></div><div><span>o</span><span> </span><span>< 30 degrees malalignment</span></div><div><span>o</span><span> </span><span>Preserved ankle motion<br></br><br></br></span></div><div><span>·</span><span> </span><span>Contraindications</span></div><div><span>o</span><span> </span><span>Young active</span></div><div><span>o</span><span> </span><span>Active infection</span></div><div><span>o</span><span> </span><span>Significant malalignment</span></div><span>o</span><span> </span><span>Charcot</span></b>”
“<b><div>All true about spine TB except:<br></br><br></br></div><div><span>a)</span><span> </span><span>In vertebral bodies</span></div><div><span>b)</span><span> </span><span>More severe kyphotic deformity in kids</span></div><div><span>c) </span><span> </span><span>Pre and paravertbral septate collections common</span></div><span>d)</span><span> </span><span>Kyphosis deformity more common in lumbar spine</span></b>”
“<b><span>d)</span><span></span><span>Kyphosis deformity more common in lumbar spine<br></br><br></br></span></b><b><div><span>JAAOS: September 2015, Vol 23, No 9. Granulomatous Vertebral Osteomyelitis</span></div><div><span>JBJS: 2020 Apr 1;102(7):617-628 .Concepts Review: Tuberculosis of the Spine<br></br><br></br></span></div><div><span>Three major patterns of spread have been described: peridiscal, central and anterior. Peridiscal is most common, where it begins at an endplate, and then spreads to the disc. Spreads to adjacent levels deep to ALL. Central pattern involves abscess in the vertebral body which leads to collapse and deformity. Anterior involves abscess anterior to vertebral body that spreads to multiple levels under ALL, causing scalloping and multilevel abscesses. </span>TB doesn’t have proteolytic enzymes, so it doesn’t tend to destroy the disc space as much as other infections.<br></br><br></br></div><div><span>Distinctive MRI findings include contiguous VB involvement with </span>preservation of disc spaces, <span>marrow edema, prevertebral and paravertebral septate loculated collections, subligamentous collections, end-plate erosions, and intraosseous abscess with epidural extension.<br></br><br></br></span></div><div><span>The VBs in children are cartilaginous and highly susceptible to rapid destruction. VB cartilage loss produces severe deformities in active disease. Asymmetrical loading affects the growth potential differentially, leading to the development and/or progression of the spinal deformity with growth.<br></br><br></br></span><div> <div> <div><img></img><br></br>Fever and less duration assx with pyogenic vs TB<br></br><br></br>Stupid at risk signs<br></br><img></img><br></br></div> </div></div></div></b><br></br>”
“<div><span><b>Role of botox is spasticity management?<br></br><br></br></b></span></div> <div><span>a. Botox and serial casting are the same for dynamic equinus</span></div> <div><span>b. Botox and serial casting vs. casting shows no difference</span></div> <div><span>c. Botox can prevent delay and prevent surgery</span></div> <div><span>d. Something else</span></div><br></br><br></br>”
“Don’t get this<br></br><br></br>b.Botox and serial casting vs. casting shows no difference<br></br><br></br><div>facts: <br></br>1. botox has been shown to improve equinus gait and passive ROM<br></br>2. botox>casting in <b>dynamic</b> contractures<br></br>3. casting>botox in fixed contracture<br></br>4. when comparing botox alone vs casting alone vs botox + cast, botox alone has worse outcomes)</div><br></br><div>Contrary to our hypothesis, the addition o<b>f botulinum toxin A to a serial casting</b> regimen led to <b>earlier recurrence of spasticity, contracture, and equinus during gait.</b> The results of the present study suggest that botulinum toxin combined with serial casting for the treatment of fixed contractures will lead to a recurrence of plantar flexor spasticity and equinus contracture by six months in this patient population. (JBJS 2004)</div>”
“<b><div>Open comminuted pilon, planning for initial surgery as exfix. All true except:<br></br><br></br></div><div><span>A)</span><span> </span><span>It is ok to fix the fibula as the same time as doing the ex fix</span></div><div><span>B)</span><span> </span><span>After applying ex fix, it is ok to wait as long as 2 weeks for definitive ORIF</span></div><div><span>C) You need CT scan before the initial surgery</span></div><div><span>D) Definitive surgery should be done when swelling is gone, + wrinkle sign and blisters epithelialized</span></div></b><br></br>”
“C) You need CT scan before the initial surgery<br></br><br></br><b><div>JAAOS: October 2011, Vol 19, No 10 Pilon Fractures: Advances in Surgical Management</div><div></div><div><span>“Clinical series from the mid 1980s through the early 2000s using immediate ORIF indicate wound complication rates of up to 100%”. Therefore, a staged approach with initial ex fix with or without limited fixation of the fibula is now the standard of care which has been shown to limit soft tissue complications.<br></br><br></br></span></div><div><span>“Many surgeons perform fibular ORIF at the time of external fixation to gain length and align the tibia”.<br></br><br></br></span></div><div><span>“Obtaining a CT scan after initial ankle spanning external fixation improves fracture fragment visualization secondary to ligamentotaxis.”<br></br><br></br></span></div><div><span>“Definitive ORIF is generally recommended following resolution of soft-tissue injury. This is indicated clinically by resolution of ecchymosis over the intended surgical site, re-epithelialization of fracture blisters, healing of open fracture wounds without infection, and resolution of soft-tissue edema sufficient to allow the skin to wrinkle (ie, wrinkle test) (Figure 3, A). Typically, this occurs 10 days to 3 weeks after injury.” <br></br><br></br><br></br></span></div></b><br></br>”
“<b><div>Possible sites of compression in pronator syndrome, All true except:</div><ol><li><div><span>Ligament of Struthers</span></div></li><li><div><span>Arcade of Struthers</span></div></li><li><div><span>Accessory muscular head of FPL</span></div></li><li><div><span>Lacertus fibrosus</span></div></li></ol></b>”
“Arcade of Struthers<br></br><br></br><b><div><span><img></img><br></br><br></br></span></div><span>Pronator syndrome originally referred to compression of the </span>median nerve<span> between the two heads of the pronator teres. <br></br></span><br></br>Patients present with sensory symptoms similar to CTS<span>. These patients also complain of aching pain in the proximal volar forearm and have sensory loss in the distribution of the </span>palmar cutaneous branch of the median nerve<span> (thenar eminence). <br></br><br></br>Patients will have a p</span>ositive resisted FDS middle finger test;<span> pain or paresthesia with resisted flexion of the long finger FDS is suggestive of median nerve compression at the level of the fibrous arch between the heads of the FDS. Some now refer to this as Lacertus syndrome</span></b>”
“<b><div>Regarding Charcot neuropathy of foot/ankle. All true except</div><ol><li><div><span>Plantar incisions can heal reliably</span></div></li><li><div><span>Immobilization is often prolonged</span></div></li><li><div><span>No palpable pulse is a contraindication for surgical treatment</span></div></li><li><div><span>Best to plan the operation in an ulcer healed period.</span></div></li></ol></b>”
“<b>No palpable pulse is a contraindication for surgical treatment. </b><br></br><br></br><div>If pulse is not palpable (usually is in Charcot foot) then you get further studies to assess perfusion and see if vasculopathy needs to be addressed first<br></br><br></br><div><div><div>J Foot Ankle Surg<span></span>2019 Sep;58(5):1030-1035.</div></div><span>doi: 10.1053/j.jfas.2019.01.004.</span></div><h1>Plantar Approach for Midfoot Wedge Resection to Reconstruct the Rocker Bottom Foot</h1><div><div><div><a>Justin D Persky</a><a>1</a>,<a>Travis Langan</a><a>2</a>,<a>Clair N Smith</a><a>3</a>,<a>Patrick R Burns</a><a>4</a><br></br><br></br><span>An 87% limb salvage rate (26/30) was demonstrated</span><br></br></div></div></div></div><br></br><br></br>”
“<b><div>Regarding expected neuro exam after C6-C7 facet dislocation, all true except</div><ol><li><div><span>Able to feel dorsum thumb</span></div></li><li><div><span>Able to extend wrist</span></div></li><li><div><span>Able to abduct fingers</span></div></li><li><div><span>No tricipital reflexes</span></div></li></ol></b>”
“<b><span>Able to abduct fingers (T1)<br></br><br></br></span></b><b><div><span>Remember its shooting a basketball:<br></br><br></br>Cock elbow (elbow flexion C5), cock wrist (wrist extension C6), start shot (extend elbow C7) and relase ball (wrist flexion C7), follow through (finger flexion C8), watch swoosh (abduct fingers T1)<br></br><br></br></span><img></img><span><br></br><br></br><br></br></span><img></img><br></br><span><br></br></span></div><div><span>C6 – sensation to thumb, wrist extension</span></div><div><span>C7 - triceps and wrist flexion, and triceps reflex</span></div><div><span>C8 – DIP flexion</span></div><div><span>T1 – hand intrinsic (intrinic’s)</span></div></b><br></br>”
“<b><div>All are true except regarding the management of type II odontoid fractures in the elderly:<br></br><br></br></div><div><span>a)</span><span> </span><span>halovest in minimally displaced fractures</span></div><div><span>b)</span><span> </span><span>posterior screw-rod fixation for comminuted fractures</span></div><div><span>c) </span><span> </span><span>posterior screw-rod fixation for severely displaced fractures</span></div><span>d)</span><span> </span><span>rigid collar for minimally displaced fractures</span></b>”
“<b><div>a)halovest in minimally displaced fractures<span><br></br></span><span><br></br>The management of odontoid fractures remains relatively controversial, specifically when treating Type-II fractures in the aging population.<br></br><br></br></span></div><div><span>·</span><span> </span><span>Halo vest immobilization should also be used carefully in patients >65 years of age given the conflicting evidence for increased mortality, secondary to pulmonary complications, with mortality rates as high as 21% to 40% across the literature</span></div><div><span>·</span><span> </span><span>Traditionally, the only option for odontoid fracture treatment had been a posterior approach and arthrodesis of C1-C2</span></div><span><br></br><br></br></span></b>”
“<div style="">All the following about OI are true, except:<br></br><br></br></div><div style=""><span>a)</span><span> </span><span>50% associated with scoliosis</span></div><div style=""><b><span>b)</span><span> </span><span>there is delayed fracture healing</span></b><br></br></div><div style=""><span>c)</span>Heal with weakened bones</div><b><span>d)</span><span> </span><span>typically there are less severe symptoms as the patient ages</span></b><br></br>”
“<b><div><div><span>heals slower than normal</span></div><br></br>https://posna.org/Physician-Education/Study-Guide/Osteogenesis-Imperfecta</div><div></div><div><span>OI is a qualitative and quantitative disorder of collagen 1 that leads to multisystem involvement including eyes (blue sclera, lens subluxation/dislocations, discoloration of teeth, hearing loss, joint hypermobility, and recurrent fractures that </span>often die of cardiac valve insufficiency / aneurisms<span>. The incidence of scoliosis in the population with OI varies from 39% to 80%. Bracing is contra-indicated in OI due to risk of fractures (especally ribs)</span></div><div><span></span></div><span>The severity depends on the mutation and dictates when it is diagnosed, with severe mutations causing death as an infant. </span><span>Fractures heal with normal time but they don’t have enough time to remodel before the bone breaks again</span><span>. Fracture healing is unaffected in patients with OI and therefore the duration of immobilization should not be extended. Once this deformity occurs, it becomes a natural stress riser and then they have a worsening deformity.<br></br><br></br>fractures also don’t have enough time to remodel, so that angular deformities occur</span></b>”
“<b><div>Kid with displaced radial shaft fracture. What is the start point for dorsal entry flexible nail in radius?<br></br><br></br></div><div><span>a)</span><span> </span><span>Between EPL and ERCL</span></div><div><span>b)</span><span> </span><span>Between ECRL and ECRB</span></div><div><span>c) </span><span> </span><span>Between EPL and ECRB</span></div><span>d)</span><span> </span><span>Between EPL and EDC</span></b>”
“<b><span>c) </span><span> </span><span>Between EPL and ECRB<br></br><br></br></span></b><b><div><span>https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/forearm-shaft/approach/approaches-to-the-radius-for-intramedullary-nailing#introduction</span></div><div><span>The correct nail entry point and so the chosen approach depends on the nail type used. The following entry points are used:</span></div><ol><li><div><span>On the ulnar side of the radial styloid, between the first and second extensor tendon compartments</span></div></li><li><div><span>On the radial side of the Lister’s tubercle, between the second and third extensor tendon compartment</span></div></li></ol><div><span><img></img></span></div></b><br></br>”
“<b><div>Which of the following structures can usually be seen when performing the modified Stoppa anterior approach for pelvic fracture?<br></br><br></br></div><div><span>a)</span><span> </span><span>Superior gluteal artery</span></div><div><span>b)</span><span> </span><span>Obturator nerve</span></div><div><span>c) </span><span> </span><span>SI joint</span></div><span>d)</span><span> </span><span>Quadratus femoris muscle</span></b>”
“b)Obturator nerve<br></br><br></br><b><div><a><span>https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/acetabulum/approach/modified-stoppa-approach#deep-dissection</span></a></div><br></br><div><span>At this level, the obturator neurovascular bundle is crossing the quadrilateral surface. In most cases it should be mobilized. A spatula or malleable retractor is used to protect the obturator neurovascular bundle and pelvic floor.</span></div><br></br><div><span><img></img><br></br><br></br>The SI joint is better seen through the lateral window</span></div><br></br></b>”
“<b><div>Kypho/scoli in a patient with myelodysplasia. What is true? (repeat)<br></br><br></br></div><div><span>a)</span><span> </span><span>Will progress after 1 year when they begin to sit</span></div><div><span>b)</span><span> </span><span>Level of lesion does not influence scoliosis development/progression</span></div><span>c) </span><span> </span><span>Can treat with orthosis reliably</span></b>”
“<b>Will progress after 1 year when they begin to sit</b><br></br><br></br>Also, lets bring back the favorite table<br></br><br></br><img></img><br></br><br></br>And foot deformity..<br></br><br></br><div>L1-2 = equinovarus</div> <div>L3 = equinovarus – resting position of foot</div> <div>L4 = cavovarus – tib ant works - causes cavus</div> <div>L5 = calcaneovalgus – peroneals and edc</div><div><br></br></div> <div>Level denoted means that that level is the last one that works</div><br></br><br></br>”
“<div style=""><div style=""><b>Aerosolizing procedures, what is arranged in order from highest to lowest risk?<br></br><br></br></b></div> <div style=""><span>a. Removal hemovac, ? <span>(rongeur Mcgill, suction UofC)</span>, electrocautery</span></div> <div style=""><span>b. Pulsed lavage, suction, dressing change</span></div> <div style=""><span>c. Skeletal traction, highspeed burr, ??</span></div> <div style=""><span>d. ??, osteotomes, rongeur</span></div></div>”
“b.Pulsed lavage, suction, dressing change<br></br><br></br><b><ul><li><div><span>High risk: Power drills, reamers and high-speed saw,</span><span>High-speed burr,</span><span>Pulsed lavage,</span><span>Electrocauterization,</span><span>Lasers</span></div></li></ul></b><b><br></br></b><br></br>”
“<b><div><span>What is true regarding UKA</span></div><ol><li><div><span>Tibial component perpendicular to tibia axis (coronal)</span></div></li><li><div><span>Mild patella OA with good tracking is a contraindication</span></div></li><li><div><span>Ideally larger flexion gap than extension gap</span></div></li><li><div><span>Ok to increase tibia slope with placement of tibia component</span></div></li></ol></b>”
“<span>Tibial component perpendicular to tibia axis (coronal)</span><b><br></br><div><span><br></br>Black Book:<br></br>Tibia component<br></br>1. Horizontal tibia cut should be minimal and match the native tibial slope. Some say <7 to protect ACL<br></br>2. Sagital cut should be as close to tibial spine as possible<br></br>3. Tibial component should be perpendicular to long axis of tibia in coronal plane<br></br>4. Avod undersizing tibia - this can cause fracture or subsidence<br></br>5. Avoid posterior cortex penetration<br></br><br></br></span></div></b><br></br>”
