All Orthopaedics Flashcards
What causes prosthesis squeaking following a THA
Squeaking is multifactorial and may include
- impingement
- edge-loading
- loss of fluid film lubrication
- third-body particles
What is the indications for unicondylar replacement ?
- non-inflammatory arthritis
- mechanical axis deviation <10 degrees from neutral in varus or 5 degrees in valgus
- intact ACL
- flexion contracture <15 degrees
- no patellofemoral symptoms (although radiographic arthritis alone at the PF joint is not a contraindication)
- flexion to 90 degrees or greater
- age >60
- low activity demand
- weight <82 kilograms
what are Options of loose stem with poor proximal femoral bone stock
- fully coated stem
- fluted tapered stem
- proximal femoral replacement with megaprosthesis
- allograft-prosthesis composite
- impaction bone grafting.
how many cuts we have in the TKR? NAME them.
7 bone cuts in a total knee replacement
tibial cut
patellar cut
5 knee cuts
- anterior femoral cut
- posterior femoral cut
- posterior chamfer cut
- anterior chamfer cut
- distal femoral cut
most TKA systems have a 4-in-1 cutting block and the distal femoral cut is made separately
what are the risk factors for well-fixed Supracondylar periprosthetic fractures
- anterior femoral cortical notching
- use of the rotational constrained implant
what are the causes of Periprosthetic tibial fractures?
- loose components
- malalignment
- malposition of implants
what are the causes of patella periprosthtic fracture?
- rheumatoid arthritis
- use of steroid
- osteonecrosis
- over reaming
- malalignment of implants
what are the causes of apparent shortening?
- flextion contracture of the hip
- flextion contracture of the knee
- Sacral agenisis
- adduction contracture
- Genu varum
- Genu valgum
what are the fixation strategies of TYPE B AND C periprosthetic Hip fracture?
- ORIF with cortical strut allografts alone.
- ORIF with cable plate or compression plate.
- ORIF with cable plate or compression plate with the use of cortical strut allograft.
- ORIF with locking plates.
signs of scapholunate dissociation
- Scapholunate angle increase >70 degree
- Widened schapholunate gap
- Ring sign of scaphoid
- Positive stress view
Four important variables that help determine the stability of THA
- component design
- component alignment
- soft-tissue tensioning
- soft tissue function
what are the help tips in Kids resuscitation?
- Broselow tape = estimate medication doses, size of equipment, shock voltage for defibrillator
- ETT = (age/4) + 4 or (age+16)/4 = uncuffed
- BP = 80 + (age x 2)
- Chest tube = 4 x ETT
- Blood volume = 70 x wt (kg) or 75 - 80 mL/kg
what is the pediatric trauma score consist of?
- size (kg)
- Airway
- BP
- Mental status
- Open wound
- extremity fracture
what are the association conditons in fibular deficiency?
anteromedial tibial bowing
- most common cause is fibular hemimelia
ankle instability
- secondary to a ball and socket ankle
talipes equinovalgus
tarsal coalition (50%)
absent lateral rays
femoral abnormalities (PFFD, coxa vara)
cruciate ligament deficiency
genu valgum
- secondary to lateral femoral condyle hypoplasia
significant leg length discrepancy
- shortening of femur and/or tibia
what is Beighton Scale?
- passive hyperextension of each small finger >90° (1 point each)
- passive abduction of each thumb to the surface of forearm (1 point each)
- hyperextension of each knee >10° (1 point each)
- hyperextension of each elbow >10° (1 point each)
- forward flexion of trunk with palms on floor and knees fully extended (1 point)
score of 5 or more on 9-point defines joint hypermobility
what are the orthopaedic manifestations in Hemophilia?
hemophilic arthropathy
- synovitis
- cartilage destruction
- joint deformity
- pseudotumor
intramuscular hematoma (pseudotumor)may lead to
- nerve compression
- iliacus hematoma may compress femoral nerve and presentswith paresthesias in the L4 distribution
leg length discrepancy
- due to epiphyseal overgrowth
fractures
- due to generalized osteopenia
- will heal in normal time
compartment syndrome
What is the indecations and goal of the surgical treatment of Congenital Dislocation of the Knee
indications
failure to gain 30° of flexion after 3 months of casting
surgical soft tissue release
goal of surgery is to obtain 90° of flexion
- quadriceps tendon lengthening (V-Y quadricepsplasty or Z lengthening)
- anterior joint capsule release
- hamstring tendon posterior transposition
- collateral ligaments mobilization
why pelvic fracture in kids is defferint for adult?
- increased bony elasticity
- cartilage able to absorb more energy
- SI joint/symphysis pubis more elastic
- thick periosteum
- apparent dislocations (symphyseal, SI) may have a periosteal tube that heals like a fracture
what is Friedreich Ataxia? and what is its characterized with?
The most common form of spinocerebellar degenerative diseases
characterized by lesions in the
- dorsal root ganglia
- corticospinal tracts
- dentate nuclei in the cerebellum
- sensory peripheral nerves
what is the spectrum of Proximal Femoral Focal Deficiency
- absent hip
- femoral neck pseudoarthrosis
- absent femur
- shortened femur
what is the Goal of Treatment in PFFD?
treatment must be individualized based on
- ultimate leg length discrepancy
- presence of foot deformities
- adequacy of musculature
- proximal joint stability
what do you need to measur in the intoeing foot?
- femoral anteversion
- tibial torsion
- metatarsus adductus
how to measure the femoral anteversion?
hip motion (tested in the prone position)
- increased internal rotation of >70° (normal is 20-60°)
- decreased external rotation of < 20° (normal 30-60°)
anteversion estimated on degree of hip IR when greater trochanter is most prominent laterally
- trochanteric prominence angle test
patella internally rotated on gait evaluation
how would you measure tibial torsion?
- look at thigh-foot angle in prone position
- normal value in infants- mean 5° internal (range, −30° to +20°)
- normal value at age 8 years- mean 10° external (range, −5° to +30°)
how would you examin for Metatarsus adductus?
- heel bisector line
- adducted forefoot deformity, lateral border should be straight
- a medial soft-tissue crease indicates a more rigid deformity
- evaluate for hindfoot and subtalar motion
what are the poor prognostic factors for osteosarcoma?
- advanced stage of disease (most predictive of survival)
- response to chemotherapy (as judged by percent tumor necrosis of resected specimen)
- tumor site and size
- expression of P-glycoprotein
- high serum alkaline phosphatase
- high lactic dehydrogenase
- vascular involvement
- surgical margins
- type of chemotherapy regimen
what are the Reconstruction options in distal femur OS? OR ANY malignancy?
- tumor-prosthesis
- expandable prosthesis
- osteoarticular allograft
- combination alloprosthetic composite and rotationplasty.
what are Small-round-cell tumor differential by age?
- < 5 yrs: neuroblastoma or leukemia
- 5-10 yrs: eosinophilic granuloma
- 5-30 yrs: Ewing’s sarcoma
- >30 yrs: lymphoma
- > 50 yrs: myeloma
what are the indecations of adjuvant radiation in ES?
- positive post-resection surgical margins
- patients who present with widely metastatic disease
- where chemotherapeutic response has been poor
Paget’s Disease Radiographs?
- coarsened trabeculae
- remodeled cortices
- long bone bowing
- fractures
- hip and knee osteoarthritis
- osteitis circumscripta
- Paget’s secondary sarcoma
Laboratory findings Paget’s Disease?
- elevated serum ALP
- elevated urinary collagen cross-links
- elevated urinary hydroxyproline (collagen breakdown marker)
- increased urinary N-telopeptide, alpha-C-telopeptide, and deoxypyridinoline
- normal calcium levels
what are the prerequisites for a biopsy?
- CBC, platelets, coagulation studies
- cross-sectional imaging to evaluate local anatomy
- treatment center performing biopsy must be capable of proper diagnosis and treatment
what are the factors found to increase physeal injury in pediatric ACL reconstruction?
- large tunnel diameter (>12mm) is most important
- 8mm tunnel corresponds to <3% physeal cross-sectional area
- 12mm tunnel corresponds to >7-9% of physeal cross-sectional area is violated
- oblique tunnel position
- interference screw fixation
- high-speed tunnel reaming
- lateral extra-articular tenodesis
- dissection close to the perichondral ring of LaCroix
- suturing near tibial tubercle
what are the physical finding in chronic steroid use by athlets?
- increased body weight
- testicular atrophy
- irreversible deepening of female voice
- alopecia (irreversible)
- reduction in gonadotropic and sex hormones (estrogen and testosterone)
- can lead to decreased bone mineral density
- oligospermia or azoospermia
- growth retardation
- gynecomastia
what are the indications of not returining to play in Concussions & Head Injuries?
- LOC
- prior Grade 1 concussion in same season
- symptoms > 15 minutes
- positive exertional stress test
- amnesia
- postconcussion syndrome
what are the PLC structures?
static structures
- LCL (most anterior structure inserting on the fibular head)
- popliteus tendon
- popliteofibular ligament
- lateral capsule
- arcuate ligament (variable)
- fabellofibular ligament (variable)
dynamic structures
- biceps femoris (inserts on the posterior aspect of the fibula posterior to LCL)
- popliteus muscle
- iliotibial tract
- lateral head of the gastrocnemius
what are the methodes to evaluate for patellar height (patella alta vs baja) in patellar instability case?
Blumensaat’s line should extend to inferior pole of the patella at 30 degrees of knee flexion
Insall-Salvati method
normal between 0.8 and 1.2
Blackburne-Peel method
normal between 0.5 and 1.0
Caton Deschamps method
normal between 0.6 and 1.3
Plateau-patella angle
normal between 20 and 30 degrees
what are the decision-making algorithm based on in OCD knee treatment?
patient factors
- age
- skeletal maturity
- low vs. high demand activities
- ability to tolerate extended rehabilitation
defect factors
- size of defect
- location
- contained vs. uncontained
- presence or absence of subchondral bone involvement
what is the Diagnostic criteria for CTS?
- numbness and tingling in the median nerve distribution
- nocturnal numbness
- weakness and/or atrophy of the thenar musculature
- positive Tinel sign
- positive Phalen test
- loss of two point discrimination
what are the EMG finding in CTS?
- increased insertional activity
- sharp waves
- fibrillations
- fasciculations
- complex repetitive discharges
what is the stump examined for?
- zone of injury
- tissue viability
- supporting tissue structures
- contamination
what is the amputated portion inspected for
segmental injury
bone and soft tissue envelope
contamination
Indications for replantation after trauma?
primary indications
- thumb at any level
- multiple digits
- through the palm
- wrist level or proximal to wrist
- almost all parts in children
relative indications
- individual digits distal to the insertion of flexor digitorum superficialis [FDS] (Zone I)
- ring avulsion
- through or above elbow
Contraindications to replantation?
primary contraindications
- severe vascular disorder
- mangled limb or crush injury
- segmental amputation
- prolonged ischemia time with large muscle content (>6 hours)
relative contraindications
- single digit proximal to FDS insertion (Zone II)
- medically unstable patient
- disabling psychiatric illness
- tissue contamination
- prolonged ischemia time with no muscle content (>12 hours)
time to replantation?
proximal to carpus
- warm ischemia time < 6 hours
- cold ischemia time < 12 hours
distal to carpus (digit)
- warm ischemia time < 12 hours
- cold ischemia time < 24 hours
Factors that increase stability of conventional external fixators
- contact of ends of fracture (most important)
- larger diameter pins (second most important)
- additional pins
- decreased bone to rod distance
- pins in different planes
- increasing size or stacking rods
- rods in different planes
- increased spacing between pins
Factors that increase stability of circular (Ilizarov) external fixators
- larger diameter wires
- decreased ring diameter
- olive wires
- extra wires
- wires cross perpendicular to each other
- increased wire tension
- placement of two central rings close to fracture
- increased number of rings
