All Subjects Flashcards
How do you make the diagnosis of Buerger’s disease
CT angiography
This type of trauma has highest risk of HO development
blast injuries, especially if amputation is performed through the zone of the injury
Lateral scapular winging is caused by injury to:
Cranial nerve XI (traps, rhomboids)
When should you brace for osteofibrous dysplasia?
When the lesion is PAINFUL otherwise, just observe
ADI limit for Downs Syndrome participation in sports:
ADI of 5 or greater should be limited from contact sports - normal ADI is <4
Slocum Anterior rotary drawer test:
assess ACL/MCL injury with anterior drawer in 30 deg external rotation - anteromedial rotatory instability
What are the salvage osteotomies for acetabular dysplasia in CP hip?
Shelf Chiari Do these if skeletally mature
Layer of the physis affected by distal femoral fractures:
multiple zones injured - due to undulating topography of the physis here - this is different than all other physeal fractures
C6 External Landmark
Cricoid cartilage
C3 external landmark
Hyoid Bone
C4 external landmark
Thyroid cartilage - upper border
C5 external landmark
Thyroid cargilage - lower border
Incidence of major complications following adult spinal deformity surgery?
20%
Serum marker with highest correlation with PJI:
IL-6
Lateral scapular winging is caused by injury to:
Cranial nerve XI (traps, rhomboids)
3 components of the lateral elbow collateral ligament complex:
annular ligament LUCL radial collateral ligament (most posterior)
ADI limit for Downs Syndrome participation in sports:
ADI of 5 or greater should be limited from contact sports - normal ADI is <4
Absolute contraindication to TTC nailing?
severe peripheral vascular disease (AVI < 0.4)
Management of Shoulder AVN:
Grade I and II (pre-collapse) = core decompression Early collapse with normal glenoid = hemiarthroplasty With glenoid changes = TSA
Layer of the physis affected by distal femoral fractures:
multiple zones injured - due to undulating topography of the physis here - this is different than all other physeal fractures
Schwann cell response to chronic peripheral nerve compression is:
proliferation and apoptosis - there is no wallerian degeneration
Brooker classification of:
heterotopic ossificaiton
risk factors for HO in trauma:
- prolonged ventilator course - spinal cord injury - severe burns - amputations through zone of a blast injury
Management of septic prepatellar bursisits:
complete bursectomy and IV antibiotics
Becker’s Muscular Dystrophy
- X linked dominant - pseudohypertrophy of calves - elevated CK levels - some dystrophin is present
Serum marker with highest correlation with PJI:
IL-6
Last muscle to reinnervate following peroneal nerve axonotmesis:
EHL
These muscles lie on the posterior tibia:
FDL, post Tib
Mannerfelt lesion:
attritional rupture of the FPL in RA (STT joint arthritis) - reconstruct with palmaris longus
Ocular trauma with secondary visual field changes requires:
emergent CT to evaluate for traumatic optic neuropathy
What is the next best step in an adult following a shoulder dislocation and exam suggestive of RCT?
- get an MRI - do PT after
Congenital pseudoarthrosis of the clavicle is typically in this location:
right side middle 1/3
When is it not appropriate to eccentrically ream the gleniod
in patients with >15 deg retroversion, can’t eccentrically ream because you enter the glenoid vault. Instead, do posterior allograft or augment - otherwise, for retroversion <15 deg you can eccentrically ream
if you do a central ray amputation in the hand, should consider this reconstructions:
index or small finger transfer to close down the interdigital space
Preserve this artery during lateral retinacular release of patella:
superior lateral geniculate artery
Mazabraud’s Syndrome
polyostotic fibrous dysplasia with multiple intramuscular myxomas - associated with mutations in the GNAS1 gene
Primary deforming force in basilar joint OA:
EPB - pulls the thumb MP joint into extension and adduction
Blood supply to the heel pad
medial calcaneal branch of the posterior tibial artery
Blood supply to the lateral flap along the calcaneus
lateral calcaneal artery - branch of the peroneal artery
Paget’s disease can metastatize and turn into:
- chondrosarcoma - fibrosarcoma (spindle cell sarcoma) - osteosarcoma
Scurvy affects on the growth plate:
changes to the primary spongiosa - widening of calcification - see a broad white stripe across the physis near the metaphysis
What is the Geyser sign
swelling at the AC joint in cuff tear arthropathy - synovial fluid can communicate above the cuff, and with recurrent effusions makes a large swelling about the AC joint
Deforming forces in Bennet’s Fracture:
- APL - metacarpal abduction (PIN) - Adductor Pollicis - distal adduction;supination (ulnar n)
OPerate on a boxer’s fracture?
rare - can tolerate extensive angulation - treat in remoable splint
Dorsal MP joint dislocation - what prevents reduction?
volar plate
Pedicle for the medial femoral condyle bone graft for scaphoid nonunion:
descending geniculate
In a Mayfield IV Injury, waht ligament is still attached to the lunate?
the short radiolunate - the SL, RSC, LRL are all disrupted
most common block to reduction for Galeazzi fractures?
ECU
strongest component of the IOL?
central band of the interosseous ligament
Most common neurapraxia with Bado 1 injuries:
AIN - anterior dislocation
Most common neurapraxia with Bado 2 injuries:
PIN - posterior dislocation
What is the angle of a Weil Osteotomy
nearly parallel to the plantar surface of the foot - to prevent plantar migration of the distal segment
tendon transfer to treat chronic foot drop?
PTT (plantar medial navicular) to the dorsal lateral cuneiform
Self-passivization:
adherent oxide layer on titanium prevents titanium corrosion
fretting corrosion:
frictional corrosion on metal modular implants - think trunion disease
galvanic corrosion:
two dissimilar metals causing corrosion - titinium and stainless
Spine manifestations in McCune Albright
scoliosis occurs at vertebral levels of fibrous dysplasia - get spine radiographs if there is back pain
If a person has upper extremity lymphadenopathy and caseating granulomas, the answer is probably:
Bartonella henselae (cat scratch disease) - could be mycobacterium, but upper estremity suggests cat scratch
The correct procedure to perform for UCL reconstruction is:
- flexor-pronator mass split - dock graft technique - NO ulnar nerve transposition
Indications for C spine surgery in RA:
- PADI < 14 - cervicomedullary angle < 135 deg - basilar invagination w >5mm migration of dens proximal to McGregor’s line - <14mm subaxial canal diameter
This PADI value corellates with poor recovery following decompression for myelopathy
<10 mm have no recovery >14mm have full recovery
Limb length discrepancy following clubfoot
- due to full limb hypoplasticity - anterior tibial artery is hypoplastic
most commonly injured retroperitoneal vessel during posterior spine surgery:
common iliac artery
Where does the aorta most commonly bifurcate:
most common is at L4
Spiral cord displaces the NV bundle in this direction:
palmarly and ulnarly
most common complication of halo placement:
abducens nerve palsy - can’t laterally deviate the eye
best way to make dx of ganglion cyst at wrist:
aspiration and cytology
How does BMP-2 change the composition of the intervertebral disk?
increases its chondrogenic phenotype increases disk matrix synthesis
Primary function of the posterior oblique ligament of the knee:
resist internal rotation with the knee in full extension
What is the best radiographic view to determine displacement of a peds medial epicondyle fracture:
distal humerus axial view
Are arthrogrypotic contractures progressive?
No
what is the gold standard meniscal repair technique:
inside-out with vertical mattresses
where do salter-harris 1 fractures occur?
zone of hypertrophy/zone of provisional calcification - both are correct - provisional calcification is a region of the hypertrophic zone
Proven method to decrease shoulder and elbow injuries in throwing athletes
Posterior capsular stretching
Type 1 SMA
Auto recessive Presents Near birth, age <6 months Tongue fasciculations Global weakness Death by age 2
Type 2 SMA
Auto recessive Presents between 6 months and 2years Wheelchair bound by teenage years Death in the 5 or 6 decade
What gene in SMA is most important to determine severity?
SMN2 gene Type 1has no SMN1or 2whereas the less severe types have increasing amounts of SMN 2 genes
Doing an MUA after TKA for stiffness results in best outcomes if done within:
12 weeks
What are the important findings from LEAP study on patient outcomes?
Two year patient satisfaction outcomes are most dependent upon ability to return to work, have a good walking speed, Have a limited pain, and at baseline do not have depression
What is the most appropriate culture medium for the HACEK bacteria
Standard blood culture medium for a one week duration
The arcuate Ligament complex inserts here
On the fibular head Avulsion of the complex occurs sometimes association with ACL injury Avulsion fx is called arcuate sign
Contraindication for ulnar shortening osteotomy for ulnar impaction syndrome
Degenerative change in the druj
What is the first toe Jone’s procedure?
First MTP fusion with EHL transfer for a extension MTP deformity following correction of cavus foot
The smallest pedicle is:
L1
How do you calculate relative risk
Incidents in the study population is divided by incidents in the control population. This is the result of a prospective study
PCL single bundle Reconstructions should be tension and at what degrees flexion
90°
What surgery can be done to treat a long-standing foot drop with a supple ankle joint
Tibialis posterior transfer to the lateral cuneiform through the interosseous membrane
SSEP monitoring allows for evaluation of what tracts?
Dorsal columns only. The anterior tracts and may be injured without changing signal
Negative predictors of diabetic wound healing
Transcutaneous oxygen < 30 ABI < 0.45 Albumin < 3 Lymph’s < 1500
Most common structure preventing reduction of a dorsal MTP dislocation
The volar plate
When is Akin closing wedge osteotomy indicated?
When HVI angle is >10 degrees
Supergior Gluteal nerve innervates:
medius minimus tensor fascia
Dinstinction between spinoglenoid notch vs suprascapular notch cysts:
anatomically in different locations - spinoglenoid notch cysts affects only infraspinatus - suprascapular notch cyst affects supra/infra compression is typically from a ganglion
TKA following HTO can be complicated most commonly by:
- patella baja (lost flexion, challenging exposure) - challenges with ligamentous balancing causing TKA instability
Most likely wrist extensor tendon to rupture in the setting of RA is:
EDQ - overlies the ulnar head - Vaughn Jackson Syndrome
Chondromyxoid Fibroma
biphasic histology
chondroid areas AND low grade spindle cell areas
aggressive radiographically
bright on T2
Wide resection is grafting
25% recurrenc rate
Treatment of Wassel type 1, 2, and 3 deformities:
radial thumb ablation
extensor tendon centralization
collateral ligament preservation
OR a Bilhaut Cloquet Procedure
How long until frostbite tissue “declares” itself?
1-3 months
At what age should you avoid SLAP repair and opt instead for LHBT tenodesis?
> 40 years
Dinstinguishing features of EIP and EDC in the 4th dorsal compartment
EIP is deep and ulnar to EDC
EIP has a more distal muscle belly
What is a funnel plot
for systematic reviews/meta-analysis
detects publication bias
What is Rothmund Thomson Syndrome
- growth retardation
- thin eyebrows/lashes
- teeth abnormalities
- hypogonadism
- high risk of cancers: osteosarcoma
Physiologic progression of genu valgum in children:
0-2 years physiologic varus
14 months may reach neutral
by 3 years peak genu valgus
by 7 years is normal physiologic valgus
Contents of deep posterior compartment
tibial nerve
tibialis posterior
FDL
FHL
Duchenne’s Muscular Dystrophy is from this mutation:
Deletion in Xp21 gene
Anakinra is:
IL-1 Receptor antagonist
competitively inhibits IL-1
Location of the 3,4 Wrist Arthroscopy Portal
1cm distal to Lister’s tubercle
What saline load volume to the knee will produce a 99% sensitivity for traumatic arthrotomy?
175cc
What artery is implicated in compartment syndrome following tibial tubercle avulsion fractures
recurrent anterior tibial artery
- letter D in the image
Thoracic disk herniations occur most commonly through which region?
lower 1/3
- the T11 and 12 ribs do not protect against the concentration of flexion forces in this area.
Thumb soft tissue defects of up to 2cm - treat with:
Moberg flap
Thumb soft tissue volar losses of 2.5-3.5cm treat with:
Island volar advancement
- this is NOT a Moberg flap
Warfarin acts on clotting factors:
II, VII, IX, X
Treatment of Camptodactyly
if <30 deg contracture, then passive stretching and observation
if >30 deg contracture, then do FDS tenotomy
Arcade of Struthers vs Ligament of Struthers
Arcade = ulnar nerve entrapment
Ligament = supracondylar humerus to the medial epicondyle, entrapping MEDIAN nerve
can remember this by “median nerve is compressed by ligaments” - the transverse carpal, and Struthers
Diastrophic Dysplasia Inheritance is:
Autosomal Recessive
Contraindications to AMZ?
proximal medial patellar facet and medial femoral condyle (trochlear) chondrosis/arthrosis
- these become the knee load bearing surfaces
The pulmonary effects of doing a thoracotomy for AIS release in an adult?
Transient as well as long term functional pulmonary losses.
- long-term improvement compared with pre-op is uncommon
Most common treatment for failed total ankle arthroplasty?
Ankle and Subtalar Fusion
Management of dorsiflexion malunion of the 1st metatarsal following proximal crescenting osteotomy for hallux valgus?
Plantarflexion producing 1st MT ostseotomy
Effect of PTH on Serum PO4
decreases it
This biomarker correlates with likelihood of recurrence of Chondrosarcoma:
Telomerase
Is there a proven difference in post-operative ROM dependent upon the type (PS, CR, mobile bearing) of TKA performed?
No
- but UKA has higher post-op ROM than TKA
Conditions associated with atlantoxial rotatory displacement?
Downs syndrome
Tumors
Viral Illnesses (grisel’s)
Congenital anomalies
RA
Treatment of Type I AARD for <1week
soft collar, NSAIDs, gentle stretching
Treatment of AARD Type I for >1 week
head halter traction (5lb)
NSAIDs
Benzos (muscle relaxation)
Hard collar x3 Months
Treatment of AARD Type I for >1 month
Halo traction + Halo Vest
Treatment of AARD Type I for >3 months (or late diagnosis)
C1-2 posterior fusion
Risks involved with use of perc long lateral locked plating of tibia?
Superficial peroneal nerve injury
- in the distal holes (10-13) the nerve may be milimeters away
- make incision larger and bluntly dissect down to bone
Largest risk of mortality in patients with closed head injury comes with this medial error:
hypotension (especially intraoperative)
Free antegrade lateral arm flap
- goes where?
- is based on what pedicle?
coverage of the forearm
based on the posterior recurrent radial artery pedicle
maximum flap width 8cm
can be transposed 8cm distal
Complications of medial sesamoidectomy?
removal of medial sesamoid can leave the flexor hallucis brevis deficient, causing
- hallux valgus
- claw toe
Imhauser Osteotomy
used for correction of late presenting SCFE deformity
- flexion
- internal rotation
- valgus
C8 Radiculopathy Manifests As:
Numbness on medial hand
Weakness to long finger flexors of all digits including the thumb
Lengthening along the mechanical axis of the femur reuslts in what change to the mechanical axis of the limb?
Lateralizes it.
What ligament is ruptured in a dorsal thumb CMC dislocation?
Dorsoradial ligament is torn
This is the primary restraint to dorsal dislocation
The volar oblique ligament may avulse also
What intra-articular abnormalities are seen with internal impingement:
- SLAP tears (#1)
- partial articular sided rotator cuff tears
Deactivating mutation in PTHrP Receptor would have what affect on the physeal zone of hypertrophy?
- would cause more rapid maturation
physeal chondrocytes secrete Indian Hedgehog (Ihh) which stimulates PTHrP receptors which SLOWS down physeal maturation
-
Cellular function of BMP3
antagonizes BMP2
Most abundant in DBM
BMP3 knockout mice have excessive trabecular bone
Indications for resection of a hindfoot coalition?
involves <50% of the joint surface
*if >50% consider primary arthrodesis
*consider a triple if there is deformity an arthrosis among the remaining hindfoot joints
To decrease risk of transient hypotension in a pregnant patient with a closed head injury, position them in the :
left lateral decubitus position
- prevents inadvertant aortocaval compression by the fetus which may occur in supine position
Define: Secondary amenorrhea
absent menses x 6 months
