Imperium Im Imperio JAAOS 2019 Flashcards
1
Q
20% of Primary ACLs have co-existing chondral or meniscal pathology
A
False
50%
JAAOS Jan 2019
2
Q
90% of Revision ACLs have co-existing pathology
A
True
JAAOS Jan 2019
3
Q
A delay in surgical reconstruction of ACL of 12 weeks will increase the risk of chondral or meniscal injury by 12%
A
False
3%
JAAOS Jan 2019
4
Q
Males have a consistently higher rate of meniscal tears with ACL injuries than females
A
True
JAAOS Jan 2019
5
Q
Total medial meniscectomy has no appreciable bearing on examination findings during Lachmanns manoeuvre
A
False
Increase from 5mm to 11mm
JAAOS Jan 2019
6
Q
Total lateral meniscectomy has no appreciable bearing on examination findings during Lachmanns manoeuvre
A
True
But does increase AP translation during pivot shift
JAAOS Jan 2019
7
Q
By far the majority of tears involve the posterior horns of medial and lateral meniscus
A
True
95% Medial and 77% Lateral are posterior horns
JAAOS Jan 2019
8
Q
“Benign neglect” of stable meniscal tears found during ACL reconstruction have a low rate ~ 5% of requiring revision surgery
A
True
5.4% (with 9% medial and 3% lateral
JAAOS Jan 2019
9
Q
The failure rate of meniscal tear repairs done during ACL reconstruction are the same for ‘all-inside’ and ‘inside-out’
A
False
10% inside-out, 16% all inside
JAAOS Jan 2019
10
Q
Most common location of bone bruising in ACL injuries is lateral tibial plateau and medial femoral condyle
A
False
Lateral tibia + Lateral femur
JAAOS Jan 2019
11
Q
OATS is superior to microfracture for acute chondral injuries treated during ACL reconstruction with an average size of 2.6cm2
A
True
JAAOS Jan 2019
12
Q
The rate of adjacent level disease (symptomatic radiculopathy) after ACDF is unacceptably high and arthroplasty (disc replacement) should be preferred
A
False
2.9% per year
JAAOS Jan 2019
13
Q
90% of cervical radicular symptoms are progressive and worsen with majority requiring surgery
A
False
Benign course, 29% require surgery
JAAOS Jan 2019
14
Q
Cervical myelopathy is progressive and does not respond to non-surgical treatment
A
True
JAAOS Jan 2019
15
Q
Cervical disc arthroplasty should be limited to 3 levels
A
True
JAAOS Jan 2019
16
Q
Cervical arthroplasty is contraindicated with kyphotic deformity, previous surgery or facet joint arthropathy
A
True
JAAOS Jan 2019
17
Q
Cervical arthroplasty is proven to have a notable improvement is saggital plane motion compared to ACDF
A
False
No difference in motion in any plane
JAAOS Jan 2019
18
Q
Disc pressure is the same in adjacent levels with ACDF and Cervical arthroplasty
A
False
Lower pressure in disc replacement (in cadavers)
JAAOS Jan 2019
19
Q
Breaking through the subchondral bone is essential for bony integration of Cervical arthroplasty and is a requirement of implantation
A
False
Risk of subsidance, avoid breakthrough
JAAOS Jan 2019
20
Q
Long term studies are available and show a lower secondary procedure rate for arthroplasty compared to ACDF for adjacent segment disease
A
True
But interpret with caution due to different implant designs
JAAOS Jan 2019
21
Q
Incidence of HO is variable with Cervical arthroplasty (7-70%) and has not been shown to be clinically significant
A
True
JAAOS Jan 2019
22
Q
The smooth surfaces of the SI joint make it susceptible to ligamentous strains
A
False
Articular surface is rough
JAAOS Jan 2019
23
Q
Ventral branches of L4-S3 supply the SI joint
A
False
Dorsal branches of L4-S3 and Anterior branches of L2-S2
JAAOS Jan 2019
24
Q
Inflammatory arthropathy affects SIJ neural structures more due to the incompetent capsular envelope
A
True
Poor / incomplete capsule allows inflammatory mediators to “leak” out to neural structures
JAAOS Jan 2019
25
There is 5-10deg movement in saggital and axial planes only of the SIJ
False
Saggital (1-4mm) and translation (0.5-2mm)
JAAOS Jan 2019
26
Only the anterior 1/3 of the SIJ between sacrum and ilium is a true synovial joint and the rest is just ligamentous structures
True
JAAOS Jan 2019
27
Scoliosis, previous spinal fusions and LLD are the main secondary contributors of SIJ pain
True
JAAOS Jan 2019
28
Ank spond is the only inflammatory arthropathy to affect the SIJ
False
Reiter's, Rheumatoid, Psoriatic
JAAOS Jan 2019
29
Most common symptom of SI joint pathology is buttock pain
True
94% have buttock pain, 72% have back pain
JAAOS Jan 2019
30
Fortin finger test is SIJ pain reproduced during PR examination
False
There is no such test. Why are you even doing a PR?
No reference needed.
31
Physical exam can reliably elicit SIJ pathology especially rising from a chair
False
Dreyfuss et al tested 12 exam findings, none were reliable. Pain on rising from a chair is most highly correlated with SIJ pathology.
JAAOS Jan 2019
32
Multiple national joint registries show a lower revision with cemented vs cementless in the >75yr age group
True
JAAOS Feb 2019
33
Collars in cemented stems have been proven to improve proximal loading of the cement mantle and prevents stress shielding
False
JAAOS Feb 2019
34
2mm of cemented stem subsidence, typically seen at the shoulder of the prosthesis is normal in the first 12 months
True
JAAOS Feb 2019
35
Lat dorsi originates from the iliac crest, thoracolumbar fascia, and inferior thoracic and lumbar spinous processes and inserts on the medial lip of the intertubercular groove
True
JAAOS Feb 2019
36
Lat dorsi nerve supply is from the dorsal scapular nerve (C5-7)
False
Thoracodorsal via C5,6,7
JAAOS Feb 2019
37
Lat dorsi acts to adduct, extend and externally rotate the shoulder
False
Add, Ext and ER
JAAOS Feb 2019
38
Most common Lat dorsi injury is muscle belly strain, seen in pitchers/ crossfit and rock climbing
True
JAAOS Feb 2019
39
All Lat dorsi injuries (except humeral insertion rupture) can be managed conservatively
True
JAAOS Feb 2019
40
Radial nerve passess anterior to lat dorsi tendon at an average of 2cm from its insertion
True
JAAOS Feb 2019
41
In hip ostoelysis, Particles <7um (micrometers or microns) can be eaten by macrophages
True
JAAOS Mar 2019
42
In hip osteolysis, The time from 3rd body wear to visible bone loss on Xray is quite fast 1-2 years
False
Usually doesn't start until 1 year and no bone loss until 5+ years
JAAOS Mar 2019
43
THR Constrained liners are indicated with abductor dysfunction
True
JAAOS Mar 2019
44
In hip osteolysis, the primary reason for a head and liner exchange is to address the wear generator
True
JAAOS Mar 2019
45
In THR wear, most common complication of a head/liner exchange is not recognising implant loosening
False
Hip dislocation is most common
JAAOS Mar 2019
46
PFJ OA is a contraindication for UKR due to risk of early revision due to disease progression
False
No difference in function or revision with PFJ OA
JAAOS Mar 2019
47
Valgus stress views at 20 deg flexion showing >5mm width and correctible alignment are good predictors of lateral compartment OA in the decision making of UKR
False
No correlation with Outerbridge grading of lateral joint cartilage
JAAOS Mar 2019
48
Most common reason for revision for UKR is aseptic loosening regardless of cemented or uncemented
True
JAAOS Mar 2019
49
Revision rate for cemented and uncemented UKRs are equivalent
True
95% cemented and 97% uncemented survivorship at 10 years.
JAAOS Mar 2019
50
IV drug user is the second most common risk factor for Necrotizing Fasciitis
True
43% IVDU, but Diabetes is 71%
JAAOS Mar 2019
51
Clostridium monomicrobial Necrotizing Fasciitis accouns for the highest mortality and limb amputation
True
Higher than monomicrobial Strep A
JAAOS Mar 2019
52
In Necrotizing Fasciitis, Exotoxins caused by the strep A prevent the spread of the infection and keep it localised
False
Causes a highly invasive infection
JAAOS Mar 2019
53
Bullae/ ecchymosis is a hard sign and are almost always present in Necrotizing Fasciitis
False
Present 44% of the time
JAAOS Mar 2019
54
Gas tracking along fascial planes is a soft sign of Necrotizing Fasciitis due to multiple differential causes
False
This is a hard sign. Few other things can cause it (post-op ob, or gas injection)
JAAOS Mar 2019
55
CRP 150 and WCC >25 are indications for immediate surgical debridement in cases of Necrotizing Fasciitis
True
JAAOS Mar 2019
56
Mortality from Necrotizing Fasciitis is high ~ 60%
False
33% (still high)
JAAOS Mar 2019
57
The apical ectodermal ridge, the zone of polarisation and Wnt signalling pathway are key for limb development between 4th and 7th week of life
True
JAAOS Mar 2019
58
There is a specific gene which is responsible for tibial deficiency
False
JAAOS Mar 2019
59
Associations in Tibial Deficiency are DDH, vertebral malformations, imperforate anus and hypospadias
True
JAAOS Mar 2019
60
Visceral organ ultrasound is not required in cases of tibial deficiency
False
JAAOS Mar 2019
61
Treatment fundamentally revolves around a stable plantigrade foot/ankle
True
JAAOS Mar 2019
62
Tibial deficiency is typically associated with equinovalgus foot
False
EquinoVarus (swings to empty area where tibia is supposed to be)
JAAOS Mar 2019
63
Fibula centralisation (brown procedure) is robust with good results
False
Most end up needing amputation
JAAOS Mar 2019
64
Children with unreconstructable Tibial Deficiency with functioning knee should get a Symes amputation and those without should get a Through Knee amputation
True
JAAOS Mar 2019
65
50% of patients over the age of 66 have degenerative rotator cuff tears
True
JAAOS Mar 2019
66
Supraspinatus has the largest footprint of the rotator cuff tendons on the GT
False
Supra 12.6mm, Infra 32.7mm
JAAOS Mar 2019
67
Vascular supply to the rotator cuff has little involvement in the development of degenerative Rotator Cuff tears
False
Directly related to poor vascularity, tendinopathy and tear
JAAOS Mar 2019
68
The risk of partial rotator cuff tears progressing is approximately 10% over 2 years and 30% for 5 years
True
JAAOS Mar 2019
69
The incidence of scapular notching in shoulder replacement is wide and clinical implications are unknown
True
4%-96% incidence, no clinically proven complications
JAAOS Mar 2019
70
Clinical outcome scores are equivalent between shoulder replacement with notching or without notching
False
Lower Constant scores in the notching group
JAAOS Mar 2019
71
Ways to avoid scapular notching in shoulder replacement is a smaller glenosphere and decreased offset
False
Increase Glenosphere and Offset to reduce risk
JAAOS Mar 2019
72
Implant removal and reconstruction (Post traumatic THA) are usually planned to be performed in a single procedure
True
Except for cases of infection. No literature to support 1 or 2 stage.
JAAOS April 2019
73
In THA after previous ORIF, existing implants are left in situ until the hip is dislocated
True
To avoid fracture during hip dislocation
JAAOS April 2019
74
Patients over 60 having hip arthroplasty due to post traumatic arthritis have lower revision rates for aseptic loosening than patients with primary OA
False
Higher risks of infection, dislocation, loosening, sciatic nerve damage and heterotopic ossification
JAAOS April 2019
75
Patients who underwent salvage total hip arthroplasty for prior intertrochanteric fractures reported a mean surgical duration of 4 hours and estimated blood loss of 1,125 mL
True
JAAOS April 2019
76
Alzheimer Disease is a progressive, incurable neurologic illness
True
Loss of neuronal synapses. 3 to 12 year survival after diagnosis.
JAAOS April 2019
77
Global memory decline is typically the first sign of Alzheimer Disease
True
Dx criteria:
1. Loss of cognitive function
2. Progressive deterioration
3. Duration >6 months
4. Absence of another cause of dementia
JAAOS April 2019
78
Patients with Alzheimer Disease treated with surgical fixation for stable femoral neck fractures are less prone than the general geriatric population to loss of reduction and fixation failure than healthy elderly individuals
False
JAAOS April 2019
79
Ankle fractures in Alzheimer Disease treated with hind foot fusion nailing has better outcome than ORIF
True
Lower complications and shorter hospital stay
JAAOS April 2019
80
The incidence of Fat Embolism Syndrome in paediatrics is less than in adults
True
JAAOS April 2019
81
Patients with Duchenne Muscular Dystrophy have lower risk of developing Fat Embolism Syndrome than average population
False
Higher risk
JAAOS April 2019
82
Petechial rash of Fat Embolism Syndrome can appear on the back of a supine patient
False
Never on the back (at least in supine patient). Fat droplets float up to non-dependant areas.
JAAOS April 2019
83
Patients with long bone fracture who get late stabilization are in an increased risk of Fat Embolism Syndrome in comparison to patients who
get early stabilization
True
JAAOS April 2019
84
There is a Six times greater incidence of acute lung injury with intramedullary femoral nailing compared to Ex Fix
True
However, no difference in ARDS or Mortality
JAAOS April 2019
85
Good evidence to suggest that unreamed nailing is better in multitrauma setting with regard to Fat Embolism Syndrome
False
No evidence
JAAOS April 2019
86
Reamer irrigator aspirator (RIA) has less embolic load than normal reamer.
True
JAAOS April 2019
87
The use of an intramedullary bone vacuum during cementation in arthroplasty was shown to significantly decrease embolization of marrow contents
True
JAAOS April 2019
88
Routine prophylaxis with steroids is recommended to reduce Fat Embolism Syndrome
False
JAAOS April 2019
89
Fat Embolism Syndrome is characterized by pulmonary distress, neurological symptoms and petechial rash
True
JAAOS April 2019
90
Prolonged NSAID use has a negative effect on bone healing
True
Except in Paediatric population
JAAOS April 2019
91
The first case of DVT after elective shoulder arthroscopy was reported by Burkhart in 1990
True
JAAOS April 2019
92
DVT in upper extremity is higher after shoulder arthroscopy than arthroplasty
False
Up to 2.6% in Arthroplasty, Up to 0.38% in Arthroscopy
JAAOS April 2019
93
rTSR is found to have higher VTE risk than anatomical TSR or hemiarthroplsty
False
No definitive link between types of arthroplasty, only surgical time, etc.
JAAOS April 2019
94
No definitive correlation can be drawn between positioning of shoulder arthroscopy (beach chair or lateral decubitus) and VTE risk
True
JAAOS April 2019
95
Recurrence after Upper Extremity DVT is lower than that after Lower Extremity DVT.
True
JAAOS April 2019
96
Post-thrombotic syndrome of a limb is characterized by hypopigmentation, atrophy and pain
False
HypERpigmentation, Edema, Pruritis, Paresthesias, Pain and ulceration.
JAAOS April 2019
97
Excessive anterior tightening in shoulder stabilization can result in increased posterior subluxation of the humeral head, shearing forces on the posterior glenoid, and eventual arthrosis.
True
JAAOS April 2019
98
Shoulder instability is common, with an incidence of 5% in the general population
False
1.7% incidence
JAAOS April 2019
99
More than 50% of patient with shoulder dislocation will develop arthritis in 25 years
True
JAAOS April 2019
100
Suboptimal (lateral) positioning of the coracoid transfer and/or prominent screws used in the Bristow-Latarjet procedure is thought cause impingement against the humeral head during abduction and external rotation
True
JAAOS April 2019
101
The number of anchors used in Bankart repair is not a risk factor of radiographic arthritic changes
False
More anchors, number of dislocations, young age at primary dislocation, anterior tightening procedures all associated with more arthritis
JAAOS April 2019
102
Eden-Hybinette operation -is an augmentation of the anterior glenoid rim with an iliac crest bone graft – is associated with extremely high shoulder arthrosis rate
True
JAAOS April 2019
103
In post-dislocation arthropathy, tightening of the anterior capsule can result in posterior displacement of the head, resulting in severe B2 and B3 deformities
True
JAAOS April 2019
104
Radiographs of post-dislocation arthropathy typically demonstrate joint space narrowing, osteophyte an cyst formation, subchondral sclerosis, and posterior glenoid wear
True
JAAOS April 2019
105
The aim of ream & run technique is to create a cancellous bed for the humeral head to minimize the risk of glenoid erosion
False
The aim is to re-center the glenoid without resurfacing, to help prevent glenoid component failure in young patients
JAAOS April 2019
106
Matsen highlighted the increased failure risk of total shoulder arthroplasty in patients with the “arthritic triad” of posterior humeral head displacement, glenoid biconcavity, and retroversion
True
JAAOS April 2019
107
Reverse total shoulder arthroplasty should be considered over anatomic in older patients with post-dislocation arthropathy with an intact rotator cuff and sufficient bone stock to support the glenoid component
False
Consider anatomic, not reverse (weird question though)
JAAOS April 2019
108
Shoulder arthroplasty outcome is similar for patients with prior instability to results in patients with primary osteoarthritis.
False
Better outcomes in primary OA
JAAOS April 2019
109
Outcome of reverse TSA in patients with prior anterior instability are similar to outcome in patients with cuff
arthropathy
True
JAAOS April 2019
110
The B2 glenoid has been associated with poor outcomes after anatomic shoulder arthroplasty
True
JAAOS April 2019
111
Velocity of the bullet is a more important determinant of Kinetic Energy than bullet mass, and a higher velocity bullet will lead to a much higher degree of soft-tissue and bony injury
T
KE = 1/2 m v2
JAAOS April 2019
112
Lower density tissues, such as lung tissue, fat, and muscle, will generally absorb more energy from the bullet than bones
False
Absorb less
JAAOS April 2019
113
Handguns generally cause minimal soft-tissue injury, whereas shotguns can cause extensive soft-tissue injury, especially when fired at close range.
True
JAAOS April 2019
114
The rate of fractures associated with GSWs to the extremities was 22%.
True
JAAOS April 2019
115
Lead levels greater than 18 μg/dL-1 in adults and 5 μg/dL-1 in children are associated with neurotoxicity
True
Can also develop lead arthropathy or tenosynovitis if fragments are not removed from around wrist and hand
116
No increased nonunion rate in patients with gunshot-associated fractures compared to those with closed fractures
True
JAAOS April 2019
117
In GSW associated fracture there is a slight increase in non union (without statistical significance) with patients treated non surgically compared with surgically treated patients
True
Satisfactory healing rates if treated non-op
JAAOS April 2019
118
Elbow arthroplasty in non reconstructable elbow fractures associated with GSW is associated with poor results
True
JAAOS April 2019
119
The spontaneous recovery rate is < 40 % in nerve palsies associated with low-velocity GSWs to the upper extremity
False
69% spontaneous recovery rate within 4-8 months. 27% nerve laceration rate with palsy
JAAOS April 2019
120
The shoulder accounts for approximately 15% of primary sarcomas and is the third most common site, behind hip, pelvis and the knee
True
JAAOS April 2019
121
Malignant tumors are more commonly symptomatic with severe pain
True
Benign tumors usually less symptomatic
JAAOS April 2019
122
Osteochondromas are the most common primary benign lesion of the shoulder
True
JAAOS April 2019
123
Enchondromas are the second most common benign tumor
True
JAAOS April 2019
124
The risk of malignant transformation is low for solitary enchondromas; however, the risk is 25% for Ollier disease (multiple enchondromatosis) and even higher in Maffucci syndrome (multiple enchondromas and soft-tissue hemangiomas)
True
JAAOS April 2019
125
Osteoblastoma are lesions > 2 cm and the pain is typically relieved with NSAID
False
Not relieved with NSAIDs and usually requires surgery for pain relief
JAAOS April 2019
126
Multiple myeloma is the most common primary malignancy of bone, with an incidence approximately double that of osteosarcoma.
True
JAAOS April 2019
127
The features of soft-tissue sarcomas over benign lesions are 1. Non-tender, 2. Firm consistency, 3. Subfascial location, 4. Size larger than 5 cm
True
JAAOS April 2019
128
A broad zone of transition can be seen in aggressive lesions, infection and eosiophilic granuloma
True
JAAOS April 2019
129
There is a 1.5% rate of C5 palsy after single or multi-level ACDF
False
5.1% rate of palsy
JAAOS April 2019
130
Parallel oriented cannulated screws for subcapital NOF # are associated with poor outcomes in up to 46% of the clinical cases
True
JAAOS June 2019
131
Kibler assessment of scapular dyskinesia: Type I dyskinesis has a prominent inferior medial scapular border
True
```
1 = Inferior medial border prominence
2 = Entire medial border prominence
3 = Superior medial border prominence (migration)
4 = Normal symmetric posterior tilting, ER and upward rotation
```
JAAOS June 2019
132
Tests of scapular dyskinesia have low sensitivity & specificity
True
JAAOS June 2019
133
The Neer sign is the only test to reliably predict subacromial bursitis alone or partial thickness rotator cuff tears
True
JAAOS June 2019
134
Many of the physical examination tests with a high sensitivity and low LR- (negative likelihood) are excellent screening tests.
True
JAAOS June 2019
135
A diagnosis of RCTA (rotator cuff tear arthropathy) encompasses patients with three defining characteristics: rotator cuff insufficiency, glenohumeral arthritis, and superior migration of the humeral head
True
JAAOS June 2019
136
The best screening test for ruling out AC joint pathology if negative is the tenderness to palpation at the AC joint
True
Sensitivity 96%, NLR 0.4
JAAOS June 2019
137
The O’Brien test is a good tool to diagnose SLAP lesion
False
O'Brien is not a reliable screening or confirmatory test
JAAOS June 2019
138
Combining the anterior slide and crank tests improved the ability to rule in a SLAP tear
True
JAAOS June 2019
139
MRA has been shown to have a specificity of 91% to 98% in diagnosing labroligamentous lesions compared with arthroscopy
True
Arthroscopy is the gold standard, so 100% sensitive
JAAOS June 2019
140
The anterior apprehension, Jobe relocation, surprise, and anterior load and shift tests are all excellent screening and confirmatory tests for diagnosing anterior shoulder instability, given their high sensitivity and specificity
True
Crucial to use "apprehension" as the positive rather than "pain", as this significantly improves post-test probability
JAAOS June 2019
141
The Jerk and Kim tests are both excellent screening and confirmatory tests for diagnosing posterior shoulder instability, given their high sensitivity and specificity.
True
JAAOS June 2019
142
Adhesive Capsulitis primarily involves contracture of the joint capsule and the rotator interval, which is composed of the superior glenohumeral ligament and the coracohumeral ligament (CHL).
True
JAAOS June 2019
143
The degree of stiffness of the capsule in Adhesive Capsulitis directly correlates to patient pain
False
Degree of stiffness correlated with ROM (well, duh)
JAAOS June 2019
144
The incidence of Adhesive Capsulitis in the diabetes group was associated with how long they had been diabetic and had poor blood glucose control
True
Diabetics are 5x more likely to develop Adhesive Capsulitis
JAAOS June 2019
145
30% of patients with Adhesive Capsulitis have diabetes, while 13% of the diabetic patients have AC.
True
JAAOS June 2019
146
5-11% of the patients who had previous shoulder surgery develop Adhesive Capsulitis at 6 months
True
JAAOS June 2019
147
Intra-articular injection of steroids in the early stages of Adhesive Capsulitis has both improved outcome on the short & long term
True
Aim for early injection after 1 month of physio
JAAOS June 2019
148
Hydrodistention combined with joint manipulation under an interscalene block provided better long term results when compared with single intra articular corticosteroid injection in patients with AC
False
Better short term, but same long term
JAAOS June 2019
149
Patients with Adhesive Capsulitys on a background of type 1 diabetes mellitus were at a 38% increased risk of requiring a repeat MUA, compared to 18% risk in all comers
True
JAAOS June 2019
150
Blind MUA in Adhesive Capsulitis has more complications than arthroscopy with MUA.
True
JAAOS June 2019
151
Over half of all postoperative infections after shoulder arthroplasty are due to Propionibacterium acnes
T
Even "aseptic" revisions often end up culturing P. acnes.
JAAOS June 2019
152
Current standard antibiotic prophylaxis and skin preparation methods in Shoulder Arthroplasty are effective against P. acnes
False
Skin preparation should add benzoyl peroxide
JAAOS June 2019
153
The main sources of instability in the setting of Reverse TSA are inadequate soft tissue tensioning and component malpositioning leading to impingement
True
Bilateral full-length humeral x-rays could be useful in revision cases to judge deltoid tensioning.
JAAOS June 2019
154
Humeral loosening is generally rare in shoulder arthroplasty
True
JAAOS June 2019
155
Glenoid component loosening is common in Reverse TSA
False
It is "common" in Anatomic TSA, but "uncommon" in Reverse TSA
JAAOS June 2019
156
The vertical humeral osteotomy for stem removal in Shoulder Arthroplasty is generally performed just medial to the pectoralis insertion
False
Just lateral to pec insertion. An osteotomy 4cm less than the length of the stem is usually enough for removal of the stem and then re-implantation of a normal sized (similar) stem, without risk of fracture propagation
JAAOS June 2019
157
Techniques to address osseous deficiencies in Revision Shoulder Arthroplasty include eccentric reaming, augmented glenoid components, and bone grafting techniques
True
Revision TSA = global bone loss
Primary OA = posterior wear
Cuff Arthropathy = superior wear
JAAOS June 2019
158
Klippel-Feil Syndrome, down syndrome and Achondroplasia can lead to cervical spine deformity
True
JAAOS June 2019
159
In Seronegative spondyloarthropathies, psoriatic arthritis is the most common of the seronegative disorders to affect the Cervical Spine
False
Ankylosing Spondylitis is most common
JAAOS June 2019
160
Rheumatoid arthritis (RA) is the most common inflammatory disorder that can affect the Cervical Spine
True
JAAOS June 2019
161
During surgical exposure of the lateral masses, facet capsule violation can lead to accelerated spondylosis, axial neck pain, and loss of lordosis
True
JAAOS June 2019
162
Postoperative functional outcome scores are markedly lower in patients with C2-C7 SVA –sagital vertical axis- of >50mm
True
SVA is normally 16.8 +/- 11.2mm
JAAOS June 2019
163
The incidence of cervical kyphosis is likely to be twice as high if a patient has a higher T1 slope
True
JAAOS June 2019
164
The chin brow vertebral axis (CBVA) is used to assess horizontal gaze and is defined by the angle subtended between a line drawn from the patient’s chin to brow and a vertical line
True
JAAOS June 2019
165
Normal cervical lordosis is between 10⁰ and 20⁰ with an average of 14.4⁰ (as measured by C2-C7 angle).
True
JAAOS June 2019
166
C8 or T1 nerve root palsy with profound intrinsic hand weakness can occur after C7 or T1 pedicle substraction osteotomy
True
PSO's should be done at T2 or below
JAAOS June 2019
167
Obesity affects about 2/3 of the general population
False
1/3rd of the population
JAAOS June 2019
168
There is no relationship between obesity and back pain
False
Linear relationship between BMI and degenerative disease of the spine
JAAOS June 2019
169
Obesity has been linked to arthritis in non–weight-bearing joints such as the hand
True
JAAOS June 2019
170
Nonsurgical & surgical (bariatric surgery) weight loss may improve the back pain and the neurological symptoms with association of increase disk height
True
JAAOS June 2019
171
Obesity is an important risk factor for failure of nonsurgical care in severely obese patients
True
JAAOS June 2019
172
Obese patients scheduled to undergo bariatric surgery demonstrated substantial deficiencies in vitamin D and iron
True
JAAOS June 2019
173
Intraoperative frozen section is accurate in 95.3% of bone biopsy cases
False
```
Accurate in 54.2% of cases
Helpful in 75.4% of cases
Open biopsy (not the FrozSect part) has a diagnostic accuracy of 95.3%
```
JAAOS June 2019
174
Extended culture (14 days) improves the culture yield by 30% in hip and knee prosthetic joint infection
False
No change to culture yield. Grew a few more cases of P.acnes (so might be useful in shoulders)
JAAOS June 2019
175
Periprosthetic intraoperative THA and TKA fractures are associated with a 2x increase in mortality among patients with primary osteoarthritis
False
No excess mortality with intraop or post-op periprosthetic fractures (except in comorbid patients)
JAAOS May 2019
176
Narcotic medications have adverse effects of habituation, nausea and constipation
True
JAAOS May 2019
177
Nerve ablations can be associated with burning discomfort, lack of efficacy, recurrent symptoms, and infection
True
JAAOS May 2019
178
High-frequency stimulation, burst stimulation, tonic stimulation with broader paddles, and new stimulation targets such as the dorsal root ganglion hold promise for improved pain management via neuromodulation
True
JAAOS May 2019
179
Electrical stimulation of Aβ fibers in the dorsal column, could alter painful signals in the small Aδ and C fibers
True
JAAOS May 2019
180
For ischaemic limbs, limb salvage rate is significantly higher with the use of Spinal Cord Stimulation
True
JAAOS May 2019
181
Burst spinal cord stimulation can deal with the physiological tolerance which arise from tonic constant stimulus.
True
JAAOS May 2019
182
Psychiatric illness is correlated with better outcomes after Spinal Cord Stimulation
False
Worse outcomes
JAAOS May 2019
183
Spinal Cord Stimulation is more expensive and less effective than revision surgery in selected failed back surgery syndrome patients
False
More effective and less expensive.
JAAOS May 2019
184
The ultrasonography beam creates a two dimensional image of sound waves emitted from the footprint of the probe.
True
The waves from the transducer generate an image by returning echoes from the structures encountered, which are identified by their different echogenicity
JAAOS May 2019
185
Local anaesthesia chondrotoxicity is dose and time dependent
True
JAAOS May 2019
186
Corticosteroid injection can increase a patient’s risk of periprosthetic infection if given within 90 days of surgery
True
JAAOS May 2019
187
Corticosteroid injection (CSI) may accelerate the rate of loss of total cartilage volume without reducing the overall pain levels with repeated injections over a 2-year period
True
JAAOS May 2019
188
Hyaluronic acid injections into the hip joint are are not recommended due to a high incidence of serious adverse side effects
False
No significant adverse effects except for local reactions of pain and transient synovitis
JAAOS May 2019
189
Leukocyte-poor Protein Rich Plasma is preferred for Intraarticular (IA) injections, and leukocyte-rich PRP is better for tendon and muscle injections
True
JAAOS May 2019
190
Platelet Rich Plasma should not be injected into the tendon to prevent injury
False
PRP should be injected directly into the areas of injury within the tendon to stimulate healing while corticosteroids should not be injected directly into the tendon to avoid iatrogenic rupture
JAAOS May 2019
191
Positive response to local intraarticular injection will predict a positive outcome with arthroscopic FAI surgery
False
A positive response doesn't predict success, but
A negative response does predict surgical failure
JAAOS May 2019
192
Corticosteroid, PRP & Hyaluronic acid injections are shown to improve pain & function in mild hip OA on the short term
True
JAAOS May 2019
193
Piriformis syndrome has both somatic and neuropathic components.
True
somatic component is caused by a myofascial pain syndrome of the muscle itself, and the neuropathic component is caused by irritation of the sciatic nerve while it traverses near or through the piriformis
JAAOS May 2019
194
Compartment syndrome in a child is generally done via the “3 A’s”, which are anxiety, agitation, and an increasing analgesia requirement
True
JAAOS May 2019
195
Pediatric distal humerus injuries rarely require physical therapy postoperatively
True
JAAOS May 2019
196
Similar to adults, paediatric remodeling is extremely limited in the distal humerus
True
Occurs mainly in the saggital plane
JAAOS May 2019
197
Biomechanically, the crossed pin configuration confers the same stability as divergent lateral pin configuration in paediatric elbow fractures
False
Superior stability with crossed pins
JAAOS May 2019
198
Patients with an average limb-length discrepancy of 1.6 +/- 2.3 cm have no demonstrable difference in gait mechanics between the short and long side
True
patients adopted toe-walking as a compensatory mechanism when the limb discrepancy reached 6.5 +/- 2.8 cm, or a difference >5.5% between the short and long leg
JAAOS May 2019
199
Sustained pelvic obliquity –due to LLD- throughout gait can potentially result in dynamic uncovering of the femoral head with point-loading causing increased weight bearing on the articular cartilage of the hip
T
this is a mechanism through which hip arthrosis of the longer limb can develop
JAAOS May 2019
200
Peak height velocity (PHV) and the Risser sign has specifically been used to assist with skeletal maturity assessment in the setting of limb length inequality
False
JAAOS May 2019
201
Before onset of the adolescent growth spurt, chronologic age is superior to skeletal age for predicting ultimate limb length
True
However, skeletal age is superior for predicting limb length once the child enters his or her adolescent growth spurt
JAAOS May 2019
202
Computer software systems -such as Bone Xpert- analyze differences in bone age radiographs to determine skeletal age. This method has been shown to be faster and potentially introduces less variability in bone age analysis when compared to Gruelich-Pyle or Tanner-Whitehouse methods
T
JAAOS May 2019
203
The transition from stage 2 to stage 3 in Sanders method -of estimation of skeletal age- correlates with 90% final height and the onset of PHV
True
JAAOS May 2019
204
The multiplier Method is the least accurate among the other methods to predict LLD
True
it has an error of 1.1 +/- 0.9 cm in LLD prediction. The use of skeletal age can improve its accuracy
JAAOS May 2019
205
Scheuermann believed that osteonecrosis of the vertebral ring apophysis resulted in longitudinal growth arrest of the anterior vertebral body, thus causing a wedging of the vertebrae
True
JAAOS May 2019
206
In patients with mild Scheuermann's Kyphosis treated non surgically, the degree of radiographic deformity increased only slightly during long term follow-up
True
JAAOS May 2019
207
Initial bracing treatment can achieve an almost 50% reduction in kyphosis in many patients, but some loss of correction occurred after termination of brace treatment
True
indications of bracing are: smaller and more flexible curves in immature patients (ie, curves less than 55⁰ to 80⁰, with passive correction of 40% or more
JAAOS May 2019
208
Post-operative Spinal Junctional Kyphosis is defined as a Cobb measurement of greater than 40⁰ between the fused and unfused segments
False
Greater that 10 degrees
JAAOS May 2019
209
Proximal junctional kyphosis (PJK) was found to be related to obtaining greater than 80% correction of Scheuermann's Kyphosis at the time of surgery
False
Greater than 50% correction
JAAOS May 2019
210
In Scheuermann's Kyphosis, the fusion should extend roughly the same extent from the apex proximally and distally, with some consideration for adding one additional proximal fusion level to ensure that the proximal end vertebra is also included in the fusion construct
True
JAAOS May 2019
211
Metastatic disease, myeloma, and lymphoma are the most common diagnoses in a patient older than 40 years with a destructive bony lesion
True
JAAOS May 2019
212
The use of CT based structural rigidity analysis (CTRA) of metastatic lesions is less accurate than Mirel criteria for predicting fracture risk in femoral metastatic disease
False
More accurate
JAAOS May 2019
213
Human monoclonal antibody that binds to RANKL, denosumab, competitively inhibits the osteoclast binding of RANK and RANKL, decreasing bone resorption
True
JAAOS May 2019
214
Cementless arthroplasty is preferred more than cemented due to better outcome in the tumour patients
False
cemented arthroplasty should be used because of the low likelihood of bony ongrowth and risk of fracture associated with press-fit implants in pathologic and/or irradiated bone
JAAOS May 2019
215
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance, and/or cardiac arrest during cementation and/or implantation of the femoral implant.
True
The risk of BCIS is elevated in patients with pathologic fractures particularly proximal femur fractures, metastatic disease, cardiopulmonary disease, & utilization of long-stem prostheses and cement pressurization
JAAOS May 2019
216
The presence of acral metastatic disease should raise suspicion for a lung or renal primary cancer
True
JAAOS May 2019
217
The Epineurium is a barrier to regenerating axon so when it is damaged, fascicular escape can occur and neuroma can be formed
False
Perineurium is the barrier.
(in to out = Endo, Peri, Epi. Coul remember Endocolon, Peritoneum, Epithelium are in that order)
JAAOS May 2019
218
Long-duration (10 seconds) bipolar diathermy can have a significant reduction in neuroma formation
True
JAAOS May 2019
219
Transposition of the proximal nerve stump after neuroma excision into a muscle with large excursion (abductor pollicis longus) or intrinsic hand muscles has been shown to be more effective than transposition into the pronator quadratus (PQ)
False
Less effective. The implanted nerve should be:
1. Tension free
2. In an area where it will not regenerate to the skin
3. In an area with minimal scar formation
JAAOS May 2019
220
Augmentin for 100 days can be an effective treatment of Modic type 1 degenerative disc disease.
True (but controversial topic)
100% of Modic type 1 cases grew Cutibacterium acnes.
Patients randomized to Augmentin reported statistically significant improvement in outcome scores.
JAAOS July 2019
221
Cutibacterium acnes is a spore forming organism
False
Anaerobic, non-spore-forming, G+ve rod
JAAOS July 2019
222
Cutibacterium acnes is gram positive rod
True
Anaerobic, non-spore-forming, G+ve rod
JAAOS July 2019
223
Spondylodiscitis with Cutibacterium acnes usually leads to elevated ESR and CRP
False
Normal or mildly elevated ESR and CRP
JAAOS July 2019
224
In spinal Cutibacterium acnes infection, the surgical incision may not show any signs of erythema or breakdown
True
Incisions usually heal without any signs of infection. Infection is often not picked up for a year after the surgery.
JAAOS July 2019
225
Outcomes of spinal implant-associated infections secondary to Cutibacterium acnes are generally poor compared with infection secondary to other organisms
True
"Generally poor compared with infection secondary to other organisms"
JAAOS July 2019
226
Weight bearing films are gold standard and most reliable for diagnosis of syndesmotic injuries
False
Stress or Gravity stress external rotation x-rays are gold standard.
JAAOS July 2019
227
MRI is more reliable than stress test for diagnosis of deltoid ligament injury and determination of surgical Vs non surgical treatment
False
Stress x-rays have a better inter and intra observer reliability than MRI, particularly when deciding surgical management.
JAAOS July 2019
228
Normal ankle medial clear space is > 5 mm on mortise view
False
Should be less than 4mm or within 1mm of the superior mortise clear space.
JAAOS July 2019
229
A 1-mm lateral deviation of the talus on the tibia results in a 40% reduction in the tibio-talar contact area
True
1mm translation = 42% less contact area, which lead to more point loading and wear.
JAAOS July 2019
230
Revision Carpal Tunnel Release provides favourable outcomes in majority of patient with recalcitrant CTS
False
40% unfavourable outcomes in Revision cases
JAAOS Aug 2019
231
Open or endoscopic carpal tunnel decompression have similar incidence of incomplete decompression in clinical studies
True
JAAOS Aug 2019
232
Patients with a history of cervical spine surgery are likely to have inferior outcomes, and lower satisfaction after peripheral nerve release
True
Inferior patient reported outcomes and satisfaction if had cervical surgery.
JAAOS Aug 2019
233
Meta-analysis shows similar rate of iatrogenic nerve injury with open and endoscopic techniques
False
Higher rate of nerve injury with endoscopic
JAAOS Aug 2019
234
Nerve conduction may not fully recover after Carpal Tunnel Release and may remain abnormal for at least 24 months postoperatively
True
Nerve function may not recover in 25% of patients.
JAAOS Aug 2019
235
Ultrasound is as effective as electrodiagnostic studies in diagnosis of primary Carpal Tunnel Syndrome
True
Median nerve cross-sectional area at the site of compression is as reliable as NCS (area >9mm2)
JAAOS Aug 2019
236
Perneus longus becomes tendinous distal to the fibular tip, while brevis becomes tendinous proximal to it
False
JAAOS Aug 2019
237
The Superficial Peroneal Retinaculum is the most important factor in preventing the Peroneal tendons to subluxate or dislocate
True
JAAOS Aug 2019
238
The peroneal tendons have good vascularity between the tip of fibula and cuboid
T
It was commonly believed that they don't, but studies show that they have adequate vascularity in this area.
JAAOS Aug 2019
239
Peroneus longus is more prone to tears than brevis
False
Brevis breaks, Longus slips
JAAOS Aug 2019
240
Peroneus longus more prone to dislocation than brevis
True
Brevis breaks, Longus slips. PL far more commonly dislocates. PB sits more anterior and medial in the groove.
JAAOS Aug 2019
241
Treatment of the shoulder with Benzoyl Peroxide pre-operatively does not affect Cutibacterium acnes count on the skin at the time of surgery.
False
Treatment with Benzoyl peroxide within 48 hours of surgery reduces C acnes.
JAAOS Aug 2019
242
Addition of MRI to CT significantly increases the detection of clinically important cervical spine injuries over CT alone.
False
JAAOS Aug 2019
243
Stress radiography and laxity testing reliably diagnoses TKR flexion instability in the clinical setting
False
JAAOS Sept 2019
244
Increasing poly thickness in TKR flexion instability can usually leads to good patient outcomes
False
JAAOS Sept 2019
245
Revision options for TKR flexion instability such as a larger femoral implant with posterior augments and joint line elevation are not usually required
False
JAAOS Sept 2019
246
Patient with TKR flexion instability have poor satisfaction rates after revision surgery compared to other indications for revision
True
JAAOS Sept 2019
247
Recurrent hemarthrosis after TKA usually presents within weeks following surgery
False
Usually presents 24 months post-op
JAAOS Sept 2019
248
Acute presentation of haemarthrosis following TKA within 6 months is more likely because of iatroenic injury in the form of aneurysm or AV fistula
True
JAAOS Sept 2019
249
Patellofemroal maltracking after TKA has been identified as a common cause of impingement leading to recurrent hemarthrosis
True
Also, lateral retinacular release predisposes to recurrent haemarthrosis
JAAOS Sept 2019
250
Angiography with/without MRI is gold standard in determination of treatment for Recurrent Haemarthrosis following TKR
True
MRI / MRA with metal suppression is the author's prefered investigation.
JAAOS Sept 2019
251
Arthroscopic synovectomy is as successful as open procedure and is preferable in cases of Recurrent Haemarthrosis following TKR
False
Can't get to the area behind the poly without taking it out.
JAAOS Sept 2019
252
US guidance provides more accuracy with placement of intra-articular knee HCLA compared to tactile, non imaged injections
True
JAAOS Sept 2019
253
Acurately placed intra-articular knee HCLA injection leads to better reduction in pain scores in osteoarthritis
False
Similar results with extra-articular injection
JAAOS Sept 2019
254
Use of sterile gloves for intra-articular HCLA injection for knee OA leads to decreased infection rates
False
Similar rates and sterile gloves are 50x more expensive
JAAOS Sept 2019
255
Repeat HCLA injections for knee OA have similar pain relief and duration of efficacy compared to first injection
False
JAAOS Sept 2019
256
Intra-articular placebo injection had statistically significant pain relief compared to oral placebo or NSAIDs for symptomatic knee OA
True
JAAOS Sept 2019
257
Corticosteroid injections have a higher risk of causing intra-articular infection compared to hyaluronic acid
True
Risk factors for infection: GP administration, BMI > 25, Rheumatoid arthritis, Corticosteroid injection.
JAAOS Sept 2019
258
GP administered knee HCLA injections have higher risk of infetion compared to orthopods
True
Risk factors for infection: GP administration, BMI > 25, Rheumatoid arthritis, Corticosteroid injection.
JAAOS Sept 2019
259
No evidence to suggest intra-articular HCLA injection within 3 months prior to TKA leads to increased risk of infection
False
Higher risk of infection if injection within 3 months.
JAAOS Sept 2019
260
Anterior reduction and fixation is the most important stabilizing factor in pelvic ring injuries
False
Posterior reduction and fixation is most important. Anterior reduction is only supplementary or indirect reduction of the posterior structures.
JAAOS Sept 2019
261
The "Gluteal Pillar" used for iliac crest external fixation of the pelvis begins 6-8 cm posterior to the ASIS and extends for 2-3 cm.
False
Gluteal pillar begins 2-3 cm posterior to ASIS and runs for 6-8 cm.
JAAOS Sept 2019
262
The corridor of bone for supraacetabular pin external fixation of pelvic ring injuries runs from the Anterior Inferior Iliac Spine to the Posterior Superior Iliac Spine.
True
Joint penetration and sciatic notch contents injury are possible complications.
JAAOS Sept 2019
263
In Vertically Unstable pelvic ring injuries, external fixation is likely to worsen the deformity.
True
Dickson and Matta found worsening of flexion and / or internal rotation deformity in 73% of patients with a Tile C injury after external fixator placement
JAAOS Sept 2019
264
Traumatic brachial plexopathy usually involves the lower trunk
False
Usually involves the upper trunk
JAAOS Sept 2019
265
In traumatic brachial plexopathy a variable degree of weakness in the muscles may last for up to 6 weeks in more severe cases
True
JAAOS Sept 2019
266
Cadaveric studies have found the cross-sectional area of the C4-5 neuroforamina to be markedly smaller than C5-6 and C6-7
True
JAAOS Sept 2019
267
Patients with decreased space available for the cord or signs of spinal stenosis on imaging studies are more prone to brachial plexus "stingers"
True
JAAOS Sept 2019
268
Athletes post brachial plexus "stingers" should have a normal EMG before being allowed to return to sports
False
JAAOS Sept 2019
269
The management of brachial plexus "stingers" is predominantly surgical
False
JAAOS Sept 2019
270
Preganglionic brachial plexus injuries don't heal well with non-operative management and usually require surgical intervention with nerve grafting
False
Nerve TRANSFERS, not grafts. And ideally before 4 months.
JAAOS Sept 2019
271
40% of Adult Brachial Plexus injuries are associated with a vascular injury.
False
28%
JAAOS Sept 2019
272
Mortality rate for distal femur fractures in the elderly is similar to mortality for proximal femur fractures in the elderly
True
JAAOS Oct 2019
273
Distal Femoral Replacement for treatment of distal femur fractures in the elderly has no difference in mortality at 12 months as compared to ORIF
True
JAAOS Oct 2019
274
The normal angulation of the radial neck in children is 15 degrees Valgus and 10 degrees Apex Posterior relative to the diaphysis
True
JAAOS Oct 2019
275
The overall rate of AVN of paediatric radial head fractures is 10-25%
True
25% in those that require open reduction
JAAOS Oct 2019
