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surgery > More Ortho 1/5/17 > Flashcards

More Ortho 1/5/17 Flashcards

1
Q

define acetabulum

A

confluence of ilium ischium pubis forming socket over femoral head

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2
Q

growth plate for the acetabulum

A

triradiate cartilage (confluence of ilium ischium pubis, at medial acetabulum)

also appositional growth at edges, increasing acetabular depth

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3
Q

if DDH goes untreated

A

chronic disloc sublux
shallow acetabulum
rsk oa as adult

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4
Q

innominate bones….

A

ilium ischium pubis

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5
Q

big hole made by the ischium and pubis

A

obturator forman

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6
Q

ligamentum teres

A

from acetabular fovea to femoral head fovea
contains artery of ligamentum teres (a branch of obturator artery)
delivers 10-20% blod flow to femoral head

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7
Q

hip analogue to knee meniscus

A

labrum

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8
Q

ligamentem teres aka

A

round ligament

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9
Q

largest sesamoid bone

A

patella

sesamoid bone = embedded in tendon

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10
Q

what kind of bone is the pisiform

A

sesamoid
(in tendon of flexor carpi ulnaris)

carpal

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11
Q

define moment

A

force applied for torque

moment = force * distance from fixed axis

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12
Q

function of sesamoid bone

A

inc distance from fixed a is for multiplication of force aka greater moment
moment = f x d from fixed axis

eg patella multiplies force exerted by quads

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13
Q

this bone is an embryologic metacarpal

A

trapezium

because thumb metacarpal acts more like proximal phalanx

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14
Q

describe a hole in bone

A

size
location
matrix (what fills hole)
margins

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15
Q

tf

periosteum is soft tissue

A

t

per delahay

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16
Q

how does cartilage appear on xr

A

speckled calcification

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17
Q

age of osteosarcoma

A

teens

also second spike in elderly from malignant transformation of paget’s disease

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18
Q

most common malignancies that go to bone

A

BLT and a Kosher Pickle

breast lung thyroid kidney prostate (then melanoma)

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19
Q

malignancies that rarely go to bone

A

ones that kill you quickly

-glioblastoma, pancreaqs, hepatocellular (liver), ovarian

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20
Q

hole in bone in pt over age 50 think…

A

metastatic until proven otherwise

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21
Q

prostate ca mets to bone osteoblastic or lytic?

A

osteoblastic

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22
Q

define “acral”

A

distal
distal to elbow, knees
nose, ears

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23
Q

acral bone met think…

A

Lung
or leukemia

(acral = distal to elbow, knees… nose, ears)

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24
Q

calcaneal fx is classic for what mechanism of injury

A

ladder inury

forefoot on ladder, dorsiflexed, heel hits first

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25
Q

calcaneous vs tibia

which is more trabecular/cancellous bone vs cortical

A

calcaneous trabecular/cancellous

tibia cortical

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26
Q

healing of bone has everything to do with…

A

blood supply duh

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27
Q

bones most common for non-union post fx

A

tibia
ulna

mostly cortical bone, little blood supply
(per delahay)

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28
Q

define “leg”

A

below the knee

“thigh” = above knee,
“lower leg” and “upper leg” are not ortho terms
per delahay

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29
Q

biggest complication of tibial fx

A

delayed / non-union

mostly cortical bone, little blood supply

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30
Q

tf

“talo-calcaneal joint” is a thing

A

f

“subtalar joint” is correct term

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31
Q

subtalar joint fx post-traumatic OA functional concern is…

A

inversion/eversion walking on uneven surfaces (beach)

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32
Q

4 types of (anatomic) cartilage

A

hyalin
fibro
elastic
physeal

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33
Q

DDH gender preference

A

female

rare in males

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34
Q

key mgmt step for 6yo w scfe

A 
endocrine referral
(eg for hypothyroidism and growth hormone deficiency, which can cause abnormal growth and mineralization of cartilage)
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35
Q

why do kids get greenstick and torus (buckle) fractures

A

cortex more porous w blood supply,

bone crunches instead of breaking like chalk

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36
Q

what differentiates intertrochanteric from femoral neck fx

A

intertrochanteric is extra-capsular

femoral neck is intra-capsular so hematoma intracapsular high pressure vascular compromise avn higher risk

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37
Q

tf

risk of death from hip fx = risk of death from breast cancer in 50yo women

A

t

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38
Q

what kind of elderly pts get total hip arthroplasties vs hemiarthroplasties for hip fx

A

short life span remaining - hemiarthroplasty ok (doesn’t last as long – wears native acetabulum, but don’t need it to last long

“active elderly” - sporty, active, will not tolerate slower recovery and limited activities of hemi as well, get total and back to stuff faster
vs arthritic elderly, not moving much prior to sx… will tolerate slower recovery better…

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39
Q

soft tissue tears to expect w shoulder dislocation

A

always come with a labral tear

^4yo likely to have rotator cuff tear as well

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40
Q

reduce a dislocated shoulder

A

milch - (supine or prone)hand on thoulder with thumb on humeral head, external rotation, abduct, use stabilizing thumb to push humeral head back into place

Hippocratic - supine, put heel in pt’s armpit while pulling arm inferiorly (watch our for axillary nerve inj)

stimson - prone hang weight off arm, leave them there, will spontaneously reduce

stimson - supine, abduct traction while rot int and ext to free, w counter traction provided with folded sheet under arpit pulled to opposite side by assistant

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41
Q

radiographic sign for posterior shoulder dislocation`

A

light bulb sign

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42
Q

mechanism of posterior shoulder dislocation

A

eg seizure, lightning strike,

internal rotators are much stronger than external rotators, so in seizure the arm internally rotates (decubitus?) and dislocates

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43
Q 
trigger finger
define
epi
associated conditions
pres
dx
tx
compx
A

stenosing tenosynovitis from inflammation of flexor tendon sheath (FDP FDS) (flexor tendon entrapment at level of A1 pulley - over MP joint - most often) w fibrocartilagenous metaplasia of tendon and pulley
diabetics, ring finger most common
DM RA amyloidosis
finger clicking, pain at distal palm (MP joint) near A1 pulley, locking in flexion, ttp over A1 pulley, palpable bump
clinical dx (no imaging required)
nonop splinting, act mod, nsaids… steroid injections..
operative surgical debridement and release of A1 pulley w/wo 1 slip of FDS
compx - radial digital nerve inj

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44
Q

carpal tunnel boundaries

A

scaphoid tubercle trapezium radially
hook of hamate pisiform ulnarly
proximal carpal row dorsally (floor)
transverse carpal ligament palmarly (roof)

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45
Q

contents of carpal tunnel

A

nine flexor tendons (FPL most radially, 4 fdp 5 fds)

median nerve

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46
Q

where is carpal tunnel narrowest

A

at hook of hamate

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47
Q

where to cut carpal tunnel in carpal tunnel release

A

far ulnar
to avoid cutting recurrent motor branch of median nerve if it is transligamentous (50% extraligamentous, 30% subilgamentous, 20% transligamentous)

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48
Q

carpal tunnel treatment

A

NSAIDs, night splints, activity modifications
steroid injections
carpal tunnel release

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49
Q

fracture displacement is described with respect to

A

the distal fragment

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50
Q

what is a spiral fracture

A

basically a long oblique

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51
Q

what is a segmental fracture

A

two fractures creating floating segment…?

52
Q

borders of anterior compartment of leg

A

tib
sydnesmosis
fib
tib ant fascia

53
Q

posterior tibial slope
define
function

A

tibia slopes 10 degrees downward posteriorly, posterior meniscus minimizes to about 3 degrees

to decrease shear force when knee in flexion and generating greater force (vs allowing some increased shear force when standing upright not generating extra force)

54
Q

complications of high tibial osteotomy

A 
recurrence of deformity
loss of posterior slope
patella baja
compartment syndrome
peroneal nerve palsy (more common w Lateral opening wedge osteotomy)
malunion or nonunion
55
Q

causes of patella baja after high tibial osteotomy

A

rasing of tibiofemoral joint after Opening wedge osteotomy

retropatellar scarring causing tendon contracture

56
Q

indications for high tibial osteotomy

A

varus deformity more than valgus deformity

to redistribute weight bearing away from worn side

57
Q

most common location of knee ocd

A

posterolateral medial femoral condyle

58
Q

stap muscles of the neck

A

aka infrahyoid muscles, 4 pairs
sternothyroid (most medial, deep)
sternohyoid (overlaying sternothyroid and thyrohyoid)
omohyoids (just lateral)
thyrohyoid (superior to sternothyroid, deep to sternohyoid)

59
Q

vertebral body level of
hyoid
thyroid cartilage
cricothyroid cartilage

A

C3
C4-C5
C6

60
Q

why is left side typically preferred for ACDF anterior cervical discectomy and fusion

A

because course of recurrent laryngeal nerve more consistent

61
Q

where are scalenes relative to strap muscles

A

lateral, similar plane

62
Q

neck muscles superficial to deep

A

platysma
scm, traps
straps and scalenes deep to scm (and scalenes deep to traps too)

63
Q

name 3 scalenes

A

anterior
middle
posterior

64
Q

blood vessels to patch out for when dissecting the pretrachial fascia with straps retracted medially and scm retracted laterally

A

sup
mid
inf thyroid arteries

in pretracheal fascia anterior to C3 C5 C6 respectively

65
Q

ascending location of left recurrent laryngeal nerve

A

in tracheoesophageal groove near midline (nearer than right recurrent laryngeal)

after curving around aortic arch
after branching from vagus

66
Q

right recurrent laryngeal nerve curves around…

A

right subclavian artery

67
Q

retract structures to perform ACDF anterior cervical discectomy

A

incise platysma
straps medial, scm lateral
dissect paratracheal fascia, watching out for sup mid and inf thyroid arteries
carotid sheath lateral, trach and esoph medial
elevate longus colli

68
Q

describe longus colli muscles

A

crom c vertebral bodies (anteriorly) to other c or upper t vertebra
and c and upper t vertebral bodies to transverse processes

69
Q

name ligament along posterior side of vertebral bodies, anterior to spinal cord

A

posterior longitudinal ligament

70
Q

vertebral foramen vs intervertebral foramen

A

spinal cord vs roots

71
Q

origins of superior and inferior thyroid arteries

A

sups - external corotids

infs - subclavians

72
Q

how many xr planes to eval displacement

A

2 duh

73
Q

tf

knee dislocation xr is a rare thing to see

A

t
should be
should be reduced immediately, don’t wait for xr

74
Q

fracture patterns from lowest to highest energy

A

avulsion spiral transverse oblique comminuted/segmented

75
Q

segond fx

A

avulsion fx of lateral tibial plateu (eg lcl) usually associated w ACL tear (w rotation and varus stress usually… not more common acl mechanism of valgus stress…)

76
Q

define degloving

A

extensive section of skin torn off (a type of avulsion), severing blood supply

77
Q

common sites of heterotopic ossification

A

in muscle “myositis ossificans”
brachialis - distal humerus fx
quadriceps - contusion
hip abductors - surgical dissection

78
Q

grades of nerve injury
from high recovery rate
to low recovery rate

A

neuropraxia - physiologic disruption (stretch)
axonotmesis - axonal disruption, epineurium intact
neurotmesis - nerve transected

79
Q

mechanism of buckle fx

A

compression

80
Q

examples of people who get stress fxs

A

new military recruits
ballet dancers
anorexics
more…

81
Q

salter-harris classification

A

of pediatric growth plate fractures
i - thru physis (parallel with)… that’s it… can’t see on acute xr, only mos later when…
II - thru physis out metaphysis (away from joint) * most common
III - thru physis out epiphysis into joint
IV - thru physis, metaphysis
V - thru physis only, like type I, but due to crush injury and causes growth arrest

82
Q

define ganglion cyst

A

mucin-filled synovial cyst caused by…

  • trauma
  • mucoid degeneration
  • synovial herniation

filled w fluid from tendon sheath or joint
no true epithelial lining

83
Q

most common hand mass

A

ganglion cyst (65% of hand masses)

mucin-filled synovial cyst caused by…

  • trauma
  • mucoid degeneration
  • synovial herniation
84
Q

common locations of ganglion cysts of hand

and associated conditions

A

dorsal carpal 70% (scaphoid-lunate articulation)

volar carpal 20% (radiocarpal or scaphotrapezotrapezoidal articulations)… median or ulnar nerve compression, vascular occlusion hand ischemia

dorsal dip (mucous cyst assoc w heberden nodes… dip oa osteophytes

85
Q

molecules in synovial fluid

A

include
hyaluronan secreted by synovial membrane cells
lubricin (a proteoglycan) secreted by chondrocytes of articular cartilage
interstitial fluid filtered from blood plasma

86
Q

contents of carpal tunnel

A 
9 or 10 tendons depending
4 flexor digitorum superficialis
4 flexor digitorum profundus
flexor pollicus longus
plus minus flexor carpi radialis - technically embedded in flexor retinaculum the roof of carpal tunnel but some consider part of contents

1 nerve, median nerve

87
Q

visualize axial cut of wrist, contents of radial carpal tunnel around the horn to dorsal radial aspect

A

median nerve just radial and superficial to flexor digirotums in ct
flexor pollicus longus radial to that
flexor carpi radialis embedded in flexor retinaculim the roof of carpal tunnel
thenar muscle superficial to top tip of trapezium distally or scaphoid just proximal
abductuor pollicus longus tendon radial to trapezium/scaphoid, start snuff box
extensor pollicus brevis tendon just deep to that, basically perfectly lateral
cephalic vein slightly lateral to…
radial artery
extensor policus longus, end snuff box
extensor carpi radialis longus then brevis

88
Q

directly inferior shoulder dislocation
how common
mechanism

A

rare

body surfer w hands extended over head crashing into sand

89
Q

hill-sachs lesion

A

depression of posterolateral cortex of humeral head, from impaction against anteroinferior lenoid rim w anterior shoulder dislocation

-specific for anterior shoulder disloc so can be used to id past disloc… can be painful w clicking catching or popping

90
Q

mechanism of knee dislocation

A

classically high velocity

low velocity becoming concerningly more prevalent with very obese

91
Q

manage knee dislocation

A 
propofol right away
don't take no for an answer
reduce it
don't even wait for xrays
popliteal artery an acute risk, and a hematoma can occlude late
92
Q

multiple septic joints think…

A

gonococcal
rheumatic

septic jionts usually occur in isolation

93
Q

most sensitive test for septic joint

A

pain w passive motion

94
Q

what to do w aspirate of swollen painful joint

A

cell count
cx
crystals

to diff septic arthritis from crystalline…

95
Q

common bugs in septic arthritis by hematogenous spread

A

staph a - skin lesions (cuts pimples eczema etc)
pseudomonas - diabetic foot wound… ivdu (but staph a still more common)
e.coli - older woman uti

96
Q

joints w mataphysis partly in the joint…

A 
4
shoulder
hip
elbow
ankle...
97
Q

tx infection in ortho

A

bug
succeptibility
right drug
right route…

98
Q

crystal molecule in
gout
pseudogout

A

monosodium urate crystal deposition

CPPD calcium pyrophosphate dihydrate

99
Q

tf

presence of uric acid crystals excludes septic arthritis

A

f

gout and septic arthritis commonly associated

100
Q

define primary gout

A

idiopathic disorder of nucleic acid metabolism (inc purine breakdown product) leads to hyperuricemia and monosodium urate crystal deposition in joints

101
Q

define secondary gout

A

disease w high metabolic turnover (psoriasis hemolytic anemia leukemia chemo)… inc purine breakdown product leads to hyperuricemia and monosodium urate crystal deposition in joints

102
Q

presentation of gout

A

male 40-60yo lower limb (podagra - gouty arthritis attack of big toe), tophi in ear eyelid achilles etc

103
Q

iatrogenic risk factor for gout

A

chemo

high metabolic turnover (psoriasis hemolytic anemia leukemia chemo)… inc purine breakdown product leads to hyperuricemia and monosodium urate crystal deposition in joints

104
Q

gout pathophys

A

dysfunc nucleic acid metab (purine breakdown)… hyperuricemia… monosodium urate crystal deposition… inflammatory response activates proteases prostaglandins leukotriene b4 free ROS

105
Q

conditions associated w gout

A 
renal stones
septic arthritis (presence of urate crystals does not exclude septic arthritis)
106
Q

gouty arthritis sx… also check for…

A

kidney stone sx

107
Q

what does gouty tophus aspirate look like

A

white toothpasteish

108
Q

gout xr

pseudogout xr

A

ap and lateral views
punched out periarticular erosison w sclerotic overhanging borders
soft tissue crystal deposition (tophi)

chondrocalcinosis… calcification of fibrocartilage structures eg knee meniscus

109
Q

tf

elevated blood uric acid is diagnostic of gout

A

f

80% of those elevated will never get gout

110
Q

diagnose gout

A

aspirate - crystal analysis - thin tapered needle shaped intracellular strongly negatively birefringent crystals

elevated blood urate not diagnostic! 80% of those w elevated urate never get gout…

111
Q

presentation of pseudogout

A

acute warm erythematous Monoarticular joint tenderness
knee or wrists usually

mimics gout except 
older pts (^60yo)
affects more proximal joints (knees or wrists)
POSitively birefringent crystals
112
Q

loosely define tfcc

A

triangular fibrocartilage complex

composed of multiple ligaments and tendons at base of wrist

113
Q

scoring criteria to predict risk that metastasis will cause pathologic fracture

A 
mirel's criteria
site upper vs lower vs peritrochanteric
pain mild moderate functional
lesion blastic mixed lytic
size... 3 sizes...

score 1-3 for each
total ^8 recommend prophylactic fixation

114
Q

when is total joint arthroplasty indicated

A

pain… subjective pain level and desire for total joint basically… per churchill

115
Q

proposed mechanisms of aseptic implant loosening from bone

A

type 4 (delayed type hsn, cell-mediated cd4+ Th cells present mhc II to macs…) response to metal

innate inflammatory response to polyethylene

116
Q

lurching vs vaulting gait

A

lurching shoulders move laterally

vaulting shoulders move up and down

117
Q

do non-cement implants see aseptic loosing earlier or later than cement implants

A

non-cement loosen EARLY - once bone bonded/grown into pores etc it it pretty in there…

cement implants loosen later after inflammatory response erodes surrounding bone

118
Q

xr views of ankle

A

ap lat mortis

119
Q

triplane fracture

A

of peds distal tibia
epiphyseal fx in sagittal plane (seen on ap xr)
physis separated in axial plane
metaphysis fx in coronal plane (seen on lateral xr)

salter-harris type IV thru epiphysis physis diaphysis
from rotational force

usually older children in last 2 years of growth (12-14yo… physis closing cent med lat order), like tillaux fx

120
Q

tillaux fracture

A

salter-harris III (physis epiphysis) of distal tibia

caused by avulsion of aitfl anterior inferior tibiofibular ligament… from external rotation force

usually older children in last 2 years of growth (12-14yo, physis closing cent med lat order), like triplane fx

121
Q

manage femoral fracture

A

0-6mo - pavlic harness
7mo-5yo - spica.. or… flexinails if body habitus… obese?
5yo-11yo flexinail vs submuscular plate…. vs im nail via lateral troch entry if obese…

122
Q

to check on exam in femoral shaft fx

A

fem neck
length rotation alignment
knee exam

123
Q

lumbosacral motor roots on exam

A 
hip flexors L2
knee extensors L3
ankle dorsiflexors L4L5
big toe extensor S1
ankle plantarflexion anal sphincter S4S5
124
Q

6 types of spondylolisthesis

A 
dysplastic
isthmic
degenerative
traumatic
pathologic
iatrogenic
125
Q

presence of degenerative disk on MRI in asymptomatic pop

A

34% age 20-39
93% age 60-80

(boden et al…weisel… 1991, 2001)

126
Q

annulus
vs
nucleus pulposus

of intervertebral disc
types of collagen

A

annulus - type I collagen

nuc pulp - type II collagen

127
Q

nerve endings in intervertebral disc?

A

only in outer annulus… not within disk itself…

surgery (22 decks)

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