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OITE Review Book > OITE > Flashcards

OITE Flashcards

1
Q

The highest risk of viral transmission with blood transfusion is…

A

Hepatitis B.

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2
Q

Donor blood is screened for…

A 
HIV-1
HIV-2 
HBV
HCV 
West Nile virus
Syphilis
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3
Q

Normal lactate

A

Less than 2.5

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4
Q

Normal gastric mucosal PH

A

Greater than 7.3

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5
Q

Normal base deficit

A

-2 to +2

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6
Q

Injury severity score equal to

A

A squared plus B squared plus B squared

A, B and C refer to top three most severely injured regions

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7
Q

Risk factors for under triage in trauma bay

A

Female, age greater than 65, 2+ comorbid conditions, non-white, GCS 15

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8
Q

Risk factors for mortality after poly trauma in elderly individuals

A

ISS, Initial GCS less than or equal to 10, admission PH, admission lactate, need for ventilation

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9
Q

After major trauma, compared to men, women have…

A

Poorer quality of life outcomes ( higherPTSD, more sickleave time)

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10
Q

Compared to adults, with regards to physiologic inflammatory response, children have…

A

A dampened systemic response but a robust local inflammatory response. In children, multi organ failure occurs early after the admission, during resuscitation.

In adults, multi organ failure begins 48 hours after the injury due to the robust systemic response.

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11
Q

Neurogenic shock

A

Disruption of sympathetic activity leading to hypotension and bradycardia

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12
Q

Spinal shock

A

Temporary loss of spinal cord function below the level of the injury; in addition to loss of sympathetic tone (neurogenic shock), There is complete loss of sensory motor function and reflexes

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13
Q

Class 2 hemorrhagic shock Is differentiated from class three by…

A

Blood pressure.

Class 2:15 to 30% blood volume loss. Tachycardic and normotensive

Class 3:30 to 40% blood volume loss. Tachycardic and hypotensive

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14
Q

Antibiotics for type one and two open fracture

A

First generation cephalosporin, gram-positive coverage. Example is ancef.

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15
Q

Antibiotics for type three open fracture

A

First generation cephalosporin and aminoglycoside. Example gentamicin for Graham negative coverage

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16
Q

Antibiotics for farm injury or bowel contamination of a fracture

A

Add penicillin for anaerobic coverage. Example clostridium.

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17
Q

Best method of irrigation for open fracture

A

Saline at low flow or pressure

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18
Q

In the masquelet technique, the membrane around the spacer harbors…

A

BMP-2 which peaks at four weeks and returned to baseline at six months

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19
Q

PMMA antibiotic spacer has the highest antibiotic concentration At…

A

24 hours. Levels remain bactericidal for up to four months.

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20
Q

Vancomycin is released in a…

A

Time dependent manner.

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21
Q

Tobramycin is released in a…

A

Concentration dependent matter

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22
Q

Maximum recommended concentration of vancomycin

A

10.5 g/ 40 mg of PMMA

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23
Q

Maximum recommended concentration of Tobramycin

A

12.5 g per 40 mg of PMMA

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24
Q

Treatment of intra-articular gunshot wound

A

I&D And retrieval of bullet fragments to prevent plumbism

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25
Q

Gunshot wound to the hip is most Commonly associated with…

A

Bowel perforation. Needs laparotomy.

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26
Q

Gun shot wound to the spine treatment

A

Antibiotics for 24 to 48 hours or longer if there is intestinal injury. Needs decompression and fusion only if there is neurologic deficit or instability.

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27
Q

During initial exploration of a gun shot wound, if there is nerve transaction…

A

It should be treated 1 to 3 weeks post injury.

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28
Q

What nerve has the worst functional recovery after repair due to a gunshot wound?

A

Ulnar nerve

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29
Q

When comparing amputation to limb reconstruction, there is no difference between…

A

Return to work, functional outcomes, cost

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30
Q

After severe lower extremity injury, psycho social function…

A

Does not improve with time.

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31
Q

After severe injury to soft tissue, hyperbaric oxygen therapy can be utilized. Contraindications include…

A

Insulin pump, pacemaker and ICD.

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32
Q

The most energy efficient amputation is…

A

Syme amputation

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33
Q

Energy expenditure for traumatic versus vascular BKA

A

25% versus 40%

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34
Q

Does a bilateral BKA or unilateral AKA result in higher energy expenditure?

A

Unilateral AKA. This is 65% versus 40% for bilateral BKA

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35
Q

Factors for improved wound healing

A 
Albumin greater than three
ABI greater than .45
Lymphocyte count greater than 1500
Toe pressure greater than 40
Transcutaneous oxygen tension greater than 30
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36
Q

Compared to a regular BKA, and Ertl bridging synostosis…

A

Provides equivalent functional outcomes but higher complications

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37
Q

What should you do with the dog ears on a BKA?

A

Leave them alone to prevent injury to the blood supply to the flap

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38
Q

In children, What is the most proximal level at which walking speed can be maintained without significantly increase in energy expenditure?

A

Knee disarticulation

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39
Q

What artery hasto be patent for any amputation distal to a BKA?

A

Posterior tibial artery. Requires a viable heel pad.

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40
Q

ChoPart amputation

A

Through the transverse tarsal joints. Can lead to Equinus deformity so need to perform Achilles tendon lengthening and transfer the tibialis anterior to the talar neck

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41
Q

Lisfranc amputation

A

Through the TMT joints. Need to maintain insertion of peroneus brevis or will lead to equinovarus deformity

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42
Q

Treatment of post amputation neuroma pain

A

TMR

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43
Q

High rates of SLAP repair failures have been associated with…

A

age > 36. Consider tenotomy for this age group.

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44
Q

Treatment for clavicle

A

sling (NOT figure of 8)

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45
Q

Predictors of clavicle nonunion

A

female, displacement, comminution, advanced age

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46
Q

Nonoperative treatment of clavicle fractures has higher risk of…

A

symptomatic nonunion and malunion, lower functional outcomes

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47
Q

What provides the AP stability fo the AC joint?

A

superior and posterior AC ligaments

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48
Q

What provides the superoinferior stability of the AC joint?

A

CC ligaments (conoid is medial to trapezoid)

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49
Q

Congenital pseudarthrosis of the clavicle is usually located at…

A

the middle third of the right clavicle.

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50
Q

Treatment of sternoclavicular dislocation is generally…

A

non-op except for posterior SC dislocation with compression of the trachea and esophagus (closed vs open reduction with thoracic surgery avaialble)

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51
Q

What is predictive of intact vascular supply for proximal humerus fx?

A

posteromedial calcar spike > 8 mm

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52
Q

Predominant blood supply to the humeral head?

A

posterior humeral circumflex artery

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53
Q

Most common complication of ORIF of porximal humerus fractures

A

screw cut out and intraarticular penetration

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54
Q

What is key to preventing varus collapse of proximal humerus fx?

A

adding an inferomedial screw to purchase the calcar

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55
Q

What guides the humeral prosthesis height for rTSA?

A

superior edge of of the pec major insertion.

The PMI is 5.6 cm distal to the superior aspect of the humeral head.

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56
Q

Normal retroversion and neck shaft angle of the humerus?

A

30 degrees of retroversion

130-140 degrees neck shaft angle

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57
Q

rTSA dislocation is associated with…

A

subscapularis rupture/insufficiency postoperative. Dislocation usually occurs with arm in extension, ADD and ER - anterior dislocation)

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58
Q

Treatment of isolated greater tuberosity fracture

A

Surgery for > 5 mm displacement. The cuff pulls the GT superior (which blocks abduction) and posterior (which blocks ER).

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59
Q

When and what is considered humeral shaft nonunion?

A

Fracture site mobility at 6 weeks.

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60
Q

Indications for plating of humeral shaft fracture

A

open fracture, vascular injury requiring repair, brachial plexus injury (higher nonunion rate with nonop), floating elbow, b/l humeral shaft fx, polytrauma

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61
Q

When to use anterior vs posterior approach to the humerus

A

Anterior: proximal and middle third humeral shaft
Posterior: middle and distal third

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62
Q

In relation to the heads of the triceps, where does the radial nerve lie?

A

Medial to long and lateral heads and proximal to the deep head. You can follow the posterior antebrachial cutaneous nerve proximally to find the radial nerve

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63
Q

When cabling the humerus, what reduces risk of iatrogenic radial nerve injury?

A

fixation proximal to the inferior edge of the lat dorsi

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64
Q

When compared to plating humerus, IMN is associated with…

A

higher total complications (shoulder stiffness and impingement).

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65
Q

IMN humeral nail distal interlock dangers

A

A to P: musculocutaneous nerve

L to M: radial nerve

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66
Q

Radial nerve palsy in closed vs open humeral shaft fracture

A

Closed: likely neuropraxia –> observe
Open: likely neurotmesis –> explore and repair

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67
Q

First and last muscles to recover with radial nerve palsy

A

Brachioradialis is first (wrist extension in radial deviation) and EIP is last to recover (index finger MCP hyperextension)

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68
Q

When operating on a distal humerus and deciding between TEA or ORIF, what should be avoided?

A

Avoid olecranon osteotomy during exposure as this may affect TEA.

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69
Q

Chevron osteotomy for olecranon osteotomy

A

Perform 2 cm distal to triceps insertion in bare area of ulna. AIN is at risk.

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70
Q

Postoperative ulnar neuropathy is associated with…

A

intra-op ulnar nerve transposition.

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71
Q

What does a double arc sign represent?

A

coronal shear fracture of the capitellum with extension into the trochlea. This requires exposure of the entire lateral column, elevating off the common extensors and capsule.

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72
Q

When operating on the lateral aspect of the elbow, disruption of the posterior perforating vessels leads to…

A

AVN of the capitellum.

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73
Q

When operating on the lateral aspect of the elbow, disruption of the LUCL leads to…

A

valgus posterolateral rotatory instability.

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74
Q

Mechanism of elbow dislocation

A

fall onto outstretched arm (axial compression, forearm supination, and valgus load

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75
Q

After closed reduction of an elbow dislocation, it should be splinted in…

A

elbow flexion and pronation.

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76
Q

Direction of elbow dislocation is usually…

A

posterolateral and structures fail from lateral to medial. LCL fails via ligament avulsion off the lateral epicondyle.

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77
Q

Most common complication of elbow dislocation is…

A

loss of terminal extension

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78
Q

Most common associated injury with pediatric elbow dislocation is…

A

medial epicondyle fracture. Treat surgically if > 5 mm displacement or incarcerated fragment.

Ulnar nerve is at risk of entraptment.

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79
Q

For a simple pediatric elbow dislocation, treat with…

A

splint for 10 days followed by protected ROM.

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80
Q

Mechanism of a terrible triad

A

fall onto outstretched hand with the forearm in supination and valgus thrust

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81
Q

Order of fixation of terrible triad

A

radial head, then coronoid, then LCL and finally MCL

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82
Q

When to fix vs repair radial head

A

fix radial head if < 3 fragments and replace if greater than or equal to 3 fragments. Never perform acute resection.

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83
Q

When to repair coronoid fracture

A

if less than 50%, may not have to repair (?). Less than 10% does NOT need repair.

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84
Q

If only LCL is ruptured in terrible triad, then splint in…

A

flexion and pronation.

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85
Q

If LCL and MCL are ruptured in terrible triad, then splint in…

A

neutral and flexed position.

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86
Q

Terrible triad post op ROM should start at…

A

48 hours.

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87
Q

The anterior bundle of the MUCL inserts on…

A

the sublime tubercle (the anteromedial facet of the coronoid).

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88
Q

Fracture of the sublime tubercle or injury to the anterior bundle of the MUCL leads to…

A

varus instability/varus posteromedial rotatory instability.

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89
Q

When treating olecranon fractures, penetration of the anterior cortex of the ulna leads to…

A

AIN injury and mechanical block to prono-supination.

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90
Q

Treatment of comminuted olecranon fracture in elderly, osteoporotic patient

A

excision with triceps advancement if fracture involves < 30-50% of the articular surface.

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91
Q

HO prophylaxis

A
  • Indomethacin

- single radiation (700 cGY dose) either 4 hours before or within 72 hours after surgery

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92
Q

With regards to a monteggia fracture, the apex of the ulnar fracture is…

A

generally in the same direction as the radial head dislocation.

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93
Q

What nerve is at greatest risk after a Monteggia fracture?

A

PIN which leads to radial deviation of the hand with wrist extension (from pull of the mobile wad)

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94
Q

What may block anatomic reduction of the monteggia fracture?

A

annular ligament interposition in the radiocapitellar joint

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95
Q

Treatment of radial head fracture with no or minimal displacement

A

early ROM

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96
Q

Treatment of radial head fracture with > 2 mm displacement

A

< 3 fragments: ORIF

comminuted: radial head replacement

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97
Q

Safe zone for HW placement of radial head

A

90 degree arc from radial styloid to Lister’s tubercle

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98
Q

Acute radial head resection can lead to…

A

proximal radial migration resulting in distal ulnar impaction syndrome

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99
Q

Esesx-Lopresti injury

A

radial head fracture with DRUJ dislocation and disruption of the interosseous membrane

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100
Q

How position forearm with lateral approaches to the elbow…

A

pronate the forearm to pull the PIN anteriorly away from the field

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101
Q

What is the most important ligament of the interosseous membrane in the forearm?

A

central band

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102
Q

Best plate to use for BBFF

A
  1. 5 mm LC-DCP

4. 5 plate has higher risk of refracture

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103
Q

for BBFF, do not remove hardware before…

A

15 months. after plate removal, consider bracing to prevent refracture.

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104
Q

Single incision for BBFF has higher risk of…

A

synostosis.

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105
Q

On x-ray, mature HO is characterized by….

A

sharp cortical margins.

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106
Q

When to use bone graft on BBFF

A

if there is segmental bone loss of the radius.

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107
Q

Formal PT after DRF (surgery or injury) does…

A

not change outcomes

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108
Q

CRPS prevention

A

vitamin C 500 qd for 50 days

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109
Q

CRPS type 1 vs 2

A

type 1: no identifiable nerve lesion

type 2: identifiable nerve lesion

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110
Q

Treatment of EPL rupture

A

EIP to EPL transfer.

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111
Q

EPL rupture of volar plate fixation is related to…

A

screw penetration through the dorsal cortex.

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112
Q

FPL rupture of volar plate fixation is related to…

A

plate placement distal to the watershed line and protrusion of the plate beyond volar lip of the radius.

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113
Q

Dorsal plate fixation of the DR is reserved for…

A

intra-articular DRF with significant comminution.

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114
Q

Reduction of a galeazzi fracture may be blocked by….

A

ecu interposition.

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115
Q

At what level do radial shaft fractures have a higher incidence of DRUJ instability?

A

< 7.5 cm from articular surface.

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116
Q

The DRUJ is most stable in…

A

supination.

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117
Q

After fixing a DRF, if the DRUJ is stable, then immobilize in…

A

supination if the DRUJ dislocates dorsally or pronation if DRUJ dislocates volarly.

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118
Q

The TFCC has 7 components:

A
  1. volar and dorsal radioulnar ligaments (primary stabilizers of the DRUJ)
  2. central articular disc
  3. meniscal homologue
  4. ulnolunate and ulnotriquetral ligaments
  5. ulnar collateral ligament
  6. ECU tendon sheath
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119
Q

A positive ulnar fovea sign indicates…

A

TFCC tear

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120
Q

Position of hip in dislocation

A

Posterior: hip will be flexed, ADD and IR
Anterior: hip will be flexed, ABD and ER

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121
Q

If open reduction of a hip is required, you should approach from…

A

the direction of dislocation since those soft tissues are already compromised.

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122
Q

Most common complication of a FNF…

A

osteonecrosis. Main blood supply is the MFCA.

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123
Q

Biggest risk factor for necrosis in FNF

A

pre-operative degree of displacement

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124
Q

CRPP treatment of FNF

A

inverted triangle with inferior screw in posteroinferior neck adjacent to calcar

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125
Q

Treating a FNF with DHS leads to…

A

higher AVN than cannulated screws but equivalent union

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126
Q

Treatment of femoral neck nonunion in young patient

A

valgus intertrochanteric osteotomy which converts vertical fracture line (shear force) to a horizontal fracture line (compressive force)

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127
Q

Treatment of femoral neck stress fracture

A

compression side: PWB (but consider CRPP if > 50% neck is involved)
tension side: CRPP

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128
Q

In peri-troch hip fracture, the proximal fragment is displaced…

A

flexed (iliopsoas), abducted (gluts) and ER (SERs)

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129
Q

2 hole vs 4 hole DHS

A

equivalent

130
Q

There has been increased use of CMN over DHS for intertroch fractures due to…

A

higher medicare reimbursement.

131
Q

Treatment of stable intertroch fx

A

DHS or short locked CMN

132
Q

Performing CMN nail in lateral position advantages

A
  • easier to identify starting point

- facilitates fracture reduction

133
Q

Most common deformity with CMN of peritroch fractures

A

varus and flexion (procurvatum)

134
Q

No differences been shown between short and long CMN except…

A

cost (higher with longer nails)

135
Q

what percentages of patients with femoral shaft fracture have ipsilateral FNF?

A

as high as 10%

136
Q

Femoral shaft fracture blood loss

A

1250 cc

137
Q

Sx of fat embolism syndrome

A

petechiae, hypoxemia and AMS

138
Q

Weakest muscle groups after antegrade IMN femoral fx

A

quads and abductors

139
Q

If you use a straight nail with a trochanteric starting point, this can lead to…

A

varus malalignment.

140
Q

Most common complication after IMN femur is…

A

malrotation. CT is best to diagnose. Defined as > 15 degrees compared to contralateral side.

141
Q

Using a fracture table to fix femoral shaft fracture increases risk of…

A

internal malrotation.

142
Q

If the LE IR is increased after femur IMN, then either…

A

too much femoral anteversion of proximal fragment or too much IR of distal fragment.

143
Q

After IMN of femur, if the LE ER is increased, then either…

A

too much femoral retroversion proximally or too much ER distally.

144
Q

Treatment of femoral shaft nonunion

A

compression plating with bone graft

145
Q

Shortening of the femur will deviate the mechanical axis…

A

medially whereas lengthening will deviate it laterally.

146
Q

Hoffa fracture

A

coronal fracture of femoral condyle (lateral more common than medial)

147
Q

For distal femur fractures, a golf club deformity will occur if the locking plate is placed…

A

too far posterior distally.

148
Q

Blood supply to the patella

A

genicular arteries arising from the popliteal

149
Q

How to minimize wire migration with patella fx

A

bend k-wires both proximally and distally

150
Q

Predictors of fixation failure for patella fractures

A

increasing age, fixation with k-wires (compared to screws)

151
Q

Bipartite patella is most commonly located…

A

superolateral. Has smooth cortical borders and fibrocartilage between the two fragments.

152
Q

How to treat pediatric patellar sleeve fracture

A

ORIF, usually with suture fixation

153
Q

What structures are at risk with knee dislocation

A

Common peroneal nerve and popliteal artery

154
Q

SPN deficit

A

peroneal brevis and longus

senation over dorsum of foot

155
Q

DPN deficit

A

TA, EHL, EDL

sensation over 1st dorsal webspace

156
Q

If patient is pulseless after reduction of knee…

A

vascular consult with exploration (NOT imaging).

157
Q

Buttonholing at the knee is caused by…

A

posterolateral dislocation with the medial femoral condyle coming through the capsule (dimple sign). This can prevent closed reduction.

158
Q

Treatment of multilig knee injury with early arthroscopy leads to…

A

increased risk of compartment syndrome due to capsular defects.

159
Q

What is a poor prognostic factor after multi-lig knee injury?

A

morbid obesity

160
Q

Traumatic knee arthrotomy joint loading

A

175 cc - detects 99%

155 cc - detects 95%

161
Q

Lateral tibial plateau is…

A

convex and proximal; medial plateau is concave and distal

162
Q

Lateral plateau fracture and meniscus tear is associated with…

A

> 10 mm articular depression.

163
Q

With plateau fractures and meniscus tears, treat radial tears with…

A

debridement and longitudinal tears with repair.

164
Q

Primary goal of tx of plateau fx

A

restore joint stability and limb alignment (articular reduction is 2ndary goal)

165
Q

Does timing to definitive ORIF for plateau fractures after fasciotomy influence infection risk?

A

no

166
Q

calcium phosphate

A

less subsidence than even autograft

167
Q

calcium sulfate

A

not preferred because of fast resorption and serous wound drainage

168
Q

Risk factors for infection after tibial plateau ORIF

A
  • male
  • smoker
  • high ASA
  • pulmonary disease
  • bicondylar pattern
169
Q

Treatment of plateau fractures with hybrid external fixation leads to…

A

higher malunion rates comapred to ORIF.

170
Q

TKA after tibial plateau fx is associated with…

A

higher complications, equivalent patient reported outcomes and satisfaction.

171
Q

Starting point for tibial IMN

A

just medial to the lateral tibial spine and at the reflection point between the tibial plateau and anterior tibial metaphysis

172
Q

Proximal third tibial shaft fracture deformity

A

valgus and procurvatum

173
Q

where to place poller screws for proximal third tibia fractures

A

-posterior (to prevent procurvatum) and lateral (to prevent valgus)

174
Q

Suprapatellar or semiextended position nailing for proximal third tibial shaft fractures leads to…

A

procurvatum

175
Q

lateral entry point for proximal third tibial shaft fractures leads to…

A

valgus

176
Q

Best way to prevent malalignment of distal third tibial shaft fractures

A

plating. Plating of the fibula can also help.

177
Q

Deformity seen with isolated tibial shaft fracture with intact fibula

A

varus

178
Q

Why can you see a dropped hallux after tibial IMN?

A

transient peroneal nerve neurapraxia –> EHL weakness/sensory deficit in 1st websapce

179
Q

danger with proximal tibia LISS plating

A

SPN injury when placing perc screws at holes 11-13

180
Q

Soft tissue coverage of the leg

A

proximal third: use gastroc flap
middle third: use soleus flap
distal third: use free flap

181
Q

Gastroc flap is supplied by…

A

sural artery

182
Q

compartment syndrome is a compromise of…

A

venous outflow relative to arterial inflow.

183
Q

Diagnosis of exertional compartment syndrome

A

resting P > 15
1-min post exercise P > 30
5 minute post exercises P > 20

184
Q

Most accurate measure of exertional compartment syndrome

A

continuous pressure measurement

185
Q

Recurrence of exertional compartment syndrome is most often due to…

A

postsurgical fibrosis within the fascial defect.

186
Q

3 main fragments of a pilon fracture

A
  1. anterolateral/Chaput (AITFL)
  2. posterolateral/Volkmann (PITFL)
  3. medial malleolus (deltoid)
187
Q

after pilon fracture (or any intra-articular fracture), chondrocyte apoptosis occurs…

A

in the superficial zone of cartilage at fracture margins.

188
Q

Treating a pilon with acute fibular fixation and ex fix is associated with…

A

increased post-op complications.

189
Q

Brake time after long bone diaphyseal/metaphyseal ORIF:

A

returns to normal 9 weeks after surgery or 6 weeks after initiation of weight bearing

190
Q

How to evaluate the integrity of the deltoid ligament

A

manual or gravity ER stress test (check medial clear space)

191
Q

Disadvantages of lateral vs posterior fibular plating

A

lateral: HW prominence, intra-articular screw penetration
posterior: peroneal tendonitis (but biomechanically stronger)

192
Q

Treatment of supination adduction ankle fracture

A

buttress plating of medial mal and place screws parallel to plafond

193
Q

Interval for posterior approach to ankle

A

between FHL and peroneus longus

194
Q

Syndesmosis is most unstable in…

A

AP plane

195
Q

4 ligaments of the syndesmosis

A
  1. AITFL
  2. PITFL
  3. transverse tibiofibular ligament
  4. interosseous ligament
196
Q

Most sensitive/specific test for syndesmotic injury

A

MRI (see lambda sign on coronal)

197
Q

Bosworth fracture dislocation

A

fibula is entrapped behind the posterolateral ridge of the tibia at the incisura fibularis

198
Q

Treatment of diabetic ankle fractures

A

ORIF with multiple syndesmotic screws, immobilize 12 weeks instead of 6

(non-op treatment poses risk for loss of reduction)

199
Q

greatest risk factor for postop complications of diabetic ankle fracture is

A

peripheral neuropathy

200
Q

The superior glenohumeral ligament resists…

A

Inferior translation at 0° of abduction

201
Q

The middle glenohumeral ligament resist…

A

Anterior and posterior translation at 45° of abduction

202
Q

The inferior glenohumeral ligament resists…

A

Anterior and if your translation at 90° of abduction and external rotation (Anterior band)

Posterior translation at 90° of flexion and internal rotation (posterior band)

203
Q

Buford complex

A

A congenital variant with no anterior superior labrum and a cord like MGHL

204
Q

Bankart lesion

A

Avulsion of anterior band of a IGHL and anterior labrum

205
Q

Boundaries of the rotator interval

A

Supraspinatus tendon superior, subscapularis tendon inferior, transverse humeral ligament lateral

206
Q

Content of the rotator interval

A

SGHL, coracohumeral ligament, long head of biceps tendon

207
Q

What is the strongest predictor of redislocation of the shoulder?

A

Age less than 40 at time of dislocation

208
Q

For an anterior shoulder dislocation, the shoulder is unstable in…

A

Abduction and external rotation

209
Q

Glenoid bone loss is best assessed with…

A

3D CT reconstruction

210
Q

Latarjet procedure

A

Performed for glenoid deficiency more than 20 to 25%. This is a coracoid transfer to the glenoid. Musculocutaneous nerve is most commonly injured. Axillary nerve also at risk.

211
Q

Remplissage procedure

A

Transfer of posterior capsule and infraspinatus into hill sachs lesion of the posterosupererior humeral head

212
Q

A large hill sachs lesion will engage with the glenoid when…

A

There is more than 25 to 40% of the bone missing. There will be catching sensation when the arm is 90° abducted and externally rotated.

213
Q

After a remplissage procedure, avoid…

A

Adduction with shoulder forward flexed because this will stress the posterior myocapsulodesis

214
Q

Blood supply to the talus is via…

A

PT artery branches - artery of the tarsal canal (main branch) and deltoid branch

215
Q

Option to preserve the deltoid ligament for surgical approach to the talus

A

medial malleolar osteotomy

216
Q

Where is the comminution typically located in a talus fracture?

A

dorsal (leads to dorsal malunion) and medial (leads to varus malunion)

217
Q

Treatment of a displaced talar neck fracture

A

ORIF thru medial and lateral incisions

218
Q

What do you do with an extruded talus fragment?

A

clean and reimplant during ORIF

219
Q

Hawkins sign

A

subchondral lucency on xrays (indicating bone resorption) at 6 weeks is a good prognostic sign indicating intact vascularity

220
Q

After a talus fracture, is posttraumatic tibiotalar or subtalar arthritis more common?

A

subtalar

221
Q

What is the common skier/snowboarder fracture?>

A

fracture of lateral process of talus (lateral talocalcaneal ligament)

If chronic, comminuted and symptomatic: fragment excision

222
Q

Superomedial (constant) fragment of calcaneus

A

FHL wraps inferior to the sustentaculum tali.

Thus, FHL is at risk when placing lateral to medial screw, esp when the screw is too long (leads to tethered FHL and a fixed, flexed hallus).

223
Q

Treatment of subtalar arthritis with loss of calcaneal height after calc fx

A

distraction bone block subtalar arthrodesis

***will see limited dorsifelxion and anterior ankle impingement

224
Q

Factors associated with better outcomes after calcaneus ORIF

A
  • female
  • non workers comp
  • < 29 years old
  • less comminution
  • sedentary jobs
  • Bohler’s angle 0-14
225
Q

Bohler’s angle

A

The angle between two lines drawn tangent to the superior aspect of the anterior and posterior calcaneus (normal is 20-40 degrees)

226
Q

Most common direction of subtalar dislocation

A

Medial is more common but lateral is more often open.

227
Q

Block to reduction of medial subtalar dislocation

A

lateral structures (peroneal tendons, EBD)

228
Q

Block to reduction of lateral subtalar dislocation

A

medial structures (PT, FHL/FDL)

229
Q

Subtalar dislocation can also be associated with…

A

talonavicular dislocation.

230
Q

Lisfranc ligament location

A

medial cuneiform to base of 2nd MT

231
Q

Treatment of ligamentous or chronic lisfranc injury

A

open reduction and arthrodesis of TMTs 1-3

232
Q

Treatment of bony lisfranc

A

ORIF of TMT 1-3 with screws (not K-wires)

233
Q

APC pelvic ring injuries are associated with…

A

hemorrhage

234
Q

LC pelvic ring injuries are associated with…

A

head injury

235
Q

Difference between APC II vs III

A

II: posterior sacroiliac ligaments are intact

236
Q

Complications associated with anterior subcutaneous pelvic fixator (INFIX)

A

HO is most common.
LFCN is most common nerve injury.

Femoral nerve injury leads to loss of knee extension.

237
Q

What can result in underestimation of pelvic ring injury severity?

A

application of pelvic compression device and CT

238
Q

Risk with SI screws

A

L5 nerve root (EHL) as it runs over the sacral ala

239
Q

What do you see on inlet view for SI screws?

A

anterior-posterior screw placement

240
Q

What do you see on outlet view for SI screws?

A

superior-inferior screw placement

241
Q

what do you see on lateral sacral view?

A

entry point for SI screws

242
Q

What pelvic ring injury poses the greatest risk for loss of fixation of SI screws?

A

vertical shear fracture

243
Q

Risk factors for deep infxn after pelvic/acetabular sx?

A

obesity
leukocytosis
embolization
injury severity

244
Q

The most common urethral injury associated with pelvic fracture is…

A

posterior urethral tear

**diagnose with retrograde urethrocystogram

245
Q

How to treat a sacral insufficiency fracture if chronic and symptomatic

A

perc screws

246
Q

Chronic pelvic ring instability is best assessed with…

A

alternating single-leg-stance pelvic xrays

247
Q

How to treat parturition induced pubic diastasis

A

non-op (bedrest, binder) if less than 4 cm

248
Q

What does a judet view show you?

A

iliac oblique: posterior column, anterior wall

obturator oblique: posterior wall, anterior column

249
Q

What is a transverse acetabular fracture?

A

an elementary acetabular fracture pattern involving both columns

**axial CT demonstrates a vertical fracture line

250
Q

Both column acetabular fracture

A

complete discontinuity between the articular surface and the posterior ilium

**see the spur sign on the obturator oblique view (which is the posterioinferior aspect of the intact ilium)

251
Q

What protocol has lower joint reactive forces on the hip?

A

TTWB is lower than NWB.

252
Q

What aspect of the acetabulum experiences the highest joint reactive forces?

A

posterosuperior

253
Q

When treating acetabular fractures surgically, operate within…

A

5 days because it is easier to mobilize and reduce fracture fragments

254
Q

What approach to the acetabulum has the highest risk of HO?

A

extended iliofemoral

255
Q

What do you see on inlet iliac oblique view for perc screws?

A

AP screw placement in the pubic ramus

256
Q

What do you see on the inlet obturator oblique view?

A

ensure screw placement within the inner and outer tables of the ilium

257
Q

What do you see on the outlet obturator oblique view?

A

ensure placement outside of the joint (superior/inferior placement)

258
Q

Corona mortis

A

anastomosis of the epigastric (branch of external iliac) and obturator (branch of internal iliac)

*needs to be ligated during Stoppa approach

259
Q

The ulnar artery supplies which part of the palmar arch?

A

The ulnar artery supplies the superficial palmar arch while the radial artery supplies the deep palmar arch.

260
Q

In the digit, the digital artery is located…

A

Dorsal to the digital nerve.

261
Q

The rotator interval is an extension of…

A

the coracohumeral ligament.

262
Q

What size Hill Sachs lesion requires bone grafting?

A

> 40%

263
Q

Shoulder is at risk for posterior dislocation in…

A

flexion, adduction and IR.

264
Q

What structure is most important in preventing posterior subluxation/dislocation of the shoulder?

A

subscapularis

265
Q

To protect a posterior labral tear, avoid…

A

adduction with shoulder flexed for 3 weeks.

266
Q

Treatment for a reverse hill-sachs lesion > 25-40%

A

McLaughlin - subscapularis transfer

or lesser tuberosity transfer (modified McLaughlin)

267
Q

Luxatio erecta

A

inferior shoulder dislocation; will be fixed in abduction

268
Q

Multi-directional instability is…

A

instability in 2 or more planes.

269
Q

If MDI fails 6 months of PT, then treat with…

A

capsular shift and plication, closure of rotator interval.

270
Q

Closure of the rotator interval will…

A

limit shoulder ER with the arm adducted.

271
Q

Avoid thermal capsulorrhaphy because of…

A

chondrolysis.

272
Q

Parsonage-Turner syndrome

A

aka brachial neuritis or neuralgic amyotrophy

intense shoulder/UE pain, multifocal weakness, fatty atrophy on MRI, EMG with denervation and reinnervation potentials

treatment: observation

273
Q

Thoracic outlet syndrome

A

compression of brachial plexus –> paresthesias and sensorimotor deficits

compression of subclavian artery –> cool, pallor UE

compression of subclavian vein –> swelling/discoloration of UE

274
Q

Symptoms of thoracic outlet syndrome occur with…

A

overhead activities.

275
Q

Common causes of thoracic outlet syndrome

A

hypertrophy of scalene muscles, pancoast tumor, cervical rib

276
Q

Quadrilateral space boundaries

A

teres minor, teres major, long head of triceps, humerus

277
Q

Quadrilateral space contents

A

axillary nerve, PCHA

278
Q

Quadrilateral space syndrome

A

compression in thrower during late cocking/early acceleration

279
Q

Glenohumeral OA pattern

A

eccentric glenoid wear (posterior wear with posterior humeral head subluxation)

280
Q

Glenohumeral inflammatory arthritis wear pattern

A

concentric glenoid wear leading to medialization of GH joint

281
Q

Does TSA or hemiarthroplasty have lower revision rate?

A

TSA

282
Q

After TSA, most common reason for revision is…

A

loosening (glenoid > humerus).

283
Q

In rTSA, the center of rotation is moved….

A

medially and inferiorly which decreases deltoid abduction force and joint load.

284
Q

Latissimus dorsi transfer can help with…

A

ER. If loss of ER, consider concomitant LD transfer with rTSA.

285
Q

Risks with anterior vs posterior lat dorsi transfer

A

anterior: radial nerve
posterior: axillary nerve

286
Q

For TSA, the thickness of the humeral head is about…

A

70% its radius of curvature.

287
Q

The humeral head COR is…

A

4 mm posterior and 8 mm medial to the center of the humeral intramedullary canal.

288
Q

Most common organism responsible for shoulder PJI

A

P. acnes (gram positive aerotolerant anaerobic bacillus)

289
Q

Treatment of elbow flexion contracture > 30 or flexion < 130

A

static progressive elbow splinting

290
Q

If elbow stiffness fails non-op tx, then…

A

perform capsular release with possible release of posterior oblique bundle of MCL (which is tight in flexion)

291
Q

Arthroscopic contracture release of the elbow should be avoided in…

A

obese patients and those with prior elbow surgery.

292
Q

Treatment of young laborer with advanced OA at the elbow with stiffness/pain

A

osteophyte resection and capsular release

293
Q

Treatment of active patient with ulnohumeral arthritis and minimal radiocapitellar arthritis

A

arthroscopic ulnohumeral arthroplasty (fenestration of olecranon fossa, osteophyte debridement)

294
Q

OCD of elbow is usually at…

A

the capitellum. Sx include painful catching, clicking, locking.

295
Q

Total elbow arthroplasty is the best outcome for….

A

RA.

296
Q

Best TEA systems are…

A

semi-constrained (linked).

297
Q

The ulnar artery supplies which portion of the palmar arch?

A

The superficial palmar arch while the radial artery supplies the deep arch.

298
Q

In the digit, the digital artery is located….

A

dorsal to the digital nerve.

299
Q

What is the radial most extrinsic ligament of the wrist?

A

Radioscaphocapitate ligament

300
Q

What can prevent reduction of a dorsal MCP dislocation?

A

volar plate

301
Q

Location of wrist arthroscopy 3,4 portal

A

1 cm directly distal to Lister tubercle between EPL and EDC tendons

302
Q

With the 6R or 6U wrist portal, what structure is at risk?

A

dorsal sensory branch of the radial nerve

303
Q

With the 1,2 wrist portal, what structures are at risk?

A

superficial branch of radial nerve and radial artery

304
Q

Function of free nerve ending

A

pain (nociception)

305
Q

Function of meissner corpuscle

A

touch, pressure

306
Q

function of pacinian corpuscle

A

deep pressure and vibration

307
Q

function of merkel cell

A

sustained touch and pressure

308
Q

function of ruffini ending

A

skin stretch

309
Q

function of golgi tendon organ

A

muscle length and tension proprioception

310
Q

1st dorsal compartment

A

EPB, APL

Pathology: deQuervain’s tenosynovitis

311
Q

2nd dorsal compartment

A

ECRL, ECRB

Pathology: Intersection syndrome (often seen in rowers, pain 5 cm proximal to wrist joint)

312
Q

3rd dorsal compartment

A

EPL

313
Q

4th dorsal compartment

A

EIP, EDC, PIN

314
Q

5th dorsal compartment

A

EDM

Pathology: Vaughan-Jackson syndrome (rheumatoid wrist, DRUJ instability causes volar carpal subluxation which leads to attritional rupture of digital extensor tendons from ulnar to radial; EDM is first to rupture)

315
Q

6th dorsal compartment

A

ECU

Pathology: snapping ECU due to attenuation of ECU subsheath. ECU subluxates with forearm supination.

316
Q

Mechanism of scaphoid fracture

A

fall onto outstretched wrist in extension

highest load transmission through the radioscaphoid articulation is when the wrist is extended

317
Q

Most common location of scaphoid fractures in adults and children

A

adults: waist fracture
children: distal pole

318
Q

What artery supplies the scaphoid?

A

the dorsal carpal branch of the radial artery (retrograde)

319
Q

Treatment of scaphoid fracture

A

Nondisplaced or suspected: thumb spica cast

any displacement: ORIF

320
Q

Approach to scaphoid ORIF

A

proximal pole fracture: dorsal approach

waist or distal pole or humpback deformity: volar approach

***use long screw down the central axis of the scaphoid

321
Q

Best way to ensure proper screw seating below subchondral bone in scaphoid ORIF

A

direct visualization

322
Q

Treatment of scaphoid nonunion in a young person

A

revision ORIF with vascularized medial femoral condyle graft

(obtain CT scan along axis of the scaphoid to assess union)

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