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Phase 2 > Ortho > Flashcards

Ortho Flashcards

1
Q

What are the zones of cartilage

A

Superficial zone (highest cell density)
Transitional
Radiate
(Tidemark)
Calcified cartilage

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2
Q

What are the zones of the physis

A

Resting zone (primarily stem cells)
Proliferative zone (chondrocytes undergoing mitosis)
Hypertrophic zone (Chrondrocytes hypertrophy and undergo apoptosis)
Calcification/mineralization zone (Chrondrocytes secrete matrix to promote calcification, undergo apoptosis)

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3
Q

What are the steps of fracture healing?

A

Inflammation
Intramembranous ossification
Soft callus (chondrogenesis)
Hard callus (osteogenesis, endochondral ossification)
Remodeling

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4
Q

What are the components of elastic plate osteosynthesis and what is the formula for compliance?

A

Increase compliance by:
Longer working length, longer plate, smaller plate (lower ami), lower modulus of elasticity, minimal manipulation, 2-3 screws at each metaphysics, divergent screws, no tapping.

Compliance = L^3/I x E
L = functional working length
I = AMI
E = Young’s modulus of the plate material

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5
Q

Gustily-Anderson Classification (and risk of infection/delayed union)

A

I: <1 cm wound (inside out) 2%/5%
II: >1 cm wound (outside in) 10%/15%
III: open with extensive soft tissue damage 50%/40%
IIIa= adequate soft tissue coverage
IIIb= extensive loss of soft tissue/periosteum
IIIc= arterial injury

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6
Q

What are the locking mechanisms of advanced locking plate system, Fixin, SOP, polyaxial locking plate system?

A

ALPS: proximal threads lock into plate, morse taper
Fixin: Morse taper into the titanium bushings
SOP: proximal threads lock into plate, contact ridge
PAX: head threads cut path into the plate

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7
Q

How to prevent weakness at the bone-pin interface of a ESF

A

Predrill with drill bit 0.1 mm smaller than the core diameter
Saline lavage
Low speed (<300 rpm) drilling
Pins in the center of the bone
Threaded, not smooth, pins
Pins 25-30% of bone diameter

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8
Q

What are the types of nonunions and their causes?

A

Viable:
Hypertrophic: motion
Moderate hypertrophic
Oligotrophic: lack of cellular activity
Nonviable:
Dystrophic: lack of blood flow
Necrotic: infection/dead bone
Defect: critical gap
Atrophic: dead bone removed by host, no healing

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9
Q

What are Paley’s rules of ALD correction?

A

1: If ACA and osteotomy are based on the CORA –> co-linearity achieved
2. If osteotomy is not based on the CORA –> translation
3. If ACA AND osteotomy not based on CORA –> parallelism of axes with undesirable translation

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9
Q

Where can you harvest autogenous cancellous bone?

A

Proximal humerus
Ilial wing
Subtrochanteric femur
Femoral condyle
Proximomedial tibia
Caudoventral mandible
Rib

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10
Q

Scapula fracture classification

A

Type 1: body/spine/acromion
Type 2: neck
Type 3: glenoid

OR

Extra-articular stable
Extra-articular unstable
Intra-articular

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11
Q

Surgical options for medial shoulder instability

A

Biceps/supraspinatus tendon transposition
Medial GHL reconstruction
Imbrication of subscapularis tendon
Radiofrequency induced thermal modification
Excision arthroplasty
Arthrodesis

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12
Q

What is normal supination and pronation on the Campbells test and how is it performed?

A

Elbow and carpus at 90 deg.
Sup= 17-50
Pro= 31-70

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13
Q

What are the types of congenital elbow luxations?

A

Type 1: humeroradial
Type 2: humeroulnar (most common)
Type 3: combination of HR and HU

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14
Q

Treatment options for UAP

A

Excision
Lag screw/pin (PLUS ulnar osteotomy)
Ulnar osteotomy

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15
Q

Treatment options for OCD lesions

A

Palliative
Debride, lavage
Reparative
Curettage
Abrasion arthroplasty
Forage
Microfracture
Spongialization
Restorative
Fragment reattachment
Mosiacplasty
OATS autograft
Allograft
SynAcart

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16
Q

Treatment options for FMCP, which are contraindicated with lateral compartment disease?

A

Conservative/ Alternative tx
Fragment removal + Subtotal Coronoidectomy
BURP
Radius
Radial Osteotomy (CERO)
Ulna
Ulnar Osteotomy (DDUO, DPUO)
PAUL**
PURO**
Humeral
SHO**
ERHO
CUE**
Arthrodesis

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17
Q

What are the types of Monteggia fractures?

A

Type 1: cranial luxation
Type 2: caudal luxation
Type 3: lateral luxation
Type 4: cranial luxation + fracture of proximal radius

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18
Q

What are the types of accessory carpal bone fractures?

A

Type I (67%): distal + cranial (ligament to ulnar carpal bone)
Type IA (palmarolateral)
Type IB (palmaromedial)
Type II (13%): proximal + cranial (ligament to distal R/U)
Type III (3%): distal + palmar (ligament to MC III/IV)
Type IV (12%): proximal + palmar (FCU)
Type V (5%): comminuted

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19
Q

Types of metacarpal fractures that occur in Greyhounds and their treatment

A

Stress/fatigue

Type I = endosteal and cortical bone thickening, lame after race –> 3 months rest
Type II = minimally displaced hairline fractures –> 2 months of coaptation
Type III = complete fractures –> surgical fixation + coap (prognosis = guarded for return to racing)

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20
Q

What are orthopedic conditions associated with racing Greyhounds?

A

Fractures:
Central tarsal bone (right)
Accessory carpal bone fx (right)
Sesamoid fractures (2 and 7) (forelimb?)
Intermedioradialcarpal bone fx (right)
Calcaneal fracture +/- central tarsal bone (right)
3rd tarsal bone fx
Metacarpal fx (Left V or Right II)
Muscle/tendon:
Carpal collateral ligament sprains
SDF luxation
Muscle ruptures (Long head of triceps, gracilis)
Medial biceps tendon luxation
Misc:
Paw pad corns
Greyhound polyarthritis
OSA

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21
Q

What are orthopedic conditions associated with Shetland Sheepdogs?

A

SDF luxation
Plantar instability from proximal intertarsal (sub)luxation
Pes valgus
Congenital elbow lux (type I and II)
Shoulder instability
Congenital glenoid dysplasia

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22
Q

What are orthopedic conditions associated with Dachshunds?

A

Pes varus
Villonodular synovitis
Glenoid Dysplasia/ Shoulder instability
Congenital elbow luxation (Type 1)

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23
Q

What are orthopedic conditions associated with Rottweilers?

A

Sesamoid fractures
CHD
Osteochondrodysplasia
Panosteitis
OSA
Histiocytic Sarcoma
Sublingual SCC
Biceps and Supraspinatus tendinopathy (calcifying)
IOHC
Elbow dysplasia (UAP, FMCP)
(also, diabetes mellitus)

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24
Q

What are orthopedic and neurologic conditions associated with German Shepherd?

A

CHD
GH deficiency
Gracilis Rupture
Gracilis and Semitendinosis contracture
Chondrocalcinosis
Elbow dysplasia (FMCP, OCD, Incongruity, UAP, Flexor enthesopathy)
IOHC
HOD
Panosteitis
Craniomandibular Osteopathy
OSA
Medial biceps tendon luxation
Congenital elbow luxation (Type 1)

Diskospondylitis (Aspergillus)
Degenerative Myelopathy
FCE
T1-T9 IVDE
CES
Extrarenal nephroblastoma

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25
Q

What are orthopedic and neurologic conditions associated with Weimaraners?

A

HOD
SRMA
Myelodysplasia (Dysraphism)

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26
Q

What are the guidelines for iliosacral screw placement?

A

1-2 Lag screws, as large as possible, 60% of sacral width
Dogs: (sacral wing notch) (100 deg from transverse plane for sacral drilling)
Sacrum: 60% from dorsal, 50% from cranial to C cartilage
Ilium: 75% caudal length of tuber sacrale, 33% from dorsal
Cats:
Sacrum: 50% from dorsal, 50% from cranial
Ilium: 70% caudal length of tuber sacrale, 50% from dorsal

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27
Q

Types of sacral fractures:

A

Type I = alar
Type II = foraminal
Type III = transverse
Type IV = avulsion
Type V = comminuted

28
Q

Closed options for hip luxation

A

Conservative (walking cats)
Closed reduction
Ehmer or Hobbles
Ischioilial pinning (Davita)
ESF
Transarticular pinning

29
Q

Open options for craniodorsal hip luxation

A

Ischioilial pinning
Transarticular pinning
ESF
Capsulorrhaphy +/- deep gluteal tenodesis to ilium
Prosthetic capsule
Greater trochanter transposition
Toggle pin/rod
Fascia lata loop
Sacrotuberous ligament transposition
Extraarticular iliofemoral suture
THR
TPO
FHO

30
Q

Open options for ventral hip luxation

A

Prosthetic capsule/toggle rod
Ventral acetabular lig repair
Ventral acetabular lip augmentation (autogenous ilic crest shelf graft, extracap sling, plate)
(Trochanter transposition)

31
Q

Classification of Intracapsular, Extracapsular, and Distal Femur fractures

A

Intracapsular:
Epiphyseal
Physeal (capital)
Subcapital
Transcervical
Extracapsular:
Basilar neck
Intertrochanteric
Subtrochanteric
Distal:
Supracondylar
Intercondylar
Condylar

32
Q

What are extracapsular stabilization methods for CCL rupture?

A

Lateral fabellotibial suture
TightRope
SwivelLock
Fibular head transposition

33
Q

What are the grades of patellar thickening and what are the risk factors after TPLO?

A

Grade 0= mild, up to double of baseline
Grade 1= 6-11 mm
Grade 2= >12 mm
Patellar tendinosis= Grade 2 + lameness + pain on palpation + ST swelling

Heavier dogs, lower posts TPA, cranial osteotomy +/- partial CCL

34
Q

Types of central bone fractures

A

Type 1: non displaced dorsal slab
Type 2: displaced dorsal salb
Type 3: medial slab
Type 4: medial + dorsal slab
Type 5: comminuted (most common)

35
Q

What are the classifications for ligament injury?

A

First-degree (minor overstretching, but fibers intact)
Second-degree (tearing of some fibers)
Can be address with suture imbrication or conservative tx
Third-degree (complete tearing or avulsion of the ligament, ligament nonfunctional)

Only third-degree and some second-degree injuries resulting in significant joint instability warrant surgical treatment

36
Q

What orthopedic conditions are associated with Bernese Mountain Dogs?

A

External metatarsal rotation
Panosteitis
Histiocytic Sarcoma
Elbow dysplasia (Incongruity, UAP, FMCP)

37
Q

What orthopedic conditions are associated with Dobermans?

A

Drug induced IMPA
Panosteitis
Craniomandibular Osteopathy
Bone cysts
OSA
Synovial myxoma
Congenital elbow luxation type I
Carpal collateral sprains
Carpal laxity syndrome
Atraumatic partial CCL tears

38
Q

What are the parts of the pes anserinus?

A

Sartorius, Gracilis, SemiTENdinosus

39
Q

What are the parts of the common calcaneal tendon?

A

Paired gastroc tendons
Gracilis/SemiTENdinosus/Biceps femorus
Superficial digital flexor tendon

40
Q

What are the basic principles of surgical arthrodesis?

A

Careful planning
Removal of all cartilage at all sites to be fused
Close apposition of the joint surfaces at a functional standing angle
Rigid internal fixation using compression
Use of cancellous bone graft
Careful preservation of soft tissue

41
Q

What are three buttresses of the maxilla?

A

Medial nasomaxillary (vertical)
Lateral zygomaticomaxillary
Caudal pterygomaxillary (vertical)

42
Q

What is the normal cell count for joint fluid, and % of neutrophils?

A

Normal joint fluid: <2 x 10^9 cells/L, >94% mononuclear cells, <6% neutrophils.

43
Q

What are the stages of muscle strain?

A

Stage I: myositis and bruising but architecture intact
Stage II: myositits and some tearing of the fascial sheath
Stage III: tearing of the fascial sheath, muscle fiber disruption, and hematoma formation

44
Q

What are the options for limb-sparing surgery?

A

Cortical allograft (Traditional)
Endoprosthesis (most common)
Pasteurized autograft
Vascularized ulnar transposition
Lateral manus translation
Microvascular transfer of the ipsilateral distal ulna
Bone transport osteogenesis
Irradiated autograft
Stereotactic radiosurgery

45
Q

Potential etiologies for OCD

A

Genetic
Joint morphology/limb conformation
Rapid growth/overfeeding
Calcium/Vitamin d oversupplementation
Microtrauma

46
Q

Grading for OC lesions

A
  1. Cartilage surface normal, thicken, minuscule subchondral defect
  2. Cartilage surface mottled, more thick, small cleft between cartilage and bone
  3. Discoid elevation of cartilage surface, large cleft, underlying sclerotic subchondral bones
  4. Typical partially detached cartilage flap or separated flap and joint mice
47
Q

Modified Outerbridge Cartilage Scores

A
  1. Normal
  2. Chondromalacia (soft, swollen)
  3. Partial thickness fibrillation and fissuring
  4. Full thickness fissuring
  5. Full thickness cartilage erosion with subchondral bone exposure
  6. Subchondral bone eburnation
48
Q

How much strain can cortical, cancellous, fibrocartilage, and granulation tissue handle?

A

Cortical bone 2%
Cancellous 75%
Fibrocartilage 10-15%
Granulation tissue 100%

49
Q

What are the phases of secondary bone healing?

A

Inflammation/Hematoma
Intramembranous Ossification –> sleeve of early hard callus
Chrondrogenesis–> cartilage model in middle
Endochondral ossification –> hard callus
Remodeling –> woven to lamellar bone

50
Q

How can you decrease locking plate strain?

A

Span longer length of bone
Limit screw hole density to <0.5
Limit distance from bone <2mm
Add IM pin

51
Q

How can you increase locking plate stiffness?

A

Larger plate
Additional implants
Far-near-near-far
2-3 screws per segment

52
Q

How to increased strength of a ESF

A

More complex frame
Add diagonal bar
Add fixation pins
IM pin tie-in
Smaller diameter rings

53
Q

What is the weakest part of a nonlocking construct? Locking? ESF?

A

Nonlocking: screw-bone interface
Locking: screw-plate interface
ESF: pin-bone interface

54
Q

What are the properties of bone grafts?

A

Osteogenesis: contains bone-forming cells
Fresh autogenous cancellous graft
Osteoinduction: allows for bone formation where there normally would not be (recruits stem cells and induce differentiation)
Demineralized bone matrix, growth factors (BMPs)
Osteoconduction: scaffold
Allografts
Osteopromotion: enhances regenerating bone
PRP, biphasic calcium sulfate

55
Q

What are the tests than can help diagnose biceps tendinopathy on physical exam?

A

Shoulder drawer test
Biceps tendon test
German biceps tendon test
Biceps retraction test

56
Q

Treatment options for UAP

A

Removal: 50% success
Reattachment +PUO: <24weeks, 93%
PUO: <7mo,

57
Q

Etiologies of MCD

A

Incongruity
Supraphysiologic loading
Instability
Medial Humeral Condyle kissing lesions

58
Q

Guidelines for preventing carpal arthrodesis complications

A

Screws <40% of bone diameter
Plate spans >50% of MC III
Add IM pins
Ensure proper aligment
Remove adequate cartilage

59
Q

Ways to prevent premature healing of a ulnar osteotomy

A

Ostectomy
Ostectomy 1.5x diameter of bone
Fat graft in between
Removal of periosteum

60
Q

What is the Hueter-Volkmann law?

A

aka Delpech’s Law: physeall growth is slowed by compression and accelerated by distraction

61
Q

What is Wolff’s law?

A

Bones will adapt to the degree of mechanical loading,

62
Q

Methods for ilial fracture reduction

A

Direct fragment manipulation with bone forceps
Indirect fragment manipulation (bone forceps on the ischiatic tuberosity (requires it to be intact)
Implant lever (plate applied from caudal to cranial, overcontoured)
Forceps sliding maneuver

63
Q

What are the primary and secondary stabilizers of the hip?

A

Primary: (Luxation with loss of 2+)
Ligament of the head of the femur
Joint capsule
Dorsal acetabular rim
Secondary:
Acetabular labrum (continues ventrally as the transverse acetabular lig)
Joint fluid (hydrostatic pressure)
Periarticular muscles (gluteals, iliopsoas, quad femoris, gemelli, internal/external obturator)

64
Q

Vancouver Classification for THR femur fractures

A

AG = greater trochanter
AL = lesser trochanter
B1 = stable prosthesis
B2 + B3 = unstable prosthesis
C = distal to the prosthesis

65
Q

What are predisposing factors to quadriceps contracture?

A

Immature animals
Exuberant callus
Extended coaptation
Muscular trauma
Infection
Extensive soft tissue manipulation?

66
Q

Types of IMPA

A

Type I Idiopathic
Type 2 Remote Infection
Type 3 GI disease
Type 4 Neoplasia
Drug induced
Nonerosive + multisystem disease
SLE
Breed associated (Shar Pei, Japanese Akita)

67
Q

Types of erosive IMPA

A

Rheumatoid arthritis
Greyhound polyarthritis
Periosteal proliferative polyarthritis in cats

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