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ortho5 Flashcards

1
Q

proximally what is the internervous plane for the anterior approach to the radius?

A 
brachioradialis(radial n)
pronator teres(median n)
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2
Q

what type of instability direction in the pelvis could potentially be controlled with an external fixator? what can’t?

A

rotational not vertical

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3
Q

major complication of pelvic injury that can be life-threatening?

A

hemorrhage

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4
Q

anterior compression type pelvic ring injury, what structure is damaged first?

A

pubic symphysis

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5
Q

in AP pelvis xr, what should the pubic symphysis line up with?

A

sacral spinous processes

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6
Q

Between what two levels should top of symphysis/rami be on in outlet radiograph of the pelvis?

A

at the S2-S3 level

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7
Q

Inlet view of proximal sacrum, outlet view of caudal sacrum clue to what type of fracture?

A

U typed sacral fracture

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8
Q

what complication can you get with nonop rx of vertical shear sacral fracture?

A

leg length inequality

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9
Q

percutaneous fixation with SI screws can lead to damage to what nvb?

A

superior gluteal

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10
Q

this treatment is contraindicated for SLAC wrist with incompetent radioscaphocapitate ligament or capitolunate arthritis?

A

proximal row carpectomy

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11
Q

what bones are excised in proximal row carpectomy?

A

scaphoid, lunate, triquetrum

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12
Q

why protect the radioscaphocapitate ligament with a proximal row carpectomy?

A

prevent ulnar subluxation

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13
Q

besides PRC, what other option for treating stage II/III SLAC wrist?

A

scaphoid excision and four corner fusion

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14
Q

how treat stage III SLAC wrist/any form of pancarpal arthritis?

A

wrist fusion

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15
Q

if MRI shows a rupture of the plantar plate of the 1st MTPj, what do next in terms of treatment?

A

immobilize in a boot

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16
Q

what not lining up on oblique view of the foot with the third MT clues you into a lisfranc injury?

A

lateral base of the 3rd MT with lateral aspect of the lateral cuneiform

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17
Q

Compared with a 32mm head of similar material and neck length, a 36mm head will exhibit which of the following when used with highly cross linked PE in terms of wear?

A

similar wear rate

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18
Q

which ligament is a good anatomic landmark when placing the acetabular component in the appropriate position during a THA?

A

transverse acetabular ligament

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19
Q

attenuation of what ligament a/w basilar thumb arthritis?

A

anterior oblique ligament (beak ligament)

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20
Q

what deformity a/w thumb CMCJ arthritis at the MCPJ?

A

hyperextension

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21
Q

what is the name of the classification of basilar thumb arthritis?

A

eaton and littler

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22
Q

what condition can be concomitant with basilar thumb arthritis 50% of the time?

A

carpal tunnel syndrome

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23
Q

what position want thumb when taking XR of basilar thumb arthritis?

A

hyperpronated

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24
Q

what type of stability does the radial head help support?

A

valgus

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25
Q

what does the radial head articulate with?

A

capitellum

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26
Q

axial load in relatively more or less flexion a/w radial head fracture vs capitellum fracture?

A

more

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27
Q

radial head fracture treating nonop, what is one thing you can do to increase pain relief?

A

aspiration w/wout injection of a local anesthetic

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28
Q

persistent pain with nondisplaced radial head fracture being treated nonop may represent what?

A

capitellar fracture (osteochondral)

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29
Q

what does the greenspan view help you see?

A

radiocapitellar articulation

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30
Q

how get a greenspan view?

A

angle the beam 45 degrees cephalad of the elbow with elbow flexed 90 degrees

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31
Q

what type of fat pad sign more sensitive for nondisplaced radial head fracture?

A

posterior

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32
Q

why have to examine forearm with a radial head fracture?

A

look for essex lopresti lesion

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33
Q

what is essex lopresti lesion?

A

radial head fx/dx with associated IO ligament and DRUJ disruption

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34
Q

what do if trying to examine painful elbow due to radial head fracture?(2)

A

aspirate the elbow

inject with lidocaine

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35
Q

what compartment does the EDM run in?

A

4th

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36
Q

where does the EDM originate from?

A

lateral epicondyle

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37
Q

Signs that are suggestive of *** include progressive radiolucent lines, change of implant position on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem

A

aseptic loosening

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38
Q

Signs that are suggestive of aseptic loosening include ***, change of implant position on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem

A

progressive radiolucent lines

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39
Q

Signs that are suggestive of aseptic loosening include progressive radiolucent lines, *** on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem

A

change of implant position

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40
Q

Signs that are suggestive of aseptic loosening include progressive radiolucent lines, change of implant position on sequential radiographs, a ***, and pedestal formation at the distal aspect of a femoral stem

A

positive bone scan

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41
Q

Signs that are suggestive of aseptic loosening include progressive radiolucent lines, change of implant position on sequential radiographs, a positive bone scan, and * at ***the distal aspect of a femoral stem

A

pedestal formation

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42
Q

Revisions for THA <2 years from the time of surgery were most commonly due to ***

A

infection

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43
Q

history of prior ankle sprains usually affects what side of the ankle?

A

lateral

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44
Q

what is an extruded disc?

A

through annulus but confined by PLL

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45
Q

what is a sequestered disc?

A

disc material free in canal

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46
Q

what is the most common symptom with thoracic disc herniation?

A

axial back or chest pain

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47
Q

hyperreflexia
sustained clonus
positive Babinski sign

are all what type of symptom?

A

upper motor neuron signs

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48
Q

weakness, upper motor neuron signs, and gait changes examples of compression to what structure?

A

spinal cord

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49
Q

acute disc herniation with myelopathic findings attributable to the lesion, especially if there is progressive neurologic deterioration indication of what type of treatment for thoracic disc herniation?

A

surgical

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50
Q

someone with a vertically placed ACL graft, what sporting movement would they have instability with?

A

cutting

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51
Q

what bundle of the ACL helps with rotational stability?

A

posterolateral

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52
Q

what happens to the webspace in 1st CMC arthritis?

A

gets contracted

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53
Q

what are the different areas that can be affected in a proximal humerus fracture?

A

greater tuberosity
lesser tuberosity
articular segment
humeral shaft

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54
Q

what mm insert on the greater tuberosity of the humerus?

A

supraspinatus
infraspinatus
teres minor

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55
Q

what mm inserts on the lesser tuberosity of the humerus?

A

subscapularis

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56
Q

are the FDP tendons all separate from one another?

A

no, share common muscle belly

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57
Q

relatively how much angulation allowed for proximal both bone forearm fractures in kids?

A

less

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58
Q

ideal cast index is below what value?

A

.8

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59
Q

congenital dislocation of the radial head is often in what direction?

A

posterior

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60
Q

how is the radius often deformed in congenital radial head dislocation?(2)

A

short

bowed

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61
Q

partial deficiency of growth of distal radial physis
excessive radial inclination and volar tilt
ulnar carpal impaction

all features of what disorder?

A

madelung deformity

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62
Q

what part of distal radius physis affected in madelung disease?

A

ulnar volar physis

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63
Q

how is madelung inherited?

A

autosomal dominant

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64
Q

how dupuytren inherited?

A

autosomal dominant with variable penetrance

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65
Q

any type of what joint contracture indication for sugery in dupuytren?

A

PIPJ

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66
Q

glenoid avulsion from scapular periosteum is what?

A

bankart lesion

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67
Q

what is seen in stage 2 kienboch according to the lichtman classification?

A

lunate sclerosis

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68
Q

what is needed to diagnose kienboch in stage 1 disease?

A

MRI

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69
Q

what bone migrates proximal in SLAC wrist?

A

capitate

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70
Q

*** should be included in the differential of trigger finger, where the collateral ligament or volar plate tethers on a prominent metacarpal head or osteophyte

A

MCP locking

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71
Q

Most radial structure of the carpal tunnel?

A

FPL

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72
Q

pentrating trauma to arterial wall replaced by organized hematoma and fibrous wall an example of what?

A

pseudoaneurysm

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73
Q

women in 3rd trimester of pregnancy can get what idiopathic disorder?

A

idiopathic transient osteoporosis of the hip

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74
Q

how does the joint space appear in idiopathic transient osteoporosis of the hip?

A

preserved

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75
Q

what needs to be excluded with diagnosis of idiopathic transient osteoporosis of the hip?

A

femoral neck stress fx

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76
Q

how treat transient osteoporosis of the hip in terms of wb?

A

protective weightbearing

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77
Q

most common cause of ulnar nerve compression in guyon canal?

A

ganglion cyst

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78
Q

what inn the APL?

A

PIN

79
Q

what is a normal cervical canal diameter?

A

17mm

OB

80
Q

what is the torg pavlov ratio?

A

canal/vertebral body width

81
Q

normal torg pavlov ratio?

A

1.0

82
Q

Formation of this structure is associated with a poor prognosis after revision of a failed metal-on-metal resurfacing hip arthroplasty to total hip arthroplasty?

A

pseudotumor

83
Q

at the level of tibial bone resection during a TKA, behind what muscle does the common peroneal n lie?

A

lateral head of the gastrocnemius

84
Q

how does the acetabular sourcil move during a PAO(2)?

A

anterior

lateral

85
Q

A to P how is the humeral head usually oriented?

A

retroverted

86
Q

On what side is the construct placed when fixing something using tension band principle?

A

on the tension side

87
Q

If suspecting burner/stinger, Bilateral symptoms or lower extremity symptoms are more suggestive of what?

A

spinal cord injury

88
Q

what approach use to reduce C1/C2 distal femur fracture in preparation for a retrograde nail?

A

open medial or lateral parapatellar approach to the knee

89
Q

Partial articular fractures (all B subgroups) and complex articular fractures (C-3 subgroups) should not be considered for *** femoral nailing.

A

retrograde

90
Q

what use for femoral fractures where trying to restore length with nailing and can’t do it manually?

A

femoral distractor

91
Q

why prep out the whole hip for retrograde femoral nailing?

A

have field in case there is a femoral neck fracture

92
Q

How is the starting wire positioned for retrograde femoral nailing on the AP?

A

just medial to the midline in the trochlear groove, in line with the femoral shaft

93
Q

what can you use to gain control of proximal fracture fragment in subtrochanteric/proximal shaft fractures for retrograde femoral nailing to get the reduction?

A

5mm unicortical shanz pin

94
Q

what do to the knee to relax the gastrocnemius muscle when trying to reduce a femoral shaft fracture that is in recurvatum?

A

flex the knee

95
Q

what can you see in someone with a webspace collar button abscess on PE?

A

abduction/spread of the affected fingers

96
Q

two br of the superior trunk of the brachial plexus are what?

A

suprascapular n and br to subclavius

97
Q

have to do what before revising a TKA esp <2 yrs from the index surgery?

A

rule out infection

98
Q

what ligament can get attenuated in CR knee leading to ligament/flexion instability?

A

PCL

99
Q

when measuring nail sizes for retrograde femoral nail, if nail is between sizes what do you pick?

A

the smaller of the two sizes

100
Q

Aseptic Lymphocyte-Dominated Vascular-Associated Lesions (ALVAL) are also known as what?

A

pseudotumors

101
Q

population that does the best with hip resurfacing

A

young men w/ good bone stock

102
Q

how does patella baja affect knee flexion?

A

decrease

103
Q

*** is a key level in myelodysplasia because the quadriceps can function and allow independent ambulation around the community

A

L4

104
Q

Following gunshot wounds, [upper extremity] nerve injuries exhibit the worst functional recovery.

A

ulnar

105
Q

Semi-constrained knees or constrained condylar knees rely on a large *** to enhance varus/valgus stability

A

tibial post

106
Q

Changing the mechanical axis of the knee or recuting the tibia in extreme varus or valgus should not be done to balance knee as it may increase risk of this complication***

A

aseptic loosening

107
Q

In knees, Finally, in the patient with severe bone loss and gross instability, a *** may be necessary to achieve stability.

A

rotating hinge knee

108
Q

what has better oral availability gabapentin or pregabalin?

A

pregabalin

109
Q

what is mechanism of gabapentin/pregabalin?

A

reduce hyper-excitability of voltage dependent Ca2+ channels

110
Q

what type of exercises do for rehab after total knee?

A

closed chain concentric exercises

111
Q

in reverse oblique fractures, the major frx line extends from proximal-*** through intertroch-subtrochanteric region

A

medial to distal-lateral

112
Q

what should tibiofibular overlap be greater than (including men)?

A

> 6mm

113
Q

*** in a revision knee allows for good exposure and is especially indicated if there is patella baja as it allows proximal translation of the tibial tubercle

A

tibial tubercle osteotomy

114
Q

what is rate of infection relatively in revision TKA?

A

higher

115
Q

what use to fill <1cm cavitary defect in revision TKA setting?

A

cement

116
Q

Spine—reduced rate of spinal fusion in animal model leading to recommendation of withholding [this medication type] is recommended after surgery

A

bisphosphonate

117
Q

what landmarks can use as intraop guide for safe placement of implant in radial head?(2)

A

arc bw radial styloid

and lister

118
Q

what is advantage of cervical disc replacement over fusion?

A

don’t need to worry about pseudarthrosis

119
Q

disease indication for cervical disc replacement?

A

single and double level cervical radiculopathy/myelopathy

120
Q

why not plunge through the far cortex when drilling the proximal interlock in a retrograde nail?

A

sciatic back there

121
Q

newborn where does the spinal cord end?

A

L3

122
Q

what type of knee implant gets patellar clunk?

A

posterior stabilized

123
Q

another word for hemipelvis?

A

innominate bone

124
Q

what makes up the innominate bone?

A

ilium, ischium, pubis

125
Q

what have to rule out with TKA stiffness?

A

infection

126
Q

how treat persistent stiff tka?(2)

A

arthroscopic lysis of adhesions with manipulation under anesthesia

127
Q

for more exposure in the deltopectoral approach, the superior 1cm of what tendon can be incised?

A

pectoralis major

128
Q

what nerve is palpable at the anteroinferior border of the subscapularis?

A

axillary n

129
Q

AP pelvis, the pelvic brim and IP line should intersect what landmark on the back of the pelvis?

A

superior margin of the S2 foramen

130
Q

Unilateral lateral column damage results in *** muscle paralysis below the level of injury with spasticity, hyperreflexia, clonus, loss of superficial reflexes, and a positive Babinski sign.

A

ipsilateral

131
Q

Unilateral lateral column damage results in ipsilateral muscle paralysis below the level of injury with spasticity, ***, clonus, loss of superficial reflexes, and a positive Babinski sign.

A

hyperreflexia

132
Q

Injury to the dorsal column results in an *** loss of joint position sense, vibratory sense, and tactile discrimination below the level of injury.

A

ipsilateral

133
Q

what is the prognosis for recovery from brown sequard type injury?

A

pretty good except hand recovery can be poor

134
Q

what modality usually used to treat brown sequard syndrome?

A

nonsurgical

135
Q

Among the spectrum of clinical presentations following failed metal-metal total hip replacements, *** damage from localized inflammation is one finding that can lead to hip instability.

A

abductor

136
Q

This will require antibiotic therapy to cover ***, a gram-negative bacteria that is normal intestinal flora in leeches

A

aeromonas hydrophila

137
Q

how patella position affected by lateral distal femoral osteotomy?

A

patella alta

138
Q

how does horizontal femoral offset affect aseptic loosening?

A

more offset increase risk of loosening

139
Q

The *** articulates with the ring and small metacarpals by two concave facets separated by a ridge

A

hamate

140
Q

how rotate the forearm to see 5th CMCJ fx better? how many degree?

A

30 pronated view

141
Q

lost reduction of 5th CMCJ can lead to problem with what hand function?

A

weak grip

142
Q

how treat vancouver b2 fracture (ie what implants add[including relative length]/change) (2)?

A

femoral component revision

application of plate that spans fracture by 2 cortical diameters

143
Q

what is broken in a hangman fracture? (what part of vertebrae)

A

BL pars interarticularis

144
Q

mechanism of hangman fracture(2)?

A

hyperextension

secondary flexion

145
Q

what is characteristic of type III hangman fracture?

A

BL facet dislocation C2-3

146
Q

what is most common reason for knee arthrodesis?

A

salvage for failed TKA

147
Q

What motion can MUA help increase if stiff after TKA?

A

flexion

148
Q

There are many risk factors for postoperative stiffness after TKA the most important being ***

A

preoperative stiffness

149
Q

The appropriate treatment for a transverse periprosthetic patella fracture with an intact extensor mechanism is ***(2)

A

closed treatment and immobilization in a long leg cast.

150
Q

can you mobilize vertical periprosthetic patella fx after TKA immediately?

A

yes

151
Q

what have to do to wrist to test radial n?

A

extend it

152
Q

A 72-year-old woman has been experiencing decreased ability to use her hands for knitting. She states that her handwriting has been changing as well. Her primary care physician ordered a head and neck MRI that revealed canal stenosis throughout the cervical spine but no intracranial pathology. Signal changes were noted in the spinal cord just distal to the area of compression around C7-T1. Upon questioning, she states she has fallen more in recent months. An examination shows some mild hand weakness and a positive Hoffman sign result. What is the most appropriate treatment?(2)

A

Staged anterior cervical decompression and fusion followed by posterior laminectomy and instrumentation

153
Q

what is the molecular cause of aseptic loosening?

A

particulate bone debris

154
Q

what cell type is involved in aseptic loosening?

A

macrophage

155
Q

aseptic loosening femoral condyles usually occurs where?

A

posterior

156
Q

what imaging can get for larger osteolytic defects?

A

CT

157
Q

Fat atrophy and skin depigmentation can happen if inject steroid where when giving a trigger finger injection?

A

subQ

158
Q

Extraarticular fractures at the base of the proximal phalanx occur at the metaphyseal-diaphyseal junction. The fracture is usually comminuted dorsally, is impacted, and has apex *** angulation

A

volar

159
Q

Malunion of base fractures of the proximal phalanx can lead to what?

A

pseudoclawing

160
Q

What position should the MP joint be positioned for Base Fractures of the Proximal Phalanx?

A

flexion

161
Q

Receptor activator of nuclear factor kappa binds its ligand and activates ***

A

osteoclasts

162
Q

gait instability, clumsiness and loss of manual dexterity, and glove-like (rather than dermatomal) numbness of the hands symptoms of what?

A

cervical myelopathy

163
Q

when do an ACDF as opposed to corpectomy for cervical myelopathy?

A

when compression just disc based not retrovertebral

164
Q

The *** is the predominant blood supply to the spinal cord

A

anterior spinal artery

165
Q

Treatment for pancarpal arthritis?

A

wrist fusion

166
Q

What articulates with radius after scaphoid excision and 4 corner fusion?

A

lunate

167
Q

what ligament incompetence contraindication to PRC?

A

radioscaphocapitate ligament

168
Q

what tendon inserts on the navicular?

A

posterior tibialis

169
Q

non-neural, fibrous extension of the conus medullaris that attaches to the coccyx

A

filum terminale

170
Q

external sphincter of the bladder is controlled by the ***

A

pudendal nerve

171
Q

bladder dysfunction involved in cauda equina syndrome involves what?

A

urinary retention and eventually to overflow incontinence

172
Q

The one accepted indication for operative treatment of a displaced partial radial head fracture (Mason II) is a ***

A

block to motion

173
Q

Kocher approach to the elbow bw what two muscles?

A

ECU

anconeus

174
Q

what marks the 90 degree safe zone of the radial head for implant placement?

A

bw radial styloid and lister tubercle

175
Q

what is the cm cutoff for saying someone has sagittal plane imbalance of the spine?

A

5cm

176
Q

what region of spine more often gets degenerative scoliosis?

A

lumbar

177
Q

primary restraint to lateral patellar translation

A

MPFL

178
Q

what inserts bw the adductor magnus and superficial medial collateral ligament?

A

MPFL

179
Q

*** are expansile metaphyseal lesions that are never wider than the physis

A

Unicameral bone cysts

180
Q

early infection, may be only evidence on the XR?

A

soft tissue sweling

181
Q

*** are eccentric metaphyseal lesions with scalloped borders.

A

nonossifying fibroma

182
Q

Surgical dissection of the posterior arch of C1 should be limited to *** lateral to the midline

A

1.5cm

183
Q

spinal tumors usually emanate from the level of the ***, not the disk space.

A

vertebral body

184
Q

alendronate, risedronate, pamidronate, ibadro- nate are examples of what type of diphosphonate?

A

nitrogen containing

185
Q

what enzyme do nitrogen containing diphosphonate inhibit?

A

inhibit farnesyl pyrophosphate synthase

186
Q

how do nonnitrogen containing bisphosphonate work?

A

form ATP analog that induces osteoclast apoptosis

187
Q

what patient population not give teriparatide to due to risk of osteosarcoma?

A

paget

188
Q

A 47-year-old man undergoes a posterior cervical procedure for a benign tumor. Postoperatively, severe dysfunction with decreased forward elevation and abduction develops and he has lateral winging of the scapula. What nerve is hit?

A

spinal accessory nerve

189
Q

Split pectoralis major transfer is performed to restore ***function

A

serratus anterior

190
Q

A 22-year-old college baseball pitcher reports the recent onset of anterior and posterosuperior shoulder pain in his throwing shoulder. Examination shows a 15-degree loss of internal rotation, tenderness over the coracoid, and a positive relocation test. Radiographs are normal, and an MRI scan without contrast shows no definitive lesions. A rehabilitation program is prescribed. Which of the following regimens should be initially employed?

A

stretch posterior capsule and pec minor

191
Q

SICK scapula stands for what?

A

SICK (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement) scapula

192
Q

In this procedure, the levator scapulae and rhomboid minor and major muscles are transferred laterally?

A

eden lange

193
Q

Compression of the suprascapular nerve at the *** causes isolated infraspinatus weakness while compression at the suprascapular notch would affect both the supraspinatus and infraspinatus

A

spinoglenoid notch

194
Q

Compression of the suprascapular nerve at the spinoglenoid causes isolated infraspinatus weakness while compression at the *** would affect both the supraspinatus and infraspinatus

A

suprascapular notch

ortho (6 decks)

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