Orthobullets New Flashcards
Time for return to preop braking reaction time after THA
4-6 weeks
retrograde drilling in ankle arthroscopy is useful for what?
OCD lesion with a cartilage cap
buerger’s diseases is painful or painless?
painful
Random contraindication to TTC nail?
severe peripheral vascular disease
ACL Recon technical error that leads to loss of terminal extension?
tibia tunnel too anterior causing graft impingement on notch
Undifferentiated pleomorphic soft tissue sarcomas are treated with?
Wide excision and XRT
Metaphyseal Diaphyseal Angle (MDA) cutoff for surgical intervention?
16
Bracing is effective first line treatment for infantile blounts until what age?
3
bisphosphonates binds what particle that leads to them being detectable for years?
calcium hydroxyappetite
Humeral head version is?
20 retro
Degrees of extensor lag for every 2mm of shortening of metacarpal
7 degrees
Cricoid cartilage is what level
C6
Hyoid cartilage is what level
C3
Upper thyroid cartilage is what level
C4
Lower thyroid cartilage is what level
C5
only effect of FHL transfer for achilles
decreased pressure under hallux
In cavovarus foot what muscle is “Strong” and what is “weak”
Peroneus longus, tib ant
Position of tibia tunnel relative to PCL for ACL graft
10mm anterior to anterior border
carotid tubercle is at what level?
c6
Foot deformity associated with posteromedial bowing?
calcaneovalgus
MOA heparin
binds and enhances antithrombin III to inhibit factors III, IIA, XA
MOA Wafarin
Inhibits synth of vit K dependent II, VII, IX, X, Proteins c&S
MOA enoxoparin
enhances antithrombin III to inhibit factors IIA, XA
Freidberg’s Infarction is _
infarct to second MT head
Nerve that can be injured during anterior exposure to c2-3
hypoglossal nerve exits are C2
Nonoperative management of mid clavicle fx associated with what at 1 year?
decreased shoulder strength and endurance
Type X collagen significant in what part of physis
zone of hypertrophy
Kerboul angle is used to measure what?
Area of AVN in femoral head on coronal and axial images summed together; predictor of risk of collapse
Extraabdominal Desmond tumors are positive for what hormone receptor?
estrogen receptor
Patellar reflex nerve root
L4
Achilles reflex nerve root
S1
primary blood supply to ACL
middle genicular
Congenital hand disorder rare in caucasians, common in blacks
postaxial poly dactyly
Overpowering and weak muscle that lead to dorsal bunion after posteromedial clubfoot release
Strong = tib ant, weak = peroneus longus (may be inadvertently cut or lengthened at time of release)
biggest risk factor for not healing rotator cuff repair
age
“Critical canal stenosis” defined as:
AP diameter < 10mm
Viniculae disrupted when FDP tendon retracts to level of A2?
Brevia
Viniculae disrupted when fdp tendon retracts to palm
brevia and longa
Posteroinferior glenoide a potential pain generator for what athlete
baseball pitcher; repetitive stress on posterior capsule during deceleration; can get ossified and called a Bennet’s lesion
increased IL-6 in trauma patients associated with _
increased mortality
Highest level LE amputation a child can get and still walk at normal speed c/t peers without increased energy?
through knee
When do most children with SCH achieve normal ROM after crpp?
6 months
Is UKA contraindicated in osteonecrosis of femoral condyle?
no
Flexion contracture greater than_ is contraindication to UKA
10
What preop CTS finding is associated with worse outcomes?
Severe EMG changes
Minimum follow up to be a level I study?
80%
Hypophosphotasia is a defect in the production of?
alkaline phosphatase
3.0T MRI is what factor of higher proton energy c/t 1.5?
9
DISH is highly correlated with what other diseases?
DM
PS TKA with increased posterior offset and small patellar component can lead to ?
patellar clunk syndrome
Achondroplasia is a defect in what enzyme and affects what part of the physis?
fgf3, zone of proliferation
“pencil in a cup” IP joint destruction associated with?
psoriatic arthritis
At what age is pavlik not the tx for femur fx?
6 months
Parts of knee with DJD in PCL deficiency?
medial and PFJ
CMT is caused by a mutation of what protein on what chromosome?
PMP, 17
What LE amputation has the worst outcomes in adults?
through knee (decreased prosthesis use, worse outcomes)
Liposarcoma associated with amplication of what gene?
MDM2
Thickness of cartilage cap on osteochondroma is useful for what?
in adults a thin cap (<2cm) is associated with malignant transformation; no use in kids
Most common reason for revision of charnley THA
acetabular component failure
Juvenile RA is diagnosed by serologic tests?
False, typically seronegative
Triad for Hand Schuler Christian disease?
Lytic skull lesions, diabetes insipidus, and exophtalmos. Basically this is Disseminated LCH
Anterior approach for ASD is associated with _ c/t posterior
higher rate of pseudarthrosis
fibula in the incisura most unstable in which plane
anterior posterior
Does irradiation lead to decreased immune response to allografts?
no. it sterilizes it
Antibiotic choice for psuedomonas osteo?
fluoroquinolone; except in kids ceftazidime or cefepime
maximum medial pool dye thickness after closed reduction of DDH for successful outcome
<5-7. Higher likely means reduction blocked by something, less chance of success
centigray of radiation for the following: HO ppx, soft tissue sarcoma, Bone mets
6, 60, 30
Fibrous dysplasia associated with what syndrome?
McCune Albright
Triad for McCune Albright
Fibrous dysplasia, precocious puberty, cafe au lait spots
Mutation in McCune Albright
activating mutation of the G(s) alpha gene
Levels of PTH, Phos, Ca in renal osteodystrophy
High, High, Low
only orthothotic effective for plantar fasciitis?
Nighttime dorsiflexion splint
Patellar tendonitis associated with _
muscle inflexibility (quads or hamstrings)
Spinal muscle atrophy associated with what cellular changes?
progressive loss of alpha motor neurons in anterior horn of spinal cord
Nuclei shape on eosinophilic granuloma?
bilobed Coffee bean nuclei
histologic appears of LCH
Langherhan cells (bilobed nuclei) surrounded by eosinophils
Virchow’s triad
hypercoagubility, venous stasis, endothelial injury
Factor most associated with poor outcome after pilon fx with successful union?
lower education level
Camptodactyly is _
non traumatic flexion deformity to PIP joint. Treated with stretching first prior to any surgery consideration
Apert syndrome is comprised by _ and caused by what mutation?
Facial dysmorphism and severe hand syndactyly
Metal hypersensitivity is what type of hypersensitivity?
IV (DELAYED, cell mediated, not antibody mediated)
Frostbite demarcation can take how long?
1-3 months
Two herbal supplements that interfere with platelet function?
ginkgo and ginseng
Release of popliteus tendon is useful for what issue inTKA?
Valgus deformity, tight in flexion
Release of IT tendon is useful for what issue in TKA?
valgus deformity tight in extension
Apert’s syndrome is a mutation of?
FGFR2.
Long term basal joint DJD leads to what hand deformity?
first webspace contracture
Oiller’s disease has what chance of malignancy?
~25%
Bisphosphate tx has what effect on psif spine surgery in the postop period?
decreased fusion rates (in rats, no human clinical recs currently available)
Most common reason for late TKA revision?
aseptic loosening
Biggest risk factor for poor outcome after combined acetabular fx and hip dislocation?
Age > 55. time to reduction > 12 hrs
Rheumatoid factor is an auto antibody of what type against what type of host antibody?
IgM, IgG
Stenner lesion in UCL injury of thumb is caused by what muscle which blocks reduction of the ligament?
adductor policus, ulnar nerve
Tissue from groin flap has what NV supply?
superficial circumflex iliac a., LFCN
SSEMs or MEPs are more sensitive to the effect of anesthesia?
MEPs
After ceramic head fracture and revision, what can be a late complication?
3rd body wear from retained ceramic pieces
For cortical bone, as strain rate increases this has what effect on modulus and ultimate strength?
both increase
Largest negative predictor for good outcome in laborers with chronic MSK pain?
High initial VAS scores
IV Pain dosage for morbidly obese patients should be based on?
ideal body weight, not actual
Type of bone Metastatic lesion that has worst survival?
lung
Myxoid liposarcoma translocation
t(12,16)
In adult ASD surgery, extending fusion to sacrum or pelvis has what advantage?
improved correction and maintenance of sagittal balance
Reduction maneuver for nursemaid’s elbow?
flexion and supination
Psych drug with increased risk for osteoporosis and fx?
phenytoin
Morquio’s syndrome has what laboratory finding and what spine finding?
increased urine keratin sulfate, OA dissociation
Hemophilia A is deficiency in what factor?
VIII
Hemophilia B is deficiency in what factor?
IX
Gene mutation in Fibrodysplasia ossificans progressiva?
ACVR1
What is the worst indicator for prognosis of chondrosarcoma?
pelvis location
Larsen’s syndrome is composed of:
multiple joint dislocations, scoliosis, potentially lethal cervical kyphosis
Gait abnormality seen in kids with spondylolisthesis?
shorten strides, flexion of hips/knees
Surgical delay leading to worse outcomes in acetabulum fx?
3 weeks
BMP-2 is approved for acute open tibias treated with what implant?
IMN
BMP-2 is approved for what spine indication?
Lumbar ALIFs
ECRB origin and insertion
lateral epicondyle, 3rd MC base
Most common sarcoma of the foot?
Synovial
Other msk finding associated with CMT besides cavovarus foot?
DDH
intermalleolar distance should be less than?
8cm
Smaller pedicle diameter, T12 or L1?
L1
Fracture table for femur fx associated with what deformity?
IR
What antibiotic improves the effect of methotrexate compared to methotrexate alone?
Doxycycline
Extensile lateral approach to distal femur fx has what complication c/t submuscular?
increased non union
In addition to RANKL, what else is increased with osteolysis?
VEGF
Is child bearing age a contraindication to metal on metal THA
Yes
Displacement/angulation for extra artic glenoid fx to be operative?
1cm, 40 degree
What percent of people have a posterior dominant biceps insertion to glenoid?
70%
What sacral fracture factor can lead too increased implant breakage?
vertical fracture line
Sever’s disease is _
calcanea apophysitis
Osteopenia has what effect on the strength of the bone-cement interface in comparison to normal bone?
increased strenght
The use of EPO preop has had what complication?
Increased thrombotic risk
Treatment for periosteal chondroma is?
Marginal with excision of underlying cortex
Pronation abduction ankle fracture pattern
comminuted fibula fracture, horizontal medial mal
Pronation external rotation ankle fracture pattern
oblique fibula fracture above syndesmosis
Supination adduction ankle fracture pattern
transverse fibula, vertical medial mal
In children multi organ failure occurs _ and affects what organ system first?
shortly after admission, all systems simultaneously
In adults multi organ failure occurs _ and affects what organ system first?
48 hours after admission, lungs first
Urinary _ is a breakdown product of type I collagen and a marker of increased bone turnover
N-telopeptide
Most common site of boney mestasis?
spine
Most common site for path fx from met lesion?
prox femur
At what age is open reduction preferred for DDH?
18 months
What is the max amount of hip abduction to maintain hip reduction to continue with closed reduction only?
60
t(2, 13)
alveolar rhabdomyosarcoma
slip progression of spondy in kids associated with what parameter?
pelvic incidence
males or females have higher risk of non union of mid clavicle fx?
females
central cord syndrome now thought to be injury to what tract?
lateral corticospinal tract
What percent chance of hip fracture over ten years warrants bisphosphonate therapy?
3%
enteracept binds what molecule
tnf alpha
Anakinra binds what molecule?
IL-1
most water in cartilage is located in what layer?
superficial
water content in cartilage _ with DJD
increases
Water content in cartilage _ with age
decreases
Signs of preganglionic obstetric brachial plexus palsy?
winged scapula (long thoracic), absent rhomboids (dorsal scapular), Horner’s syndrome, elevated hemidiaphragm
Age at which to perform nerve transfers for preganglionic obstetric brachial plexus palsy?
< 3 months
Compared with CSI, PT has _ effect in tennis elbow?
improved
Bands seen near physics in OI patients is associated with what?
Bisphosphonate use
TLIFs with PSIF are associated with?
increased cost only, no improvement in outcome or fusion rates
T/F: inflammatory arthritis associated with increased THA dislocations?
true
T/F: post traumatic arthritis associated with increased THA dislocations?
false
Collagen orientation in the superficial zone?
parallel to tidemark
Dominant collagen in cartilage in superficial and intermediate zone?
II
Collagen orientation in the intermediate zone?
oblique
translocation in clear cell sarcoma?
t(12,22)
translocation in myxoid liposarcoma?
t(12,16)
translocation in chondrosarcoma?
t(9,22)
Lateral mass overhang over what represents disrupted transverse ligament?
7mm
Viruses screened for in allografts
Hep B/C, HIV, Syphillis
According to SPORT, failure to improve with conservative management for lumbar disc herniation for what period of time pushes to surgery?
6 weeks
major side effect of doxorubicin?
cardiac
earliest radiographic finding seen in bed osteodiscitis of lumbar spine?
loss of lordosis
dega and salter osteotomies performed with _ triradiate
open
PAO requires _
congruent joint
Chiari osteotomy used for _
non congruent joint, closed triradiate
metastatic lesion that is often osteoblastic?
prostate
Endothelin is a molecule involved in?
osteoblastic metastasis
Benefits of vertebroplasty in RCT?
none, equal to sham procedure at all times
rivaroxaban is a _ inhibitor
Xa
Are hangman fx associated with vert art injuries?
no
At what age cutoff are you pushed towards surgery for perthes?
> 8
anterolateral bowing of tibia associated with
NF-1
CD20 and CD45 markers are associated with
lymphoma
Unique part of Ewing’s workup c/t osteosarcoma?
bone marrow biopsy
varus malunion of talar neck decreases what motion?
subtler eversion
Diplegia CP has
Affects lower more than upper extremity, mild spasiticity in UE
Paraplegia CP has
abnormal LE, sparring of UE
Pneumatic compression devices decrease risk of clot through what mechanism?
increased venous blood flow
Asia score level is based on
last normal level
X linked hypophosphatemic rickets is X linked _
dominant
Fibrous dysplasia is caused by a gene mutation involved in what signaling?
G protein involved in cAMP signalling
Name of law that forbids referral of patients to facilities the doctor has ownership in?
Stark
Morquio’s is caused by _
lysomal storage disorder causing increased keratin sulfate
With aging there is greater mechanical strength loss to cortical or trabecular bone?
trabecular
What muscles are paralyzed in Erb’s
Deltoid, and biceps (does not affect hand for true Waiter’s tip, that is a Type II, which is less common)
Marker for angiosarcoma?
CD31
T/F: Radial head resection is contraindication to TEA?
False, worse outcomes, but not contraindication
What artery is encountered between IT band and biceps femoris in posterolateral approach to knee?
inf lat genicular artery
What head of pec is normally torn?
Sternocostal, not clavicular
Inheritance pattern of NF1
autosomal dominant
Marfan’s is AD with defective _ gene
fibrillin
lisch nodules associated with
NF-1
ERLENMeyer flask femurs are seen in pediatric
osteopetrosis
tumoral calcinosis is seen in
hyperphosphatasia
T/F: Ewing’s can be treated with XRT in situation where resection is risky
True
Most common origin of bony met when CT C/A/P is negative?
lung
