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Orthopaedics HARIBO > Others > Flashcards

Others Flashcards

1
Q

How to predict risk of growth disturbance?

A

Bone age by radiograph (Greuloch and Pyle Atlas)

Knee radiographs

Menarchal status in females

Tanner staging
–> Tanner 3 and above have less chance of sig issues due to their reduced growth potential

Skeletal growth is usually complete by 14 in gis and 16 in boys

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2
Q

Corona mortis and in which approach to be ligated?

A

Vascular connection between the obturator and external iliac vessels

Located behind the superior pubic ramus at variable distance from the symphysis pubis

To gain visualisation laterally and into the true pelvis during the Stoppa (anterior intra pelvic) approach

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3
Q

Indications for Stoppa approach

anterior intra pelvic approach

A
  1. Acetabular fractures

2. Pelvic ring fractures

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4
Q

Protrusio acetabuli when seen

A

Medial migration of the femoral head past the radiographic teardrop

Seen in:

  1. RA
  2. Marfan’s syndrome
  3. Paget’s disease
  4. Otto’s pelvis
  5. Other metabolic diseases
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5
Q

Rituximab

Rituxan

A

Monoclonal AB to CD20 antigen (inhibits B cells)

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6
Q

Rituximab

Rituxan

A

Monoclonal AB to CD20 antigen (inhibits B cells)

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7
Q

Anakinra

Kineret

A

Recombinant IL1-receptor antagonist

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8
Q

Most frequently injured tarsal bone?

A

Calcaneus

Accounts for 60% of all tarsal fractures and 1-2% of all fractures

Approximately 75% of these have a displaced Intra-articular component

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9
Q

Radiographs for calcaneal fractures

–> 2 important radiographic measurements for measuring the degree of posterior facet collapse

A
  1. AP ankle view
  2. Lateral ankle view
  3. Calcaneal Harris view

–>

  1. Bohler’s angle (normal 20-40°)
  2. Giassane’s angle (normal 120-145°)
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10
Q

Classic appearance of stress fractures in MRI

A

Low signal on T1

Increased signal on T2

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11
Q

Inferior gluteal artery

A

Leaves pelvis beneath piriformis

If it is cut and retracts into the pelvis, then treat by flipping patient, open abdomen, and tie off internal iliac artery

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12
Q

Kocher-Langenbeck approach

A

Posterior approach to the acetabulum

Uses same interval as Southern /Moore approach (no internervous plane (gluteus max innervated by inf gluteal nerve) (vascular plane (upper 1/3 of muscle supplied by superior gluteal artery, lower 2/3 of muscles supplied by inferior gluteal artery))

Provides access to

  1. Posterior wall of acetabulum
  2. Lateral aspect of the posterior column of acetabulum
  3. Indirect access to true pelvis and anterior aspect of posterior column through palpitation
  4. Proximal femur
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13
Q

Functional knee instability

A

Symptom that refers to the sensation of buckling, slippage or giving way of the knee during functional activities

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14
Q

Passive knee laxity

A

Clinical sign that indicates either lack of tension in the capsuloligamentous structures of the knee, or the degree of ‘joint looseness’ on passive motion testing

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15
Q

Which type of nerve is most commonly injured with extension type pediatric supracondylar fractures?

A

Anterior interosseous nerve, a branch of the median nerve, is a principally motor nerve and innervates the flexor digitorum profundus index, the flexor digitorum profundus middle, flexor pollicis longus and pronator quadratus

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16
Q

Henry approach

A

Volar approach to radius shaft

Internervous plane
Proximally between brachioradialis (Radial nerve)
Pronator tere (median nerve)

Distally between
Brachioradialis (radial nerve)
FCR (median nerve)

Supinate arm to minimise injury to posterior interosseous nerve (branch of the radial nerve)

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17
Q

Wartenberg syndrome

A

Superficial radial nerve compression syndrome

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18
Q

Test nerves hand

A

Thumbs up - posterior interosseous nerve (radial nerve)

OK sign - anterior interosseous branch (median nerve)

Cross fingers - (ulnar nerve)

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19
Q

Hip anterior approach

Smith-Petersen

A

Superficial internervous plane
Satorius (femoral nerve)
Tensor fascia lata (superior gluteal nerve)

Deep internervous plane
Rectus femoris (femoral nerve) 
Gluteus medius (superior gluteal nerve)

Dangers
1. Lateral femoral cutaneous nerve, most commonly between sartorius and tensor fascia lata

  1. Femoral nerve
  2. Ascending branch of lateral circumflex artery, Proximally in superficial internervous plane, be sure to ligate to prevent excessive bleeding
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20
Q

What needs to be reduced in Intra-articular radius fractures?

A
  1. Radius height
  2. Articular surfaces
  3. Volar tilt
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21
Q

Metastatic lesions distal to knee/elbow most likely due to

A

Primary lung or renal tumor

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22
Q

Outcome measures of Intra-articular fractures

A
  1. Correction of meta- and diaphyseal deformity
  2. Restoration of joint stability
  3. Restoration of ROM
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23
Q

Glasgow coma scale

A 
Eye opening response
4 spontaneously 
3 to speech 
2 to pain 
1 no response 
Verbal response
5 oriented to time, person and place 
4 confused 
3 inappropriate words 
2 incomprehensible sounds 
1 no response
Motor response
6 obeys commands 
5 moves to localized pain
4 flex to withdraw from pain 
3 abnormal flexion 
2 abnormal response
1 no response

Severe, GCS <8-9
Moderate, GCS 8 or 9-12
Minor, GCS above 13

Usually 3-8 means in coma

Document as GCS 9 = E2 V2 M3 at 07:35

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24
Q

Severe trauma

A

ISS > 16

Injury severity score assigns a score of 1-5 (minor to severe) to six organ systems. The three worst organ system scores are squared, and the ISS is the sum of those three squares.

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25
Q

Revised trauma score

A

Respiratory rate
Systolic blood pressure
GCS

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26
Q

Principles of damage control

A

Limit the surgical burden (or 2nd hit phenomenon) on the immune response that occurs in poly-trauma patients with an already high risk of adverse outcome

This is based on the finding that prolonged operation on poly-trauma patients can lead to coagulation disturbances and an abnormal immuno-inflammatory state causing remote organ injury

27
Q

CPP

Cerebral perfusion pressure

A

CCP = MAP - ICP
(mean arterial pressure)
(intracerebral pressure)

Autoregulatory mechanisms of cerebral blood flow may be disrupted in severe head injury

28
Q

Hip anterolateral approach

A

Watson-Jones

Intermuscular plane
Tensor fascia lata (superior gluteal nerve)
Gluteus medius (superior gluteal nerve)

Danger
Compression neuropraxia of the femoral nerve caused by medial retraction

29
Q

Anterior lumps of the knee

A

Housemaid’s knee (pre-patellar bursa)

Clergyman’s knee (infra-patellar bursa)

30
Q

3 Tests for knee effusion

A
  1. Ballotment test –> for large effusion
  2. Patella tap test –> moderate effusion
    Obliterate the supra-patellar pouch and press patella posteriorly
  3. Wipe (or bulge) test –> small effusion
    Obliterate the supra-patella pouch and wipe fluid from one side of the patella tendon followed by the other side
31
Q

Pivot shift test

A

A valgus force is applied to an internally rotated tibia, which, in the presence of a ruptured ACL, subluxes the joint
and when the knee is then passively flexed the iliotibial band, in the presence of an intact MCL, reduces the knee joint with a palpable and sometimes audible clunk.

Best performed under anaesthesia

32
Q

Differentiate between isolated MCL/LCL tear and rupture of the collaterals + the secondary restraints (cruciates)

A

Isolated : opening of the joint at 30°flexion (which relaxes the cruciates and isolates the collaterals)

Combined : opening of the joint at full extension

33
Q

Clark’s test

A

May indicate chondromalacia or arthritis of the patellofemoral joint

Patient supine

Patient is asked to contract the quadriceps whilst a hand is placed over the superior pole of the patella with a slight downward pressure

–> discomfort

34
Q

Normal T5-T15 kyphosis

A

20-50°

Any degree of kyphosis at thoracolumbar area is considered abnormal

35
Q

Hip direct lateral approach

A

Hardinge, transgluteal approach

No true internervous plane

Intermuscular plane
Splits gluteus medius distal to innervation (sup gluteal nerve)
Vastus lateralis is also split lateral to innervation (femoral nerve)

For THA and prox femur fractures

36
Q

Osteoconduction

A

Promotion of bone opposition to its surface, functioning in part as a receptive scaffold to facilitate enhanced bone formation

37
Q

Osteoinduction

A

Provision of a biologic stimulus that induces local or transplanted cells to enter a pathway of differentiation leading to mature osteoblasts

38
Q

Major complications following autologous chondrocyte implantation or cartilage grafting

A

Hypertrophy of the transplant

Disturbed fusion of the regenerative cartilage and the healthy surrounding cartilage

Insufficient regenerative cartilage

Arthrofibrosis

Osteonecrosis

39
Q

Osteochondrosis dissecans

A

Acquired phenomenon localized to the subchondral bone, which can result in destabilisation of the overlying articular cartilage

Classic : involves lateral aspect of the medial femoral condyle

Males > females

Cause multifactorial or microtrauma

40
Q

Classic test for Osteochondrosis dissecans of the knee

A

Wilson’s test

Aims to impinge the tibial spine on the OD lesiin

Performed by
Internal rotation of the involved knee while extending the knee from 90° of flexion
The pain is relieved when the same motion is performed with the knee externally rotated

41
Q

Presentation of osteochondrosis dissecans of the knee

A

Initially : vague knee pain that is worse with activity

If the OD is loose or unstable, mechanical symptoms with episodes of giving way and recurrent effusions are common

The patient may ambulate with an externally rotated gait

On examination :
May have effusion, point tenderness over the condyle, and positive Wilson’s test

42
Q

Role of MRI in osteochondrosis dissecans

A

Imaging modality of choice

Differentiating between OD and variations of normal ossification centres

Can assess lesion size, location, and stability

Instability criteria :
High intensity signal rim on T2 imaging
Articular breach
Fluid filled cysts

43
Q

Prognostic features in osteochondrosis dissecans

A

Skeletal maturity, juvenile better healing

Lesion stability

44
Q

Hip medial approach

A 
Open reduction of congenital hip dislocation
Psoas release (danger medial femoral circumflex  artery)

Plane
Superficial
No superficial internervous plane as both adductor longus and gracilis are innervated by the anterior division of the obturator nerve

Deep
Internervous plane between adductor brevis and adductor magnus
Adductor brevis supplied by the anterior division of the obturator nerve
Adductor magnus has dual innervation
Adductor portion is supplied by the posterior division of the obturator nerve
Ischial portion by the tibial portion of the sciatic nerve

45
Q

Which view best depicts acetabular fractures?

A

Judet view

Easily reproducible in the OT for surgical planning

46
Q

Retroperetoneal (anterolateral) approach to the lumbar spine

A

Can access L1-sacrum

Bifurcation of great vessels anterior to L4 vertebral body

47
Q

Only branch of the common iliac vessels

A

Iliolumbar vein

Must be ligated to safely mobilise the common iliac vessels towards midline from laterally

48
Q

Systemic, local and other risk factors for patella tendon rupture

A 
Systemic
SLE
RA
DM
chronic renal disease

Local
Patellar degeneration (most common)
Previous injury
Patellar tendinopathy

Other
Coricosteroid injection

49
Q

Insall-Salvati ratio

A

Patella tendon length /patella bone length

Patella tendon length
Length of posterior surface of the patella tendon from the lower pole of the patella to its insertion on the tibia

Patella bone length
Patellar length :greatest pole-to-pole length

On plain radiographs (30° flexed lateral knee)

Patella baja: <0.8
Normal : 0.8-1.2
Patella alta : >1.2

Slightly different values for sagittal MRI

50
Q

Clinical findings of patellar tendon rupture

A

Inability to extend the knee against gravity

Large hematoma

Palpable gap below the inferior pole

51
Q

When and why primary repair of ruptured patella tendon

A

Within 2 weeks to prevent extensor mechanism contracture

52
Q

Most common location of patella tendon rupture

A

At the junction of the tendon and the distal patella pole

53
Q

Closed kinetic chain exercises

A

When terminal or distal segment of an appendage is fixed

Squat, leg press, pull up

54
Q

Open kinetic chain exercises

A

When terminal or distal segment is free to move

Leg extension, hamstring curl

Tend to produce greater shear stresses than closed chain

55
Q

Screw home mechanism

A

Tibia externally rotates 5° in the final 15° of extension

56
Q

Acute knee swelling may indicate

A

ACL tear

Peripheral meniscal tear

Osteochondral fracture

Capsule tear

57
Q

Most sensitive view for revealing early knee OA

A

Rosenberg view

Weight-bearing 45-degree knee flexion posteroanterior

58
Q

Radiographs used in pediatric patients
to evaluate injury to the femoral physis and
to differentiate it from an MCL injury

A

Stress radiographs

Used to characterise PCL, MCL, LCL, PLC injuries

59
Q

Arcuate sign on knee radiographs

A

Avulsion of tip of fibular head

60
Q

Block of knee ROM

A

Meniscus (bucket handle) injury
Loose body
Impingement of ACL tear

61
Q

Kissing lesion

A

Chondral lesions adjacent to each other on the femur and tibia

62
Q

Pellegrini-Stieda sign

A

Calcification at the medial femoral condyle insertion

May be present in chronic MCL injuries

Usually responds to a brief period of immobilisation followed by progressive motion

63
Q

MCL injuries occur most commonly at

Treatment

A

The femoral condyle

Non-operative treatment (hinged knee brace) highly successful

64
Q

What to check in LCL injury?

A

Rarely isolated, check for PCL and PLC injury

10% associated with peroneal nerve palsy

Orthopaedics HARIBO (12 decks)

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