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Ali's Flashcards > RACS True/False Quiz 2018 > Flashcards

RACS True/False Quiz 2018 Flashcards

1
Q

No difference in PROMs, complication or revision rates between mechanical and kinematic alignment TKR groups at 2 years.

A

True

But long-term data are still lacking

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2
Q

Mechanical alignment in TKR is created by making a femoral cut perpendicular to the anatomical axis of the femur

A

False

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3
Q

Increased failure rate in patients with femoral components in > 8º of anatomic valgus, in addition to tibial components positioned in > 3º of varus relative to the midline

A

True

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4
Q

Femoral components in kinematic knee are aligned in 2 to 4º more valgus and tibial components that are positioned in 2 to 4º more varus, while maintaining similar hip-knee-ankle angles

A

True

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5
Q

Studies show marked difference in Knee Society Scores at 3/12, 6/12, and 5 years postoperatively when compared CAS (computer assisted surgery i.e Navigation) to non-CAS TKA

A

False

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6
Q

Young and Burgess lateral compression never causes bleeding requiring angioembolization

A

False

Patterns most commonly requiring angioembolization are the Young and Burgess LC and APC types and Tile type C

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7
Q

Approximately 85% of bleeding associated with pelvic fractures is from veins or bones

A

True

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8
Q

Ligation of the internal iliac artery during laparotomy is an effective way to control pelvic arterial haemorrhage

A

False

Due to rich collaterals

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9
Q

Hemodynamic instability on presentation (defined as systolic arterial pressure ,90 mm Hg after an infusion of 2 L of lactated Ringer solution and the initiation of transfusion of packed red blood cells) as an indication to immediately perform angiography with embolization

A

True

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10
Q

Fractures through the sciatic notch are thought to be associated with a high rate of arterial injury

A

True

Because of the proximity of the superior gluteal artery

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11
Q

Patients who get embolization after pelvic injury have higher mortality rates

A

True

Because of substantial high-energy trauma with multiple injuries (Mortality of 16-50% reported)

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12
Q

Survival substantially improves when embolization is performed within 6 hours of arrival

A

False

Within 3 hours

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13
Q

Name the most commonly embolized arteries in pelvic fractures in decreasing order

A

Internal iliac & its branches, Sup Gluteal, Obturator, Internal pudendal

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14
Q

Inadequate response to initial resuscitation is very sensitive but not specific to predict arterial bleeding in angiography

A

True

100% sensitive and 30% specific

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15
Q

Pressures of only 10 mm Hg are require for tamponade of venous bleeding in the pelvis

A

True

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16
Q

Harder bearings (e.g. cobalt-chromium and ceramics) have lower wear rates than soft bearings because of lower surface roughness and less vulnerability to deformational forces

A

True

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17
Q

Ultra high–molecular weight polyethylene (UHMWPE) and XLP, have a lower Young modulus of elasticity and therefore exhibit higher deformation under force

A

False

Higher Young modulus of elasticity

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18
Q

UHMWPE has the highest surface roughness factor resulting in higher frictional forces during articulation and the generation of more wear particles than other bearing surfaces

A

True

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19
Q

Large cobalt-chromium femoral heads (>32 mm), when coupled with both UHMWPE and XLP, have demonstrated low volumetric wear rates because larger femoral heads have more surface area for articulation

A

False

Larger surface area= higher volumetric wear

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20
Q

Ceramic on-ceramic implants, given the nature of their smoother surfaces, have the best lubrication performance and can establish fluid-film lubrication at various femoral head sizes

A

True

Ceramic and metal are hydrophilic which aids in forming fluid film and fluid film lubrication

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21
Q

XLP is irradiated at 200 kGy to increase the cross-linking potential between free radicals

A

False

50-100. Higher doses will cause breakdown of the mechanical structure

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22
Q

The threshold for osteolysis resulting from polyethylene debris has been considered 0.10 mm/y for linear wear and 80 mm3/y for volumetric wear

A

True

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23
Q

Trunnion corrosion related to larger femoral head sizes, longer length of trunnion, smaller trunnion diameter, longer neck length, higher taper angle, lower flexural rigidity, and dissimilar alloy pairings

A

True

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24
Q

The bare area of the glenoid is thought to converge with the center of the inferior glenoid circle

A

True

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25
Q

Coracoid process transfer procedures act mainly as a bone block to prevent further dislocation

A

False

Sling effect by the conjoined tendon contributed 76% of the restored stability in the end range of motion & 56% in the midrange of motion

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26
Q

Latarjet procedure proved to be superior to Bristow in the presence of a significant bone lesion

A

True

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27
Q

Classic Latarjet procedure restored a 30% defect to within 5% of the intact glenoid surface area, whereas the congruent arc modification allowed full restoration to the intact condition

A

True

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28
Q

Coracoid osteolysis is often observed after anterior glenoid grafting. Osteolysis is usually around the inferior screw & more obvious when the reconstructed glenoid defect is > 15%.

A

False

More around the superior screw and when the defect is <15%

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29
Q

Bony Bankart lesion is seen in 20% of first time and 90% of recurrent dislocations

A

True

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30
Q

Hill-Sachs lesions, are found in 67% of first-time dislocations and up to 100% of recurrent dislocations

A

True

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31
Q

15% glenoid bone loss in a patient with off-track lesion is an indication for Latarjet procedure

A

True

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32
Q

In paediatric ACL injuries peripheral physeal drilling is associated with a lower risk of growth arrest compared with central drilling

A

False

Central is associated with less risk

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33
Q

In paediatric ACL injury In all epiphyseal technique distal post fixation may distribute a tethering force across the physis

A

True

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34
Q

The risk of ACL rupture is approximately two to eight times higher in females than in males

A

True Due to endocrine, biomechanical factors such as increased Q-angle and genu valgum, a high body mass index, unbalanced quadriceps strength, GLL , patella alta, a high tibial slope, and a low notch width index

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35
Q

Non surgical treatment in patients <14 years of age with ACL injury and normal physical exam is not effective

A

False

Non op Tx: functional bracing, activity modification, and physical therapy

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36
Q

The ACJ is a true synovial joint with the articular cartilage, a capsule, and several stabilizing ligament

A

True

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37
Q

Patient should start full ROM exercises immediately after ACJ stabilization

A

False

6/52 in sling then gradually start ROM

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38
Q

The center of the trapezoid attachment is roughly 26 mm from the ACJ

A

True

Conoid insertion is 46 mm from lateral end of the clavicle

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39
Q

Stryker notch view allows better visualisation of ACJ

A

False

Zanca view

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40
Q

Patient with GIII ACJ separation who is still symptomatic after 4/52 of non operative treatment and has media-lateral instability and scapular dyskinesia should be offered surgery.

A

True

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41
Q

50% of patient post ACJ stabilisation demonstrate some degree of loss of reduction

A

True

53% to be exact, 20% clavicle or crocoid fracture, 6% infection

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42
Q

Meniscal homologue and any other interposed tissue should be excised after performing clavicle excision in Weaver Dunn procedure

A

True

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43
Q

Achilles tendon is the largest and strongest tendon in the human body

A

True

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44
Q

The aponeuroses from each of 2 heads of gastrocnemius muscles combine to form the Achilles tendon, approximately 5-6 cm proximal to the Achilles insertion

A

True

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45
Q

Achilles tendon fibers undergo a clockwise rotation, imparting maximal stress 2 to 5 cm proximal to the Achilles insertion (hypovascular zone).

A

False

Counterclockwise

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46
Q

Gastrocnemius-soleus (GCS) provides 83% of the plantar flexion torque to the ankle

A

False

93%

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47
Q

In patients who have chronic Achilles tendon ruptures that have healed in continuity, a Z-shortening procedure has been described to restore normal tension to the GSC

A

True

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48
Q

Primary repair of a chronic Achilles tendon rupture with gap <3cm should not be attempted

A

False

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49
Q

The axis of pull of the FHL tendon most closely replicates that of the Achilles tendon

A

True

FHL tendon advantages: Stronger than PB or FDL, in phase, in anatomic proximity to TA, Muscle belly of FHL may provide vascularity

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50
Q

Transferring FHL in chronic TA rupture causes no disruption to inversion/eversion

A

True

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51
Q

Dual-mobility systems increase the jumping distance by decreasing the femoral head offset

A

True

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52
Q

Osteolysis is uncommon, with wear rates of <0.1 mm/yr.

A

True

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53
Q

Constrained tripolar designs carry less risk of impingement compaired to non constrained tripolar

A

False

More risk of impingement

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54
Q

When press-fit constrained acetabular components are used, the shell and the host bone contact area is accepted to be <50%.

A

False

Must be > 50% in Tripolar otherwise high failure rate at the bone shell interface: type I failure

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55
Q

Retentive failure is a term used specifically for dual mobility cup failure associated with dislocation

A

True

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56
Q

Constrained liners cause increase wear, ROM and impingement

A

False

Increase wear and impingement Decreased ROM

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57
Q

Greater trochanteric (GT) pelvic impingement is a GT impingement on the ischium during a combination of hip flexion, abduction, and external rotation

A

True

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58
Q

Pelvic inclination does not affect loads on the lumbar spine

A

False

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59
Q

Hip joint disorders that limit terminal hip extension can aggravate symptoms due to hyperlordosis, narrowing of the foramina, and consequent lumbar nerve root compression

A

True

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60
Q

Sciatic nerve has 28 mm of excursion during hip flexion

A

True

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61
Q

Hamstring syndrome is the experience sciatic nerve irritation and symptoms in the lower buttock in the presence of Hamstring tear

A

True

Because of inflammation

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62
Q

The branches from the Sciatic nerve to the long head of the biceps femoris and semitendinosus muscle emerge in the mid thigh

A

False

Near ischial tuberosity

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63
Q

Pudendal nerve entrapment and/or irritation can occur at different locations such as the intrapelvic region, piriformis muscle at the sciatic notch, sacrospinous ligament and sacrotuberous ligament

A

True

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64
Q

Deep gluteal syndrome describes the entrapment of the inferior gluteal nerve in the deep gluteal space

A

False

Sciatic nerve

Structures causing entrapment: Fibrous bands containing blood vessels, gluteal muscles, hamstring muscles, the gemelliobturator internus complex, bone structures, vascular abnormalities, and space-occupying lesions

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65
Q

Long-stride walking test is positive in cases of lesser trochanter impingment on ischium.

A

True

Pain is produced posteriorly and lateral to ischium

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66
Q

Inbone ankle replacement is designed to be a primary ankle replacement

A

False

A revision

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67
Q

Inbone ankle replacement has a low survival rate

A

True

77% survival @ 2years due to talus osteonecrosis secondary to talus reaming

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68
Q

The STAR (Scandinavian Total Ankle Replacement) ankle is the only three piece mobile-bearing design

A

True

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69
Q

4th generation STAR is showing survival of 70% at 10 years

A

False

>90%

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70
Q

Second generation total ankle replacement required syndesmosis fusion

A

True

porous metal-backed surfaces to improve osseous integration; replacement of the tibiotalar, talofibular, and medial-malleolar talar articulations; and/or improved stability with the fusion of the syndesmosis

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71
Q

Minimal bone resection, superior bony ingrowth, retention of ligamentous support, and anatomic balancing are some of 3rd and 4th generation total ankle replacement improvments

A

True

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72
Q

The revisions for 3rd and 4th generation total ankle replacements were attributed to poly wear and infection.

A

False

aseptic implant loosening, talar & tibial components subsidence and talar osteonecrosis

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73
Q

Zimmer biomet trabecular metal ankle replacement requires a lateral transfibular approach therefore minimizes wound healing complications

A

True

It also mimics the natural curvature of the tibiotalar joint and results in less bone removal and more surface area contact.

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74
Q

The average age of patients with ipsilateral femoral neck & shaft fractures is 50 years, and 75% of patients are female

A

False

The average age of patients is 35 years, and 75% of patients are male

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75
Q

In patients with ipsilateral femoral neck and shaft faractures, ipsilateral knee injury is rare

A

False

20% to 40% of patients have ipsilateral knee injuries, including ligamentous injury, tibial plateau fracture, patellar fracture, or knee dislocation

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76
Q

In patients with ipsilateral femoral neck and shaft faractures, femoral neck fractures will be always diagnosed on pelvis CT scan

A

False

Can be missed in CT scan, so special CT scan with fine-cut (2-mm) CT scan through the femoral neck should be considered in addition to fluoroscopic AP in internal rotation after nailing

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77
Q

In patients with ipsilateral femoral neck and shaft faractures, Fixation with a single intramedullary device has a higher rate of malreduction in comparison to two devices

A

True

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78
Q

In patients with ipsilateral femoral neck and shaft faractures,The most significant factor to determine the femoral neck non union is the accuracy of reduction

A

True

Varus malunion has a higher rate of non union (>5 degrees of varus)

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79
Q

In patients with ipsilateral femoral neck and shaft faractures, Miss-a-nail technique is placing the cannulated screws posterior to the antegrade nail.

A

False

Anterior

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80
Q

In patients with ipsilateral femoral neck and shaft faractures, The risk of malunion or nonunion are less than the risk malunion and non union in pts with isolated neck of femur fractures.

A

True

5% risk of each of malunion or nonunion in patients with femoral shaft & ipsilateral neck fracture

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81
Q

In patients with ipsilateral femoral neck and shaft faractures, Femoral shaft fracture in this combined injury has a higher rate of non union than isolated fracture

A

True

20% of non union due to high energy trauma with a higher incidence of compound fractures

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82
Q

15% of patient with femoral shaft fracture as a result of high energy trauma will have ipsilateral NOF #

A

False

9%

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83
Q

NOF # in ipsilateral neck and shaft fracture are usually a Pauwel type III

A

True

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84
Q

For NOF # compared to THA, hemiarthroplasty has reduced surgical time, less blood loss, decreased risk of instability, and fewer postoperative complications

A

True

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85
Q

THA has been shown to produce better pain relief than hemiarthroplasty and is associated with lower long-term reoperation rates

A

True

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86
Q

THA for hip fractures confers the same risk of complications than elective THA

A

False

Higher risk

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87
Q

Elderly patients can yield up to 40% reduction in muscle Strength after 4 weeks bed rest

A

True

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88
Q

Decreased mortality after NOF # is demonstrated when surgery is performed within 48 hours of injury

A

True

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89
Q

Cemented stems in comparison to cementless show some improved postoperative pain and hip function with less implant-related complications but longer surgical times

A

True

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90
Q

No statistical differences in mortality, hospital stay, operation time, residual pain, or complications between cemented and noncemented prostheses

A

True

Remember it is about failed hemiarthroplasty

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91
Q

Chronic institutionalized patients have higher risk of infection 67% caused by gram-positive bacteria

A

False

Gr-ve

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92
Q

55% of dislocated hemiarthroplasties were observed to have inappropriate femoral offset

A

True

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93
Q

Posterior approach has been proven to have higher dislocation rates in hemiarthroplasty

A

False

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94
Q

Leucocyte Esterase (LE) strip test is more sensitive than alpha-defensin test

A

False

Both are 100% specific

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95
Q

Mortality increases after complications of hemiarthroplasty as infection or dislocation

A

True

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96
Q

Oblique pulley in the thumb is most important for preventing bowstringing of the flexor pollicis longus

A

True

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97
Q

Core suture material is relatively unimportant compared with the suture technique

A

True

The strength of the repair is proportional to the number of core sutures and the caliber of the sutures that cross the repair site

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98
Q

In hand flexor tendon repair Peripheral stitch increased repair strength by 10% to 50% and substantially reduced gap formation

A

True

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99
Q

In hand flexor tendon repair Adding an epitendinous suture decreased the rate of reoperation by 84%.

A

True

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100
Q

In hand flexor tendon repair Advancing the tendon 5 mm can cause a quadriga effect

A

false

>1cm

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101
Q

The midaxial incision in finger should lie parallel and volar to the midline of the finger

A

False

Dorsal

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102
Q

25% of A2 and all of A4 may be incised with little functional deficit

A

True

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103
Q

In hand flexor tendon repair Gap formation of >5 mm also decreased the strength of the repair site and led to ultimate failure

A

True but the figure is more than 3mm of gap

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104
Q

Spaghetti wrist is the term used to describe injury in zone IV or V involving multiple tendons and the median nerve

A

True

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105
Q

The Kleinert rehab protocol allows the patient actively flex the fingers

A

False

The Kleinert protocol involves attaching rubber bands to the patient’s fingers. The patient actively extends the fingers within the confines of the orthosis. Elastic bands passively flex the fingers to the palm

106
Q

The modified Duran protocol involves a dorsal protective splint with 40 to 50 degrees of flexion at the metacarpophalangeal joint

A

True

107
Q

Early passive motion protocols, including the Duran and Kleinert protocols, have a decreased risk of rupture but decreased postoperative digit ROM compared with active motion protocols.

A

True

108
Q

During the inflammatory phase of flexor tendon healing, the strength of the tendon is equivalent to the strength of the suture repair

A

True

is also the period during which postoperative tendon repair rupture is most likely to occur

109
Q

During the proliferative phase tenocytes lay down type I collagen

A

False

type III collagen which has poor mechanical properties; however, the strength of the repair increases compared with that of the inflammatory phase

110
Q

During the remodeling phase, type I collagen synthesis begins and the extracellular matrix aligns in response to mechanical stresses

A

True

111
Q

Cell density and synthetic activity decrease during the remodeling phase

A

True

112
Q

Dorsal placement of the suture in flexor tendon repair is biomechanically advantageous

A

True

Also should be placed 7-10mm from the edge of the tendon

113
Q

In repairing flexor tendons of hand, Knots are the weakest component of the construct, with ruptures occurring at knot locations

A

True

114
Q

In hand flexor tendon repair internal knots have decreased strength compared with external knots at day zero of repair but similar strength at 6/52

A

True

115
Q

Risk of flexor tendon rupture in hand post active and passive rehab protocol is the same

A

False

Higher in active protocol

116
Q

Phases of healing are three: inflammatory (2-3 days), proliferative (5 days to 4 weeks), and remodeling (up to 16 weeks).

A

True

117
Q

Intrinsic tendon healing process is resposible for creating scar tissue and adhesions

A

False

Extrinsic healing causes scarring and adhesions

118
Q

Capsulorrhaphy arthropathy in shoulder refers to the rapid anterior chondral wear due to overtightening of the anterior capsule and resultant compressive joint forces and loss of external rotation

A

False

Causes post chondral wear

119
Q

Shoulder pain at the end ranges of the motion arc is typical of the inflammatory arthritis process

A

False

Osteoarthritis

120
Q

Capsular release for shoulder arthritis should be considered in young patients in whom there is a 20 degrees side-to-side difference, particularly in external or internal rotation

A

True

121
Q

Inferior osteophytes may limit shoulder abduction

A

True

By tensioning the axillary pouch and compressing the axillary nerve, which can contribute to posterior shoulder pain

122
Q

Biological shoulder replacement is shown to have successful rate better than that of the knee

A

False

Less success than the knee

123
Q

Results after conversion from Hemiarthroplasty (HA) to TSA are inferior to results after primary TSA

A

True

124
Q

Glenohumeral arthrodesis is still viable option for young patients with end-stage disease and strenuous physical demands

A

True

125
Q

Post traumatic arthritis is the most common cause of degenerative shoulder in young pateint population

A

False

Osteoarthritis is the most common cause

126
Q

The most common complication after rTSA is infection

A

False

Instability

Most common causes for revision in AOANJR: instability, infection, loosening & fracture

127
Q

Females are at higher risk of dislocation after rTSA.

A

False

Fx associated with instability: BMI>30, Male, SC deficiency, previous surgery, Surgical approach, bone deficiency, previous trauma

128
Q

In the native shoulder, the anterior deltoid is primarily a flexor, the middle deltoid an abductor, and the posterior deltoid an extensor

A

True

129
Q

After rTSA, all three regions of the Deltoid become primary abductors

A

True

130
Q

In medialized (centre of rotation) COR systems, the main biomechanical advantages are a constrained prosthesis with a large ball and greater range of motion (ROM).

A

True

131
Q

A larger glenosphere diameter has the most impact on stability

A

False

Larger glenosphere has more impact on ROM before impingement

132
Q

In rTSR Inferior aspect of the glenoid, creating an overhang, may reduce the incidence of adduction impingement

A

True

133
Q

Superior tilt of 10 degrees is recommended in Glenosphere positioning

A

False

Inferior tilt is recommended to increase stability & reduce inferior notching

134
Q

Lateralizing the glenosphere resulted in a stepwise increase in forces required for anterior dislocation in 5-, 10-, and 15-mm lateral offsets rTSR (i.e. more stable joint)

A

True

135
Q

Disadvantages of lateralized Glenoid are increased deltoid forces required for abduction, with a potential risk for acromial stress fractures, deltoid pain and increases the risk of glenosphere failure secondary to increased torque on the short neck

A

True

136
Q

More constrained cups are associated with an increased likelihood of impingement & less ROM in rTSR

A

True

137
Q

Decreasing neck-shaft angle to 135 degrees, potentially increases adduction deficit

A

False

Decreases abduction deficit

138
Q

Both glenosphere lateralization and humeral lengthening improve stability but at a cost of increased deltoid force requirement

A

True

139
Q

Humeral lateralization was the only parameter that decreased deltoid forces

A

True

140
Q

In rTSR Glenoid retroversion should be around 30 degrees for maximum stability while the Humerus version should be slightly anteverted

A

False

Glenosphere shoulde be <10 degrees retroverted

141
Q

Humerus version does not have much impact on stability in rTSR

A

True

Retroversion of the stem ranges 0-30 degrees

142
Q

Humeral retroversion has been suggested to improve postoperative internal rotation

A

False

ER

143
Q

Excessive glenoid medialization, defined by Boileau as a humeral axis medialized >15 mm relative to the lateral acromion

A

True

143
Q

Increasing glenosphere size, distalizing the humerus or more constrained poly are different ways of increasing stability in revision rTSR

A

True

144
Q

Patients with fracture or previous surgery may be at a higher risk of instability

A

True

145
Q

Patients who have conversion from anatomical TSA to rTSA are the hardest to manage

A

True

Due to bone loss on both glenoid and humerus and compromised soft tissues

146
Q

Deltopectoral approach has been associated with higher rates of dislocation compared with the superolateral approach when it comes to rTSR

A

True

5% rate of instability due to SC compromise

147
Q

Revision to hemiarhtoplasty with large head is an option for recurrent instability post rTSR

A

True

147
Q

In the primary setting, the humeral neck osteotomy should be made at the level of the native supraspinatus insertion and can be made in varying degrees of retroversion

A

True

148
Q

Aggressive reaming of the Glenoid is recommended to medialize the COR

A

False

not recommended as it can cause instability. Reaming should be only to remove the articular cartilage & to remove only enough bone to correct inclination or version

149
Q

Tractioning shoulder at 45 degree of abduction with postero supriorly directed force while counter traction in applied using a sheet in the axilla is the maneuver to reduce dislocated rTSR

A

False

45 degree abduction with posteroinferiorly directed force and counter traction

149
Q

The use of thicker polyethylene is a good option in revision surgery for instability when > 15 mm of humeral shortening is present

A

False

In cases of humeral shortening <15 mm and no excessive medialization, soft-tissue tension can be increased with a metallic spacer or thicker polyethylene; otherwise >15 mm of humeral shortening requires humeral stem revision

150
Q

No strong evidence (on RCT) to suggest that transtendinous approach for Tibial IM nailing is associated with more anterior knee pain in comparison to paratendinous approaches

A

True

JAAOS Sep 2018

151
Q

Weak evidence to support that suprapatellar approach has less anterior knee pain to infrapatellar approach

A

True

JAAOS Sep 2018

152
Q

Safe zone for nail entry is on average 9 mm lateral to the midline and 3 mm lateral to the tibial tubercle

A

True

JAAOS Sep 2018

153
Q

Infrapatellar branch of the saphenous (IPBS) nerve are not at risk of injury during infrapatellar nailing

A

False

154
Q

The suprapatellar and lateral extraarticular parapatellar approaches may have potential benefits in terms of preventing anterior knee pain

A

True

because of less injury to the fat pad & IPBS nerve + avoid the pressure are when kneeling

JAAOS Sep 2018

155
Q

Studies showed that Knee pain was correlated with fracture union

A

True

This finding could explain improving pain during early and mid-term follow-up

JAAOS Sep 2018

156
Q

More than half of the patients have improved anterior knee pain after metal removal

A

True

JAAOS Sep 2018

157
Q

The MPFL arises on the medial femur approximately 4 mm distal and 2 mm anterior to the medial epicondyle

A

False

Anterior and distal to adductor tubercle

JAAOS June 2018

158
Q

Almost 50% of pt post IMN tibia exprience some anterior knee pain within the first 12/12 post op

A

True

JAAOS Sep 2018

159
Q

MPFL is nearly isometric throughout knee ROM

A

True

JAAOS June 2018

160
Q

MPFL is particularly important to avoid lateral patellar translation during between 30-90 degrees of knee flexion

A

False

During the first 30º of knee flexion. After 30 degrees the trochlear groove is the most important restrain

161
Q

Greater tibial internal rotation increases the risk of lateral patellar subluxation

A

False

ER

162
Q

Moving patellar apprehension test is the most specific and sensitive sign for lateral instability

A

True

JAAOS 2018

163
Q

Types A and C are most likely to benefit from a trochleoplasty because of the presence of a supratrochlear spur, which can be removed to deepen the groove to the level of the anterior femoral cortex

A

False

Type B & D

164
Q

Caton-Deschamps ratio is preferred by many clinicians because the values do not vary with knee flexion

A

True

JAAOS June 2018

165
Q

On axial X ray sulcus angle <145 degrees is one criterion for trochlear dysplasia

A

False

>145

166
Q

(TT-TG) distance has largely replaced the Q, angle as a measure of malalignment and should be measured to guide decision making for tubercle osteotomies

A

True

JAAOS June 2018

167
Q

TT-TG measurement is affected by knee rotation and that the tibial tubercle‒ posterior cruciate ligament distance more accurately describes lateralization of the tibial tubercle because both measurements use tibial reference points

A

True

JAAOS June 2018

168
Q

TT-TG measurements on MRI are 4.1mm less on average compared to CT

A

True

JAAOS June 2018

169
Q

MPFL repair may be indicated for management of a rare peel off lesion of the patella

A

True

But primary repair has fallen out of favor

JAAOS June 2018

170
Q

2 N (approximately 0.5 lb) of MPFL graft tension accurately restored contact pressure and patellar tracking.

A

True

JAAOS June 2018

171
Q

Fixation of MPFL to the femur is recommended in 90 degrees

A

False

Recommended between 30-45 degrees, because the patella engages the trochlear groove at approximately 30 degrees of knee flexion

JAAOS June 2018

172
Q

When MPFL graft tension increases during knee flexion, the femoral tunnel is too proximal (ie, high and tight), and if tension decreases during flexion, then the tunnel is too distal (ie, low and loose).

A

True

JAAOS June 2018

173
Q

Rate of recurrent patellar instability after MPFL reconstruction is low but high complication rate

A

True

4.5% redislocation rate, but 25% complication rates of graft failure, graft overtightening, and patellar fracture

JAAOS June 2018

174
Q

Patients with spur sign measuring > 5 mm are likely to have less satisfactory outcome after MPFL reconstruction alone

A

True

JAAOS June 2018

175
Q

The main published complication after a trochleoplasty is stiffness (46%) requiring a manipulation under anesthesia and/or lysis of adhesions

A

True

Other but rare complication is catastrophic subchondral collapse

JAAOS June 2018

176
Q

In Tibial tuberosity osteotomy, A steeper angle allows for more anterior translation of the tubercle, which can be used when more chondral off-loading is needed; a flatter cut allows for more medialization and a more aggressive decrease in the TTTG

A

True

JAAOS June 2018

177
Q

Complete detachment of the tibial tubercle (compared with maintaining the distal periosteal hinge) may increase the risk of complications, including nonunion, stress fractures, and compartment syndrome

A

True

JAAOS June 2018

178
Q

Greater number of dislocations was associated with higher-grade lesions of the glenohumeral joint cartilage lesion

A

True

JAAOS June 2018

179
Q

Chondral lesions are common in patients with superior labrum anterior to posterior (SLAP) tears, with the most common location of the lesion being posterior Glenoid

A

False

Most common place is underneath the biceps tendon on the humerus side or at the ant half of the glenoid

JAAOS June 2018

180
Q

Good results achieved after arthroscopic débridement and capsular release for the management of shoulder osteoarthritis (Outerbridge grade 2 to 4 cartilage lesions)

A

False

42% of pts required total shoulder arthroplasty in 12/12

JAAOS June 2018

181
Q

There is fair evidence to support arthroscopic microfracture in GHJ articular lesion

A

True

JAAOS June 2018

182
Q

Osteochondral autograft transplantation (OAT) for the management of focal chondral defects in the glenohumeral joint warrants a grade C recommendation

A

True

JAAOS June 2018 (supported by conflicting or poor quality evidence)

183
Q

In management of GHJ articular cartilage defect Osteochondral plugs were harvested from the outer edge of the medial femoral condyle

A

False

Lateral femoral condyle

JAAOS June 2018

184
Q

Articular geometry of the lateral tibial plateau closely resembles that of the glenoid & can be used as an allograft

A

False

Medial tibial plateau (Femoral head is suitable for humeral head defects)

JAAOS June 2018

185
Q

Patients with a history of using an intra-articular pain pump experienced –with chondral reconstructive surgery- significantly inferior patient satisfaction compared with patients who had no history of pain pump use

A

True

JAAOS June 2018

186
Q

Particulated juvenile allograft cartilage implantation has the advantage of being a single-stage procedure

A

True

JAAOS June 2018

187
Q

The mean length of the LHBT from its origin to the musculotendinous junction is approximately 10 cm, whereas intra-articular LHBT length is approximately 3 cm

A

True

JAAOS Feb 2018

188
Q

Biceps brachii internally rotates 90 degrees before the long and short heads of the biceps tendon attach as a single tendinous insertion distally on the ulnar aspect of the bicipital tuberosity of the radius

A

False

Externally rotates

JAAOS Feb 2018

189
Q

On the bicipital tuberosity of the radius, the LHBT inserts more proximally and mostly functions as a forearm supinator

A

True

Short head attaches distally and acts as flexor.It is also more medial at the musculotendinous junction

JAAOS Feb 2018

190
Q

The lacertus fibrosus originates from the long head of the biceps tendon and traverses distally, inserting on the forearm fascia

A

False

From short head

JAAOS Feb 2018

191
Q

LHBT inflammation, instability, and rupture are associated with glenohumeral arthritis, labral lesions, and rotator cuff tears

A

True

JAAOS Feb 2018

192
Q

Speed & Yergason tests are sensitive but have low specificity

A

True

JAAOS Feb 2018

193
Q

Interference screws are stronger with less failure rates than anchors in LHBT tenodesis

A

True

no significant statistical difference with the use of different screw sizes, but less failure when the screw is set flush with the bone in comparison to sitting proud or recessed

JAAOS Feb 2018

194
Q

Increased risk of axillary nerve injury with the use of a bicortical button to perform LHBT tenodesis

A

True

Nerve is within 3mm of the button

JAAOS Feb 2018

195
Q

Low rates of return to play and return to previous level of play after arthroscopic SLAP repair, particularly in overhead athletes

A

True

tenodesis is a good alternative option with more patient satisfaction & earlier return to activities, this is in addition to persistant stiffness & pain after repair but repair still an acceptable option for type II SLAP in younger patients aged < 40 years

JAAOS Feb 2018

196
Q

Distal biceps tendon tears are believed to result from excessive eccentric tension as the arm is brought from flexion into extension

A

True

197
Q

Hook test is 100% sensitive and 100% specific for the diagnosis of distal biceps tendon rupture

A

True

JAAOS Feb 2018

198
Q

Patients in the single-incision group (of distal Biceps repair) had 10% better final isometric flexion strength and a higher rate of early transient lateral antebrachial cutaneous neurapraxia than the 2 incision

A

True

JAAOS Feb 2018

199
Q

LHBT is supported and stabilized by a pulley system that consists of the subscapularis tendon, the supraspinatus tendon, the coracohumeral ligament, the superior glenohumeral ligament, the pectoralis major tendon insertion, and the falciform ligament

A

True

JAAOS Feb 2018

200
Q

Intact rotator cuff, conjoint tendon or transverse humeral ligaments are amongst tenodesis options for LHBT

A

True

Other options are proximal or within bicipital groove in a subpectoral fashion

JAAOS Feb 2018

201
Q

Distal subpectoral LHBT tenodesis offers better pain relief results compared with proximal subpectoral tenodesis

A

True

Completely removal of the biceps tendon

JAAOS Feb 2018

202
Q

Displaced midshaft clavicle fracture has between 15% to 20% nonunion rate with nonsurgical management

A

True

JAAOS Nov 2018

203
Q

Fractures with greater than 1.5 to 2 cm of shortening or greater than 100% displacement leads to decreased shoulder function and worse clinical outcomes

A

True

JAAOS Nov 2018

204
Q

Scapular dyskinesia is more common in patients treated surgically after clavicle fracture than patient treated conservatively

A

False

More common in non surgical treatment i.e. 67% due to clavicular shortening while 37% in surgically treated patients

JAAOS Nov 2018

205
Q

Figure-of eight bracing for clavicle # have more dysatisfaction rate among patients than sling but the same rate of union

A

True

JAAOS Nov 2018

206
Q

No difference was found between 2.7 & 3.5 plating systems in clavicle ORIF

A

True

JAAOS Nov 2018

207
Q

With appropriate surgical technique no differences in implant irritation & removal between the anterior & superior plating of clavicles

A

True

JAAOS Nov 2018

208
Q

Dual plating of clavicle fractures resists loads better than single plating & has lower risk of metal irritation with no statistically significant improvement in the union rate

A

True

JAAOS Nov 2018

209
Q

Superior plate was worse at resisting torsional and axial loads than the IMN with more metal irritation to the plate

A

False

JAAOS Nov 2018

210
Q

Compared to non operative management, clavicle ORIF group have better outcome and shorter time to union

A

True

Average Time to union: 16.4 versus 28.4 weeks

Non-union rate: 3%versus 14.2%

JAAOS nov 2018

211
Q

Risk factors for clavicle nonunion:

lack of cortical apposition, female sex, comminution, smoking, and advanced age

A

True

JAAOS Nov 2018

212
Q

Compared to antero-inferior plating, screw lengths are longer in superior plating

A

False

Longer screws in antero-inferior plating

JAAOS Nov 2018

213
Q

Capital femoral epiphysis from one or multiple ossific nuclei beginning at age 4 to 6 months and fuses through the proximal femoral physis at age 14

A

True

JAAOS June 2018

214
Q

Injury to the trochanteric apophysis or the abductor musculature may disturb growth and angulation of the femoral neck, producing coxa vara, whereas overgrowth may result in coxa valga.

A

False

injury to trochanteric apophysis produces valgus deformity while overgrowth causes coxa vara

JAAOS June 2018

215
Q

Artery of ligamentous teres increases its blood supply to the femoral head from age 8 years to provide a peak of 20% in early adulthood before declining with age

A

True

JAAOS June 2018

216
Q

Long term outcomes of management of Delbet type I fractures are worse compared with management of other Delbet fracture types

A

True

JAAOS June 2018

217
Q

The rate of osteonecrosis in paediatric NOF # was 4.2 times higher in patients who had delayed treatment compared with those who underwent treatment within 24 hours of injury

A

True

also with delayed treatment more than 24 hours, the rate of physeal arrest is 64% & osteonecrosis is 55%)

Overall risk of AVN is 25%

JAAOS 2018

218
Q

Open reduction has been associated with lower rates of osteonecrosis in paediatric NOF #

A

False

This might be due to selection bias as ORIF is used with displaced fractute

JAAOS June 2018

219
Q

Transphyseal screws in paediatric NOF # fixation are ideally placed no less than 5 mm from the subchondral bone of the femoral head

A

True

Care must to taken to avoid posterior perforation or screw placement in the anterolateral quadrant of the epiphysis to reduce the risk of iatrogenic injury to the blood vessels. Physeal-sparing fixation methods include transphyseal fixation with smooth wires or placement of screws that do not cross the physis

JAAOS June 2018

220
Q

Pediatric femoral neck stress fractures commonly occur on the tension (superior) side of the femoral neck

A

False

Compression side

JAAOS June 2018

221
Q

The median time to development of osteonecrosis post NOF # in paediatric population is more than 12 months from injury

A

False

7.8 months

JAAOS June 2018

222
Q

Nonunion and coxa vara deformity post paediatric NOF fracture occur in 10 and 18%, respectively.

A

Ture

JAAOS June 2018

223
Q

Type II and type III Delbert fractures are the most common type of pediatric femoral neck fracture and are often displaced.

A

True

JAAOS June 2018

224
Q

Acceptable reduction in Delbet type II fractures consists of <5 degrees of angulation and <2 mm of cortical translation

A

True

JAAOS June 2018

225
Q

Acceptable reduction in Delbet type III fractures consists of <10 degrees of angulation, with valgus malalignment being most common

A

False

Varus malalignment is most common

JAAOS June 2018

226
Q

Preferred method of fixation of paediatric NOF # is smooth Kirschner wires in patients aged <4 years, physeal-sparing cannulated screws in those aged 4 to 9 years, or transphyseal cannulated screws in those aged 10 or more years.

A

True

JAAOS June 2018

227
Q

The association between surgeon caseload and risk of revision was stronger with UKA than with TKA, suggesting that UKA is a more technically demanding surgery

A

True

Revision rate after UKA decreased steeply as the surgeon’s annual caseload increased from zero to 10 procedures, with the rate plateauing at 30 cases per year

JAAOS Oct 2018

228
Q

Physiologic tibial radiolucencies are well defined but nonprogressive

A

True

Observed in <62% of cases. In contrast, pathologic radiolucencies are poorly defined, wide, and progressive and are associated with loosening or infection

JAAOS Oct 2018

229
Q

In patients with a painful UKA and normal radiographs, the use of MRI has not been advocated.

A

False

MRI can show evidence of progressive arthritis in all knees and synovitis, loosening, sinus tract, tibial fracture, and infection

JAAOS Oct 2018

230
Q

Aseptic loosening is more common in fixed bearing models than mobile-bearing designs

A

True

4.4% versus 1.2%

JAAOS Oct 2018

231
Q

Aseptic loosening is the most common cause of revision of UKA

A

True

63% of the revision is due to loosening & more commonly the revision is to TKA

JAAOS Oct 2018

232
Q

The most important predictor of progression of OA is the arthritic grade of the lateral compartment at the time of surgery

A

True

JAAOS Oct 2018

233
Q

UKA for partial-thickness cartilage defects have been associated with inconsistent pain relief after UKA and a 2.5 times higher revision rate

A

True

JAAOS Oct 2018

234
Q

Outcomes of revision of a UKA to a TKA can be better than those of a revision TKA, but may not be as good as those after a primary TKA

A

True

JAAOS Oct 2018

235
Q

In revision from UKA to TKA, it is advised to leave the components insitu as long as possible so distal femoral resection is performed with the UKA implant in place

A

True

this helps to accurate approximation of the joint line and to enable the surgeon to better reference landmarks. The saw will often hit the peg of the implant, at which time the component can be removed and the remainder of the distal femoral cut can be made

JAAOS Oct 2018

236
Q

UKA should be avoided in patients with inflammatory arthropathy and previous high tibial osteotomy.

A

True

JAAOS Oct 2018

237
Q

in UKA tibial component should be in neutral to 3 degrees of varus alignment, with <2 degrees change of posterior slope.

A

True

JAAOS Oct 2018

238
Q

Femoral component loosening in UKA is frequently attributed to component malalignment, whereas tibial loosening may be related to poor initial fixation

A

False

The other way around. 2 peg femoral implants are better than 1 peg

JAAOS Oct 2018

239
Q

In UKA Intraoperative fractures are attributed to excessive impaction of the tibial tray, whereas postoperative fractures are associated with tibial cuts and component alignment

A

True

JAAOS Oct 2018

240
Q

In Pilon ORIF, surgical incisions placed in parallel between the angiosomes pose no threat to the resultant skin bridge

A

True

JAAOS Sep 2018

241
Q

Primary arthrodesis in non reconstructable Pilon fractures reduced rate of infection compared with infection rates associated with conventional fixation techniques

A

True

JAAOS Sep 2018

242
Q

Bifocal compression/ distraction osteogenesis addresses Pilon # bone loss peripherally (through shortening) and resolves limb length discrepancy by proximal distraction osteogenesis

A

True

JAAOS Sep 2018

243
Q

Early fixation, upgrading, primary arthrodesis, staged sequential posterior and anterior fixation, acute shortening, and transsyndesmotic fibular plating have resulted in lower risk of infection in tibial plafond surgery

A

True

JAAOS Sep 2018

244
Q

In closed high energy Pilon fracture, early ORIF has similar good outcome to stage ORIF (with the use of temporarly external fixation),it also has a similar risk of deep infection provided the surgery is done in the first 3 days

A

True

However, patients with notable regional or systemic comorbidities (ie, alcohol abuse, schizophrenia, diabetes, peripheral neuropathy, hemorrhagic fracture blisters) had unacceptable higher complications with the use of early ORIF.

JAAOS Sep 2018

245
Q

Relative indications for surgery in Tibial plateaus # are an articular step-off of >3 mm, condylar widening of >5 mm, and >5 degrees of coronal alignment disruption

A

True

JAAOS June 2018

246
Q

Very high rate of failure was noticed for ORIF tibial plateau in elderly

A

True

79% fixation failure rate in patients aged >60 years and a 100% fixation failure rate in patients with marked osteoporosis, this is in addition to other medical complications e.g. DVT…etc

JAAOS June 2018

247
Q

Old patients sustain tibial plateau fractures are likely to markedly drop their preinjury level of function after TKA

A

False

JAAOS June 2018

248
Q

Resection & replacement of the proximal tibia is associated with less complications than distal femur resection & replacement

A

False

major potential complications with proximal tibia replacement, specifically disruption of the tibial tubercle and the extensor mechanism, as well as potential soft tissue coverage issues

JAAOS June 2018

249
Q

Infection rate is the same in patients undergoing secondary TKA and in those undergoing standard TKA

A

False

Higher in secondary

JAAOS June 2018

250
Q

In secondary TKA flexion can be markedly improved with the proper surgical techniques

A

False

JAAOS June 2018

251
Q

Primary TKA for tibial plateau fracture in elderly patients is associated with lower reoperation rate compared to ORIF

A

True

JAAOS June 2018

252
Q

Secondary TKA for posttraumatic osteoarthritis secondary to malunion is associated with a higher rate of complications and poorer functional results than TKA for primary osteoarthritis

A

True

JAAOS June 2018

253
Q

Minor differences are seen in wear rates between Metal-on-XLP, ceramic-on-XLP and ceramic-on-ceramic bearings.

A

True

Metal-on-XLP has the longest clinical follow up

254
Q

What are fresh frozen graft options to address glenoid bone defect in recurrent shoulder dislocation

A

Glenoid

Tibial plafond

255
Q

Failure types in tripolar constrained designs

A

Type 1: shell-bone interface

Type 2: Shell-liner interface

Type 3: At bipolar locking mechanism

Type 4: Inner bearing of the bipolar components

256
Q

No evidence that three component designs total ankle replacements are better than two component designs

A

True

257
Q

Iatrogenic chondrolysis has been associated with postoperative intra-articular infusion of bupivacaine or lidocaine, the use of nonabsorbable suture anchors and the use of thermal devices

A

True

258
Q

A major advantage to superior plating is that for most fracture patterns, the plate is on the tension side of the fracture.

A

True

JAAOS Nov 2018

259
Q

Malposition, loosening, impingement, instability & sizing are some of the causes of bearing dislocation in UKA

A

True

JAAOS Oct 2018

Ali's Flashcards (2 decks)

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