Res Study Questions Flashcards
Reverse TSA vs Hemi, acutely for fracture - results of recent metaanalyses
comparable forward elevation, superior functional outcomes at expense of increased complication rtes and decreased shoulder rotation
benefit of rTSA vs Hemiarthorplasty for prox humerus fracture (acute)
forward elevation is INDEPENDENT of tuberosity healing, relies on deltoid m.
Active external rotation following rTSA for fracture relies on what?
Successful union of the greater tuberosity, incidence of tuberosity healing is higher and incidence of tuberosity resorption is lower in rTSA compared to hemiarthroplasty for fracture
What is the diagnosis
PVNS - synovial cell hyperplasia, hemosiderin laden macrophages
What patient population is most likely to develop PTSD following orthopaedic trauma
Females 4:1
Patients with a lower extremity fracture (including pelvis) 2:1
Multiple injuries DOES NOT increase risk of PTSD
What is the diagnosis?
Transient osteoporosis of the hip, treat with protected weightbearing
T1 - homogeneous low-intensity signal, T2-homogeneous high -intensity signal
What are the imaging findings in transient osteoporosis of the hip?
T1 - homogeneous low-intensity signal, T2-homogeneous high -intensity signal
What patient populations develop transient osteoporosis of the hip?
Middle aged men and pregnant women
Treatment for grade 1 hallux rigidus with NO pain midrange?
Cheilectomy
Outcomes of tibial inlay vs transtibial approach for PCL reconstruction
More graft protection during cyclical loading with the inlay approach
Indication for aTSA
endstage glenohumeral arthritis, INTACT rotator cuff
indications for rTSA
endstage glenohumeral arthritis DEFICIENT CUFF, comminuted proximal humerus fractures
indications for shoulder hemiarthroplasty
subacute presentations of 3-4 part fractures, or proximal humerus fracture dislocations, young patients with unipolar shoulder degeneration (eg avascular necrosis)
end result of scapholunate ligament injury
lunate extension, scaphoid flexion resulting in DISI (dorsal intercalated segment instability)
end result of lunotriquetral ligament disruption
Lunate flexion resulting in VISI
What is the most likely organism in peds septic joint with negative OR cultures?
Kingella kingae
COmpared to ORIF of an elderly intraarticular distal humerus, TEA results in?
improved function, with a trend toward a higher rate of major complications and reoperation after ORIF
Consequence of erronious disk space needle placement in spinal localization
3x increased risk of adjacent segment disease
When using a Grammont-style prosthesis for reverse total shoulder arthroplasty (RTSA), in which direction is the glenohumeral center of rotation shifted, compared with a native shoulder?
Medializing and distalizing the center of rotation tensions the deltoid and achieves a more constrained articulation, which allows the shear forces of shoulder abduction to be converted into a compressive force.
Volar intercalated segment instability - characteristic deformity, and ligament injured
volar lunotriquetral ligament -> dorsal radiotriquetral ligament -> volar radiolunate ligament. Lunate FLEXES (ie lunate tilts volar) forced by scaphoid while the triquetrum extends
Dorsal intercalated segment instability - characteristic deformity and ligament injured
Scapholunate interosseous ligament. Lunate EXTENDS (ie go dorsal)
Clenched fist syndrome
factitious disorder in which a patient presents with flexion contractures of the hand without an organic etiology. It often presents after a minor trauma or surgery. Surgical procedures initially are not indicated. Aggressive rehabilitative treatment accompanied by psychiatric support is necessary to facilitate improvement.
In regard to PIP arthroplasty - what implant and joint replacement approach combination has been demonstrated to have the lowest rate of revision surgery?
Silicone arthroplasty through a volar approach showed the greatest gains in arc of motion and had the lowest rate of revision surgeries. The rates of revision surgeries from low to high for each type of arthroplasty were 6% for silicone volar, 10% for silicone lateral, 11% for silicone dorsal, 18% for surface replacement dorsal, and 37% for surface replacement volar
Maximum number of days after collagenase injection that you can perform a successful manipulation
7
In a radioscapholunate fusion what effect does excising the distal pole of the scaphoid have?
Decreases the non-union rate.
preserving the midcarpal joint allows dart-thrower motion to remain, nd excising the distal pole increased radial and ulnar deviation
What ligament must be preserved in proximal row carpectomy or scaphoidectomy with four corner fusion?
Radioscaphocapitate
Compromise of the ligament would result in ulnar translocation of the carpus and early failure of the proximal row carpectomy procedure
Closed reduction of this injury is likely to be unsuccessful because
proximal phalanx head is buttonholed between the lateral band and central slip
Rotatory volar proximal interphalangeal (PIP) joint dislocations are uncommon but are more frequently irreducible than dorsal or lateral dislocations. The condyle of the proximal phalanx subluxates between the lateral band and central slip, and attempts at closed reduction tighten this area and are unsuccessful.
Closed reduction was performed, resulting in a stable concentric reduction that was confirmed with imaging. What is the best next step?
Splint in PRONATION
In the normal anatomic relationship between the distal radius and distal ulna, the distal ulna translates dorsally within the sigmoid notch during pronation. The distal ulna assumes a position along the volar aspect of the sigmoid notch when the forearm is in supination. When a closed reduction of a volar DRUJ dislocation is achieved, casting the forearm in relative pronation helps to maintain the reduction.
A patient with absent bilateral clavicles and bilateral coxa vara is consistent with what genetic syndrome?
cleidocranial dysplasia, RUNX2/CBFA1 Gene
A patient with absent bilateral clavicles and bilateral coxa vara has what type of cell is most affected by the genetic mutation causing this patient’s disorder?
Osteoblasts
Treatment for pediatric C1-2 rotatory instability involves:
if less than one week duration: NSAIDs and soft collar
>1 week but <1 month: cervical traction and hard collar immobilization
>=1 mmonth: cervical traction and halo vest application
C1-2 fusion if non-reducible, recurrent or chronic deformity
Often occurs in healthy children after a viral illness/URI
Complication of the chopart amputation and surgical option for prevention
Equinus contracture due to unopposed pull of the gastroc/soleus, prevent this by doing a posterior tibialis tendon transfer to the anterior talus
Following joint arthroplasty using conventional polyethylene as one of the bearings, what local factor is released by macrophages, leading to the activation of osteoclasts and eventual bone resorption?
TNF-alpha
Following joint arthroplasty, particulate debris can be generated from the polyethylene. These particles are typically engulfed by local macrophages, resulting in activation of the osteolytic cascade. The macrophages release TNF-alpha, which activates the osteoclasts that trigger resorption around the implants.
Treatment for Gymnasts wrist
activity modification and metabolic workup (Specifically Vitamin D levels). Casting is not often necessary as splinting and activity modification x 6 weeks alleviates symptoms
Motor innervation for Lumbar nerve roots
L2: iliopsoas/hip flexion
L3: Quadriceps/knee extension
L4: Tibialis anterior/ankle dorsiflexion
L5: EHL/great toe extension
S1: gastroc/soleus/plantarflexion
Sensory innervation for lumbar nerve roots
L3: medial thigh
L4: anterolateral thigh, medial calf
L5: anterolateral calf
S1: lateral foot
Following closed elbow dislocation, splint in pronation if:
medial collateral ligament [MCL] is intact and the lateral collateral ligament [LCL] is disrupted
Following closed elbow dislocation, splint in supination if:
Lateral collateral ligament [LCL] is intact, but the medial collateral ligament [MCL] is disrupted
Normal Acetabular index and alpha angle in developmental dysplasia of the hip
Normal Acetabular index: <25degrees in patients >6mo
Normal Alpha Angle: >60degrees
How many zone of articular cartilage cells are there?
Four:
Superficial zone: chondrocytes are elongated and collagen fibers are oriented parallel to the articular surface
Middle zone/transitional zone: chondrocytes and collagen fibers are oriented randomly
Deep Zone: chondrocytes are arranged in columns, and collagen fibers are oriented vertical to the articular cartilage.
Calcified zone: the transitional zone between the cartilage and the subchondral bone.
Structure at risk with anterior to posterior interlock screw placement in a humeral nail?
LABC (musclocutaneous nerve lies in interval between biceps/brachialis and you have to dissect this to do the A->P screw
IF the nail is malrotated and the trajectory is more anteromedial to posterolateral-> then the median nerve is at risk
Structure at risk with lateral to medial distal humeral nail interlock placment
Radial N
What type of specialty culture medium should be ordered if mycobacterium marinum is suspected?
Lowenstein-Jensen Media at 30 degrees
What type of specialty culture medium should be ordered if mycobacterium tuberculosis is suspected?
Lowenstein-Jensen Media at 37 degrees
What type of specialty medium should be ordered if Neisseria gonorrhea is suspected?
Thayer Martin medium at 37 degrees
The most common brachial plexus injuries involve which segments?
C5-6 - classic Erb palsy - deltoid and bicep palsy, intact wrist flexors/extensors
Next most common is C5-7 - deltoid, bicep, wrist and finger extensor palsy. Intact wrist/finger flexors
C5-T1 is complete brachial plexus palsy and is rare
Describe the gluteus medius insertion on the femur
Attaches along the superoposterior and lateral facets of the GT with a bald area between the gluteus medius and gluteus minimus
Which statement best describes the Insall-Salvati index, which is used to assess patellar height?
Ratio of patellar tendon length to patellar length, and it normally measures <1.2
Which statement best describes the modified Insall-Salvati index, which is used to assess patellar height?
patellar height as a ratio of patellar tendon length (from tubercle to inferior patellar articular margin) to patellar articular surface length, and it normally measures <2.0
Which statement best describes the Caton-Deschamps index, which is used to assess patellar height?
ratio of inferior patellar articular surface distance from the plateau to patellar articular surface length, and it normally measures <1.3
What syndrome/disease does this 2 week old have?
This patient has Caffey disease, or infantile cortical hyperostosis.
It is a self-limiting disorder characterized by acute edema and inflammation of the soft tissues and thickening of the bone secondary to increased periosteal bone formation.
There is usually spontaneous regression of the findings by 2 years of age; however, at presentation the child may initially appear to have osteomyelitis based on the elevated inflammatory markers and clinical edema.
The mandible is involved in 70 to 90% of cases followed by the clavicle, ribs, and scapulae.
What ligaments comprise the hip ligament complex?
Iliofemoral (strongest of the three - inverted Y shape), pubofemoral, and ischiofemoral.
Two week old male with the following radiographs, no evidence of NAT, Laboratory studies show elevation of erythrocyte sedimentation rate, serum alkaline phosphatase level, and serum C-reactive protein level. What is the diagnosis? And what bone involvement is pathognomonic?
Caffey disease, or infantile cortical hyperostosis. It is a self-limiting disorder characterized by acute edema and inflammation of the soft tissues and thickening of the bone secondary to increased periosteal bone formation. There is usually spontaneous regression of the findings by 2 years of age; however, at presentation the child may initially appear to have osteomyelitis based on the elevated inflammatory markers and clinical edema. The mandible is involved in 70 to 90% of cases followed by the clavicle, ribs, and scapulae
