Review

Question 1

Dupuytren’s disease

Answer 1

• Structural anomalies
  
  • Pretendinous band - MCP flexion contracture
  • Natatory ligaments - webspace contracture
  • Spiral bands - MCP and PIP flexion contracture
  • Lateral digital sheet - PIP or DIP flexion contracture
  • Retrovascular band - DIP HYPEREXTENSION contracture
• Clelend ligaments are SPARED
• Operative indications
  
  • MCP flexion of >30 degrees
  • Any PIP flexion
    
    • Assess with HUESTON TEST - place hand flat on table

Question 2

Xray views of shoulder

Answer 2

• Velpeau - use if unable to abduct the arm for an axillary view
• Stryker notch - Hill-Sachs lesion
• Zanca - evaluates the AC joint

Question 3

Brachial plexus

Answer 3

Question 4

Sarcomere components

Answer 4

• H-band contains only thick filaments
• I-band contains only thin filaments
• A-band lies between I-bands, contains H-band and combo of thick and thin filaments
• Z-lines anchor thin filaments together
• M-line anchors thick filaments together
• Z to Z is one sarcomere

Question 5

Female athletic triad

Answer 5

• AKA anorexia athletica

1. Amenorrhea –> demineralization of bones–>
2. Osteoporosis –> stress fractures
3. Anorexia

Question 6

Cutaneous and SubQ mechanoreceptors

Answer 6

• Meissner’s corpuscle - touch, fast
• Pacinian’s corpuscle - vibration, fast
• Ruffini’s corpuscle - stretch, slow
• Merkle’s receptor - pressure, slow

Question 7

Major orthopedic X-linked recessive disorders

Answer 7

• Duchenne’s muscular dystrophy
• Hunter’s syndrome
• Hemophilia
• Spondyloepiphyseal dysplasia (tarda)

Question 8

Major orthopedic X-linked dominant disorders

Answer 8

• Hypophosphatemic rickets
• Leri-Weill dyschondrosteosis (bilateral medelung’s deformity)

Question 9

Bone morphogenic protein

Answer 9

• BMP-2 - used for acute open tibial shaft fractures (GA Type III)
• BMP-7 - used for tibial non-unions
• BMP-3 - no osteogenic activity

Question 10

Serum markers in Pagets Dz

Answer 10

• Elevated urinary hydroxyproline levels
• Elevated Alk Phos
• Elevated urinary N-telopeptide, alpha-C-telopeptide, and deoxypyridinoline
• All of these are signs of high bone turnover

Question 11

Types of rocker soles and their indications

Answer 11

• Single rocker sole - stiff midfoot or tibiotalar arthritis
• Double rocker - midfoot prominences
• Severe angle rocker sole - toe-tip ulcers
• Negative heel rocker sole - fixed angle dorsiflexion

Question 12

Tolerances of humeral shaft fxs

Answer 12

• <20 degrees of AP angulation
• <30 degrees of varus/valgus angulation
• <3 cm of shortening

Question 13

Tolerances of tibial shaft fxs

Answer 13

• <5 degrees varus/valgus
• <10 degrees AP
• <1 cm of shortening
• <50% cortical apposition
• <10 degrees of rotation

Question 14

Dupuytren’s contracture:

bands vs cords?

Answer 14

• Bands are normal tissues which become diseased cords
• Spiral cord will cause the NV bundle to migrate volarly and put it at risk during surgery

Question 15

Which pelvic views protect which structures during sacral pin placement?

Answer 15

• Pelvic outlet view
  
  • Allows visualization of the S1 neural foramina
• Lateral sacral view
  
  • Minimizes risk to L5 nerve root
  • Prevents “in-out-in” screw placment with anteriorly placed screw
• Obturator oblique to rule out joint penetration
• Inlet-illiac oblique to determine AP position of screw within pubic ramus
• Inlet-obturator oblique for supraacetabular screw within tables of the illium
• Outlet-obturator oblique for starting point of supra-acetabular screw

Question 16

Algorithm for pelvic ring xrays

Answer 16

• Examine iliopectineal and ilioischial lines
  
  • Both intact –> Post Wall fx
  • One line disrupted
    
    • Iliopectineal diruption –> Ant wall/column fx
    • Ilioischial disruption –> Post column +/- post wall fx
  • Both lines disrupted
    
    • Look at obturator ring
      
      • Intact –> Transverse +/- post wall
      • Disrupted
        
        • Look at iliac wing
          
          • Intact –> T-type fx
          • Disrupted –> Ant column-Post hemitransverse or both column

Question 17

6 sites of Ulnar nerve entrappment

Answer 17

1. Arcade of Struthers
2. Medial intermuscular septum
3. Medial epicondyle
4. Cubital tunnel
5. Osborne fascia - prox edge of FCU
6. Deep flexor pronator aponeurosis

Question 18

Order of ascending life expectancy after boney mets?

Answer 18

Lung < renal < breast < prostate < thyroid