SAQ 2 Flashcards
List 5 risk factors for failure of bracing in AIS
Male Suboptimal correction in-brace Non-compliance Obesity Hypokyphotic thoracic curve
List 5 radiographic findings of femoral head AVN in DDH
Delayed development of ossific nucleus Fragmentation of ossific nucleus Lateral physeal irregularity Metaphyseal widening Varus neck with GT overgrowth
List 5 radiographic findings in pediatric rheumatoid spine
Apophyseal fusion (C2-3 usually) Dens waist erosion (apple core deformity) Atlantoaxial instability Hypoplastic vertebral bodies Loss of cervical lordosis
List 6 risk factors for PJK
Combined approached
Fusion to sacrum (more rigidity but also worse curve)
Pedicle screws at all levels (increased rigidity)
>5 degree kyphosis at UIV preoperatively
High preoperative pelvic incidence (saggital imbalance)
Osteopenia
What are the transfers for a wrist drop?
PL to EPL
FCR to EDC
Pronator teres to ECRB
List the two transfers indicated in a high median nerve palsy
BR to FPL
D4/5 FDP side-to-side transfer to D2/3 FDP
List 5 criteria for selective thoracic fusion in AIS
Lenke C modifier Thoracic prominence > lumbar on Adams FBT Lifestyle factors Skeletally mature Absence of hyperlaxity
What is congenital radioulnar synostosis associated with?
MACKA Mandibulfacial dysostosis Apert syndrome Carpenter's syndrome Klinefelter's syndrome Arthrogryposis
What is syndactyly associated with?
PACA Poland syndrome Apert syndrome Carpenter's syndrome Acrosyndactyly
List 5 methods of assessing for patella alta and indicate normal values for each
- Caton-Deschamps (0.6-1.3)
- Insall-Salvati (0.8-1.2)
- Blackburne-Peel (0.5-1)
- Plateau-patella angle (normal 20 degrees)
- Blumenstaat’s line should touch the inferior patellar pole at 30 degrees of knee flexion
List 5 poor prognostic factors in pilon fractures
Male Multiple comorbidities Lower SES Lower education level WSIB
When is a valgus osteotomy indicated in coxa vara?
Hilgenreiner epiphyseal angle >60 degrees and neck-shaft angle <110
List 4 risk factors for Blount’s
Early walkers
Overweight
African American
Hispanic
What are the diagnostic criteria for NF1?
6 or more cafe-au-lait spots 2 or more neurofibromas/1 plexiform neurofibroma 2 or more Lisch nodules optic glioma axillary/inguinal freckling characteristic bony abnormality family history in 1st degree relative
What are the features of Klippel-Feil syndrome?
Multiple cervical levels of failure of segmentation Cervical stenosis Sprengel's deformity Scoliosis VACTERL
What’s the best predictor of progression of spondylolisthesis?
Slip angle >45
What are the 2 most common comorbid findings in patients with myelodysplasia?
Chiari II malformation
Severe latex allergy
What conditions arise from abnormalities in COMP?
Pseudoachondroplasia
MED
Ehlers-Danlos is a disorder of which collagen type?
V
Which factor is deficient in Hemophilia A? B?
A: F VIII
B: F IX
List 5 features of DISH that differentiate it from ankylosing spondylitis
HLA-B27 negative
No sacroiliitis
Disc spaces preserved
Nonmarginal syndesmophytes at 4 successive vertebrae
Strongly-associated with diabetes and gout
List 5 changes that occur in the intervertebral disks with aging
Decreased proteoglycans Decreased water content Decreased pH Increased fibrocartilage Increase degradative enzyme activity
Are MEPs or SEPs affected by inhalational anesthetics?
MEPs
What are Waddell’s 5 signs of non-organic back pain?
Overreaction to physical exam SLR negative when patient distracted Non-dermatomal pattern Superficial tenderness Pain with axial compression
What’s Ranawat’s C1-2 index?
Perpendicular distance from the center of the C2 pedicle to a line connecting the anterior and posterior arches of C1. <13-mm is indicative of basilar invagination.
What’s the rate of depression after acute orthopaedic trauma? What about PTSD?
MDD: 1/3
PTSD: 1/4
Compared to delayed closure, what are the advantages of early primary closure?
Fewer infections
Fewer non-unions
What’s the rate of articular malreductions in tibial plateau fractures? Where is the malreduction usually? What’s a risk factor?
32%
Posterolateral
Fluoroscopic-assisted reduction alone (submeniscal arthrotomy-assisted reduction had much fewer)
What did the RCT comparing standard reaming vs. RIA-reaming in antegrade femoral shaft nailing show?
Fewer total emboli in RIA-reaming group, but this did not correlate with improvement in physiologic parameters
What’s the trajectory of functional recovery following tibial shaft fracture and IMN?
Initial decline until 6 months
Improvement from 6-12 months
*At 5 years, patients are NOT back at their pre-injury baseline
What’s the most significant risk factor for hardware removal after ankle fracture surgery?
Female
What did the HULC study looking at functional outcomes following radial head arthroplasty for irreconstructable fractures, specifically comparing patients with simple and complex fracture-dislocations show?
No difference between the two groups (ie: concomitant injuries don’t affect outcomes)
What did the RCT comparing IMN vs. DHS for unstable intertrochanteric hip fractures in geriatric patients show?
No difference overall, but trend towards significant improvement for physiologically younger and active patients treated with IMN
What did the RCT comparing LISS-plating vs. DCS for distal femoral fractures show?
Same time to union
Same functional outcomes
More complications in the LISS group
Are NSAIDs safe after acute fracture surgery?
For primary bone healing, yes.
For secondary bone healing, only during the 1st week.
- What’s the most common nerve injury after acetabular fracture surgery?
- What fracture patterns are most associated with neurologic injury (3)?
- What % of iatrogenic nerve injuries recover?
- L5 nerve root contained in the sciatic nerve
- transverse-posterior wall, posterior wall, ABC
- Only 45% recover
List 5 risk factors for reoperation following ORIF of a tibial plateau fracture
open fracture bicondylar associated tibial shaft surgery performed at night/weekend surgery performed at a non-academic centre
What are the 2 risk factors for hardware removal after clavicle ORIF?
plate not pre-contoured
height <175 cm
What are the 5 risk factors for revision surgery for major complication (infection, non-union, hardware failure) after clavicle ORIF?
age >55 diabetes ETOH drug use previous shoulder surgery
*2 predictors = 90% risk
List 5 predictors of poor outcome after limb salvage/amputation
nonwhite race low SES low self-efficacy smoker WSIB
What did the FAITH study (DHS vs. cannulated screws for patients >50 with low-energy hip fracture) show?
No difference in outcomes/reoperations
AVN more common in DHS group
List 5 poor prognostic factors following tibial IMN
high-energy mechanism stainless steel nail fracture gap immediate WBAT open fracture (only if treated with reamed IMN)
What were the findings of the FLOW study?
no differences between high, medium and low pressure
saline > soap
List 5 factors that differentiates juvenile hallux valgus from adult
bilateral metatarsus primus varus increased IMA increased DMAA associated with flatfoot
Which 5 factors automatically convert an open fracture to a Gustillo III?
exposure to water exposure to soil exposure to fecal material bite wounds delay >12 hrs
List 5 risk factors for distal humerus fractures in the elderly
Female Active Independent living Polypharmacy ETOH
Rank cobalt, chromium, titanium and nickel in order of delayed hypersensitivity reaction-association
Nickel
Cobalt
Chromium
(Titanium is inert)
List 5 risk factors for metal hypersensitivity
female smoker family Hx ear piercings hand eczema
