SAQ 2010 Flashcards
1) List the 4 Stages of Perilunate Instability
- Scapholunate dissociation
- Capitolunate dissociation
- Lunotriquetrial dissociation
- Lunate dislocation
2) List the 7 CanMeds Components
“Please Help Me Memorize Stupid Canmeds Crap”
- Professional
- Health advocate
- Medical expert
- Manager
- Scholar
- Communicator
- Collaborator
3) List the 4 Types of Neural Tube Defects
- spina bifida occulta - defect in vertebral arch with confined cord and meninges
- meningeocele - sac without neural elements protruding through the defect
- myelomeningeocele - protrusion of the sac containing neural elements
- myeloschisis - neural elements exposed with no covering
4) List stages of Kienbock’s
Stage I No visible changes on xray, changes seen on MRI
Stage II Sclerosis of lunate
Stage IIIA Lunate collapse, no scaphoid rotation
Stage IIIB Lunate collapse, fixed scaphoid rotation
Stage IV Degenerated adjacent intercarpal joints
5) Unilateral DDH in 8 month old:
a) list the most important clinical sign AND
b) list 5 possible blocks to reduction
A: decreased (asymmetric) hip abduction
B: inverted labrum inverted limbus transverse acetabular ligament iliopsoas tendon pulvinar hypertrophied ligamentum teres
7) 70 yr old male with CR TKA now with NO pain, Flexion of 75 (pre-op 120) degrees and full extension. Infection ruled out. List 4 causes for this.
- Poor compliance with postoperative rehabilitation
- Postoperative complication (wound dehiscence, DVT, CRPS)
- Overstuffing of the patello-femoral joint
- Oversized components (femur)
- Failure to restore native tibial slope (insufficient tibial posterior slope)
- Incomplete osteophyte resection
- Mismatch of flexion and extension gaps (inappropriate balancing (PCL too tight)
- Component Malposition
- Elevation of the joint line
8) 45 y.o. male with left hip pain. Shown an AP pelvis. List 3 common causes of his left hip pain. You had to determine that he had AVN of the left hip.
• direct causes - trauma - irradiation - hematologic d/c (leukemia, lymphoma) - cytotoxins - dysbaric ON (Caisson disease) - Gaucher disease - Sickle cell disease / trait • indirect causes - EtOH abuse - “immune deficiency” conditions - corticosteroids - organ transplant - systemic conditions - renal failure - systemic lupus erythematosus - blood conditions - hemophilia - thrombophilia
9) 70 yr old with cemented 15 yr THA, 1 yr history of thigh pain and periprosthetic fracture. List 3 factors important in the surgical management.
- work up for infection
- Vancouver classification!
- location of fracture
- implant stability
- remaining bone stock - pre-op medical mngt
10) List 4 Indications for percutaneous pinning (CRPP) of distal radius in a child.
- Ipsilateral distal humerus fracture
- Excessive soft tissue swelling
- Inability to obtain a reduction
- SH III/IV fracture displaced
- Inability to maintain an adequate reduction (i.e. loss of reduction)
- < 50% of apposition (of physis or canal width if metaphyseal)
- After 2nd attempt at closed reduction
11) 50 yr old female with 2 week history of inability to extend 4th and 5th fingers. List 3 common causes in a Rheumatoid patient.
- Extensor tendon rupture (Vaughn Jackson syndrome)
- Subluxation of extensor tendon at MCP joint
- PIN palsy
- MCP dislocation
12) Describe the Leadbetter manoeuvre.
- flex the hip to 90 deg, w/ slight adduction, and apply traction in line with the femur;
- next, while maintaining traction, apply internal rotation to 45 deg;
- the leg is slowly brought into slight abduction and full extension, while maintaining traction and internal rotation;
- idea is that when the hip is flexed to 90 deg (quadriped position) all muscles about the hip are maximally relaxed;
- further internal rotation also relaxes the Y ligament;
- by having these structures relaxed, reduction is possible;
- finally, full flexion and adduction “books open” the frx site which then allows the reduction to procede;
Leadbetter JBJS 1938.
13) 3 sites of compression in radial tunnel syndrom
“FREAS
- fibrous bands from radiocapitellar joint
- recurrent radial artery (leash of henry)
- leading edge of ECRB
- Arcade of Frosch (#1)
- exiting Supinator
14) Patient sustained an elbow dislocation that was reduced but remained unstable at 45 degrees with posterolateral instability. List 3 stabilizers to posterolateral stability.
- Lateral ulnar collateral ligament complex
- Radial Head
- Coronoid (30% loss)
Most important structure to posterolateral elbow stability
LUCL
16) 45 yr old male with pure ligamentous instability after elbow dislocation on lateral side. What is the management of this elbow?
- Acute dislocation:
- Reduce and examine for stability under anesthesia
- If unstable, document degree of flexion needed to maintain reduction.
- Splint at 90 then get xray to ensure concentric reduction.
- If stable under anesthesia (most are), can begin early mobilization at 1 week follow up visit.
- If unstable at extension only, can fit with extension-block hinged brace and increase extension weekly until full ROM achieved.
- If elbow requires flexion more than 50-60 degrees to be stable, this is an indication for surgery (repair of avulsed MCL (+/- LUCL) to humeral origins, +/-repair of avulsed musculature.
17) 55 year-old patient has ulnar head, triquetral pain. Normal ROM and stable wrist. Active woman and cannot play tennis anymore. List 3 possible Dx.
- Hook Hamate # (if volar)
- TFCC tear
- Ulnocarpal impaction
- ECU tendonitis (If dorsal)
- Ulnar styloid impaction (on the triquetrum)
- Ulnar nerve compression
List the dorsoradial and dorsoulnar wrist scope portals
- dorsoradial (3-4): 1 cm above lister’s tubercle, btwn 3rd and 4th compartments
- dorsoulnar: 6R → just radial to ECU tendon; 4-5 btwn 4th/5th compartments just radial to 6R
• remember:
- radial midcarpal → 1 cm distal to 3-4 portal, radial border of 3rd MC - ulnar midcarpal → 1 cm distal to 4-5 portal, in line w/ 4th MC
List 5 stabilizers of the DRUJ.
- sigmoid notch
- DRUJ capsule
- pronator quadratus
- IOM
- volar and dorsal radio-ulnar ligaments
- ECU tendon sub-sheath
- TFCC
