SAQ 2012 Flashcards
Name the following Dermatomes: Nipple line, Umbilicus, Groin, medial calf
- Nipple Line = T4
- Umbilicus = T10
- Groin = L1
- Medial Calf = L4
List 4 features of Brown Sequard
- Cord Hemitransection
- Associated with penetrating Spinal Cord Injury (or Unilateral facet #/dislocation)
- Ipsilateral loss of motor/proprioception
- Contralateral loss of pain/temperature 2 levels below
- Good prognosis (>90% will walk)
- Incomplete Spinal Cord Syndrome
List four successful things to non-operatively manage carpal tunnel syndrome
- Splint / Night Splints
- Steroid injection
- Activity modification (avoid aggravating activity) – esp vibration activities
- NSAIDs
What are the three phases of muscle repair
Inflammatory
Repair
Remodelling
- Four changes in and around muscle with endurance training
- Hypertrophy of slow twitch (type I) muscle fibers
- Increased capillary density / capillarization
- Increases mitochondria (NUMBER & SIZE)
- Increases oxidative capacity
- Increases resistance to fatigue* (the four above are better)
Other
- Improved glycogen & fat storage ability
- Improved catabolism (glycogenolysis, glycolysis, lipolysis)
Name two radiographic risk factors for SCFE development
- More vertical physis / Increased physeal slope angle
- Femoral neck retroversion or decreased femoral neck anteversion (associated with fatties)
- Increased posterior physeal slope (on lateral/”axial” view”); >12mm recommend pinning
Other - Acetabular overcoverage o Increased CEA o Coxa profunda - Acetabular retroversion o Cross-Over Sign - Widened/Irregular physis*
Name 4 radiographic reasons(?) for progression of infantile Blount’s
a. MDA > 16
b. MEA > 20
c. Medial physeal bar
d. Metaphyseal beaking
- 2) Metaphyseal-Diaphyseal Angle (Drennan)
o >16 deg = 95% chance of progressing
o <10 deg = physiologic varus - Ossification of medial physis (stage VI)
- Progressive genu varum (tibiofemoral angle)
- Metaphyseal sharp varus angulation
- Irregular/widening of medial physis
- Medial sloping and irregular ossification of the epiphysis
- Beaking of the proximal medial tibial metaphysis
- Multiplanar deformity (varus, procurvatum, internal tibial torsion)
- Fragmentation of the medial tibial epiphysis
Name the Four components of the WOMAC (Western Ontario and McMaster Universities Arthritis Index)
a. Pain
b. Stiffness
c. Function
d. Global score
What is the formula for pelvic incidence
PI=PT+SS
Three ways to size a radial head?
Proximal edge of implant should align with proximal edge of Lesser sigmoid notch
Use native radial head as template
Gapping of the lateral ulnohumeral joint line
AP radiograph and look at medial Ulnohumeral joint line (not as sensitive need 6 mm of overlengthening until you see gapping)
Four principles of managing a Pilon excluding soft tissue
Fixation of fibula (restore leangth of lateral column)
Correct valgus deformity in distal tibia to reduce the chaput and volkmann fragment
Anatomic Restoration of the joint surface
Bone grafting of metaphyseal defects to prevent collapse
Buttress plating of medial tibia to prevent vaurs and neutralize rotational forces
Restoration of limb alignment
WHO pre-op checklist; list 5 points to be included (“List the 5 main components”
Patient Identity Site marked Safety check Allergies Difficult airway/aspiration
Three reasons for the progression of congenital kyphosis
Failure of formation
Failure of segmentation
Mixed anomalies
List 8 organ systems associated with congenital scoliosis
VACTERL V-vertebral anomalies Anorectal Atresia Cardiac abnormalities TracheoEsophageal fistula Renal Abnormalities Limb Deformities Organ systems: CV GU GI Renal Limb (MSK) Auditory&Sensory system CNS (spinal dysraphism) Pulmonary? (ie TIS)
List 4 principles for establishing causality
o Strength of association o Consistency o Specificity o Temporality - REQUIRED o Biological Gradient o Plausibility o Coherence o Experiment o Analogy
List the 5 structures of the shoulder superior suspensory complex
Coracoid Acromion AC joint Glenoid CC ligament Distal Clavicle
List three radiographic criteria suggesting syndesmotic injury
- Widened medial clear space
- Loss of tibial fibula overlap on any view (6mm on AP and 1mm on mortise)
- More than 6mm posterior insusura to fibila distance on a mortise view
Terrible triad; list the three injuries making this up
- Coronoid fracture
- Radial head fracture
- Ulnar dislocation or Capsul injury
5 things to systemically stage a Ewings; femoral lesion in stem
- CT chest
- Bone scan
- MR of entire bone
- LDH
- CBC
- ESR
- Bonemarrow biopsy?
- Mollecular studies for EWS translocation
List six anatomical releases for balancing a varus knee
- Superficial MCL
- POL
- Semimembranosis
- PCL
- Medial capsul
- Medial gastrocnemius
- Pes ansorine
- Medial osteophyse removal
List 3 radiographic features associated with C2-3 pseudosubluxation
- Intact spinolaminar line (Swischuk’s line within 1.5mm of posterior c2 arch
- Corrects with extension film
- Pediatric patient
- Flexion views don’t make it worse
List 5 radiographic or clinical features suggesting an unstable C spine injury
- Competence of anterior elements
- Competence of posterior elements
- Extent of dynamic and static displacement
- Neurologic injury
- Anticipated loads
- Soft Tissue injury on MR
List three complications with managing a pediatric tibial tubercle fracture
- Recurvatum deformity (theoretical)
- Compartment syndrome
- Bursitis over tibial tubercle
- Stiffness
- Patella baja
- Saphenous nerve neuroma
- Malunion
- Refracture through hardware
- Skin necrosis
- DVT
List three predictors of a poor outcome in a pediatric radial neck fracture
- Higher fracture grade (Judet) = Higher initial angulation
- Skeletal maturity / older age
- Radioulnar synostosis
- Displacement greater than 3mm
- Angulation greater than 45degrees
- Clincal range of motion less than 60 degrees each direction post reduction
- Open reduction
List 6 types of failure of a TKA requiring a revision
o Pain • Loosening and component failure • Patellar dysfunction • Limb deformity • Infection • Neuroma o Post-op stiffness o Instability
List 6 causes for groin pain and decreased function in a total hip
o Infection o Stress fracture of pelvis o Aseptic loosening of acetabular component o Psoas tendonitis o Hernia o Impingement o Synovitis secondary to poly or metal debris o Pelvic osteolysis o Pseudotumor o HO
List 4 ways a plate can function other than a buttress
o Bridge o Compression o Neutralization o Tension-band o Locking
List three considerations for applying a pediatric halo safely
o CT scan to assess cranial thickness
o Avoid fontanelles
o Use 8-12 pins
o Tighten pins to 2-4 in/lbs
List 5 indications for ORIF of a mid shaft humerus fracture
o Pathological fracture o Open fracture o Vascular injury o Segmental fracture o Floating elbow o Polytrauma o Radial nerve palsy post-closed reduction o Non-union with non-op management
List 4 contraindications to an HTO
o Flexion contracture > 15 deg or < 90 deg ROM o Lateral compartment OA o Loss of majority of lateral meniscus o Severe bone loss (>3 mm) o Patella baja o Symptomatic patellofemoral OA o Inflammatory arthritis (RA)
List 4 ways to manage an ACL injury in an 11 yr
o Transepiphyseal reconstruction
o Partial transphyseal reconstruction
o Physeal-sparing reconstruction
o Non-op
List 4 causes for decreased extension in an ACL recon
o Posterior placement of femoral tunnel o Anterior placement of tibial tunnel o Tensioning graft in flexion o Cyclops lesion o Inadequate notchplasty o Capsulitis o Immobilization in flexion o Non-compliant with physiotherapy
List 3 ways to prevent procurvatum in a proximal tibia fracture
o Posterior blocking screws o Increased Herzog Angle o Proximal Start Point o Semi-extended position o Uni-cortical anterior plating
List 3 ways to do a posterior C1-2 fusion
o Posterior sublaminar wiring
o Intra-laminar clamps
o C1-C2 transarticular screws - Posterior C1 lateral mass to C2 vertebral body
o Lateral Mass screw fixation - C1 lateral mass screw and C2 pedicle screw with rod reconstruction
o C1 lateral mass with C2 pedicle screw, plus or minus rods
o Occipito to cervical
List 4 reasons to do ORIF of a scaphoid fracture
o displacement > 1 mm o radiolunate angle > 15° o scapholunate angle > 60° o intrascaphoid angles > 35° o scaphoid fx with perilunate dislocation o comminuted fx o vertical oblique fractures o non-union
List 2 motion sparing techniques to manage a stage II SLAC wrist
o PRC
o Scaphoid excision and 4 corner fusion
o Wrist arthroplasty ??
List 4 components of the postero-lateral corner
o Popliteus o Biceps Femoris o IT Band o Popliteofibular lig o o Fabellofibular Lig o Lateral Capsule o Arcuate Lig o LCL
List 5 features associated with increased risk of peri-operative mortality in hip fractures
o age (66–85 and ≥86 yr)
o sex (male)
o number of co-morbidities (≥2)
o admission mini-mental test score (≤6 out of 10)
o admission haemoglobin concentration (≤10 g dl21)
o living in an institution
o presence of malignancy
List 4 complications with a traction table and hemi-lithotomy position
o Malrotation/malalignment o Pudendal nerve traction injury (1.9-27.6%) o Sciatic Nerve Injury o Common Peroneal Nerve Injury o Perineal Soft Tissue Injury o Crush Injury o Well leg compartment syndrome
List 5 causes of a cavovarus foot in an adult
- CMT
- CP
- Stroke
- Spinal Cord Lesion
- Post-traumatic – compartment syndrome, talar neck malunion
- Residual Clubfoot
- Idiopathic
List three considerations for successfully managing CVT in a minimally invasive fashion
I. Serial manipulations and casting
II. Percutaneous Kirschner wire fixation of TN joint
III. Percutaneous Achilles tenotomy
IV. Ankle foot orthosis with 15° plantar flexion in midfoot to be worn 23 hrs per day until walking, then when walking until 2 yrs old.
List 4 nerves to block in an ankle block
I. Superficial peroneal II. Deep peroneal III. Saphenous IV. Sural V. Tibial
List thee spinal conditions that have gadolinium enhancement
I. Osteomyelitis
II. Hemangioma
III. Post operative Scar tissue (to distinguish from disk tissue)
IV. Arteriovenous malformations
V. Mets
VI. Other Malignancies, lymphoma, osteosarcoma…
Order of ossification of the pediatric elbow (didn’t ask for age)
1 C – capitellum 1 yrs old 2 R – radial head 4 3 I – (internal) medial epicondyle 6 4 T – trochlea 8 5 O – olecranon 10 6 E – (external) lateral epicondyle 12
Chronic posterior shoulder dislocation; intra-op still unstable and large Hill-Sachs. List 4 ways to manage the Reverse Hill-Sachs.
I. Disimpaction with graft (if < 3 weeks old)
II. ORIF with moving lesser tuberosity (attached to subscapularis) into defect. (McLaughlin procedure)
III. Hemiarthroplasty
IV. Fresh or frozen humeral head allograft, sized to fit the defect
V. Capsular shift
VI. Arthroscopic modification to move the lesser tuberosity and subscapularis into the defect (Krackhardt)
What components make up Mirel’s criteria?
I. Location
II. Pain
III. Matrix (lytic, blastic, or mixed)
IV. Size
In soft tissue sarcoma, other than metastatic disease, what are the 3 most important determinants of a worse prognosis?
I. Large Size
II. High Grade
III. Deep location
4 Risk factors for SMA syndrome in peds scoliosis surgery.
Height
