SURGICAL MANAGEMENT OF TUMROS

Question 1

three most common benign tumors?

Answer 1

osteochondroma(most common), GCT, chondromyxoid fibroma

*enchondroma most common in small bones of hands and feet

Question 2

three most common malignant tumors?

Answer 2

chondrosarcoma, osteosarcoma, ewings sarcoma

*metastasis is rare below the knee, also 4x more likely to be benign than malignant

Question 3

name this type of bone biopsy?

incidence of false negative is high

relatively atraumatic procedure

provides cytologic specimen

Answer 3

fine needle aspiration biopsy

Question 4

gold standard bone biopsy?

-all tissue exposed during the biopsy is considered contaminated with tumor

maintain meticulous hemostasis
-release tourniquet

Answer 4

open biopsy

Question 5

what are the degree versions for the foot/ankle arthroscopy?

what is the central blind spot?

Answer 5

come in 0, 30, and 70 degree versions

70 degree version

Question 6

what is the technique for foot/ankle arthroscopy?

Answer 6

ankle is distended with 30 cc of saline

anteromedial portal is established just medial to ant Tib at joint level (avoid saphenous nerve)

anterolateral portal is established using transillumination (avoid superficial peroneal nerve)

Question 7

which of the portals is done first?

Answer 7

anterior-medial

Question 8

which nerve is most commonly injured?

Answer 8

superficial peroneal nerve

Question 9

this is 60% covered with cartilage (neck is fragile)

Answer 9

talus

Question 10

no muscle insertions explains?

Answer 10

lack of vascularization

stabilization problems with fractures

frequency of directly articular lesions and high risk of OA once there is an established injury

Question 11

incidence of talar dome is how common?

Answer 11

3rd most common after knee and elbos

Question 12

mechanism of injury of the of the talar dome OCD?

Answer 12

medial lesions tend to be more common

lateral lesions are more associated with trauma

DIAL A PIMP

• dorsiflexion inversion injury leading to anterolateral lesion
• plantarflexion inversion injury leading to posteromedial lesion

Question 13

little prognostic value and as many as 50% are missed on plain film

Answer 13

Bernt Harty (plain film)

Question 14

what are the operation choices for talar dome OCD?

Answer 14

marrow stimulation (micro fracture)

Question 15

this is the rationale that an articular defect is replaced with hyaline cartilage attached to its subchondral plate to allow bony integration of graft within the lesion bed?

Answer 15

OATS (osteochondral autograft transfer system)

autograft-higher morbidity

allograft-higher risk of rejection

Question 16

gold standard used for operation for talar dome OCD?

Answer 16

marrow stimulation (gold standard)