1. Home
  2. Flashcards
  3. Preview

MOCKS

  1. DDx of genu varum 4
    • Rickets
    • Blounts
    • MED
    • Post traumatic
  2. X ray findings of blounts 4
    • Medial beaking
    • Comment on physis
    • Drennan angle
    • Comment on distal femoral varus if present
  3. Work up for blounts 3
    • Skeletal survey
    • Endocrine/metabolic work up
    • MRI
  4. Case adolescent blounts with Genu varum surgical approach
    If no varus in femur: Proximal tibial opening wedge vs TSF

    If femur varus: need distal femoral lateral wedge closing osteotomy. Or distal femur medial opening wedge

    For large deformity need to cut fibula

    Prophylactic fasciotomy
  5. Peds valgus deformity that needs peroneal nerve release
    20 degree
  6. Indications for prophylactic pinning of SCFE 5
    • Age <10
    • Weight <50th percentile
    • Endocrinopathy
    • Unable to follow up
    • Renal osteodystrophy
  7. 3 complications of SCFE
    • FAI
    • Chondrolysis
    • AVN
  8. Lateral condyle # missed and displaced: mgmt
    Pin in situ: do not reduce
  9. Goal Coxa var correction
    Get hillgenreiners angle <30
  10. X ray vertebra plana in spine: Dx  (4)
    • MELT
    • Mets/myeloma
    • EG
    • Lymphoma/leukemia
    • Trauma/TB
  11. What is an adequate lateral x ray
    Volar portion of pisiform should be btw scaphoid distal pole and capitate

    Colinear distal
  12. Describe the risk factors for risk of reduction
    • Age > 60
    • Intra articular
    • Ulnar styloid
    • Initial translation >1cm / dorsal angulation > 20
  13. Distal radius x ray parameters: normal/acceptable
    • Radial height
    • Radial inclination
    • Step off
    • VOlar tilt

    • 11mm: <5mm shortening
    • 23 degrees: <5 degree change
    • congrous: <3mm step off
    • 11 degrees: dorsal angulation <5degrees or within 20 degrees of contralateral side
  14. Describe volar and dorsal approach to the distal radius
    Dorsal: btw 3 and 4 compartment.. protect and mobilize EPL incise capsule transverse to see the joint

    Volar: Modified FCR >>>BTW FCR and radial artery >>ake off pronator quadratus >>>make sure you protect the median nerve
  15. DDx radial sided wrist pain (5)
    • Scaphoid #
    • SLAC
    • SNAC
    • Dequervain tenosynovitis
    • Distal radius #
  16. Desribe 3 positive findings associated with SL disruption
    • Scaphoid cortical ring sign: scaphoid flexed
    • Increased SL distance > 3mm
    • SL angle > 60 degrees (normal 30-60_
  17. SLAC stages + treatment
    Stage 1: arthritis btw scaphoid and radial styloid >> radial stylectomy or PIN/AIN denervation

    Stage 2: Arthritis btw scaphoid and entire scaphoid facet >>> PRC , 4corner fusion

    Stage 3: Arthritis btw capitate and lunate >> 4corner fusion or wrist fusion
  18. What are the surgical options for reducible carpal malalignment
  19. What are the options for irreducible carpal malalingment
  20. What are the stages of S-L dissociation
    • Pre-dynamic: Partial tear
    • Dynamic: only seen on fluoro
    • Static: Seen on x ray
    • Fixed static: Seen on x ray but irreducible
    • SLAC
  21. Prior to DISI procedure what to think of
    • SL disruption or not
    • Reducible or not
  22. Wrist arthroscopy portals location + structures at risk
    3-4: distal to lister tubercle btw EPL and EDC >>first portal >>>>EPL and EDC tendons at risk

    4-5: In line with ring finger metacarpal btw  EDC and EDM ...portal for TFCC

    6R: Radial to ECU ...at risk is dorsal sensory branch of ulnar nerve

    6U: Ulnar to ECU ..dorsal sensory branch of ulnar nerve

    1-2: btw APL and ECRB ...superficial branch of radial nerve
  23. Mallet finger: deformity caused by
    Mechanism of injury
    • Disruption of terminal extensor tendon
    • Forced flexion of DIP
  24. Indications for surgical management of mallet finger
    Volar subluxation of distal phalanx: absolute

    • Relative: > 50% articular surface involved
    • >2mm articular gap
  25. Mallet finger describe non operative management
    Extension splinting of DIP x 6-8 weeks: Free movement of PIP


    • Avoid hyperextension
    • Volar splinting has less complitations
  26. Mallet finger: indication for fusion
    Painful, stiff, arthritic DIP joint
  27. 2 complications of mallet finger
    Extensor lag: toleaable if <10 degrees

    • Swan neck deformity: from attenuation of volar plate and transverse retinacular ligament at PIP > dorsal subluxation of lateral bands > PIP hyperextension
    • Contracture of triangular ligament
  28. Ddx of swan neck deformity 5
    • Mallet finger
    • FDS rupture
    • Intrinsic contracture
    • MCP joint volar subluxation
    • Rheumatoid arthritis
  29. SNAC classification + treatment
    Stage 1: arthrosis radial side of scaphoid ad radial styloid...Radial stylectomy + scapholunate reduction and stabilization

    Stage 2: scaphocapitate arthrosis + stage 1 ....PRC (avoid if capitate arthritis)...or 4 corner fusion

    Stage 3: Periscaphoid arthrosis PRC or 4corner fusion
  30. What to do with a chronic perilunate dislocation
    Chronic: > 8 weeks

    Need to do PRC
  31. Closed reduction manouver of perilunate dislocation
    Traction > extension and push on lunate followed by hyperflexion
  32. Describe mayfield classification
    For perilunate dislocation

    • Stage 1: SL dissociation
    • Stage 2: SL + lunocapitate disruption
    • Stage 3: SL + lunocapitate + lunotriquetral
    • Stage 4: lunate dissociated from lunate fossa
  33. 5 xray findings associated with perilunate dislocation
    • break in Gilula arc
    • Lunate and capitate overlap
    • Lunate is triangular: piece of pie sign
    • Loss of colinearity of radius lunate and capitate
    • SL angle > 70
  34. Principles of tendon transfer
    SEACOAST

    • Synergictic muscle function
    • Expendible
    • Adequate excursion
    • Contracture released
    • One muscle one function
    • adequate stenght
    • straight line of pull
    • Tissue equilibrium
  35. muscles innervated by PIN from prox to distal
    • Supinator
    • ECRB
    • EDCEDM
    • ECU
    • APL
    • EPB
    • EPL
    • EIP
  36. Location of PIN entrapment
    FLEAS

    • fibrous bands of RC joint
    • Leash of henry
    • ECRB
    • Arcade of Frohse
    • Supinator distal edge
  37. Name 4 findings that suggest primary OA
    • Subchondral sclerosis
    • Cyst
    • Joint space narrowing
    • Osteophyte
  38. TKA balancing what to do in the following scenarios: Tight in flex/ext
    Tight in flexion only
    Tight in extension only
    Loose in extension
    Loose in flex/ext
    • Did not cut enough tibia: cut more tibia
    • Did not cut enough posterior femur: decrease femoral component size (will need more resection
    • Did not cut enough distal femur: cut distal femur
    • Cut too much distal femur: augment distal femur
    • Cut too much tibia: use bigger poly or metal augments
  39. MSIS criteria for PJI
    Major

    • Sinus tract communicating with prosthesis
    • Pathogen isolated by culture from 2 separate tissue/fluid samples

    Minor

    • Elevated ESR >30 or CRP>10
    • Elevated WBC: >1100 knee, >3000 hip
    • Elevated PMN: >64% for knee, > 80% for hip)
    • Purulence of affected joint
    • Pathogen isolation of one culture
    • > 5 PMN per hpf in 5 HPF at 400X
  40. How to make antibiotic cement
    40g bag = 3g of vanco and 4g of tobramycin
  41. 6 causes of TKA failure requiring revision
    • Instability
    • Infection
    • HO
    • fracture
    • Asceptic loosening
    • Patelar maltracking
  42. 4 techniques to improve exposure in TKA
    • Quad snip
    • VY turndown
    • TT osteotomy
    • Debriding gutters/synovectomy
  43. Normal location of joint line
    • 1-1.5 above fibula
    • 2 cm distal to MCL
    • 2.5 cm distal to lateral epicondyle
  44. Name 5 elements of the frax score (12 total)
    FRAX: calculates the risk of another hip fracture within 10 years

    • Age
    • Sex
    • Weight
    • Height
    • Previous fracture
    • Parent fractured hip
    • Current smoking
    • Steroids
    • Rheumatoid arthritis
    • Secondary OA
    • Alcohol 3 or more units per dat
    • BMD
  45. How do you classify stability of uncemented femoral stems
    • Ingrown
    • Fibrous stable
    • Fibrous unstable
  46. Pre op work up for THA revision 3
    • Old reports
    • CBC ESR CRP
    • CT scan for bone stock
  47. Post operative plan following THA or TKA
    • Weight bearing status
    • Post op antibiotics
    • DVT prophylaxis
    • Physio
    • Follow up
  48. Describe physical examination findings of patient with trendelenburg
    Contralateral pelvis lowers with single leg stance

    Decreased ROM
  49. X ray findings of dysplastic Adult DDH
    • Break shentons line
    • Proximal femur anteversion
    • Widened tear drop
    • Meta-diaphyseal mismatch
    • Superolateral bone stock deficiency
  50. Pre operative assessment of patient with adult DDH had
    • Old reports
    • Anesthesia
    • IM: cardiac work up
  51. Intra op challenges of DDH hip 6
    Exposure: release glut max or TROCH OSTEOTOMY

    identify true hip center: Fluoro or find TAL

    Small cup size

    Superolateral bone stock: bone graft or augments

    Met-dia mismatch: modular stem (SROM) or taper fluted stem

    LLD: max lenghtening is 4 cm or 10% of femur size. D subtroch osteotomy shorten and cut overlap
  52. 6 risk factors for development of sciatic
    • Female
    • DDH
    • Revision
    • Post traumatic
    • LLD
    • Self reported as difficult
  53. Recovery rate post: Sciatic nerve palsy
    Femoral nerve palsy
    • 50%
    • 90%
  54. 2 options after long term foot drop following arthroplasty
    • Tendon transfer: tib post to dorsum
    • Ankle fusion: Neutral flexion, 5 degrees valgus, 5-10 degrees ER
  55. Most common intra op fracture in TKA
    Medial femoral condyle
  56. Contraindications to HTO 6
    • Flexion less than 90
    • Inflammatory OA
    • FFC 10 degrees
    • varus thrust
    • Morbid obesity
    • Fixed varus deformity greater than 15 degrees
  57. What is the main problem wth hinged TKA
    Asceptic loosening
  58. Parameters for DCO 8
    • ISS > 40
    • ISS > 20 with thoracic injury
    • AIS > 3 with head injury
    • IL 6 > 500
    • Hypothermia < 35
    • Persistent hemodynamic instability
    • Bilateral femoral shaft fracture
    • Pulmonary contusion on CXR
  59. How much uncoverage can you accept in an acetabular cup
    30%: If columns are not affected
  60. Describe leadbetter manouver
    • Flexion 90
    • traction adduction and IR
    • Circumbection bring to abduction and extension while maintaining IR
  61. List 3 radiographic criteria for determining a good reduction of a displaced femoral neck fracture
    • Garden index: 160-180
    • Double s shape in lateral x ray
    • Neck shaft angle 130-150 degrees
  62. DDx of thigh pain post THA
    • Infection
    • Instability
    • Asceptic loosening
    • Extrinsic causes hip pain
    • Tumor
    • ALVAL: Asceptic lymphocyte vasculitis associated lesion
  63. 3 sources of metal ions in THA
    • Metal on metal
    • Modular neck
    • Trunion
    • From impingement: not sure about this one
  64. Closed reduction hip manouver
    • Stabilize pelvis
    • Flexed knee: relax hamstrings
    • Inline traction with hip flexion
  65. list 6 causes of instability
    • Impingement
    • Detensioned abductors
    • Decreaed offset
    • Pseudotumor
    • Malpositioned cup
    • Malpositioned femur: small femoral head
  66. how do you classify loosening of cemented stems
    • Stable
    • Probably loose
    • Definitely loose: break in cement mantle, subsidence, broken stem
  67. Please name 2 nerve tension manoeuvres in LE?
    • SLR
    • Femoral nerve stretch test
  68. Name 5 UMN signs in spine
    • Hoffman
    • Babinski
    • Inverted brachioradialis
    • Scapulohumeral reflex
    • Hyperreflexia
  69. List 3 adjuncts techniques to place C7 pedicle
    • Navigation
    • Fluoro
    • Based on anatomical landmarks
  70. List 4 nerves at risk of ACDF?
    • Recurrent laryngeal nerve
    • C5
    • Hypoglossal nerve
    • Vagus
    • Superior laryngeal
  71. Describe 3 components of SLICS
    • Discoligamentous complex
    • Fracture morphology
    • neurology
  72. Hangman fracture: describe 3 fixation techniques to fix pars
    • C1-C3 fusion
    • ACDF: get ENT
    • Pars screw
  73. Odontoid fracture 3 fixation techniques
    • Harms screw: C1 LM + C2 pedicle
    • Transarticular C1-C2
    • Posterior wiring: need intact posterior arch
  74. 3 osteotomies to correct sagital inbalance and degree of correction of each
    • Ponte/Smith pete: 10 degrees per level
    • PSO: 30 degrees
    • VCR: 45 degrees
  75. Name 2 Rx for OA knee strongly recommended by AAOS
    • Tylenal/nsaids
    • Weight loss
  76. Name 4 contraindications for UKA
    • Tricompartmental OA
    • FFC > 10
    • Flexion <90
    • Inflammatory OA
    • Deficient ACL
    • Non correctable coronal plane deformity
    • Morbid obesity
  77. Patient wants bilat. TKA simultaneously
    How would you council this patient?
    • More mortality-cardiac and PE/DVT risk
    • Higher risk of transfusion and infection
  78. Name 4 levels of constraint in TKA
    • CR
    • PS
    • CCK
    • Hinged
  79. 3 Indications for hinged knee?
    • Global ligamentous deficiency
    • MCL attenuation
    • Hyperextension
  80. Name 2 patient factors and 2 surgical factors that decrease ROM post op
    Patient

    • Pre op ROM
    • COmpliance to PT
    • CRPS

    • Surgical
    • Joint elevation
    • Overstuffing patella
    • Oversized components
  81. Components of SINS score
    • Location
    • Functional pain
    • Matrix
    • Spinal alignment
    • VB collapse
    • Posterolateral involvement of spinal elements

    • Unstable if > 13
    • Stable <6
  82. Name FIVE non-orthopaedic manifestations of Down’s syndrome
    Macroglossia

    Developmental delay

    Epicanthic folds

    Cogenital heart disease

    Duodenal atresia

    Hirschsprung’s disease
  83. Name FIVE orthopaedic manifestations of Down’s syndrome
    • Ligamentous laxity
    • OC instability
    • Cervical instability
    • Scoliosis
    • Spondylolisthesis
    • Hip subluxation
    • Pes Planus
    • Hallux valgus
  84. What are the indications for surgical management of this problem in DS kids?
    • Neurology
    • SAC <14
    • Cord compression on MRI
    • ADI > 10
  85. What are the indications for pinning a DR fracture in peds?
    • Unable to maintain adequate reduction
    • Ipsi SCH
    • Ipsi compartment
    • Open
  86. You attempt a CRPP of a type 3 SCH # and find that after pinning the hand appears white and feels cold. Outline your next steps
    • Remove pins
    • Extend
    • Examine reduction
    • Open if
  87. Describe your open approach to the antecubital fossa for SCH#
    • Proximal medial across fossa distal lateral
    • Plane btw PT and BR
    • Relese lacertus fibrosus
    • Open reduction
  88. What are radiographic features of OI
    • thin cortices
    • generalized osteopenia
    • saber shins
    • skull radiographs reveal wormian bones
  89. What is the difference between Panner’s and OCD?
    Unlike OCD, Panner disease is not associated with trauma and is seen almost exclusively in boys aged <10 years.

    Panner disease exhibits an irregular epiphysis, OCD a well-defined subchondral lesion
  90. Risk factors for DDH
    • Frank breach
    • Female
    • Family Hx
    • First born
    • Oligohydramnios
  91. What conditions are associated with DDH? (3)
    • Torticollis
    • Metatarsus adductus
    • Congenital knee dislocation
  92. 4 physical exam findings in DDH < 3 months
    • Thigh gluteal folds
    • Ortolani, barlow, galeazzi
    • ROM: decreased abuction
    • Spine for defects
  93. What is the normal: alpha angle
    Beta angle
    • > 60
    • <55
  94. How is the Pavlik applied?
    • Chest band at nipple lines
    • Anterior straps to prevent extension: 95 degrees
    • Posterior anti adduction straps: goal 50 degrees
  95. Risk with excessive: flexion in Pavlik?
    Excessive abduction
    • Femoral nerve palsy
    • AVN femoral head
  96. What is the position for Spica casting? for DDH
    Human position: 100 flexion, 45 abduction
  97. 6 blocks to reduction in DDH
    • Inverted labrum
    • Inverted limbus
    • TAL
    • Pulvinar
    • Ligamentum teres
    • Hip capsule/iliopsoas
  98. Treatment for CRMO
    NSAIDS +/- bisphosphonates
  99. Name 3 closed reduction manouvers for radial head fracture in peds
    Patterson: hold the elbow in extension and apply distal traction with the forearm supinated and pull the forearm into varuswhile applying direct pressure over the radial head

    Israeli technique: pronate the supinated forearm while the elbow is flexed to 90° and direct pressure stabilizes the radial head

    elastic bandage technique: tight application of an elastic bandage beginning at the wrist continuing over the forearm and elbow may lead to spontaneous reduction
  100. Indications for operative intervention in radial head fracture (3)
    • > 30 degrees angulation
    • 3-4 mm translation
    • < 45 degrees pro/sup
  101. List 4 complications of radial head fractures in peds
    • Decreased ROM
    • Radail head overgrowth
    • AVN
    • synostosis
  102. Which benign aggressive tumors can metastazie to the lungs
    • GCT
    • Chondroblastoma
  103. Name conditions/syndromes associated with fibrous dysplasia
    Mazabraud syndrome: Intramuscular myxoma and FD

    McCune-Albright syndrome: Precacious puberty
  104. DDx of AARD
    • Grisel
    • Trauma
    • Down syndrome
    • RA
    • Tumor Congenital
  105. 3 things for an adequate hip US
    • Flat ilium
    • Can see labrum
    • Can see Ischium
  106. List 3 complications of operative management of lateral condyle fracture
    • Stiffness
    • AVN capitellum
    • Cubitus Valgus
  107. Describe operative approach for ped lateral condyle fracture
    Kocher approach: Anconeus/ECU, proximally btw triceps and BR

    Preserve posterior blood suppply

    • Visuailize and rduce articular surface
    • Fixation with 2- k wires
  108. What are Prognostic Indicators of Outcome in Patients With Legg-Calvé-Perthes Disease (4)
    • Age >6
    • Lateral pillar
    • 2 or more head and risk signs
    • Aspherical femoral head
  109. Non-orthopaedic manifestations of Sickle Cell 7
    • Anemia
    • Aplastic crisis
    • Splenomegaly
    • Infections
    • Acute Chest syndrome
    • Pulmonary hypertension
    • Cerebrovascular events
  110. Orthopaedic manifestations of Sickle Cell
    • Dactylitis (swollen hands and feet)
    • OM
    • Septic arthritis
    • AVN
    • Bone infarcts
    • Growth retardation
  111. List two types of bladder ruptures and management
    • Extra peritoneal: Foley
    • Intra peritoneal: repair
  112. List the treatments that the Rheumatologist will likely initiate for JIA
    • NSAIDs: Ibuprofen or Naproxen
    • DMARDs: Methotrexate (first line)
    • Biologic Agent: TNF-α antagonist (if failed trial of MTX)
  113. Patient has JIA who to refer to
    • Rheumatology
    • Ophthalmology
  114. What is Stills Disease?
    • Systemic juvenile idiopathic arthritis
    • Fever
    • Arthritis
    • Rash
    • Lymphadenopathy
  115. Describe a closed reduction maneuver to treat peds medial epicondyle displaced fracture
    • Valgus stress on the elbow
    • Supinate the forearm
    • Simultaneously dorsiflexing the wrist and fingers to place the forearm muscles on stretch
  116. You continue to follow the patient after his treatment. What radiographic findings will suggest a growth disturbance of the distal radius
    • Physeal bar
    • Increasing ulnar positive variance
    • Park-Harris lines at the distal radial metaphysis
  117. What radiographic parameters can be used to assess degree of displacement and/or adequacy of reduction in a supracondylar humerus fracture
    • Anterior humeral line: Should bisect middle third of capitellum
    • Baumann's angle: 70-75 degrees...compare to contralateral
  118. What nerve injuries are associated with a distal fragment that is rotated
    a) posterolaterally;
    b) posteromedially; and,
    c) with a flexion type?
    • Posterolateral: AIN
    • Posteromedial: PIN
    • Flexion: Ulnar nerve
  119. Describe approach for lateral condyle ORIF peds
    Anterolateral distal humerus approach along supracondylar ridge btw tricep and brachialis
  120. In the setting of a congenital leg length discrepancy, what are three different ways to predict ultimate discrepancy at skeletal maturity
    • Multiplier method
    • Moseley straight line graph
    • Green-anderson tables
  121. What are four risk factors for obstetrical brachial palsy
    • Large baby
    • difficult presentation
    • shoulder dystocia
    • forceps delivery
    • breech position
    • prolonged 2nd stage labor
  122. Neurotization: what type of lesion is it for
    Pre ganglionic
  123. What are four possible donor nerves in neurotization
    • intercostal nerves
    • spinal accessory nerve
    • phrenic
    • contralateral C7
    • hypoglossal
  124. What position would this child’s wrist and MCP and IP joints be in (3) (kid has klumpke's plasy
    • MCP: extended
    • IP joint: flexed
    • Wrist extended
  125. What are the nerve roots of the nerve that innervates serratus anterior
    Long thoracic C5-6-7
  126. 4 complications of pinning scfe
    • AVN
    • chondrolysis
    • Slip progression
    • Infection
  127. 3 causes of acute hemarthosis in kids
    • ACL
    • Meniscal tear
    • Patellar dislocation with osteochondral fracture
  128. Mom would like to know 3 specific complications related to treatment of this fracture (patellar tendon sleeve avulsion)
    • Patella alta
    • extensor lag
    • stiffness
    • hardware irritation
  129. Muscles innervated by ulnar nerve
    • FDS 4 nd 5
    • Hypothenar muscle group: Opponens/abductor/flexor DM
    • Adductor pollicis
    • Intrisics
    • Medial 2 lubricals
    • FCU
  130. Toe walker physical exam 8
    • Gait
    • Spine instpection
    • Neurological assesment
    • LLD
    • ROM: silverskiold
    • Gower sign
    • Calf pseudohypertrophy
  131. Toe walking DDx 6
    • Cerebral palsy
    • Spinal cord anmaly
    • Duchenne
    • Idipathic
    • Autism
    • CMT
    • Congenital contracture achilles
  132. Duchennes 2 systems to investigate pre op
    • Cardiac
    • Resp
  133. What anesthetic agent should you not use? Why (in duchennes)
    Acetylcholine: because there is a risk of life-threatening hyperkalemic cardiac arrest or severe rhabdomyolysis
  134. Toe walker with duchennes: what surgery to do as well
    • TAL
    • Tib post to mid dorsum to prevent recurrence of equinocavovarus
  135. Non operative management of idiopathic toe walking
    –Heel cord stretching

    –Physiotherapy.

    –Nighttime ankle-foot orthoses (AFOs)

    –Botox injection
  136. What are the abnormalities expected in this foot? (CVT)
    • Dorsally dislocated navicular
    • Eversion of calc
    • Contractor of dorsolateral structures
    • Tight achilles
    • Attenuation of spring ligament
  137. List 5 associated conditions of congenital vertical talus
    • SMA
    • CP
    • Myelomeningocele
    • Arthrogryposis
    • Larsen
  138. List 6 conditions associated with pediatric pes planus
    • Physilogic
    • Oblique talus
    • CVT
    • Tarsal coalition
    • Marfans
    • Accesory navicular
  139. Cleidocranial Dysplasia: Gene resposible
    Run x2
  140. List 4 findings in rickets
    • Bowing
    • Metaphyseal cupping
    • Loosier liners: radiolucent lines in concave cortex of bones
    • Decreased bone density
    • Prominence rib heads
  141. How to judge position of tibial tunnel in ACL
    Should be posterior to blumensats line
  142. What is double and triple varus in context of ACL + treatment for each
    Double varus: varus alignment + ligamentous laxity...HTO + ACL recon

    Triple varus: varus alignment +varus laxity + PLC laxity....HTO + ACL + PLC recon
  143. 2 physical exam for elbow MCL
    • Moving valgus test
    • Milking manouver
  144. Signs of sacral dysmorphism
    • Residual S1-2 disc
    • Foramina not round
    • Mamillary process s1/underdevelopped 
    • Superior alar slope is steeper in 2 planes
  145. 3 types of FAI
    • CAM
    • Pincer
    • Mixed
  146. 3 x ray signs of pincer impingement
    • Cross over sign
    • Posterior wall sign
    • Prominent ischial spine
  147. 3 x ray signs of CAM impingement
    • Head neck ratio < 0.17
    • Alpha angle  >40
    • Aspherical femoral head
  148. Surgery for Crouch gait
    Hip: derotation for anteversion + soft tissue (adductor and psoas)

    Knee: SOft tissue release for hamstring, PTA, Extension osteotomy

    Tibia: TAL, SMO
  149. Panner x ray findings 3
    • Entire capitellum involved
    • Ruffled lucency under capitellum
    • Absence of OCD
  150. Surgery for radial club hand with complete absence of radius
    Ulnar centraliztion
  151. Differences btw panner disease and OCD: Age
    Size
    Loose bodies
    Treatement
    Prognosis
    • <10/>10
    • Entire capitellum/focal area
    • No/Yes
    • non op/variable
    • Excellent/variable
  152. List 3 conditions associated with tarsal coalition
    • PFFS
    • Apert syndrome
    • Fibular hemimelia
  153. List 4 complications of limb lenghtening
    • Infection
    • Non union
    • Fracture
    • Premature consolidation
  154. In PFFD what 2 things must be assessed before surgery
    • Stability of knee
    • Stability of hip
  155. Describe how to determine the safe zone
    Arc of motion through which the hip remains reduced.
  156. What is the super hip procedure
    • Soft tissue release: Abductor 
    • Valgus osteotomy
    • Acetabular procedure
  157. 3 advantages of PAO
    • Immediate weight bearing
    • Does not change true pelvis
    • Large correction
  158. labs to order for rickets
    • Calcium
    • Phosphate
    • Vit D
    • Alk phos
    • PTH
  159. Nutritional Vit D deficiency lab values
    • Calcium: low
    • Phosphate: low
    • Vit D: low

    • Alk phos: High
    • PTH: High
  160. Familial hypophosphatemic rickets
    • Calcium: normal
    • Phosphate: low
    • Alk phos: high
  161. How does the blood supply to the femoral head differ in this 6 year old patient compared to when he was 3?
    After age 4, the contribution from ligamentum teres diminishes


    The contribution from the lateral femoral circumflex to the epiphysis also significantly reduces, making the lateral femoral circumflex the main contributor to the proximal femoral metaphysis


    The medial femoral circumflex becomes dominant supply to epiphysis via its posterosuperior and posteroinferior retinacular branches
  162. Chemotherapy for: osteosarcoma
    Ewings
    Osteosarc: MAC >>> methotraxate, adrimycon, cis platin

    Ewings: VAC ......Vincristine, adriomycin, cisplatin
  163. Symptoms of hypercalcemia 7
    • Polyuria
    • Polydypsia
    • Bone pain
    • Abdominal pain
    • nausea
    • Vomiting
    • CNS depression
  164. EKG finding hypercalcemia
    • Peaked t waves
    • Short QT
  165. Management of hypercalcemia 5
    • FOrced diuresis: bolus 3L NS then 200-300 cc/hr
    • Calcitonin
    • Bisphosphonates
    • Forced diuresis
    • Dyalisis
  166. Name 2 tumors responsive to rads
    Name 2 tumors unresponsive rads
    • Prostate, breast
    • Kidney, thyroid
  167. 3 conditions with multiple soft tissue masses
    • NF
    • Mafucci
    • Mazabraud
  168. Recurrence rate of ABC
    • up to 25%
    • High risk when physis open
  169. Mortality of ewing sarcoma after local recurrence
    90%
  170. Name 5 features of rheumatoid hands
    • Nodules
    • MCP ad PIP OA
    • Ulnar deviation fingers
    • Radially deviated metacarpals
    • Swan neck
  171. DDx RA cannot extend fingers
    • Sagital band rupture: ulnar subluxation of extensor tendon
    • Vaughn jackson
    • PIN palsy
  172. 4 pre op consideeration for RA
    • Stop biologics
    • Stress dose steroids
    • Anesthesia consult
    • C spine x rays
  173. 3 spine deformities in rheumatoid spine
    • occipitocervical instability
    • Subaxial instability
    • Atlanto axial instability
  174. What is the Ranawat classification?
    I: pain

    II: subjective weakness

    IIIa: objective weakness, still ambulatory

    IIIb: non-ambulatory
  175. Surgeries possible for THUMB in RA 3
    • Fuse: MCP, IP
    • CMC arthroplasty
  176. Surgery for boutonniers
    Fowlers tenotomy or fusion
  177. 2 indications for Thumb UCL injury ORIF
    • Stenner
    • Opening more than 35 degrees
  178. How to do a proximal shortening osteotomy for abutment
    –Subcutaneous approach to ulnar between FCU and FCR 2-3cm proximal to DRUJ

    –Longitudinal scoring of bone to maintain rotational alignment.

    –Pre drill for 3.5mm LCDCP plate with six cortices distal to osteotomy ensuring no DRUJ penetration  

    –Resect enough bone to result in ulnar neutral variance

    –Afix plate to bone in compression mode

    –Splint x2/52 then cast x4/52
  179. What are the arcs of Gilula? (1)
    –Curves produced by the anatomic alignment of the carpal bones
  180. What is the difference between greater arc and lesser arc perilunate instability? (1)
    Through bone vs. isolated ligamentous injury
  181. What are X ray features of carpal instability (5)
    –Scapho-lunate widening

    –Foreshortened scaphoid

    –Signet Ring sign

    –Loss of colinearity between capitate, lunate, DR

    –Spilled Tea cup sign of Lunate
  182. bennet fracture reduction manouver
    TAPE

    • Traction
    • Abduction
    • Pronation
    • Extension
  183. Describe carpal height ratio
    Lenght of capitate+ lunate divided by lenght of 3rd metacarpal (should be more than .54)
  184. Please list radiographic features consistent with this injury. (Scapholunate injury)
    • Scapholunate diastasis (>3mm)
    • Cortical ring sign
    • Scaphoid shortening

    • Increased scapholunate angle (>70 degrees)
    • Increased radiolunate angle (>15 degrees)
  185. Please describe your surgical management of a complete SL injury in the following clinical scenarios (3):
    –Acute injury (<12 weeks), no static deformity
    –Acute injury (<12 weeks), static deformity
    –Chronic injury (>12 weeks), static deformity
    Immobilize for 6 weeks; some favour arthroscopy-assisted percutaneous pinning for 6-8 weeks

    Primary open repair, possible Blatt capsulodesis

    Intercarpal fusion (RASL), possible Blatt capsulodesis; other options include open repair (if amendable), FCR tenodesis (Brunelli), ECRL tenodesis (Linscheild), Blatt in isolation, or an intercarpal ligament capsulodesis
  186. RASL procedure
    • Remove styloid tip
    • Denude cartilage scaphoid and lunate then put a screw acrosss lunate and scaphoid
  187. 2 options for chronic scapholunate injury
    • Bunelli: FCR slip ligament recon
    • RASL: screw across SL joint
  188. Describe four general radiographic features (hand and wrist x-ray) that would support the diagnosis of Rheumatoid Arthritis?
    • Diffuse osteopenia
    • Joint subluxation
    • DRUJ erosion
  189. Name FOUR possible causes for lack of extension of ring and little fingers?
    • Rupture of EDQ and EDC to ring and little finger
    • MCP joint dislocation
    • Extensor tendon subluxation (due to sagittal band rupture)
    • PIN Palsy
  190. 4 test to distinguish cause of inability to fully extend fingers in RA
    MCP dislocation: Lack passive full extension

    Ext tendon subluxation: Can maintain full extension after bringing the wrist to full extension (relocates extensor tendon)

    Vaughn jackson: Tenodesis effect

    PIN: Inability to extend IP thumb and wrist radial deviation
  191. Surgery for vaughn jackson 2
    EIP to EDC 4/5

    EDC 4/5 to EDC 3 side to side
  192. Describe the site that contributes to attritional disease for the following tendons
    EDM/EDC
    EPL
    FPL
    • EDM/EDC: Caput ulna
    • EPL: Lister tubercle
    • FPL: Distal scaphoid
  193. What is the blood supply to the scaphoid? 2
    Dorsal carpal branch (major) and minor supply from superficial palmar arch
  194. Difference btw PRC and 4CF
    • 4CF: better strength
    • PRC: better ROM

    Both less than normal
  195. Deforming forces  in bennet fracture
    • Adductor pollicis -> adduction
    • Abductor pollicis longus -> lateralizes
    • EPL -> shortens
  196. CRPP bennet location of pins
    interfrag pins if needed, MT-trapezoid, 1st MT-2nd MT. Thumb spica cast. 6 weeks.
  197. Please briefly describe a trapezial resection and LRTI.
    Expose the CMC joint through a triradiate incision along the radial border of the thumb metacarpal

    Protect NV structures
  198. Tendon transfer ulnar nerve palsy
    • Thumb adduction: FDS4 to adductor pollicis
    • Finger abduction: ECRL to dorsal interosseous
    • Clawing: ECRL to lateral bands of ulnar digits
  199. Radiologic criteria for madelungs 3
    • Ulnar tilt
    • Lunate subsidence
    • Volar carpal subluxation
    • Lunate fossa angulated
  200. X ray to diagnose SL dissociation
    Clenched fist view
  201. What is the clinical exam maneuver and please describe? for SL dissociation
    Watson shift test: Ulnar to radial deviation with palmar pressure produces pain or a click.
  202. Gold standard for dx of SL injuries
    Arthroscopy
  203. What are the main volar ligaments of the wrist that provide stability? (2)
    • Radioscaphocapitate lig
    • Radiolunate (long)
  204. Dx if you have long radiolunte ligament
    Vicker's ligament: for madelung
  205. What are your options for early SLAC wrist? (3)
    –RASL (reduction-association scapholunate)

    –BLATT

    –Triligament reconstruction (Brunelli)
  206. What is a contraindication for PRC? (1)
    • What is a contraindication for PRC? (1)
    • Scaphocapitate ligament disruption
  207. Dupuytren’s: Please list five risk factors? (5)
    • North European
    • Alcohol
    • Anti Seizure medication
    • HIV
    • Diabetes
  208. Name 5 indications to acutely ORIF a scaphoid? (8 total)
    • Open #
    • Unstable pattern – vertical/oblique
    • Proximal pole
    • Associated perilunate injury
    • Displaced >1mm
    • Humpback deformity – intrascaphoid angle >35
    • DISI – SL angle >70, radiolunate angle > 15
    • Comminuted
  209. Non operative management of CMC OA (3)
    • Activity modification
    • SPlinting
    • Steroid injection
  210. Fusion position for CMC joint
    • 35 radial abduction
    • 30 palmar abduction
    • 15 pronation
  211. List 5 unloading procedures for Stage 2 or 3A early stage Kienbocks
    • Radial shortening
    • Ulnar lenghtening
    • Capitate shortening
    • Distal radius core decompression
    • STT fusion
  212. Describe a PRC
    • Dorsal approach 3-4th compartment
    • Inverted T capsulotomy
    • Remove proximal row: Scaphoid, Lunate, Truquetrum
    • Preserve radioscaphocapitate ligament
    • Close capsule
  213. 4 x ray signs of perilunate dislocation
    • Spilled teacup sign
    • Triangular lunate
    • Scaphoid ring sign
    • Break in giula's arc
  214. Enneking classification of benign bone tumors (3)
    • Latent
    • Active
    • Aggressive
  215. 4 risk factors for failure injection steroids for UBC
    • Calc
    • Age < 6
    • Large lesions
    • Multiple septations
  216. Two forms of disseminated Histiocytosis
    • Hans-schuller-christian
    • Letterer-siwe disease
  217. What is the most common primary malignancy of bone?
    myeloma
  218. What are the types of malignant transformation? for fibrous dysplasia
    MFO

    • MFH
    • Fibrosarcoma
    • Osteosarcoma
  219. What are two characteristic findings with respect to the pain associated with osteoid osteoma? (3 total)
    • Worse at night
    • Better with NSAID's
    • Worse with ETOH
  220. What are three contra-indications to RFA in osteoid osteoma treatment?
    • Closed to spinal cord or nerve oots
    • Previous faield RFA
    • Neuro symptoms
    • Fixed deformity
  221. 3 questions for IPV
    • Lead in: IPV is very common
    • Have you been hit in the past year
    • Do you feel safe
    • Is there a partner from a previous relationship who is making you feel unsafe
  222. What is the characteristic triad of TB arthropathy (3) and what is the name of this triad (1)?
    Phemister triad


    Juxtaarticular osteoporosis,

    Peripherally located osseous erosions, and

    Gradual narrowing of the joint space
  223. List 4 tests you would order to rule out Tuberculosis arthropathy?
    • CXR
    • Biopsy
    • AFB
    • Tuberculin test
  224. Chondrosarcoma: risk factors 5
    • Osteochondroma
    • MHE
    • Enchondroma
    • Olliers
    • Maffuci
  225. Radial nerve transfers
    • PL to EPL
    • PT to ECRB
    • FCR/FCU to EDC
  226. 3 early and 3 late risks with radiotherapy
    Early: wound healing, infection, desquamation

    Late: fibrosis, contractures, AVN, secondary sarcoma, fracture
  227. Risk factors for THA infection (8)
    • Post-operative surgical site infection
    • Wound healing complications
    • Malignant disease
    • Prior surgery or infection of the joint or adjacent bone
    • Perioperative nonarticular infection
    • Rheumoid arthritis
    • Psoriasis
    • Diabetes
    • Smoking
  228. Which two antibiotics and dose can be added to a 40g bag of cement?
    • Vancomycin 3g
    • Tobramycin (or Gent) 4g
  229. What antibiotic properties are necessary for the use with cement (4)?
    • Heat stable
    • Bacteriocidal
    • Good elution profile
    • Non toxic at high doses
    • Broad antibiotic coverage
  230. Risk factors for intra-op fracture (hip periprosthetic)?
    1)Impaction bone grafting

    2)Osteoporosis

    3)Revision requiring removal components

    4)Minimally invasive techniques

    5)Uncemented press-fit technique
  231. 4 risk factors for post op hip periprosthetic fracture
    1)Osteoporosis

    2)Recurrent falls

    3)Malposition implants – varus stem placement

    4)Revision procedures
  232. Identify risk factors to extensor mechanism disruption following a TKA 5
    • Revision surgery
    • Previous HTO
    • Renal disease, Diabetes, RA
    • Obesity
    • Trauma
  233. Adjuncts that can be used to assist with TKA exposure (3)
    • Quad snip
    • Tibial Tubricle osteotomy
    • V-Y turndown (last resort, bad outcome)
  234. Classification of tibial fractures after TKA (4)
    • Type I: tibial plateau
    • Type II: fracture in metaphysis to tip of implant
    • Type III: fracture distal to implant
    • Type IV: fracture of tibial tubercle
  235. What are the typical reconstruction options of Extensor mechanism disruption in TKA
    • Autograft with semitendinosus tendon
    • Allograft with Achilles tendon with a bone block of the calcaneus
    • Whole EM allograft (proximal tibia, patellar tendon, patella, quad tendon)
  236. Position of knee fusion
    If less than 2cm LLD: 15 degrees flexion, 5-7 degrees vagus

    2-4 cm LLD: full extension

    >4 cm LLD: Use allograft to decrease LLD
  237. What is your exam of peripheral nerves for lower extremity?
    –Tibial – sensory plantar foot, motor plantar flexion ankle

    –SPN – sensory top of foot, motor ankle dorsi

    –DPN – sensory 1st webspace, motor 1st toe dorsi

    –Saphenous – sensory medial calf

    –Sural – sensory lateral
  238. What are soft tissue coverage options in Lower LEG?
    –Upper tibia = medial gastrocs

    –Middle tibia = soleus

    –Distal tibia = free
  239. Fresh water open fracture
    Salt water open fracture
    • Add cipro
    • Add doxycocline
  240. Describe closed reduction of talus fracture
    • Supine
    • Flex knee to relax gastrocs
    • Attempt closed reduction by plantar flexion ankle and direct pressure
  241. How do you improve exposure surgical approach Talar dislocation?
    Medial mal osteotomy
  242. Contraindications to closed reduction facet dislocation
    • Distracting MSK injury
    • Ext/distraction injury
    • Pt not cooperative 
    • Obtunded patient
    • Multilevel C spine injury
  243. Describe gardner wells pin placement
    1 cm above pina in line with external auditory canal
  244. What nerve roots make up the radial nerve?
    C5-T1
  245. What space/interval does the radial nerve nerve travel to as it descends the arm and what are its borders?
    • Superior: Teres Major
    • Medial: Long head of triceps
    • Lateral: Humeral shaft
  246. Name 3 things to identify the soft tissues are ready for definitive fixation
    1)Wrinkle sign present

    2)Re-epithelialization of fracture blisters

    3)No signs of infection
  247. Describe placement of: Needle for tensio pneumo
    Chest tube
    • 2nd intercoastal midclaviclar line
    • 5th intercoastal midaxillary line
  248. Becks triad
    • Muffle heart sounds
    • Distended neck veins
    • Hypotension
  249. External fixator stability increased by (5)
    • End-to-end contact of fracture fragments (#1)
    • Larger diameter pins (#2)
    • Larger diameter rods
    • Increased number of pins
    • Increased number of rods
    • Pins in different planes
    • Rods in different planes
    • Decreased bone-rod distance
    • Increased spacing between pins
  250. Where is Anterolateral interval, and what are the dangers? (2) (to distal tibia)
    • Between Peroneus Tertius and Peroneus Brevis (fibula)
    • SPN (possibly DPN and tib ant artery)
  251. What are the advantages of autogenous bone graft? (3)
    • Osteoinductive
    • Osteoconductive
    • Osteogenic
  252. What are disadvantages of autogenous bone graft? (3)
    • DOnor site morbidity
    • Finite supply
    • Possible graft resorption
  253. What are other physical exam findings of a tension pneumothorax? (5)
    –piratory distress

    –Unilateral absent breath sounds

    –Subcutaneuous emphysema

    –Neck vein distension

    –Hypotension/tachycardia
  254. List 4 factors associated with loss of reduction of distal radius fractures
    –Age (older = worse) – MOST IMPORTANT

    –Metaphyseal comminution

    –Radial shortening (aka ulnar variance)

    –Initial displacement (NOT DORSAL ANGULATION)
  255. List 4 indications for IM nail for humeral shaft fractures
    –medically unstable patient to avoid a large exposure

    –multiply injured patient to limit positioning changes

    –segmental fractures

    –pathologic fractures
  256. What are the advantages of IMN over ex-fix primarily? for tibial shaft fracture
    Superior maintenance of alignment

    Lower secondary surgery rate

    Better tolerated by patients
  257. Name and describe three physical exam maneuvers for PMRI
    Valgus stress test

    Moving valgus stress test

    Milking maneuver
  258. Deforming forces for proximal humerus
    • Proximal fragment: supra/infraspinatus
    • Distal: Deltoid, pec major
  259. What are the RFs for AVN in these fractures?
    Disruption medial hinge >2mm

    Medial metaphyseal extension <8mm

    Head smash bad

    Fracture-dislocation bad
  260. What are the advantages of opening-wedge versus closing-wedge osteotomies for this malunion? for distal radius
    Opening: corrects ulnar variance as well but needs bone graft

    Closing: no need for bone graft, get direct bone-on-bone contact, but need separate ulnar osteotomy
  261. Approach to Cubital fossa:
    –Supine, tourniquet

    –Curvi-linear incision medial border biceps to medial border brachioradialis crossing flexion crease obliquely

    –Watch for lateral cutaneous nerve between biceps and brachialis

    –Incise lacertus (artery runs directly beneath)
  262. Indicators of adequate resuscitation
    • MAP > 60
    • HR < 100
    • urine output 0.5-1.0 ml/kg/hr (30 cc/hr)
    • serum lactate levels: most sensitive indicator as to whether some circulatory beds remain inadequately perfused (normal < 2.5 mmol/L) 
    • gastric mucosal ph
    • base deficit
  263. List the components of the Denis 3 column system:
    Anterior column: ALL, anterior 2/3 VB

    Middle: PLL, posterior 1/3 VB

    • Posterior: Pedicle, lamina
    • facet,LF
    • SP, PLC
  264. List the components of the posterior ligamentous complex
    –supraspinous ligament

    –interspinous ligament

    –ligamentum flavum

    –facet capsule
  265. TLICS
    • Neuro
    • PLC involvement
    • Fracture morphology
  266. describe foot faciotomies
    3 incisions

    Medial: 6 cm incision starting 4cm anterior to posterior heel and 3cm superior to plantar foot. Releases medial, superficial and deep central, and lateral compartments

    2 dorsal incisions:Medial to 2nd, lateal to 4th..release interosseous and adductor compartment
  267. List 5 complications of untreated foot compartment syndrome
    • CRPS
    • Claw toe
    • Stiffness
    • Hammer toe
    • Insensate foot
  268. Coxa vara peds: indications for surgery

    Goal for surgery
    • HE angle > 60
    • Hip pain and trendelenburg

    Goal HE < 38
  269. Reimer migration index: <33%
    >33%
    >100%
    Indication for soft tissue
    Indication for bony
    Salvage procedure
    • Hip at risk
    • Subluxed hip
    • Dislocated hip
    • Reimers 40% children < 4
    • Reimers > 60% age >4
    • Valgus support
  270. List 4 radiographic findings of a distal radius fracture/wrist that may indicate a Galeazzi Type injury:
    • Radius Fracture within 7.5cm on DRUJ
    • Ulnar styloid fx
    • Widening of joint on AP view
    • Ulna Dorsalor volar displacement on lateral view
    • Radial shortening (≥5mm)
  271. What muscles does the Median Nerve innervate in the hand?
    • 1st and 2nd lumbricals
    • Opponens pollicis
    • Abductor pollicis brevis
    • Flexor pollicis brevis (superficial head)
  272. What are the boundaries? of the carpal tunnel
    –Radial Border: scaphoid tubercle and trapezium

    –Ulnar Border: hook of hamate and pisiform

    –Roof: transverse carpal ligament

    –Floor: proximal carpal row
  273. Please list the indications to intubate a trauma patient. (4)
    • Apnea
    • Glasgow Coma Scale < 9 or sustained seizure activity
    • Unstable mid-face trauma
    • Airway injuries
    • Large flail segment or respiratory failure
    • High aspiration risk
    • Inability to otherwise maintain an airway or oxygenation
  274. What are major sources of blood loss in trauma? (4)
    –Scalp and skin (especially small children)

    –Chest

    –Abdomen

    –Long bones

    –Pelvis

    –Retroperitoneum
  275. The patient asks you what his risk of AVN is and what the single most important factor is that determines AVN risk? (2) (FN #)
    • 20-45% for displaced femoral neck fractures
    • Appropriate reduction
  276. Describe lateral column approach for HO
    Kocher for back and start to use the interval of the triceps and humerus

    For front: ECRL/ECRB but will require a release of BR and ECRL from humerus
  277. Name the Interval?: Kocher
    Boyd
    Thompson
    • ECU/Aconeus
    • Aconeus/Ulna
    • EDC/ECRB
  278. List complications on ceramic on ceramic poly (5)
    • Ceramic Fracture
    • Squeaking
    • Less modularity
    • Stripe Wear: contact between the femoral head and rim of the cup during partial subluxation
    • Failure Secondary to Head—Neck Taper Mismatch
  279. Name 5 risks associated with blood transfusion?
    • Blood borne
    • TRALI
    • Anaphylaxis
    • Bacterial contamination
    • Hematologic reaction
  280. Patellofemoral maltracking is managed on the basis of aetiology: list 4 options
    • Lateral retinacular release
    • VMO advancement
    • Osteotomy and medial displacement of the tibial tubercle.
    • TKA revision for malalignment.
  281. 1.List 4 risk factors for tibial loosening
    • Malalignment
    • Infection
    • Obesity
    • Early generation wear
  282. List 3 ways to deal with the proximal tibial defect.
    1.Bone grafting

    2.Cement filling of the defect

    3.Trabecular metal (porous tantulum) modular tibial augmentsPorous tantulum metaphyseal cones for severe tibial bone loss
  283. Advantages of DCO 6
    1.Improved survival rates

    2.Rapid skeletal stabilization

    2.Stop cycle of ongoing Musculoskeletal injury

    3.Control haemorrhage

    4.Lowers risk of pulmonary complications (emboli from reaming)

    6.Reduce inflammatory burden
  284. treatment of FICAT 2
    Core decompression
  285. List 2 bony landmarks for placement of your plate (proximal humerus plate)
    • Lateral to bicipital groove
    • 5-8 mm distal to top of GT
  286. What two foot positions clinically can be used to elicit peroneal tendon subluxation?
    –Rapid dorsiflexion

    –Active eversion against resistence
  287. When would you plan to perform a medial malleolar osteotomy for improved visualization? (IN ankle OCD)
    –When the lesion is in the posterior 1/3 of the talus.
  288. Please describe the 4 most important part of this anatomic repair.(bronstrom
    –Shortening and repair of ATFL

    –Shortening and repair of CFL

    –Reinforce with inferior extensor retinaculum

    –Reinforce with distal fibular periosteum
  289. Please list the lateral ankle ligaments from strongest to the weakest 3
    –Posterior talofibular ligament (strongest)

    –Calcaneofibular Ligament

    –Anterior talofibular ligament
  290. Describe Achilles vy turndown
    Go to myotendinous junction with a apex proximal chevron: twice the length of gap
  291. List 3 musculoskeletal effects of perioperative smoking:
    • Increased deep wound infection
    • Fracture non-union
    • Decreased healing of osteotomy/arthrodesis
    • Increased failure of joint arthroplasty
  292. 2 types of ATFL reconstructio
    • Anatomic: Bronstrom
    • Non anatomic: Evans with peroneous brevis
  293. Outline treatment for CRPS
    • PT
    • Pharmacologic: NSAIDs, neuromodulators
    • Sympathectomy
  294. Rheumatoid foot surgery recipee (problem/solution)
    • Forefoot 
    • Problem: Metatarsals sublux plantar and proximal (walk on metarsal heads) > claw toes
    • Solution: Cut EDB, Lengthen EDL, resect metatarsal heads maintaining cascade, Fuse PIP, Fuse 1st TMT (15 to floor, 15 adbuction, neutral rotation)

    • Midfoot
    • Problem: Tib post disfunctin
    • Solution: Debride tib post
  295. Describe schober test
    For Dx of Ank spond

    Put fingers 10 cm apart, need 5 cmexcursion
  296. Criteria for operative fixation with a pars repair
    –Normal disc

    –Young pt

    –Relief w/ pars injection

    –No slip
  297. Mangament of hypoglycemia 3
    If obtunded



    –20 g of glucose orally

    –50cc of D50W should be administered if patient is obtunded

    –In severe situations 1mg of glucagon can be given intramuscularly
  298. XR findings of cervical spondylosis (5)
    • Facet hypertrophy
    • Loss of disc height
    • Loss of cervical lordosis
    • Osteophytes
    • Subchondral sclerosis/cysts
  299. List 3 ortho and 3 non ortho injuriess associated with scapula #
    Ortho: Clavicle, prox humerus, brachial plexus, rib #, brachial plexus

    Non ortho: pulmonary contusion, pneumothorax, head injury, vascular injury
  300. Indications for ORIF of scapular # 4
    • > 25% articular surface glenoid involvement and humerus subluxation
    • Scapular neck displaced: >40 degrees angulation or 1 cm translation
    • Open #
    • coracoid # with >1cm displacement
  301. 3 stabilizers PIP
    • Volar plate
    • Collaterals
    • Sagital bands
  302. List 3 Extra-skeletal manifestations of TB in children:
    • Pleural TB
    • Renal involvement
    • Eye involvement
  303. List 4 indications for the surgical management of Lumbar Burst fractures
    • Kyphosis >30 degrees
    • Vertebral Height Loss >50%
    • Canal compromise
    • Neurological deficit consistent with level of injuryIntractable pain/disability
  304. Which radiographic views are best for:
    AC joint
    SC joint
    Acromium type
    Hill sach
    Banckart
    • Zanca view
    • Serendipidy view
    • Suprascapular outlet
    • Stryker notch
    • Westpoint view
  305. List 7 radiographic findings for RTA.(rotator cuff arthropathy)
    • Acetabularization of acromion
    • Femoralization of humeral head
    • Proximal migration of the humeral head ( distance is less than 7 mm from acromion)
    • Anteriosuperior escape of humeral head (CA loss)
    • Eccentric superior glenoid wear
    • Lack of typical peripheral osteophytes of OA
    • Osteopenia
    • Subarticular sclerosis (snowcap sign)
  306. List 4 indications for reverse TSA.
    –Cuff tear arthropathy

    –Failed TSA

    –Acute 4 part proximal humerus fractures in elderly

    –Nonunion of tuberosities following trauma or arthroplasty
  307. Risk Factors for dislocation (2%) (rsa) (5)
    • Irreparable subscap
    • Proximal humeral bone loss
    • Failed prior arthroplasty
    • Proximal humeral nonunion
    • Fixed GH dislocation preOP
Author
egusnowski
ID
345799
Card Set
MOCKS
Description
Mocks
Updated

  1. Home
  2. Flashcards
  3. Preview