Prediction of short answer Qs

  1. List extra-MSK manifestations of Ankylosing Spondylitis
    • Inflammatory bowel disease
    • Uveitis
    • Psoriasis
    • Pulmonary fibrosis
    • Aortitis
    • Genitourinary problems
  2. List the 8 non-spinal manifestations of Ankylosing Spondylitis
    • Uveitis
    • Aortitis
    • Pulmonary fibrosis
    • Large joint arthritis (Eg. Hips (most common ? need THA), knees, shoulders)
    • Renal amyloidosis
    • Inflammatory bowel disease
    • Cardiac conduction abnormalities
    • Cardiac valve abnormalities
  3. List the 5 modified New York criteria for Ankylosing spondylitis diagnosis
    • Low back pain for at least 3 months which is improved by exercise and not relieved by rest
    • Limitation in lumbar spine motion in sagittal and coronal planes
    • Chest expansion decreased relative to normal values for age and sex
    • Bilateral sacroiliitis seen on xrays, grade 2-4
    • Unilateral sacroiliitis seen on xrays, grade 3-4
  4. List the 4 pre-operative issues before elective surgery for ankylosing spondylitis
    • Pulmonary function tests and pulmonology for restrictive lung disease
    • Heart echo and cardiology for heart abnormalities
    • Ophthalmology for uveitis
    • C-spine flex/ex views to rule out C1-C2 instability
  5. List 6 complications with elective spine deformity correction in ankylosing spondylitis
    • Dural tears due to dural ectasia
    • Transient nerve root compression
    • Loss of correction
    • Implant failure
    • Postoperative spinal instability
    • Aortic injury
  6. List 3 reasons why cervical spine corrective osteotomy for Ank Spond is done at C7-T1 (Posterior closing wedge osteotomy for about 40 to 50-degrees of correction)
    • Spinal canal is larger in this area
    • Spinal cord and nerve roots are more mobile
    • The vertebral arteries are not present in the foramen transversarium at this level
  7. List the 4 major seronegative spondyloarthropathies
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Reiter?s syndrome (Triad of: Conjunctivitis / Arthritis / Nongonococcal urethritis)
    • Arthritis of inflammatory bowel disease
  8. List the 3 diagnostic criteria for multiple myeloma (all must be present)
    • > 10 % clonal plasma cells on bone marrow biopsy
    • Monoclonal proteins deteced via UPEP or SPEP
    • Evidence of end-organ damage (one of the following)
    • Hypercalcemia
    • Lytic lesions in the bone
    • Renal insufficiency
    • Anemia
    • > 2 severe infections in one year
    • Amyloidosis
    • Hyperviscocity syndrome
    • Mnemonic ?CRAB? ? HyperCalcemia, Renal insufficiency, Anemia, Bone lesions***
    • Pathology of multiple myeloma is driven by the activation of osteoclasts by malignant cells ? same mechanism as metastatic bone tumors (activation of osteoclasts through the RANKL pathway).
  9. List sites of PIN nerve compression at the elbow (Mnemonic FREAS)
    • Fibrous bands between brachioradialis and elbow capsule
    • Leash of Henry (Arcade of vessels from radial recurrent artery)
    • Tendinous edge of ECRB
    • Arcade of Froeshe (proximal edge of supinator)
    • Distal edge of supinator
  10. List sites of ulnar nerve compression at the elbow
    • Arcade of Struthers (medial intermuscular septum)
    • Entrance into cubital tunnel
    • In the cubital tunnel (Osborne?s ligament)
    • 2 heads of FCU
    • Anomalous muscles (anconeus epitrochlearis)
  11. List sites of Median nerve compression at the elbow (aka Pronator Syndrome) (Lenzcner Loves Fucking Pussies)
    • LigaMent of Struthers (vestigial structure, in 0.5% of cases)
    • Lacertus fibrosis
    • Thickened proximal edge of FDS
    • Between 2 heads of pronator
  12. List sites of AIN compression
    • Deep head of pronator teres
    • Origin of FDS
    • FCR
    • Accessory muscle that connect FDS to FDP
    • Gantzer muscle (accessory muscle of FDP)
  13. List etiologies of thoracic outlet syndrome (i.e. offending agents)
    • Cervical rib
    • Vertebral transverse process
    • Rib or clavicle malunion
    • Anamolous insertion of the scalenes
    • Fibromuscular bands
    • Repetitive shoulder use
    • Sports (weightlifting, swimming, rowing)
  14. List things that can elevate Rheumatoid factor
    • Aging
    • Cirrhosis
    • SLE
    • Sjorgens
    • Endocarditis
    • TB, Syphillis, Hep C
    • Sarcoidosis
    • Idiopathic pulmonary fibrosis
  15. List Spine Manifestations of Neurofibromatosis
    • Rib pencilling
    • Dural ectasia
    • Sharp short segments
  16. List Osseous Manifestations of neurofibromatosis
    • Bone scalloping
    • Penciling of ribs
    • Sharp vertebral end plates
    • Tibial pseudoarthrosis
    • Nonossifying fibromas
    • Scoliosis
  17. List NIH diagnostic criteria for NF-1
    • > 6 caf? au lait spots
    • axillary freckling
    • 1st degreee relative with NF-1
    • >2 neurofibromas or >1 plexiform neurofibroma
    • Lisch nodules
    • Optic glioma
    • Bone scalloping
  18. List Secondary causes of Trigger Finger
    • RA
    • Gout
    • HTN
    • Carpal Tunnel
    • Diabetes
    • Dupuytren?s disease
    • De Quervain?s tenosynovitis
  19. List Causes of Secondary osteoporosis
    • Hyperthyroid
    • Hypothyroid
    • Steroids
    • Immobilization
    • Heparin
    • Phenytoin
  20. List tumours associated with Proteus syndrome
    • Lipomas
    • Bilateral ovarian cystadenomas
    • Monomorphic adenoma of the parotid gland
    • Vascular malformations
  21. List patient selection criteria for optimal results for Unicompartmental Knee Arthroplasty
    • Non-obese
    • ROM > 90 degrees
    • < 10 degrees fixed flexion contracture
    • Intact cruciate ligaments
    • Non-inflammation arthritis
    • XR tibio-femoral OA confined to one compartment
    • Clinical symptoms confined to one compartment
    • < 15 degrees varus or valgus coronal deformity
    • XR evidence of tibiofemoral subluxation indicating instability
  22. List causes of scapular winging (serratus anterior nerve palsy specifically)
    • Long thoracic nerve palsy
    • Superior trunk palsy (C5-7)
    • SLE
    • Brachial plexus neuritis
    • Guillain-Barre syndrome
    • Viral illness
    • Lyme disease
    • Arnold-Chiari malformation
  23. List conditions that can cause peripheral nerve compression syndromes (e.g. carpal tunnel)
    • Diabetes
    • Rheumatoid arthritis
    • Mucopolysaccarhidosis (Most common cause of CTS in children)
    • Hypothyroidism
    • Pregnancy
    • Hemodialysis
    • Myxedema
    • Alcoholism
    • Exposure to toxins (long-term)
  24. List tumours that can spread to regional lymph nodes (SCARE)
    • Synovial sarcoma
    • Clear cell sarcoma
    • Angiosarcoma
    • Rhabdomyosarcoma
    • Epithelial sarcoma
  25. List 3 soft tissue tumours responsive to chemotherapy (all others are resistant)
    • Rhabdomyosarcoma
    • Synovial sarcoma
    • Fibrosarcoma
  26. List 6 Determinants of Gait (if 2 or more are disturbed, gait is inefficient)
    • Pelvic obliquity
    • Pelvic rotation
    • Knee flexion during stance
    • Foot and ankle motion
    • Axial rotations of the L/E
    • Lateral displacement of the pelvis
  27. List Predictors in Failure-Free Survival in Patients without distant metastasis and with Soft Tissue Tumours
    • Presence of tumor in local lymph nodes (0 vs 1)
    • Size (< 5 cm)
    • Invasiveness of the tumour (superficial or single vs. deep or multiple)
  28. List 10 reasons to immobilize and image a pediatric patient suspected of having a C spine injury
    • Mechanism of injury suggesting C spine injury
    • Neurological findings
    • History of transient neurological findings (SCIWORA)
    • Unconscious patients
    • Neck pain
    • Focal neck tenderness or distracting injury
    • Physical signs of neck trauma
    • Unreliable exam secondary to substance abuse
    • Inconsolable child
    • Significant trauma to the head or face
  29. List indications for initiating treatment in patients with early-onset scoliosis (i.e. bracing and casting, and then OR) ? List Risk Factors for Progression in patients with infantile (or early-onset idiopathic scoliosis)
    • Phase 2 rib relationship (when the rib head overlaps with vertebral body) 100% indication of surgery ? no reason to calculate RVAD
    • RVAD > 20 degrees
    • Progression to Cobb angle of > 30 degrees
  30. List indications for growing rods in pediatric spine
    • Flexible curve
    • Curve progression > 50 degrees
    • Significant growth remaining
  31. List the systems that are affected with patients diagnosed with congenital scoliosis
    • Auditory system
    • Renal
    • Renal collecting system
    • Genital
    • Upper extremity (radial hypoplasia)
    • Congenital heart abnormalities
    • Visceral abnormalities
    • Anal atresia
    • Tracheo-esophageal fistula
    • Thoracic insufficiency syndrome
  32. List Short-Term Postoperative Complications with Scoliosis Surgery
    • Ileus
    • Infection
    • Postoperative syndrome of inappropriate ADH secretion
    • Superior mesenteric artery syndrome
    • Pneumonia
    • Atelectasis
  33. List the things that you would do intraoperatively when you suspect a true neurological deficit performing scoliosis surgery (assume that technical factors are not responsible)
    • Release the correction
    • Raise the blood pressure
    • Transfuse the patient if the Hct is low
    • Administer the wake-up test
    • Administer steroids solumedrol 30 mg/kg bolus then 6 mg/kg x 23 hrs
    • Remove instrumentation
  34. List the MRI Spine findings that can be associated with congenital scoliosis
    • Syringomyelia +/- Chiari I malformation
    • Fatty filum terminale
    • Intradural lipoma
    • Diastematomyelia
    • Tethered spinal cord
    • Low conus
  35. List the tendon/ligaments involved (or can be) in adult acquired flatfoot
    • Spring ligament
    • Interosseous ligament
    • Achilles tendon
    • Posterior tibialis tendon
    • Deltoid ligament
    • Ligaments supporting naviculo-cuneiform joint
    • Ligaments supporting tarso-metatarsal joint
  36. List associated conditions that must be ruled out in patients with heel pain (especially bilateral), Plantar Fasciitis
    • Ankylosing spondylitis
    • Reiter?s syndome
    • Diabetes, soft tissue abscess
    • Rheumatoid arthritis
    • Osteoarthritis
  37. List Contraindications for Hip Arthrodesis
    • Obesity
    • Systemic arthritis (RA)
    • Contralateral hip dysfunction
    • Ipsilateral knee OA or dysfunction
    • Lumbosacral disease
  38. Advantages for Ganz Osteotomy
    • Only one incision
    • Straight, reproducible, extra-articular cuts
    • Large corrections in all direction
    • Posterior column remains intact
    • Vascularity of acetabular fragment is preserved via infection gluteal artery
    • No shape to true pelvic
    • No violation of Abductors
  39. List disadvantages of placing a cup at a higher hip center (defined > 3.5 cm proximal to interteardrop line)
    • Decreased tension on abductors
    • Higher loosening rate
    • Small cups (~40 mm)
    • Higher dislocation rate
    • Shortened limb
    • Impingement of proximal femur on ischium, levering the hip anteriorly
    • Impingement of proximal femur on ASIS or ilium, levering the hip posteriorly
  40. List advantages of tantalum as a fixation material in revision acetabular reconstruction
    • 70-80% porosity
    • low modulus of elasticity
    • high friction (allows for improved initial bony fixation
    • excellent biocompatibility
    • compressive strength and elastic modulus are closed to bone than any other bone-substitute
  41. List signs of definite loosening on XR for a femoral stem
    • fracture of cement mantle
    • fracture or deformation of femoral prosthesis
    • progressive varus
    • component migration
    • PROBABLE SIGNS
    • Complete radiolucent lines surrounding implant
    • SIGNS OF INSTABILITY
    • Pedastal
    • Calcar hypertrophy
    • Lack of stress shielding
  42. List Engh Signs of Implant Stability
    • Stable bony ingrowth
    • Spot welds at junction of porous coating
    • Stress shielding in proximal femur
    • Stable Fibrous ingrowth
    • No spot welds
    • Parallel lines up to 1 mm thick
    • Unstable
  43. List Features Associated with Marfan syndrome (diagnostic criteria)
    • Ectopic lentis
    • Glaucoma
    • Myopia
    • Cataracts
    • Retinal detachment
    • Pectus excavatum
    • Spontaneous pneumothorax
    • Aortic root dilatation
    • Ascending aortic dissection
    • Mitral valve prolapse
    • Mitral valve regurgitation
    • Ventricular dilatation
    • Scoliosis
    • spondylolisthesis
    • Kyphosis
    • Dural ectasia
    • Long and wide transverse processes
    • Thin lamina
    • Osteopenia
    • Wrist sign (able to wrap thumb and 5th digit around wrist and pass distal phalynx)
    • Thumb sign (crossing over ulnar border of hand)
    • Acetabular protrosio
    • High arched palate
    • Joint hypermobility
    • Arm span greater than height >1.05
    • Pes planus
  44. List Associated Conditions with Torticollis
    • Congenital muscular torticollis (contracture of SCM)
    • Grisel?s syndrome (inflammatory conditions of the ENT)
    • Retropharyngeal abscess
    • Traumatic atlantoaxial rotatory subluxation
    • Spinal column tumours
    • Upper-extremity congenital malformations (Klippel-Fiel syndrome)
    • GERD (Sandifer?s syndrome)
    • Ocular pathology
    • Developmental dysplasia of the hip
    • Metatarsus adductus
    • Posterior fossa brain tumours
    • Pyogenic cervical spondylolitis (disciitis of the C-spine)
    • Rheumatoid arthritis with rotatory or lateral sublucation of C1-C2
  45. List 8 causes of vertebral plana (MELTS)
    • Langerhans cell histiocytosis (EG)
    • Trauma/TB
    • Osteoporosis
    • Multiple myeloma
    • Metastatic tumor
    • Ewing?s sarcoma
    • Lymphoma
    • Steroids
  46. List 6 causes for an ivory vertebra
    • Mets (prostate, breast)
    • Paget?s disease
    • Lymphoma
    • Infection
    • SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis)
    • Primary bone tumor
  47. List indications of hip arthrodesis
    • High activity
    • Monoarticular arthritis
    • No contralateral hip arthritis
    • No lumbar spine arthritis or decreased mobility
    • No ipsilateral knee arthritis
    • THA contraindicated
  48. List Disadvantages for including L5-S1 in fusion for adult degenerative scoliosis
    • Higher pseudoarthrosis rate
    • Abnormal gait
    • Insufficiency fractures of sacrum
    • Increased surgical time
    • Higher reoperation rate
  49. List Risk Factors for Curve Progression in Adult Degenerative Scoliosis
    • Apical rotation > 33%
    • Curve > 30 degrees
    • Lateral listhesis > 6mm
    • Poor seating of L5 on S1
  50. List Reasons for Combined Anterior-Posterior Approaches in Adult Deformity Correction Surgery
    • Osteoporosis
    • Fusion across lumbosacral junction
    • Lumbar pseudoarthrosis
    • Coronal imbalance > 5 cm
    • Cobb > 60 degrees
    • Loss of lumbar lordosis
    • Open disk spaces at L3-4, L4-5, L5-S1
    • Previous posterior instrumentation
  51. List features of de novo adult spinal deformity
    • Confined to the lumbar spine
    • No rotation
    • Smaller Cobb angles
    • Fewer vertebral segments involved
  52. List risk factors for pseudoarthrosis in adult deformity correction
    • > 55 years of age
    • longer fusions > 12 segments
    • > 20? of thoracolumbar kyphosis
    • OA of the hip joint
    • Incomplete sacropelvic fixation
    • Positive sagittal balance > 5 cm
  53. List Factors that increase risk of infections in spine surgery
    • Longer surgery
    • Immunocomprimised patient
    • Poor nutritional status on patient
    • Older age
    • Increased blood loss
    • Posterior approach
    • Instrumentation
    • Smoking or EtOH
    • Obesity
    • Longer constructs
    • Multiple trauma
    • Revision surgery
    • Previous radiation
  54. List risk factors for non-union in Type II odontoid fractures
    • Age > 40
    • Posterior displacement > 5 mm
    • Posterior angulation > 11 degrees
    • Comminution
    • Pre-operative neurologic deficit
  55. List Factors that predispose to neurologic deterioration in spine infections
    • Diabetes
    • Rheumatoid arthritis
    • Advanced age
    • Steroid use
    • Higher thoracic and cervical vs. lumbar
    • Staphylococcus infection
  56. List 4 Signs of subaxial cervical Instability on C-Spine XR
    • > 11 degrees of angulation
    • > 25% of anterior column compression
    • >3.5 mm of translation
    • disc space widening > 1.7 mm
  57. List the 4 lines to assess when looking at a lateral c-spine xray
    • Anterior vertebral body line
    • Posterior vertebral body line
    • Spinolaminar line
    • Spinous process tips line
  58. List 5 Contra-indications for odontoid screw fixation
    • osteoporosis
    • fracture pattern, sagittal plane fractures
    • comminution
    • patients with big chests, pectus carinatum (barrel chest)
    • delayed union or non-union
  59. List the 7 diagnostic criteria for rheumatoid arthritis
    • polyarticular (> 3 joints)
    • symmetric
    • hand arthritis
    • XR erosive arthritis
    • Rheumatoid nodules
    • Positive RF
    • Morning stiffness more than 1 hour
  60. List factors for C spine C1-C2 instability progression in Rheumatoid Arthritis
    • Positive Rheumatoid factor
    • Male gender
    • Subcutaneous nodules
    • Greater peripheral joint involvement ? decrease in carpal height, rapidly
    • Higher initial CRP
  61. List indications for C spine surgery in Rheumatoid arthritis
    • Progressive neurologic deficit
    • Unremitting pain, not resolved with DMARDs, NSAIDs, etc.
    • Posterior ADI < 14 mm
    • Signs of atlantoaxial impaction, Ranawat classification <15 mm in men, < 13 mm in women
    • Cervicomedullary angle < 135 degrees
    • Cord stenosis
  62. List 4 features that suggest a vertebral compression fracture is not from osteoporosis and is from a tumour
    • Constitutional symptoms
    • Fractures above T5
    • Atypical radiographic findings
    • Failure to thrive
  63. List contributing factors to the low rate of complications in modern spine surgery
    • Advances in anesthesia
    • New instrumentation systems (pedicle screws better than hooks)
    • Spinal cord monitoring (SSEP,MEP)
    • Better surgical skills (= Dr ouellet)
    • Minimizing blood loss methods (cell saver)
  64. List Advantages of using fat method of repair for dural tears
    • Water tight
    • Prevents scar formation, does not adhere to adjacent structures
    • Autologous
    • Harvested through same incision
    • Drain 120-150 cc/day
    • Keep for maximum 5 days
    • Keep on prophylactic Ancef while drain in place
    • Cervical spine dural leak patient is sitting
    • Lumbar spine dural leak patient is lying
  65. List indications for Surgery in Anterior Shoulder Dislocations
    • Rotator cuff tear - IMMEDIATE SURGERY
    • Failure of non-operative trial with recurrent anterior dislocations
    • Athletes < 25 years of age who engage in athletics ? IMMEDIATE SURGERY
    • Notable bone injuries ? IMMEDIATE SURGERY
  66. List XR signs of rotator cuff arthropathy
    • Superior migration of humeral head (leading to decreased acromio-humeral distance)
    • Osteophytes
    • Joint space narrowing
    • Rounding of the greater tuberosity
    • Acetabularization of the acromion
    • Femoralization of proximal humerus
    • Superior glenoid wear
    • Subchondral osteopenia in proximal humerus
    • Glenohumeral joint subluxation
  67. List etiologies for osteonecrosis of the humeral head
    • Steroid use
    • EtOH
    • Caisson disease
    • SLE
    • Hemophilia
    • Lipid storage diseases
    • Trauma
  68. List indications for shoulder arthrodesis (30 degrees of abduction, internal rotation and 30 degrees of flexion)
    • Combined deltoid and rotator cuff tear
    • Irrepairable rotator cuff tears with painful cuff tear arthropathy
    • Paralytic disorders from infancy
    • After tumour resection
    • Failed arthroplasties
    • Joint destruction from infection
    • Recurrent dislocations failed by other non-salvage treatments
    • Arthritis in patients who require power and not motion
  69. List Severe Injuries Associated with clavicle fractures
    • Pneumothorax
    • Scapula-thoracic dissociation
    • Brachial plexus injuries
    • Vascular injuries
    • Rib fractures
    • Scapular fractures
  70. Indications for AC joint debridement arthroscopically
    • Response on AC joint injection
    • Edema MRI on distal clavicle resection
    • Clinical tenderness on exam
  71. List factors that lead to less favorable outcomes after rotator cuff surgery
    • Increasing patient age
    • Workers compensation
    • MRI tear characteristics
  72. List XR risk factors of AVN of the proximal humeral head
    • Medial calcar displacement
    • Small medial calcar spike
    • Displacement of both lesser and greater tuberosities
  73. List Structures that keep the Long Head of the Biceps into its bicipital groove
    • Coracohumeral ligament
    • Superior glenohumeral ligament
    • Falciform ligament
    • Transverse ligament
    • Subscapularis
    • Supraspinatus
    • Pectoralis major tendon
  74. Hemiarthroplasty in Proximal Humerus #
    • Mobilize and tag the greater and lesser tuberosities
    • Inspect the glenoid
    • Inspect the rotator cuff
    • How to judge the height and version
    • Pectoralis major for the height ? 5 cm from pec major to height of humeral head prosthesis
    • Greater tuberosity should be 5-7 mm below humeral head
    • Soft tissue tension of biceps and cuffs
    • Judge from fracture anatomy if easier to reconstruct
    • VERSION:
    • 30 degrees retroversion
    • Posterior fracture-dislocation would retrovert less to increase stability
    • Take an XR with trial in place to see where you are and then implant final prosthesis
  75. List the Extensor Compartments of the Wrist
    • APL, EPB; abductor pollicis longus, extensor pollicus brevis
    • ECRB, APB; extensor carpi radialis brevis, abductor pollicus brevis
    • EPL; extensor pollicus longus
    • EDC, EIP; extensor digitorum communis, extensor indicis proprius (EIP is ulnar to EDC)
    • EDM; extensor digiti minimi
    • ECU; extensor carpi ulnaris
  76. List the Components of the TFCC
    • Dorsal and volar radioulnar ligament
    • Articular disc, TFC
    • Meniscal homologue
    • The floor of the extensor carpi ulnaris sheath
    • Ulnocarpal ligaments
  77. List the 3 layers of the annular pulleys and their function
    • Deep ? secrete hyaluronic acid
    • Middle ? collagen structure, resists palmar translation of the tendons, prevents bowstringing
    • Superficial ? helps nutrition of the pulley
  78. List the muscles in the hand not innervated by the ulnar nerve
    • Radial two lumbricals
    • APB (abductor pollicis brevis)
    • OP (opponens pollicis)
    • Superficial head of FPB (flexor pollicis brevis)
  79. List Risk Factors for developing Cerebral Palsy
    • Low gestational age
    • Poor socioeconomic status
    • Intrauterine infection
    • Maternal thyroid dysfunction
    • Multiple gestations
    • Low birth weight
  80. List Good Prognostic Findings Pre-OP that will give a better outcome in Upper-Extremity Surgery in CP
    • Higher intelligence
    • Good support system
    • Spastic hemiplegia
    • No sensory deficit
    • Voluntary control
  81. List Cause of Arthrogryposis
    • Amyoplasia
    • Distal arthrogryposis type I
    • Larsen?s syndrome
    • Metatropic dysplasia
    • Diastrophic dysplasia
    • TAR (thrombocytopenia, absent radius)
    • Sacral agenesis
    • Myelomeningocele
    • Congenital muscular atrophy
    • Spinal muscular atrophy
    • Moebius syndrome
    • Steinert?s myotonic dystrophy
  82. List the non-MSK findings in Arthrogryposis
    • Bowel atresia
    • Facial hemangioma
    • Abdominal wall defects
    • Gastroschisis
    • Inguinal hernias
    • Cryptoorchidism
    • Labial hypoplasia in females
    • Micrognathia
  83. List the MSK findings in Arthrogryposis
    • Shoulder internal rotation
    • Elbow extension
    • Wrist flexion and ulnar deviation
    • Finger flexion
    • Thumb adduction
    • Scoliosis
    • Hip dislocation
    • Hip flexion contractures
    • Knee extension contractures
    • Knee flexion contractures
    • Knee dislocation
    • Congenital vertical talus
    • Rigid equinovarus
  84. List indications for an MRI spine in a child with scoliosis
    • < 10 years of age and RVAD > 20 degrees
    • atypical curve patterns
    • left thoracic
    • sharp curves
    • absence of apical thoracic lordosis (Ouellet et al.)
    • congenital scoliosis
    • abnormal neurologic examination (abdominal reflex, cavus feet)
  85. List Plain XR findings in Patients with Scheuermann?s Kyphosis
    • decreased disc height
    • anterior wedging 5 degrees
    • spondylolysis / listhesis
    • Schmorl?s nodes
    • Verterbral end plate abnormalities
  86. List tumours with chromosomal alterations
    • Osteosarcoma
    • Ewings sarcoma
    • Alveolar rhabdomyosarcoma
    • Myxoid liposarcoma
    • Synovial sarcoma
    • Clear cell sarcoma
  87. List 4 sytemic conditions associated with basilar invagination in peds
    • Achondroplasia
    • Morquio
    • SED, spondyloepiphyseal dysplasia
    • Osteogenesis imperfecta
  88. List MSK findings in a patient with PFFD
    • Acetabular dysplasia
    • Pseudoarthrosis of the proximal femur
    • Short, dysplastic or absent femur
    • Coxa vara
    • Absent ACL
    • Fibular hemimelia
    • Tarsal coalition
    • Absent lateral rays
    • Hand anomalies
  89. List three prognostic developmental milestones that a child with CP will never ambulate
    • Persistence of 2 or more primitive reflexes by 1 years of age
    • Not sitting independently by age 4
    • Not ambulating by age 8
  90. List the GMFCS Classification for CP
    • No restrictions
    • Assistance devices
    • Cannot go up stairs
    • Wheel chair in the community
    • Wheelchair
  91. List the three hip at risk signs for CP
    • Hip abduction less than 30 degrees
    • Migration index > 25%
    • Hip flexion contracture >30-degrees
  92. List causes of acetabular protrusio
    • Marfans
    • Osteogenesis imperfecta
    • Paget?s disease
    • Rheumatoid arthritis
    • Ankylosing spondylitis
    • Otto pelvis
  93. Name the 3 Lateral Ankle Ligaments
    • Anterior talofibular ligament (ATFL)
    • Calcaneofibular ligament (CFL)
    • Posterior talofibular ligament (PTFL)
  94. List the Structures that make up the ankle syndesmosis
    • Anterior inferior talofibular ligament (AITFL)
    • Posterior inferior talofibular ligament (PITFL)
    • Interosseous ligament
  95. Name the 4 stages of Charcot arthropathy (Eichenholtz)
    • Zero, acute inflammation, periarticular swelling
    • One, developmental or fragmentation, fracture, subluxation, instability
    • Two, coalescence phase, resorption of bone, soft tissue hemostasis
    • Three, consolidation, reparative phase
  96. List the Prerequisities for lengthening a patient with LLD
    • > 4 cm difference
    • stable joints (above and below)
    • able to eliminate any braces post lengthening
  97. List CXR findings of Aortic Dissection (WHAT DDA Fuck)
    • Widened mediastinum
    • Left hemithorax
    • Obliteration of Aortic knob
    • Tracheal deviation to the right
    • Depression of left mainstem bronchus
    • Deviation of NG tube to the right
    • Obliteration of AP window
    • Fracture of 1st or 2nd rib
  98. List 10 conditions associated with Pulseless Electrical Activity (5 Ts, 5 Hs)
    • Cardiac Tamponade
    • Tension pneumothorax
    • Thrombus, cardiac
    • Thrombus, pulmonary
    • Toxins
    • Hypothermia
    • Hypotension
    • Hypokalemia / hyperkalemia
    • Hyper H (Acidosis)
    • Hypoxia
  99. List 7 Extraskeletal manifestations of fibrous dysplasia
    • Soft tissue myxomas (Mazabraud syndrome)
    • Hyperthyroidism
    • Hyperprolactinemia
    • Caf? au lait spots
    • Cushings disease
    • Hypophasphatemia
    • Precocious puberty
    • NB: In polyostotic disease ? need to refer to an endocrinologist to assess for all these disease. The medical treatment for fibrous dysplasia is bisphosphonates
    • NB: The monostotic lesion typically stops being active at skeletal maturity
    • The polyostotic form may PROGRESS during adulthood
  100. List 4 surgical indications for fibrous dysplasia
    • Deformity correction (eg. Sheppard?s crook deformity, Saber shin)
    • Treatment of a pathologic fracture
    • Prevent a fracture
    • Remove a painful lesion
    • NB: The best bone graft to use for these lesions is CORTICAL ALLOGRAFT (MCQ question)
  101. List the 3 main types of malignant transformation in fibrous dysplasia
    • Osteosarcoma
    • Fibrosarcoma
    • Chondrosarcoma
  102. List contraindications to electrical stimulation in fracture non-unions
    • Fracture gap > 1 cm
    • Pseudoarthrosis
    • Mobile nonunion
  103. List the 10 types of acetabular fractures
    • Simple
    • Anterior column
    • Anterior wall
    • Posterior column
    • Posterior wall
    • Transverse
    • Associated
    • T-type
    • ABC
    • Anterior column and posterior hemitransverse
    • Posterior column and posterior wall
    • Transverse and posterial wall
  104. List the signs of fat embolism syndrome (Triad is hypoxia, mental status changes and petechia)
    • Petechiae
    • Tachypnea
    • Tachycardia
    • Mental status changes
    • Hypoxemia
  105. List XR signs that the patient had a knee dislocation
    • Segond fracture (avulsion of lateral tibial plateau)
    • Arcuate sign
    • Asymmetric joint space
    • OCD lesions, ligamentous avulsion fractures
    • Obvious dislocation
    • Atypical tibial plateau fracture (Moore classification)
  106. List the Moore classification for tibial plateau fractures
    • Coronal split
    • Entire condyle (fracture line crosses tibial spine
    • Rim avulsion fracture
    • Rim compression fracture
    • 4-part fracture (fracture lines cross the spine: parts ? lateral plateau, tibial spine, medial plateau, diaphysis)
  107. List the Ottawa Ankle Rules
    • Pain at the posterior tip or edge of either malleolus
    • Inability to bear weight
    • Age > 55 years
    • Pain near the malleoli
  108. Describe the negative prognostic factors associated with calcaneal fractures
    • Male
    • Polytrauma
    • Worker?s compensation
    • Advanced age (>50)
    • Obesity
    • Bilateral fractures
    • Manual labour job
    • Smoking
  109. List complications associated with calcaneal fractures
    • Malunion
    • Fibular impingement
    • Subtalar arthritis
    • Stiffness
    • Wound healing problems (most common)
    • Calcaneo-cuboid impingement
    • Sural nerve irritation
    • Peroneal tendon irritation
  110. Describe the normal Lisfranc Joint relationships
    • No dorsal subluxation on lateral foot view of metatarsals
    • The medial aspect of the 2nd MT should line up with medial cuneiform (especially it?s lateral border)
    • The medial aspect of the 4th MT should line up with the medial aspect of the cuboid
    • No more than 2 mm diastasis between bases of 1st and 2nd MTs
  111. List 7 Factors Associated with a worse outcome in LisFranc fractures
    • Comminution
    • Non-anatomic reduction
    • Open injury
    • Purely ligamentous
    • More than 2 mm or 15? of displacement
    • Obesity
    • Bicolumnar injuries
  112. List the obstacles to reducing a medial subtalar dislocation
    • Extensor digitorum brevis
    • Talonavicular capsule
    • Inferior extensor retinaculum
    • Peroneal tendons
  113. List the obstacles to reducing a lateral talar dislocation
    • Posterior tibial tendon (most common)
    • Bony fragment (OCD from the talus)
    • FHL
    • Flexor digitorum longus
  114. List the 10 compartments in the hand
    • Hypothenar
    • Thenar
    • Adductor pollicis
    • Volar interosseous THREE (Unipennate) (PAD)
    • Volar interosseous
    • Volar interosseous
    • Dorsal interosseous FOUR (Bipennate) (DAB)
    • Dorsal interosseous
    • Dorsal interosseous
    • Dorsal interosseous
  115. List Syndromes Associated with Congenital Radial Head Dislocation
    • Nail-Patella syndrome
    • Silver?s syndrome
    • Ehrlos-Danlos syndrome
    • Klinefelter?s syndrome
    • Congenital radioulnar synostosis
    • Achondroplasia
    • Diastrophic dysplasia
  116. List 6 relative indications for retrograde IM femoral nailing
    • Ispilateral tibial fractures
    • Bilateral femoral neck fractures
    • Obese patient
    • Vascular injury
    • Ipsilateral acetabular fractures
    • Ipsilateral patella fracture
  117. List syndromes associated with Caf?-au-lait spots
    • McCune-Albright
    • Neurofibromatosis
    • Jaffe-Campanacci syndrome
  118. List 5 primary tumours that can be associated with an ABC
    • GCT
    • Chondromyxoid fibroma
    • Fibrous dysplasia
    • Chondroblastoma
    • NOF
  119. List indications for amputation in tumour surgery
    • Limb salvage would not result in a functional limb
    • Patient cannot tolerate limb salvage surgery
    • Adjacent neurovascular structures encased with tumour
    • Unresponsive to pre-operative Chemo or EBRT
    • Inadequate surgical margin
  120. List diseases associated with a neuropathic joint
    • Syphilis
    • Diabetes
    • EtOH
    • Syringomyelia
    • Spinal cord tumours
    • Syphilis
    • Leprosy
  121. Describe the Hawkins Classification of Talar Neck Fractures
    • Non-displaced talar neck
    • Displaced talar neck with associated subtalar dislocation
    • Displaced talar neck with subtalar and tibiotalar dislocation
    • Displaced talar neck with subtalar, tibiotalar and talonavicular dislocation
  122. List 4 signs of impaired healing of a femoral neck # that has undergone ORIF (or XR signs that suggest that there will be a high likelihood of revision surgery ? These are usually seen within 3 months of surgery ? if seen it means a poor prognosis for healing and a high risk for non-union)
    • Change in the angle of the screws by 5%
    • Change in fracture position > 10 mm
    • Backing out of the screws into soft tissue > 20 mm
    • Screw penetration into the joint
  123. List relative contraindications for hip arthrodesis
    • Severe degenerative changes in the lumbar spine
    • Severe degenerative changes in the ipsilateral knee
    • Severe degenerative changes in the contralateral hip
    • Poor bone stock, osteoporosis
  124. List Benefits of Mobilizing the finger after flexor tendon repair
    • Increased vascular bed
    • Decreased adhesion formation
    • Higher tensile properties
    • Improved tendon gliding
    • Improved tendon excursion
    • More DNA at the repair site
  125. List factors predisposing to adhesions formation post flexor tendon repair
    • Zone II injury (repair within the synovial sheath
    • Concominant fractures
    • Soft tissue injury
    • Older age
    • Associated infections
    • Failed primary repair
    • Excessive surgical manipulation
  126. List associated conditions with Dupuytren?s disease
    • Alcoholism
    • Epilepsy
    • Diabetes
    • AIDS
    • Vascular disorders
  127. List structures that make up Spiral Cord (PSLG)
    • Pretendinous band
    • Spiral band
    • Lateral digital sheet
    • Greyson?s ligament
  128. What is the optimal position of thumb CMC arthrodesis
    • 15 degrees of thumb pronation
    • 30 degrees of thumb palmar abduction
    • 10-20 degrees of thumb radial abduction
  129. List 3 Syndromes (or conditions) that can cause sudden death in an athlete
    • Marfans
    • Long QT syndrome
    • Hypertrophic cardiomyopathy (Most common)
    • Coronary artery abnormality (2nd most common cause)
    • Commotio cordis (blow to the anterior chest causing V-fib and death)
  130. List the risk factors for tendon ruptures at the wrist in patients with Rheumatoid Arthritis
    • Persistent tenosynovitis
    • Erosions at the ulnar side of the distal radius on XR
    • Dorsal dislocation of the ulna
  131. List 4 reasons why a patient with rheumatoid arthritis would not be able to extend their 4th or 5th MCP joints
    • PIN palsy
    • EDC subluxation at the MCP joint
    • EDC tendon ruptures
    • MCP joint dislocations
  132. List order of loss of function after a nerve is injured (Some People Think That Puppies Meow)
    • Motor
    • Proprioception
    • Touch
    • Temperature
    • Pain
    • Sympathetic
  133. List ways to reduce growth arrest in immature ACL fixation
    • Soft tissue autograft, hamstring autograft (not BPTB) ? because bone will fuse the physis
    • Central tunnel in tibial plateau
    • Small tunnel
    • No fixation across the physis (suspensory fixation)
    • Vertical tunnel
  134. List Risk Factors for Osteoporosis
    • Female
    • Advanced age
    • Low protein intake
    • EtOH
    • Steoroid use
    • Anticonvulsant use (eg. Dilantin)
    • Smoking
    • Fair-skinned
    • Low body weight
    • Early menopause
    • Maternal/paternal history of hip fracture
  135. List 3 ways S.aureus protects itself from the human immune system
    • Secretion of protein A, which inactivates human IgG
    • Production of a biofilm (glycocalyx) to prevent penetration of the immune system
    • Capsular polysaccharide to reduce the ability of the opsonization and phagocytosis
  136. List 4 local host factors that increase the likelihood of an infection
    • Neuropathy
    • Decreased vascularity
    • Trauma
    • Presence of prosthetic joints
  137. List the way in which human joints decrease the force of friction
    • Synovial fluid
    • Fluid-film lubrication
    • Elastic deformation of articular cartilage
  138. List the biomechanical changes to cartilage in aging
    • Chondrocytes increase in size
    • Decrease chondroitin sulfate
    • Increase keratan sulfate
    • Increase water content WITH OA?.BUT decreases with aging!!!
    • Decrease ?link proteins? and less binding to hyaluronic acid
    • Shorter proteoglycan chains
  139. List the 4 layers of articular cartilage
    • Superficial
    • Middle
    • Deep
    • Tidemark
    • Calcified
    • Subchondral bone
  140. List the order in which nerve injury is lost in the distal segment (Some People Think That Puppies Meow)
    • Motor
    • Proprioception
    • Touch
    • Temperature
    • Pain
    • Sympathetics
  141. List the order in which a sensory nerve recovers
    • Pressure sense
    • Protective pain
    • Moving touch
    • Moving 2-point
    • Static 2-point
    • Threshold (Semmes-Weinstein, vibration)
  142. List 4 Pre-requisities to primary nerve repair
    • Skeletal stability
    • Well vascularized repair bed
    • Adequate soft tissue coverage
    • Clean wound
  143. List Factors that decrease rate of neurotransmission
    • Cold
    • Increased age of the patient
    • Loss of axons
    • Demyelination
  144. List Contraindications to hip arthroscopy
    • Morbid obesity
    • Protrusio
    • Joint anklylosis
    • HO
    • Advanced OA
  145. List indications for an acetabular osteotomy
    • Young physiologic age
    • Pre-OA state
    • Normal hip ROM
    • Correctable structural abnormality
  146. Describe the position for knee fusion (assuming < 2 cm LLD)
    • 5-7 degrees of valgus
    • 15 degrees of flexion
  147. Describe the associated vascular risk with each quadrant
    • anterosuperior quadrant ? external iliac vessels and obturator vessels
    • anteroinferior ? obturator artery
    • postero inferior quadrant ? sciatic nerve, inferior gluteal vessel and nerve, internal pudendal vessel and nerves
    • posterosuperior quadrant ? sciatic nerve, superior gluteal vessel
  148. List Risk factors for a DVT
    • cancer
    • hypercoagulable state (Protein C deficiency, etc)
    • venous stasis
    • age
    • smoking
    • oral contraceptive use
    • previous DVT
    • obesity
    • vessel wall damage
  149. Signs or Symptoms of a PE
    • hemoptysis
    • hypoxia
    • hypotension
    • tachycardia
    • chest wall pain
    • cyanosis
    • dyspnea
    • SOB
    • Anxiety
  150. List 5 signs that an uncemented femoral stem is loose
    • Calcar hypertrophy
    • IM pedestal
    • > 2mm, migration
    • implant fracture
    • absence of stress shielding
  151. Describe the AAOS classfication for Acetabular bone loss
    • Segmental
    • Cavitary
    • Combined
    • Pelvic discontinuity
    • Arthrodesis
  152. Describe the AAOS classification for Femoral bone loss
    • Segmental
    • Cavitary
    • Cavitary
    • Ectasia
    • Combined
    • Malalignment
    • Stenosis
    • Fracture
  153. List the relative contraindications to a midvastus approach for a TKA
    • Obesity
    • ROM < 80 degrees
    • Previous medial parapetallar approach
    • Revision surgery
    • Previous HTO
    • Extremely muscular quadriceps
  154. List XR signs of infection of a total joint arthroplasty
    • Periosteal reaction
    • Scattered foci of osteolysis
    • Bone resorption
  155. List risk factors for total joint arthroplasty infection
    • Malignancy
    • Diabetes
    • Rheumatoid arthritis
    • Psoriasis
    • Previous osteomyelitis
    • Post op wound hematoma
    • Prior joint arthroplasty
    • Perioperative nonarticular infection
  156. List the 3 essential elements to informed consent
    • Information
    • Voluntariness
    • Comprehension
  157. List the Waddell signs
    • Tenderness
    • Should be specific, wide areas of superficial tenderness not localized to a specific area is BAD sign
    • Simulation tests (these tests normally should not be uncomfortable)
    • Axial loading reproducing low back pain = BAD
    • Rotation of the pelvis or torso causing pain
    • Distraction tests
    • Positive findings that are later in the exam are negative when the patient is distracted
    • Regional disturbances
    • Positive findings inconsistent with neuroanatomy
    • Overreaction
  158. List 3 Spine Manifestations with Achondroplasia
    • Foramen magnum stenosis
    • Lumbar spinal stenosis
    • Thoracolumbar kyphosis
  159. List features of Achondroplasia (autosomal dominant, FGFR-3 receptor)
    • Thoracolumbar kyphosis
    • Foramen magnum stenosis
    • Lumbar spinal stenosis
    • Short pedicles
    • Posterior radial head dislocation ? also found in Nail-Patella syndrome
    • Genu varum
    • Rhizomelic shortening
    • Frontal bossing
    • Button nose
    • Trident hands
    • Champagne glass pelvic outlet
  160. List Features of Diastrophic Dysplasia (autosomal recessive, sulfate transporter)
    • Cleft palate
    • Hitchhiker thimbs
    • Cauliflower ears
    • Cervical kyphosis
    • Scoliosis
    • Hip flexion contracture
    • Genu valgum
    • Dislocated patella
    • Rigid clubfeet or skewfeet
  161. Goals of Upper Limb Amputation Surgery
    • Preservation of functional length
    • Durable skin and soft tissue
    • Preservation of useful sensation
    • Prevent painful neuromas
    • Prevent adjacent joint contractures
    • Early return to work
    • Early prosthetic fitting
    • Controlled short term morbitidy
  162. List Features of Downs Syndrome, Trisomy 21
    • Flattened face
    • Upward slanting eyes
    • Single palmar crease
    • Mental retardation
    • Congenital heart disease
    • Alzheimers
    • Duodenal atresia
    • Hypothyroidism
    • Diabetes
    • Ligamentous laxity
    • Hearing loss
    • Leukemia, Lymphoma
    • C1-C2 instability
    • Scoliosis
    • Spondylolisthesis
    • Hip instability
    • Pes planus
    • Patellar dislocation
  163. List common features of mucopolysaccharidoses
    • Short stature
    • Corneal clouding
    • Enlarged skull
    • Bullet-shaped phalanges
    • Mental retardation
    • Visceromegaly
    • Cervical instability
    • Genu valgum
    • DDH ? later onset
    • Thoracolumbar kyphosis
    • Cervical stenosis
    • Hip osteonecrosis
    • Carpal tunnel syndrome
  164. List syndromes with atlantoaxial instability
    • Pseudoachondroplasia
    • SED
    • MPS
    • Trisomy 21
    • McKusick type metaphyseal dysplasia
  165. List conditions that have uveitis
    • Ankylosing spondylitis
    • Juvenile rheumatoid arthritis
    • Reactive arthritis (Reiter?s syndrome) = conjuctivitis
  166. In patients with a previous stroke, or spinal cord injury, list the factors that influence the patient?s ability to walk (not neurologic level)
    • Limb stability
    • Motor control
    • Balance reaction
    • Proprioception
  167. List 3 ways in research protocols to limit bias
    • Randomization
    • Concealment of treatment allocation
    • Blinding
  168. List Structures in the Posterolateral corner of the knee
    • LCL
    • Posterior capsule
    • Arcuate ligament
    • Popliteus tendon
    • Popliteofibular ligament
    • Fabellofibular ligament
    • Biceps femoris
    • IT band
  169. List Structures with Type I collagen
    • Bone
    • Annular fibrosis (disk)
    • ACL
    • Menisci
  170. List Risk factors for patellar dislocation
    • Increased patellar tilt (> 20 degrees)
    • Increased distance from the center of the femoral sulcus and the tibial tuberosity (tibial tuberosity-trochlear groove, TTTG distance > 20 mm)
    • Trochlear hyoplasia
    • Patella alta
    • Excessive femoral anteversion
    • Internal tibial torsion
    • Hypoplastic VMO
    • Generalized ligamentous laxity
    • Knee valgus
  171. List 4 clinical examination techniques to assess the posterolateral complex of the knee
    • Dial test
    • External recurvatum test (picking up great toes)
    • Reverse Pivot-shift
    • Posterolateral drawer test
  172. List poor prognostic factors with OCDs
    • Skeletal maturity
    • Lesions other than classic lateral aspect of medial femoral condyle
    • Larger size
    • Lesion instability as seen on MRI
  173. List 3 obstacles to reduction of a proximal humerus fracture in a child
    • Long head of the biceps
    • Periosteum
    • Glenohumeral joint capsule
  174. List Fractures common in child abuse
    • Posterior rib fractures
    • Corner fractures
    • Femur fracture in pre-ambulatory child
    • Transphyseal fractures
    • Fractures at different healing stages
    • Skull fractures
  175. List risk factors for pediatric Acute Hematogenous Osteomyelitis
    • Diabetes
    • Varicella infection
    • Rheumatoid arthritis
    • Hemoglobinopathies
    • Chronic renal disease
    • Immune comprimise
  176. What is SAPHO syndrome and what it is associated with? (ans chronic recurrent multifocoal osteomyelitis)
    • Synovitis
    • Acne
    • Pustulosis
    • Hyperostosis
    • Osteitis
  177. List XR signs of distal radius epiphysiolysis
    • Widened physis
    • Blurred physis
    • Metaphyseal changes ? sclerosis
    • Volar, radial fragmentation of the growth plate
  178. List ways to avoid physeal damage when performing an ACL recon in skeletally immature patient
    • Drill centrally
    • More vertical tunnels
    • Use smallest drill possible
    • No bone across growth plate
    • No metal screws across growth plate
    • Avoid dissection around perichondral ring
  179. List the embryological classification of congenital hand anomalies
    • Failure of formation
    • Duplication
    • Failure of differentiation
    • Overgrowth
    • Undergrowth
    • Congenital constriction band
    • Generalized skeletal abnormalities
  180. List syndromes associated with radial longitudinal deficiency
    • Holt-Oram
    • Thrombocytopenia, absent radius (TAR)
    • Fanconi?s anemia (is life threatening and needs bone marrow transplant)
    • VATER
    • VACTERL
  181. List 9 anatomical abnormalities in the upper extremity associated with radial longitudinal deficiency
    • Thumb hypoplasia
    • Carpal bone abnormalities
    • Deficient radius
    • Abnormally shaped ulna
    • Proximal radio-ulnar synostosis
    • Congenital radial head dislocation
    • Muscular abnormalities
    • Nerve anomalies
    • Vascular anomalies
  182. List 6 Syndromes associated with overgrowth (think elephant man)
    • Proteus syndrome (bizarre facial disfigurement with scoliosis, genu valgum, hemangiomas, lipomas and nevi ? need to differentiate from McCune Albright and NF1)
    • Neurofibromatosis 1
    • Klippel-Trenaunay-Weber syndrome (Overgrowth caused by arterivenous malformations)
    • Beckwith-Wiedemann syndrome (Overgrowth associated with spastic CP ? Wilm?s tumors)
    • Idiopathic hemihypertrophy (Needs serial abdominal U/S until age 5 to assess for Wilm?s tumors)
    • Juvenile idiopathic arthritis
  183. List 4 Syndromes associated with syndactyly (C-A-P-S)
    • Carpenter syndrome
    • Apert syndrome
    • Poland syndrome
    • Streeter?s dysplasia
  184. List Risk Factors for Brachial Plexus Birth Palsy
    • Macrosomia
    • Shoulder dystocia
    • Prior brachial plexus birth palsy
    • Difficult delivery
    • Use of forceps during delivery
    • Breech presentation
    • Weight gain during pregnancy (more than 20 kg)
  185. List poor prognostic factors for brachial plexus birth palsy and indications for surgery
    • Complete palsy
    • Horner?s syndrome
    • No return of biceps at 3 months
    • Toronto scale of <3.5/10 at 3 months
    • Failed cookie test at 9 months
    • Plateau in recovery
  186. What are the obstacles to successful concentric closed reduction in DDH
    • Iliopsoas
    • Medial capsule
    • Labrum
    • Transverse acetabular ligament
    • Hyperthrophied ligamentum teres
    • Pulvinar
    • Hip adductors
  187. List the Catterall at-risk signs for patients with LCP
    • Calcifications lateral to the epiphysis
    • Gage sign (radiolucent V in the lateral epiphysis)
    • Lateral femoral head subluxation
    • Metaphyseal radiolucencies
    • Horizontal physis
  188. List indications to pin the other side of a SCFE hip
    • Age < 10
    • Endocrinopathies (Thyroid, Growth Hormone, Hyper or Hypoparathyroidism)
    • Previous radiation to hip
    • Renal osteodystrophy
    • Pain on contralateral hip
    • Posterior sloping angle
  189. List XR findings in a patient with developmental coxa vara
    • Decrease neck-shaft angle (i.e. varus)
    • Inverted Y in the metaphysis
    • Short neck
    • Vertical physis
    • Decreased femoral anteversion
  190. List Non-operative Rx for accessory navicular
    • Doughnut shaped orthosis
    • Short leg cast
    • NSAIDs
  191. List the zones of the physis (Real People Have Career Options)
    • Reserve
    • Proliferative zone - Achondroplasia affects this zone
    • Maturation zone
    • Hypertrophy ? fracture, SCFE occurs in this zone
    • Zone of calcification - Collagen X
  192. List the functions of the 1st MTP sesamoid complex
    • Transmit weight-bearing pressure
    • Reduce friction
    • Protect the flexor hallucis longus
    • Mechanical advantage to flexor hallucis brevis tendon
  193. List indications for surgery with a turf toes
    • Loose bodies in the MTP joint
    • Retraction of the sesamoids
    • Traumatic bunions
    • Sesamoid fractures with diastasis
  194. List 6 pathologies associated with ?ankle sprains?
    • OCD talus ? (anterolateral = traumatic, posteromedial = chronic)
    • Lateral process of talus fracture = snowboarder?s injury
    • Anterior process of calcaneus
    • Base of the 5th metatarsal fracture
    • Tarsal coalition
    • Peroneal tendon pathology (tendinosis, subluxation)
  195. List 4 structures that make up the ankle syndesmosis
    • Anteriorinferior tibiofibular ligament
    • Posteriorinferior tibiofibular ligament
    • Interosseous syndesmotic ligament
    • Transverse tibiofibular ligament
  196. List sites of compression of the deep peroneal nerve
    • Tibial osteophytes
    • Talar osteophytes
    • Navicular osteophytes
    • Under an enlarged muscle belly of EDB
    • Superior edge of inferior extensor retinaculum
    • Inferior edge of inferior extensor retinaculum
    • Under an enlarged muscle belly of EHL
  197. List the 6 components in the tarsal tunnel
    • Posterior tibial tendon
    • FDL
    • FHL
    • Posterior tibial artery
    • Posterior tibial vein
    • Tibial nerve
  198. List relative contraindications of surgical release of the plantar fascia in a patient who has failed non-operative rx with plantar fasciitis
    • Smoker
    • Obesity
    • History of CRPS
    • History of hypersensitivity
    • Concominant medical conditions that contribute to pain (fibromyalgia, neuropathy, etc)
  199. Name 3 (relative) indications to transpose ulnar nerve when doing UCL reconstruction
    • Concomitant ulnar neuritis
    • Ulnar nerve subluxation
    • Ulnar nerve constrictions as noted during surgery
  200. List four arthridites that can have radiographic changes similar to those of AS
    • Psoriatic arthritis
    • Reactive arthritis
    • Undifferentiated spondyloarthropathy
    • Arthritis associated with IBD
    • Risks of recurrent anterior shoulder dislocation
  201. Name 4 criteria for return to play after stinger
    • Normal strength
    • No paresthesias
    • Full painless ROM of C-spine
    • Negative Spurlings, axial compression and brachial plexus stretch tests
    • List 4 advantages of UKA over TKA
    • Less blood loss
    • Lower perioperative morbidity
    • Faster rehab
    • Preservation of normal knee kinematics
    • Contraindications to UKA (name 4)
    • Inflammatory arthritis
    • Age < 60
    • High demand
    • Symptomatic patellofemoral OA or erosions
    • Pain at rest
    • ACL deficient knee (controversial in medial UKA, contraindicated in lateral UKA; anterior gliding might lead to accelerated wear)
    • Secondary osteonecrosis (secondary to steroid use, because risk of concurrent or subsequent ON in other compartment)
    • Flexion contracture > 10 degrees
    • Uncorrectable varus > 10 degrees
    • Uncorrectable valgus > 5 degrees
    • ROM less than 90-degrees
    • 10 possible causes for anterior shoulder pain (differential dx)?
    • LHB tendinopathy
    • RTC tendinitis
    • RTC tear
    • Subacromial bursitis
    • AC joint OA
    • Glenohumeral OA
    • Subacromial impingement
    • Glenohumeral instability
    • AVN
    • SLAP tear
    • Adhesive capsulitis
    • Cervical spine pathology
    • Name 6 indications to operate on long head of biceps pathology
    • Partial-thickness tear > 25% to 50%
    • Medial subluxation LHB
    • Subluxation associated with subscap tear
    • Type IV SLAP tear
    • Symptomatic type II SLAP in patient > 50
    • Chronic pain from LHB tendinitis
    • Intraop finding of hourglass LHB during arthroscopy
    • Differential diagnosis for ulnar-sided wrist pain (name 6)
    • Lunotriquetral ligament tear or instability
    • DRUJ subluxation or arthrosis
    • Ulnar impaction / ulnar styloid impingement syndrome
    • Distal ulna chondromalacia
    • TFCC injury
    • Triquetrohamate instability
    • Hamate fracture
    • Pisotriquetral arthritis
    • ECU subluxation
    • Periarticular calcification
    • Ulnar neurovascular syndromes
    • What 3 criteria need to absolutely be met if you are going to treat a femoral head fracture nonoperatively?
    • Anatomic or near anatomic (< 2mm) reduction
    • Stable hip
    • No interposed fragments preventing congruent reduction
    • Name the 5 intraoperative indications to perform a biceps tenodesis or tenotomy (e.g. pt getting scoped for RTC tear, what pathology would lead you to also address biceps)?
    • Subluxation
    • Fraying
    • Tenosynovitis
    • Insertional detachment
    • Hypertrophy
    • List 2 extrinsic and 3 intrinsic factors associated with rotator cuff disease
    • Extrinsic
    • Anatomy of coracoacromial arch
    • Tensile overload of tendon
    • Repetitive-use phenomena
    • Intrinsic
    • Age-related degeneration
    • Tendon vascular supply
    • Regional variation in material properties of tendon
    • Structural abnormalities of collagen fiber orientation
    • Prevalence of asymptomatic full-thickness RTC tears
    • Above 60 y/o ? 30%
    • 40-60 y/o ? 5%
    • Name 6 typical radiographic findings in cuff tear arthropathy
    • Superior migration of humeral head (decreased acromiohumeral distance)
    • Osteophytes
    • Joint space narrowing
    • Rounding of the GT of proximal humerus (= femoralization of humerus)
    • Acetabularization of undersurface of acromion
    • Superior glenoid wear
    • Osteopenia of acromion and proximal humerus
    • Glenohumeral joint subluxation
    • Name the 4 biomechanical advantages of the reverse shoulder arthroplasty
    • Large glenosphere allows more stability and a large range of motion
    • Glenosphere makes contact with glenoid surface, placing the center of rotation within the glenoid, thereby reducing the torque on the baseplate-bone interface
    • Medialized center of rotation increases the number of deltoid muscle fibers recruited for abduction
    • Lowering of the humerus places increased tension on the deltoid muscle.
  202. Boileau et al. Gammont reverse prosthesis: Design, rationale, and biomechanics. J Shoulder Elbow Surg 2005;14:147S
  203. What 4 features can help you distinguish DISH from AS on xray?
    • Nonmarginal syndesmophytes (AS is marginal)
    • No involvement of SI joints
    • Anterior cervical bone formation with preservation of disc space
    • Findings on the right side of the T spine
  204. Belanger TA, Rowe DE. Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. JAAOS 2001 (Jul-Aug)
  205. Name the 4 principles of surgical management in early onset scoliosis
    • Improve or prevent progression of spinal deformity and chest wall constriction
    • Avoid or limit early spinal fusion
    • Minimize surgical complications
    • Minimize negative effects of treatment on quality of life
    • Growth Friendly Spine Surgery, JAAOS Dec 2011
    • Classification of growth-friendly implants
    • Distraction-based (growing rods, VEPTR)
    • Guided-growth (Luque trolley, Shilla)
    • Compression-based techniques (tethers, staples)
    • Name positive prognostic factors for operative management of cervical spondylosis
    • Larger transverse area of the cord
    • Younger patient
    • Shorter duration of symptoms
    • Single rather than multiple levels
    • Severity of myelopathy
    • Cervical Spondylotic Myelopathy: Diagnosis and Management, JAAOS Nov/Dec 2001
    • Name 5 factors to consider when choosing anterior vs. posterior approach in the treatment of cervical myelopathy:
    • Number of involved levels
    • Overall sagittal alignment
    • Direction of compression
    • Presence of instability
    • Clinical symptoms
    • Dose of methylprednisolone?
    • Load with 30 mg/kg, then 5.4 mg/kg per hour
  206. List 5 signs of component loosening in TKA
    • Change in implant position on sequential radiographs
    • Progressive widening of cement-bone or bone-prosthesis interface
    • Lucencies at metal-cement interface
    • Cement cracking or fragmentation
    • Progressive shedding of beads from a coated prosthesis
    • The Failed TKA: Evaluation and Etiology. JAAOS 2004
    • List 5 effective ways of reducing radiation exposure to the surgeon
    • Inverting xray beam
    • Lead aprons
    • Giving surgeon the foot pedal
    • Collimation (Meaning: Decreasing the field of view on the xray)
    • Increased distance between surgeon and beam
    • Using low-dose option
    • 5 xray findings in Scheuermann?s kyphosis
    • Anterior wedging > 5 degrees for at least 3 consecutive levels
    • Thoracic kyphosis Cobb > 45 degrees
    • Schmorl?s nodes
    • Vertebral end plate abnormalities
    • Decreased disc height
    • Spondylolysis/listhesis
    • List 5 Xray features that would prompt you to do an MRI of the spine in a scoliosis patient
    • Left thoracic curve in AIS
    • Short angular curve
    • Absence of apical thoracic lordosis (absence of lordotic rib head)
    • Absence of rotation
    • Congenital scoliosis
    • Patient < age 10 with > 20 degree curve
    • Abnormal neuro findings, pain, or rapid progression (> 1 degree/month)
    • Syrinx = asymmetric abdominal reflexes and scoliosis without rotation
    • Source: AAOS Review
  207. Name 4 common osseous abnormalities in the upper C-spine of children with Down syndrome
    • Os odontoideum
    • Ossiculum terminale
    • Spina bifida occulta of C1
    • Persistent dentocentral synchondrosis of C2
    • Source: Down syndrome in children JAAOS 2006
  208. Name the atlantoaxial stabilizers
    • Odontoid and anterior arch of C1
    • Transverse ligament
    • Alar and apical ligaments (secondary stabilizers)
    • Name the atlantooccipital stabilizers
    • Cup shaped joint
    • Capsule
    • Tectorial membrane
    • Name 4 risks of occiput-C2 fusion in Down syndrome
    • Infection
    • Nonunion
    • Wound dehiscence
    • Neurologic deterioration
    • Resorption of bone graft
    • Junctional instability
    • Loss of reduction
    • 3 spine problems in Down syndrome
    • O-C1 instability
    • C1-C2 instability
    • Scoliosis
    • 4 other (nonspine) common orthopaedic conditions in Down syndrome
    • Hip instability
    • Hip dysplasia
    • Patellofemoral instability
    • SCFE
    • Pes planus
    • Metatarsus primus varus
    • Hallux valgus
    • Diagnostic criteria for NF1
    • 2 or more of the following
    • Family hx (1 or more first degree relative)
    • Axillary freckling
    • Lisch nodules (> 2)
    • Cafe au lait spots (> 6, 5mm in children 15mm in adults)
    • Optic glioma (1)
    • Bony abnormalities
    • Neurofibromas (>2) or 1 plexiform
    • Name 5 typical dystrophic changes of the spine in NF1
    • Scalloping of the posterior vertebral margins
    • Severe rotation of the apical vertebrae
    • Vertebral wedging
    • Widening of the spinal canal
    • Enlargement of the neural foramina
    • Widened interpediculate distance
    • Defective pedicles
    • Presence of a paraspinal mass
    • Spindling of the TP
    • Rotation of the ribs (penciling)
    • Neurofibromatosis in children, JAAOS 1999
  209. Name 3 intraspinal lesions typical of NF1
    • Dural ectasia (circumferentially expanded dura erodes surrounding bone) (get vertebral scalloping)
    • Meningocele
    • Tumor (Neurofibromas / Schwannomas)
    • Pseudomeningocele
    • Name 3 complications specific to spine surgery in NF1
    • Pseudarthrosis
    • Bleeding (from plexiform venous channels)
    • Dural leaks
    • Paraplegia
    • 4 diseases associated with dural ectasia:
    • NF1
    • Marfan
    • Ehlers-Danlos
    • Ankylosing spondylitis
    • Name 2 advantages of C1-C2 segmental fixation over C1-C2 transarticular screws
    • C1 lateral mass screws can be placed in most patients whereas some patients have anatomy that is not amenable to TA screws
    • Trajectory is easier because instrumentation can be placed directly through the incision rather than tunneling through the soft tissues
    • C1 lateral mass screws are compatible with most body types, whereas TA screws are not (esp. with large thoracic kyphosis)
    • Name 3 anatomic characteristics that may preclude placement of transarticular C1-C2 screws
    • Large, medially located vertebral arteries
    • Hypoplastic C2 pars
    • Inability to obtain anatomic reduction of C1 over C2
    • Substantial thoracic kyphosis
    • Bransford RJ. Posterior Fixation of the Upper Cervical Spine: Contemporary Techniques. JAAOS Feb 2011
    • Name the 2 structures at risk with if using bicortical fixation in C1 lateral mass screws (or when penetrating anterior cortex during transarticular screws)
    • Internal carotid artery
    • Hypoglossal nerve
    • 4 complications of C1 LM screws
    • ICA or VA injury
    • Hypoglossal nerve injury
    • Medial penetration causing dural tear or spinal cord injury
    • Irritation of the C2 dorsal root ganglion
    • 2 intraoperative technique pearls for C1 LM screw
    • Dissect posterior ring of C1 with meticulous control of the extensive venous plexus between C1 and C2
    • C2 nerve root identified and gently retracted inferiorly (if using Harms)
    • Identify edge of dura medially, palpate medial edge of LM
  210. Name 4 conditions that are associated with thoracic insufficiency syndrome:
    • Flail chest syndrome
    • Constrictive chest wall syndrome
    • Rib fusion and scoliosis
    • Hypoplastic thorax syndrome (including Jeune syndrome)
    • Achondroplasia
    • Jarcho-Levin syndrome
    • Ellis van Creveld syndrome
    • Progressive scoliosis of congenital or neurogenic origin without rib anomaly
    • Source: Thompson et al. Growing Rod Techniques in Early-Onset Scoliosis. JPO 2007
    • Name 3 signs of discoid lateral meniscus on plain xray
    • Widened joint space
    • Squaring/flattening of the lateral femoral condyle
    • Cupping of the lateral tibial plateau
    • Lateral joint lipping
    • Calcification of the meniscus
    • Obliquity of joint space
    • Degenerative changes
    • Hypoplastic lateral intercondylar spine
    • Source: Lateral meniscus variants: Evaluation and Treatment. JAAOS 1996 and Millers
    • 4 contraindications to meniscal transplantation
    • Grade III/IV chondral lesions
    • Kissing lesions
    • Advanced patient age
    • Joint space narrowing
    • (ACL deficiency and limb alignment need to be addressed)
    • Source: Millers
    • Relative indications to do retrograde femoral nailing (vs. antegrade)
    • Obesity
    • Bilateral femur fractures
    • Ipsilateral tibial shaft fracture (floating knee)
    • Patella fracture
    • Ipsilateral acetabulum (high risk of HO if going antegrade)
    • Ipsilateral femoral neck (to do pinning of the neck + retrograde nail)
    • Name the 4 factors that are significantly associated with failure of tuberosity healing in hemiarthroplasty for proximal humerus fractures (as per Boileau paper)
    • Poor initial positioning of the prosthesis (specifically excessive height and/or retroversion)
    • Poor positioning of the GT
    • Female sex
    • Advanced age (> 75 degrees)
    • Name 2 ways to judge prosthetic height intraoperatively when doing a shoulder hemi for proximal humerus fracture.
    • Pec major tendon (highest point of humeral head should be 5.6 cm proximal to superior aspect of pec major tendon)
    • Greater and lesser tuberosities reduce anatomically and under minimal tension once the trial is in place
    • 4 signs of distal clavicle osteolysis on xray
    • Widened joint space
    • Relative osteopenia
    • Tapering or enlargement of distal clavicle
    • Loss of subchondral bone detail
    • Name 4 factors associated with good prognosis in central cord syndrome
    • Young age
    • Preinjury employment
    • High level of education
    • Absence of spinal cord signal abnormality on MRI
    • Higher initial ASIA motor score
    • Absence of spasticity
    • Early motor recovery
    • Good hand function
    • Source: Central Cord Syndrome, JAAOS 2009
  211. Describe at least 8 factors that increase the risk of developing a scaphoid nonunion
    • Name 4 risk factors for progression of atlantoaxial subluxation in rheumatoid arthritis
    • Male sex
    • Rheumatoid factor seropositivity
    • Higher initial CRP
    • Presence of subcutaneous nodules
    • Advanced peripheral joint disease (specifically rapid loss of carpal height)
    • Source: Rheumatoid Arthritis in the Cervical Spine. JAAOS 2005
    • 3 methods of assessing for basilar invagination / atlantoaxial impaction
    • McRae?s line
    • McGregor?s line
    • Ranawat method (most reliable)
    • Redlund-Johnell method
    • Ranawat grading of myelopathy
    • I Normal
    • II Subjective weakness, hyperreflexia, altered sensation
    • IIIA Objective weakness and long-tract signs, ambulatory
    • IIIB As IIIA but nonambulatory
  212. Pathologies associated with protrusio
    • VINDICATE
    • Infectious (gonococcus, staph, strep, TB)
    • Neoplastic (fibrous dysplasia, hemangioma, mets, NF, radiation-induced osteonecrosis)
    • Inflammatory
    • RA
    • Ank spon
    • JIA
    • Psoriatic
    • Congenital/genetic
    • Marfan?s
    • Ehler-Danlos
    • Stickler
    • Sickle cell
    • Traumatic (acetabular fracture or excessive reaming during THA)
    • Endocrine/metabolic
    • Paget?s
    • OI
    • Osteomalacia
    • Hyperparathyroidism
    • 5 differential diagnoses for vertebra plana
    • ?MELTS?
    • Mets / multiple myeloma
    • EG / Ewings? sarcoma
    • Lymphoma
    • TB / Trauma
    • Steroids
    • Name 4 indications for shoulder fusion
    • Cuff arthropathy with incompetent deltoid
    • Tumor reconstruction with significant soft-tissue loss
    • Chronic infection
    • Refractory instability
    • Brachial plexus injury
    • Name the 4 possible initiating causes of finger swan-neck deformity in RA
    • DIP - Rupture of extensor mechanism at distal phalanx --> mallet finger
    • PIP ? Synovitis --> Volar plate laxity
    • PIP ? FDS tendon rupture
    • MCP ? Dislocation --> Intrinsic tightness --> PIP hyperextension
  213. Describe the OA staging of CMC Arthritis (Eaton classification)
    • STAGE I: widened CMC joint due to synovitis
    • STAGE II: narrowed CMC joint without subluxation
    • STAGE III: pronounced CMC joint narrowing, subchondral sclerosis, cysts but not OA in scaphoid-trapezial joints
    • STAGE IV: pantrapezial OA
  214. Describe the Stages of Adult Acquired Flatfoot
    • STAGE I: tenosynovitis along PTT, no deformity
    • STAGE IIA: unable to perform single heel rise, flexible flatfoot, < 30% talonavicular uncoverage
    • STAGE IIB: severely flexible flatfoot but > 30% talonavicular uncoverage
    • STAGE III: rigid flatfoot, with subtalar OA
    • STAGE IV: rigid flatfoot, with subtalar and tibiotalar OA and lateral talar tilt (deltoid incompetence
  215. Describe the Stages of SLAC
    • STAGE I: radiostyloid involvement
    • STAGE II: radioscaphoid OA
    • STAGE III: capitolunate migration and OA
    • STAGE IV: pancarpal OA
  216. Describe the Stages of SNAC
    • STAGE I: radiostyloid OA
    • STAGE II: scaphoid-capitate OA
    • STAGE III: periscaphoid OA
  217. List the 5 at-risk signs for LCP
    • Gage?s sign (radioluscent V in lateral epiphysis
    • Calcification on the lateral side of the epiphysis
    • Horizontal physis
    • Lateral subluxation of the femoral head
    • Metaphyseal cysts
  218. List the operative indications for humeral shaft ORIF
    • Open fracture
    • Associated articular fracture
    • Neurovascular injury
    • Floating elbow
    • Impending pathologic fracture
    • Polytrauma
    • Failure of closed management (bracing is not tolerated or provides inadequate alignment)
  219. List 4 risk factor for osteolysis progression after THA
    • High wear rate
    • High patient activity level
    • Large diameter heads
    • Lesion size of more than 10 cm3
  220. List 4 radiographic signs of hemophilic arthropathy of the knee
    • Widened intercondylar notch
    • Flatenned femoral condyles
    • Widened femoral condyles
    • Osteopenia
  221. What are the 3 components of a triplane fracture?
    • Coronal metaphyseal fracture
    • Transverse physeal fracture
    • Saggital epiphyseal fracture
  222. List 5 contraindications to hip arthrodesis
    • Obesity
    • Inflammatory arthritis
    • Lumbosacral disease
    • Contralateral hip dysfunction
    • Ipsilateral knee arthritis, deformity or instability
  223. List 10 risk factors for patella instability
    • Genu valgum
    • Femoral anteversion
    • Internal tibial torsion
    • Weak VMO
    • Tight lateral retinaculum
    • Generalized ligamentous laxity
    • Hypoplastic trochlea
    • Hypoplastic condyle
    • Patella alta
    • Increased Q-angle
  224. List 4 x-ray findings of a discoid meniscus
    • Widened lateral joint space
    • Squaring of lateral femoral condyle
    • Cupping of lateral tibial plateau
    • Hypoplastic lateral intercondylar spine
  225. List 7 contraindications for Uniarthroplasty of the knee
    • Inflammatory arthritis
    • Tri-complartment OA
    • < 90 degree flexion arc
    • Flexion contracture > 15 degrees
    • Deformity > 15 degrees
    • ACL deficient knee
    • Significaant PF OA
  226. List 8 contraindications for a high tibial osteotomy
    • Significant medial compartment arthritis
    • Tricompartmental arthritis
    • Patellofemoral arthritis
    • Inflammatory arthritis
    • Decreased flexion arc (< 120-degrees)
    • Flexion contracture > 5-degrees
    • Age more than 65
    • ? Obesity
  227. List 5 indications for a hip arthrodesis conversion to a THA
    • Fusion in malposition
    • Pseudoarthrosis
    • Severe pain in lumbar spine
    • Severe pain in contralateral hip
    • Severe pain in ipsilateral knee
  228. List 4 characteristic of hallux rigidus
    • There is a dorsal exostosis that limits dorsiflexion
    • The center of rotation is eccentric
    • There are higher than normal plantar pressures in the 1st ray
    • Total arc of motion is decreased
    • NB: Need 15 to 90 degrees of dorsiflexion for normal gait pattern
  229. List the 7 static restraints to the shoulder
    • Articular geometry
    • Labrum
    • Negative intra-articular pressure
    • Concavity-compression
    • Coracohumeral lig.
    • Joint capsule
    • Superior, middle and inferior glenohumeral ligs.
  230. List 3 contraindications to using Hamstring autograft for ACL reconstruction
    • Generalized hyperlaxity
    • Previous injury / trauma to the hamstring tendons
    • High level sprinter
  231. List 4 components to an STT (Triscaphe) fusion
    • Patient will preserve 90% of grip strength compared to contralateral side
    • 75% of ROM should return
    • Radial styloidectomy is important
    • Revision surgery is uncommon
  232. List 4 tumors that occur in the posterior elements of the spine
    • ABC
    • Osteoid osteoma
    • Osteoblastoma
    • Osteochondroma
  233. List 7 tumors that occur in the anterior elements of the spine
    • GCT
    • Langerhans cell histiocytosis (EG)
    • Multiple myeloma
    • Lymphoma
    • Hemangioma
    • Mets
    • Chordoma
  234. What is the order of the short external rotators from superior to inferior
    • Piriformis
    • Superior gemellus
    • Obturator internus
    • Inferior gemellus
    • Obturator externus
  235. List risk factors for neurologic deterioration with vertebral pyogenic osteomyelitis
    • Upper T-spine involvement
    • Advanced age
    • Impaired immune system
    • Steroid use
    • Diabetes
    • RA
    • Cervical lesions
    • S. aureus
  236. List 5 soft tissue sarcomas that metastasize to lymph nodes (SCARE)
    • Clear cell sarcoma
    • Angiosarcoma
    • Rhabdomyosarcoma
    • Synovial sarcoma
    • Epithelioid sarcoma
  237. List 7 contraindications to limb salvage tumor surgery
    • Significant soft tissue involvement
    • NV involvement where a vascular graft is not possible
    • Significant infection in field
    • Large hematoma from pathologic fracture involving a lot of soft tissue
    • Inappropriate biopsy
    • Skeletally immature patient where there will be an anticipated > 8 cm LLD
    • Poor response to chemo
  238. List 4 endocrine abnormalities related to SCFE
    • Hypothyroidism
    • Renal osteodystrophy
    • Hypogonadism
    • Growth hormone abnormality
  239. List 4 mechanical risk factors for SCFE
    • Femoral retroversion
    • Increased physeal obliquity
    • Deeper acetabulum (Increased Center edge angle)
    • Increased posterior sloping angle on frog-leg lateral radiograph (more than 12-degrees)
    • This increased posterior sloping angle can also help decide if need to prophylactically pin the other side
  240. List 3 techniques to correct late hip deformity post SCFE (to correct the retroversion)
    • Intertrochanteric osteotomy (Southwick / Imhauser ? Flexion, valgus, internal rotation)
    • Cuneiform osteotomy (osteotomy of femoral neck)
    • Surgical hip dislocation and femoral neck osteoplasty
  241. List 10 risk factors for trauma X
    • First born
    • Unplanned pregnancy
    • Handicapped child
    • Premature baby
    • Low socioeconomic family
    • Single parent
    • Drug abusing parent
    • Parent who was themselves abused
    • Unemployed parents
    • Stepchildren
  242. List 4 factors associated with a poor prognosis for LCP in children
    • Older age at onset (bone age > 6)
    • Female sex
    • Lateral column pillar classification
    • Head at risk signs (Gage?s sign, lateral calcification, horizontal physis, lateral subluxation, metaphyseal cysts)
    • Decreased abduction ROM
  243. List 4 surgical indications for capitellum OCD
    • Loose bodies
    • Mechanical symptoms
    • Unstable lesions
    • Stable lesions that have failed at least 6 months of conservative Tx
  244. List highest to lowest Young?s modulus
    • Ceramics
    • Cobalt chrome
    • Stainless steel
    • Titanium
    • Cortical bone
    • PMMA
    • Polyethylene
    • Cancellous bone
    • Tendon/ligament
    • Cartilage
  245. List the order of worsening of myelodysplasia
    • Spina bifida occulta
    • Meningocele
    • Myelomeningocele
    • Rachischisis
  246. List 3 spinal manifestations of achondroplasia
    • Foramen magnum stenosis
    • Lumbar stenosis
    • Thoracolumbar kyphosis
  247. List 4 surgical options for DRUJ arthritis
    • Darrach procedure (resection distal ulna ? reserved for older, less demand pts)
    • Hemiresection arthroplasty (Need an intact TFCC to be done)
    • Sauve-Kapandji procedure (Better for younger, higher demand pts)
    • Implant arthroplasty (Partial ulnar head, Total ulnar head, Total DRUJ arthroplasty)
  248. List the 5 components of the TFCC
    • Volar and dorsal radioulnar ligaments
    • Volar and dorsal ulnocarpal ligaments
    • Meniscus homolog
    • Articular disk
    • ECU tendon sheath
    • (NB. The ECU subsheath and volar ulnocarpal ligs do not contribute greatly to DRUJ stability)
  249. List reasons why women have higher ACL injuries
    • Smaller notches
    • Smaller ligaments
    • Increased generalized ligamentous laxity
    • Increased knee laxity
    • Different landing biomechanics
    • In landing, women have a higher total valgus knee loading with more external rotation and less flexion
    • Higher Q angles
    • Increased posterior tibial slope
  250. Risks of THA in sickle cell anemia
    • Higher infection rate
    • Higher dislocation rate
    • Higher rate of early revisions
  251. List the 3 components of Virchow?s triad
    • Stasis
    • Hypercoagulability
    • Endothelial damage
  252. List the triad of death
    • Hypothermia
    • Acidosis
    • Coagulopathy
  253. List 7 Poor prognostic factors for a whiplash injury
    • Female
    • Older age
    • Part-time employment
    • Prior cervical and low back pain
    • Previous whiplash injury
    • Lower educational achievement
    • Workers compensation
  254. List 3 acceptable numbers for distal radius malunion
    • Radial shortening less than 5 mm compared to other side
    • Radial inclination more than 10-degrees
    • Tilt between 10-degrees dorsal and 20-degrees volar
  255. List 3 acceptable reduction for humeral shaft fractures
    • < 30-degrees varus / valgus
    • < 20-degrees A-P angulation
    • < 3 cm shortening
  256. List 6 osteonecrosis of bones
    • Preiser?s disease - scaphoid
    • Kienbock?s disease - lunate
    • Kohler?s disease - navicular
    • Freiberg?s disease ? 2nd metatarsal head
    • Freidrich?s disease ? medial clavicle
    • Panner?s disease ? capitellum
  257. List contraindications to TSA
    • Deltoid dysfunction
    • Irreparable rotator cuff disease
    • Brachial plexus neuropathy
    • Infection
    • Severe glenoid erosion with insufficient glenoid bone stock
    • Rotator cuff arthropathy
  258. List essential components for a scale
    • Validated
    • Sensitive
    • Reproducible
    • Responsive
  259. List Lenke criteria for selective thoracic curve fusion
    • Thoracic to Lumbar curve cobb ratio >1.2
    • Thoracic to lumbar Apical vertebral translation ratio >1.2
    • Thoracic to lumbar Apical vertebral rotation ratio >1.2
    • Flexible T/L ? L curve (ideally less than 25-degrees on bend films)
    • T/L kyphosis < 10-degrees
    • Level or high right shoulder
    • Truncal shift exceeding waistline asymmetry
    • Thoracic to lumbar ratio by scoliometer >1.2
  260. List indications to convert a hip fusion to a THA
    • Lumbar spine or contralateral hip pain
    • Ipsilateral knee pain
    • Malpositioned hip fusion
    • Nonunion of a surgical hip arthrodesis
    • Significant LLD (> 3cm)
  261. List causes for spontaneous ankylosis of the hip
    • Trauma
    • Infection
    • Ankylosing spondylitis
    • Juvenile idiopathic arthritis
    • Hemophilia
  262. List the contents of the rotator interval
    • Coracohumeral ligament
    • Superior glenohumeral ligament
    • Joint capsule
    • Long head of biceps tendon
  263. List 7 surgical factors that decrease surgical site infections
    • Hand washing
    • Surgical site prep (Alcohol and chlorhexidine is best ? best solution when they are mixed)
    • Limiting surgical time (surgical time > 2 hours increases infection rates)
    • Limiting violations of sterile technique
    • Decrease movement in the OR
    • Limit exchange of team members
    • Limit intraoperative hypothermia
    • NB: Chlorhexidine has residual antimicrobial properties because of its ability to better bind to the skin
  264. List 4 patient factors that can increase surgical site infections
    • Diabetes
    • Obesity
    • Prior history of surgical site infection
    • MRSA colonization
  265. List 7 types of elder abuse
    • Physical
    • Sexual
    • Emotional
    • Financial
    • Neglect
    • Self-neglect
    • Abandonment
  266. List 8 patient risk factors for elder abuse
    • Poor health
    • Cognitive impairment
    • Social isolation
    • Shared living arrangement
    • History of domestic violence
    • Aggressive behavior
    • Age > 75
    • Require assistance with eating
  267. List 4 caretaker characteristics for elder abuse
    • Financial dependence on elder
    • Substance abuse
    • Mental illness
    • Perception of caretaking as a burden
  268. List 11 signs of elder abuse
    • Delay in seeking care
    • Vague explanantion
    • Described mechanism of injury inconsistent with injury pattern
    • Frequent visits to the ED
    • Multiple fractures/bruises
    • Dehydration
    • Malnutrition
    • Poor hygiene
    • Noncompliance with medical regimens
    • Withdrawal or change in behavior
    • Unclear history
  269. List 5 injuries associated with elder physical abuse
    • Long bone fractures
    • Rib fractures
    • Bruises on the face/neck, lateral right arm and posterior torso
    • Restraint burns
    • Cuts
  270. List 3 high-risk groups for intimate partner violence (IPV)
    • Women aged 19 to 29 making less than $10,000 annually
    • Pregnant women
    • Inner-city African American women
  271. List 6 skeletal problems with osteopetrosis (Hard, brittle bone ? caused by inhibition of osteoclast bone resorption)
    • Coxa vara
    • Frequent fractures
    • Osteoarthritis
    • Osteomyelitis (most commonly seen in the mandible ? can also occur in long bones)
    • Spondylolysis
    • Cranial nerve compression
    • NB: Osteopetrosis has a defect with osteoclasts to remodel bone during growth ? the bone is very hard and brittle
  272. List 3 characteristic xray findings of osteopetrosis
    • Rugger Jersey spine
    • Erlenmeyer flask deformity of the distal femur and proximal humerus
    • Bone within a bone appearance
  273. List the 3 types of osteopetrosis
    • Malignant autosomal recessive that is deadly
    • Intermediate autosomal recessive
    • Benign autosomal dominant (orthopaedic surgeons typically see this form)
    • NB: Osteopetrosis is treated medically for the disease and with surgery for the surgical manifestations
  274. List DDX of pediatric malignant spine tumors
    • Osteosarcoma
    • Ewing?s sarcoma
    • Lymphoma
    • Metastatic neuroblastoma
  275. List the MSTS classification for benign bone tumors
    • Benign latent
    • Benign active
    • Benign aggressive
  276. List 4 ways tumors are discovered in children
    • Pain
    • Palpable mass
    • Pathologic fracture
    • Incidental
  277. List 3 ways that POWER of a study is increased
    • Increasing the number of subjects (Sample size)
    • Greater treatment effect (effect size)
    • Lower variability among the data (variability)
  278. List 4 conditions with an increased risk of malignant hyperthermia
    • Duchene muscular dystrophy
    • Arthrogryposis
    • Osteogenesis imperfecta
    • Turner syndrome
  279. List 4 reasons why axillary nerve repair works well
    • Short nerve to muscle
    • Proximal
    • Monofascicular
    • Composed primarily of motor fibers
  280. List 4 types of carpal instability-nondissociative
    • Palmer (Carpus sags volarly ? lunate clunks into extension with ulnar deviation)
    • Dorsal (Capitate clunks dorsally with ulnar deviation)
    • Combined (combination of palmar and dorsal ? lunate clunks into extension and capitate clunks dorsally with ulnar deviation)
    • Adaptive (due to abnormalities extrinsic to the carpus eg. Dorsal malunion of distal radius fracture; xray: Lunate is extended and capitate is flexed)
  281. List 5 histological characteristics of high-grade neoplasms:
    • Poor differentiation
    • High cell/matrix ratio
    • High mitotic rate
    • Necrosis
    • Microvascular invasion
  282. List 5 factors associated with proper treatment of necrotizing fasciitis
    • Early diagnosis and debridement (most important factor)
    • Broad spectrum antibiotics
    • Aggressive rescucitation
    • Frequent re-evaluation
    • Comprehensive nutritional support
  283. List the 6 components for the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC)
    • CRP
    • WBC
    • Hg level
    • Sodium
    • Creatinine
    • Glucose
  284. List the 3 types of Necrotizing fasciitis
    • Type 1: Polymicrobial (most common: 80 to 90% of cases)
    • Type 2: Group 1 beta-hemolytic strep. (?Flesh-eating? type)
    • Type 3: Marine vibrio bacteria
  285. List 7 criteria for tendon transfers
    • Synergystic muscle
    • One function
    • Adequate strength (at least 4/5)
    • Adequate excursion
    • Joint mobility (supple joint)
    • Expendable donor
    • Direct line of pull
  286. List predictors of distal radius instability following closed reduction (Leone, Bhandari et al 2004)
    • Age
    • Radial shortening
    • Radial inclination
    • Dorsal/volar tilt
  287. List the classification for posterior malleolus fractures
    • Type 1: Posterolateral oblique fracture wedge-shaped fragment
    • Type 2: Fracture that extends from incisura laterally to medial mal medially
    • Type 3: Shell-shaped fragments at posterior lip of plafond
  288. List 4 anatomic differences with pediatric cervical spine that predispose to c-spine injuries
    • Horizontal facets
    • Shallow facets
    • Ligamentous laxity (interspinous ligaments, posterior capsule, cartilaginous endplates)
    • Wedge-shaped vertebrae
  289. List 5 types of pediatric ACL reconstruction
    • Physeal sparring ? all epiphyseal
    • Physeal sparring ? partial epiphyseal
    • Physeal sparring ? partial extraarticular / intraarticular (IT band over the top)
    • Partial trans-physeal
    • Complete transphyseal
  290. List 4 differences with adolescent complete transphyseal ACL reconstruction from the adult reconstruction
    • Smaller tunnels
    • More vertical tunnels
    • No hardware or bone blocks placed near the closing physis
    • Methaphyseal fixation
  291. List 5 ways to measure glenoid bone stock deficiency
    • Defect length
    • Width to length ratio (Normal is 0.7)
    • Glenoid index (Uses 2d-CT; Width of injured side to normal side)
    • Glenoid ratio (Uses 2D-CT)
    • PICO Method (uses 3D-CT and is most sensitive and specific method)
  292. What are the 6 components of the Instability Severity Index Score (ISIS) (ISIS score more than 6 predicts a 70% redislocation rate after an arthroscopic bankart repair ? therefore do Latarjet; score less than 6 is 10% risk ? therefore can do only arthroscopic bankart repair)
    • Age at surgery (less than 20 or more than 20)
    • Degree of sport activity (high level vs recreational)
    • Type of sport (contact or non-contact)
    • Shoulder hyperlaxity anterior or inferior (measured by Gague?s sign or external rotation)
    • Hill-Sach?s lesion on AP radiograph in external rotation
    • Glenoid bone loss of contour on AP radiograph
  293. List 6 findings of shoulder internal impingement
    • PASTA tear (mostly posterior supraspinatus and infraspinatus)
    • Posterosuperior labral tear
    • Posterosuperior cartilage damage of glenoid
    • Posterosuperior humeral head cartilage damage
    • Bennet lesion (postero-inferior glenoid exostosis)
    • Associated with GIRD
  294. List the 4 criteria associated with a SICK scapula syndrome
    • Scapula malposition
    • Inferior-medial scapula border prominence
    • Coracoid pain
    • Scapula dysKenisis
  295. List the 7 CanMEDS principles
    • Medical expert
    • Manager
    • Communicator
    • Scholar
    • Collaborator
    • Professional
    • Health advocate
  296. List 7 stabilizers of the long head of biceps within the biccipital groove
    • Coracohumeral ligament
    • Superior gelnohumeral ligament
    • Transverse ligament
    • Supraspinatus tendon
    • Subscapularis tendon
    • Pectoralis major tendon
    • Falciform ligament
  297. List 9 risk factors for THA dislocation
    • Female
    • Obesity
    • Alcoholism
    • Neuromuscular condition
    • THA for osteonecrosis
    • Revision THA
    • Posterolateral approach
    • Greater trochanter nonunion
    • Smaller head size
  298. List 6 complications associated with the fracture table
    • Well leg compartment syndrome
    • Pudendal nerve injury
    • Sciatic nerve injury
    • Femoral nerve injury
    • Perineal soft tissue breakdown
    • Increased internal malrotation with femur fractures
  299. List 5 ways to make sure a radial head replacement is not overstuffed
    • Accurately template excised radial head on side table
    • Within 1 mm of lateral edge of coronoid
    • Within 1 mm of lesser sigmoid notch
    • Visualize any lateral ulnohumeral joint line gapping (by removing part of extensor mass or with dental mirror) ? (Best method)
    • X-ray by seeing any gapping of medial ulnohumeral joint line
  300. List 4 anatomical considerations where can?t place C1-C2 transarticular screws (Magerl)
    • Excessively medialized and large vertebral arteries
    • Hypoplastic C2 pars
    • Inability to obtain anatomic reduction of C1 on C2
    • Substantial thoracic kyphosis where can?t get necessary angle for screw trajectory
  301. List 5 structures at risk when placing C1-C2 transarticular screws (Magerl)
    • Vertebral artery
    • C2 nerve root
    • Hypoglossal nerve
    • Internal carotid artery
    • Spinal cord
  302. List 4 types of C2 screws
    • C2 pedicle screws
    • C2 pars screws
    • C2 translaminar screws
    • C1-C2 transarticular screws
  303. List key perioperative considerations for patients with Paget?s disease
    • High output cardiomyopathy
    • Increased blood loss due to hypervascularity of diseased bone
    • Deafness from auditory nerve compression
    • Other cranial nerve compression
    • Bones affected
    • Skull
    • Spine
    • Pelvis
    • Femur
    • Tibias
    • NB: Paget?s disease is primarily from abnormal osteoclasts. There are 3 phases: 1) Initial with high osteoclastic activity (high alk phos), 2) Mixed with both osteoclastic and osteoblastic activity, 3) Mostly blastic.
    • The bone that is formed is typically woven, immature bone
    • Can be monostotic (25%) or polyostotic (75%)
    • Typically see coxa vara and acetabular protrusio
    • Medical treatment is with bisphosphonates under certain indications
    • Pre-operative treatment with bisphosphonates or calcitonin is recommended
  304. List 4 potential surgical modalities needed in patient?s with Paget?s disease (Need to think about case very well pre-op and prepare adequately!!!)
    • Osteotomies to correct deformity
    • Total joint replacement (Hip and Knee) ? For THA use cementless implants
    • ORIF for fractures
    • Think about sarcomatous transformation as well
    • NB: For joint arthritis, need to make sure the pain is not coming from bone pain, therefore try a lidocaine injection to make sure you can relieve the joint pain
  305. List 7 areas of the body where can apply a tension band construct
    • Patella
    • Olecranon of elbow
    • Greater tuberosity of shoulder
    • Greater trochanter of hip
    • Lateral aspect of femur
    • Medial malleollus (STATIC compression)
    • Distal ulna (STATIC compression)
  306. List 8 musculoskeletal manifestations of mucopolysaccharidoses
    • Cervical stenosis
    • Atlanto-axial instability
    • Thoracolumbar kyphosis ? gibbus
    • Scoliosis
    • Hip dysplasia
    • Femoral head osteonecrosis
    • Genu valgum
    • Carpal tunnel syndrome
  307. List 7 non-musculoskeletal manifestations of mucopolysaccharidoses
    • Hydrocephalus
    • Corneal clouding
    • Recurrent otitis media and conductive hearing loss
    • Chronic bronchitis and recurrent resp. infections
    • Cardiac abnormalities
    • Valve pathology
    • Coronary artery disease
    • Cardiomyopathy
    • Dysrhythmias
    • Abdominal hernias
    • Hepatosplenomegaly
  308. List 5 conditions that mimic bilateral LCP
    • SED
    • MED
    • Sickle cell disease
    • Gaucher?s disease
    • Hypothyroidism
  309. List 5 negative prognostic factors associated with a septic joint
    • Age < 6 months
    • Septic hip (as opposed to other joints)
    • Delayed diagnosis
    • Symptoms more than 4 days
    • Associated osteomyelitis
  310. List 5 future issues from a cubitus varus from a supracondylar fracture
    • Increased risk of lateral condyle fractures
    • Tardy ulnar nerve palsy (nerves displaces anteriorly over medial epicondyle)
    • Trochlea AVN
    • Cosmetic issue
    • Tardy posterolateral elbow instability (the lateral soft tissues get stretched)
  311. List 8 abnormalities and complications associated with calcaneus malunion
    • Loss of height leading to decreased push-off strength
    • Heel widening/subfibular impingement ? leads to peroneal tendon and sural nerve irritation
    • Calcaneocuboid joint impingement
    • Varus Heel
    • Posttraumatic arthrosis
    • Anterior ankle impingement
    • Tethering and scarring of FHL
    • CRPS
  312. List 4 xray findings to suggest ACL deficiency
    • Lateral translation of the femur on the tibia
    • Blunting of the intercondylar eminence
    • Intercondylar notch osteophytes
    • Lateral notch sign ? accentuation of the sulcus terminalis on lateral xray
  313. List the 4 principles of ethics
    • Beneficience
    • Non-Malefecence
    • Autonomy
    • Justice
  314. List 3 benefits for corticosteroid use in DMD
    • Prolonged walking ability
    • Delayed decline in pulmonary function
    • Reduction in the need for scoliosis surgery
  315. List 13 causes for toe walking
    • Cerebral palsy
    • Congenital muscular dystrophy (Eg. DMD, BMD)
    • Tethered cord
    • Diastematomyelia
    • Autism
    • Schizophrenia
    • Global developmental delay
    • CMT
    • Spina bifida
    • Transient dystonic reaction
    • Venous malformation of the posterior calf muscle
    • Ankylosing spondylitis
    • LLD
  316. Factors 5 predictive of mortality in pediatric polytrauma patients
    • Patient demographics
    • Number of days from injury to admission
    • Initial vital signs in the ED
    • GCS at scene and in ED
    • Mechanism of injury
  317. List 2 very important factors associated with in-hospital mortality in peds trauma
    • GCS of 3 at presence to the ED
    • Systolic BP ?98 mm Hg at presence to the ED
    • (Treatment at a pediatric trauma center may decrease the risk of mortality)
  318. List 18 Factors that differ pediatrics polytrauma from adults polytrauma
    • Timing of organ failure occurs immediately after the injury
    • The organ failure sequence occurs simultaneously
    • Low risk for Acute Lung Injury
    • Low risk of death from pelvic fractures
    • Different pelvic fracture patterns compared to adults (more iliac wing and rami fractures in peds)
    • Morbidity is associated with organ injuries
    • High recovery rate from neurologic injuries
    • Dampened systemic inflammatory response
    • Robust local inflammatory response
    • SCIWORA
    • Pseudosubluxation
    • Need to use backboard with occipital cutout or mattress pad to elevate the body (because of larger head to body ratio)
    • Can do intraosseous infusion
    • Large bore IV in the anteromedial aspect of the proximal tibia just below the tibial tuberosity (to prevent physeal damage)
    • Hypotension develops with 25% of blood volume loss, therefore need to monitor HR closely
    • Need to calculate medications by weight
    • Need to calculate bolus by weight (20 cc/kg fluid ; 10 cc/Kg PRBCs)
    • Presence of physes
    • Liver and spleen are bigger in the abdomen
    • NB: Neurologic injuries are the PRIMARY factor in continued morbidity and mortality in pediatric polytrauma patients
  319. List 4 risk factors for domestic physical abuse
    • Young age
    • Shorter duration of the relationship
    • Coexistance of emotional, psychological and/or sexual abuse
    • Drug or alcohol dependency
    • NB: Up to 35% of women visiting EDs for trauma care are there due to IPV
  320. List risk factors for Achilles tendon tear
    • Males > Females
    • Age = 30-50 year old = ?weekend warrior?
    • Left > Right = Non-Dominant > Dominant
    • Violent Dorsiflexion of Ankle Joint = RUNNERS (10%), Weekend Warriors, Baseball, Volleyball, Basketball
    • Hyperpronation and Cavus foot
    • Flouroquinolone use (Cipro etc)
    • Exercised Induced Hyperthermia
    • Topical Steroid
    • Inflammatory arthritis (RA, SLE, Ochronosis ?)
  321. Lists based off of the 2012 to 2010 MCQ exams
  322. List 7 indications for TLIF or PLIF
    • Recurrent disc herniation
    • Spondylolisthesis
    • Degenerative disc disease
    • Degenerative scoliosis
    • Pseudoarthrosis
    • Postlaminectomy instability
    • Trauma
  323. List 4 conditions associated with spondylolisthesis
    • Spina bifida occulta
    • Thoracic hyperkyphosis
    • Scheuermann?s kyphosis
    • Down syndrome
  324. List 4 ways to decrease intramedullary pressure when reaming
    • Deepening the reamer flutes
    • Distal venting
    • Increasing reamer sizes by increments of 0.5mm
    • Using the RIA system (Reamer/Irrigater/Aspirater)
  325. List 4 diseases associated with cervical kyphosis
    • Larsen?s syndrome
    • Diastrophic dysplasia
    • Conradi?s syndrome
    • NF type 1
  326. List 6 types of torticollis
    • Congenital muscular torticollis
    • C1-C2 rotatory subluxation
    • Klippel-fiel syndrome
    • Neurogenic torticollis
    • Ocular torticollis
    • Sandifer syndrome
  327. List 6 blocks to reduction for a lateral subtalar joint dislocation (think medial structures)
    • Tibialis posterior
    • FHL
    • FDL
    • Capsule
    • Impacted fracture
    • Flexor retinaculum
  328. List 4 blocks to reduction for a medial subtalar joint dislocation (most common) (think lateral structures)
    • EDB
    • Extensor retinaculum
    • Peroneal tendons
    • Talo-navicular joint capsule
  329. List 5 conditions associated with a risk factor for chondrosarcoma
    • Enchondromas
    • Ollier?s disease
    • Maffucci?s syndrome
    • Osteochondromas
    • Multiple hereditary osteochondromatosis
  330. List 12 conditions that have eye involvement
    • Marfan?s syndrome
    • Homocystinuria
    • Juvenile idiopathic arthritis
    • Ankylosing spondylytis
    • Neurofibromatosis type 1
    • Ehlers-Danlos syndrome
    • McCunne-Albright?s disease
    • Rheumatoid arthritis
    • Osteogenesis imperfecta
    • Psoriasis
    • Mucopolysaccharidosis
    • Down?s syndrome
  331. List 10 ways to decrease HIV and HCV transmission during surgical procedures
    • Pass sharps between staff through and intermediary tray
    • Wear protective gowns
    • Wear protective eye wear
    • Wear protective gloves (double glove)
    • Periodically remind staff that it is a high risk case and remind for precautions
    • No hand knot tying (instrument tie)
    • Only one surgeon at a time to suture the wound
    • Announce when passing sharp objects
    • Proper hand hygiene
    • Use blunt suture needles when possible
  332. List the order from worst to best rate of progression in congenital scoliosis
    • Unilateral hemi with a contralateral bar
    • Unilateral bar
    • Double hemivertebra
    • Single hemivertebra
    • Fully segmented
    • Semisegmented
    • Non-segmented
    • Incarcerated
    • Unincarcerated
    • Wedge vertebra
    • Block vertebera
  333. List highest to lowest Young?s modulus
    • Ceramics
    • Cobalt chrome
    • Stainless steel
    • Titanium
    • Cortical bone
    • PMMA
    • Polyethylene
    • Cancellous bone
    • Tendon/ligament
    • Cartilage
  334. List the 4 principles of ethics for research trials
    • Beneficience
    • Non-Malefecence
    • Autonomy
    • Justice
  335. List the 3 structures within the carotid sheath
    • Internal jugular vein
    • Common carotid artery
    • Vagus nerve
  336. List the correct order of ossification of the elbow (CRITOE)
    • Capitellum (age: 1)
    • Radial head (age: 3)
    • Medial epicondyle (age: 5)
    • Trochlea (age: 7)
    • Olecranon (age: 9)
    • Lateral epicondyle (age: 11)
  337. Associate disease with genetic defect
    • Achondroplasia = FGFR3
    • Pseudoachondroplasia = COMP
    • Diastrophic dysplasia = Sulfate transporter
    • Osteogenesis imperfecta = Collagen type 1
    • Friedrich?s ataxia = Frataxin
    • Marfan?s disease = Fibrillin-1
    • DMD = Dystrophin
    • CMT = PMP22
    • SED = Collagen type 2
    • Morquio (MPS type IV): Keratan sulfate accumulation
  338. List 4 poor prognostic factors for UBC treatment
    • Age less than 10
    • Radiographically active
    • Large lesion
    • Multiloculated
  339. List 4 surgical indications for coxa vara (Normal HE angle = 25-degrees)
    • Trendelenburg gait
    • Pain
    • H-E angle > 60-degrees
    • Neck-shaft angle < 90-degrees
  340. List DDx for coxa vara
    • Congenital (Congenital short femur / PFFD)
    • Developmental
    • Metabolic
    • Rickets
    • OI
    • Osteopetrosis
    • Paget?s disease
    • Dysplastic
    • MED
    • SED
    • Fibrous dysplasia
    • Traumatic (SCFE, FN #) and Iatrogenic
    • Vascular (LCP, AVN)
    • Infection
  341. List 5 diseases associated with radial clubhand
    • Fanconi?s anemia
    • Holt-Oram syndrome
    • TAR (Thrombocytopenia absent-radius)
    • VACTERL
    • VATER
  342. List 6 different types of plate function
    • Compression
    • Bridge
    • Buttress/antiglide
    • Neutralization
    • Tension
    • Internal external fixator
  343. List the 7 CanMEDs principles
    • Manager
    • Professional
    • Communicator
    • Health advocate
    • Collaborator
    • Scholar
    • Medical expert
  344. List the 4 joints with an intra-articular metaphyseal component
    • Hip
    • Ankle
    • Shoulder
    • Elbow
  345. List the classic triad of McCunne-Albright syndrome
    • Caf?-au-lait spots (Coast of Maine)
    • Precocious puberty
    • Polyostotic fibrous dysplasia
  346. List 8 possible complications with the VEPTR technique
    • Rib fractures
    • Infection
    • Thoracic outlet syndrome
    • Skin breakdown
    • Implant breakage
    • Iliac crest perforation
    • Hip destabilization
    • Post-operative pain
  347. List the order in nerve function return after repair (Some ? People ? Think ? That ? Puppies ? Meow)
    • Sympathetic
    • Pain
    • Temperature
    • Touch
    • Proprioception
    • Motor
  348. List 5 causes of snapping hip syndrome
    • IT band
    • Iliopsoas tendon
    • Rectus femoris
    • Labrum
    • Intra-articular loose bodies
  349. List 10 risk factors for post-traumatic radioulnar synostosis
    • Fracture of the radius and ulna at same level
    • Delayed treatment (more than 2 weeks)
    • Associated TBI
    • Proximal fractures (type 3)
    • Fractures fixed with same approach
    • High energy mechanism of injury
    • Fracture comminution
    • Severe soft tissue injury
    • Interosseous membrane injury
    • Screws protruding in to the interosseous membrane
    • Bone graft on the interosseous membrane
    • Retained bone fragments on the interosseous membrane
  350. List 3 provocative maneuvers for thoracic outlet syndrome (W-A-R)
    • Wright?s test (abduction and external rotation with neck rotated away)
    • Adson?s test (arm extension with neck extension and rotation towards affected arm)
    • Roos test (arms above head and flex/extend fingers multiple times)
  351. List 10 causes for thoracic outlet syndrome
    • Clavicle malunion
    • 1st rib malunion
    • Cervical rib
    • Vertebral transverse process
    • Scalene abnormality
    • Scapula ptosis (depression)
    • Fibromuscular bands
    • Abnormal pectoralis minor
    • Repetitive shoulder use
    • Extreme arm positions
  352. List 5 factors associated with poor outcome of ACL reconstruction
    • Obesity
    • Smoking
    • Severe chondrosis
    • Hearing a pop at time of injury
    • Gaining more than 15 lbs in year after OR
  353. List 4 tumors in the posterior elements of the spine
    • ABC
    • Osteoid osteoma
    • Osteoblastoma
    • Osteochondroma
  354. List 8 ways to increase stability of an external fixator
    • Decrease distance between bar and bone
    • Increase amount of schanz screws in each fragment
    • Put schanz screws in multiple planes
    • Use of multiple bars in same plane
    • Use multiple bars in different planes
    • Increase distance between outermost schanz screws
    • Use larger diameter schanz screws
    • Increase size of stacking rods
  355. List 8 ways to increase stability of a circular fixator
    • Large diameter wires
    • Decreased ring diameter
    • Olive wires
    • Extra wires
    • Wires cross perpendicular to each other
    • Increased wire tension
    • Placement of two central rings close to the fracture
    • Increased number of rings
  356. List 12 causes of a neuropathic joint
    • Syringomielia (upper extremities ? most common)
    • Leprosy (Shoulder ? 2nd most common)
    • Myelomeningocele
    • Spinal cord tumors (lower extremities)
    • Charcot-Marie-Tooth
    • Syphilis (affects the knee)
    • Multiple sclerosis
    • Chronic demyelinating polyradiculopathy
    • Diabetes (lower extremeties ? most common)
    • Alcoholism
    • TB arachnoiditis
    • Congenital insensitivity to pain
  357. List 6 factors in females associated with increased ACL injuries
    • Smaller notches
    • Smaller ligaments
    • Ligamentous laxity
    • Increased estrogen
    • Different landing biomechanics
    • More valgus
    • More extended
    • (NB: therefore teach women to land in a more flexed and varus/neutral knee position)
    • Hamstring weakness with more quads strength (Quads dominant)
  358. List 12 potential causes for metatarsalgia (primary / secondary / iatrogenic)
    • Hallux valgus
    • Metatarsal length discrepancy - congenital
    • Brachymetatarsia
    • Excessive MT plantar flexion
    • Cavus foot
    • Flatfoot
    • Abnormal metatarsal head anatomy
    • Hallux rigidus
    • MTP joint instability
    • Malunion of metatarsal fracture
    • Freiberg?s infarction
    • Iatrogenic
  359. List 4 poor prognostic factors for SHS screw cut-out
    • TAD more than 25 mm
    • Fracture pattern (more unstable patterns)
    • Advancing age
    • Quality of the reduction
  360. List 4 risk factors for femoral neck nonunion treated with cannulated screws
    • Triangle configuration (Inverted triangle is better)
    • Fracture displacement
    • Borderline or inadequate reduction
    • More centralized screws (Ie need to spread them apart)
  361. List 8 factors associated with Juvenile Idiopathic arthritis (Pauci-articular (50%) (?4 joints involved), Poly-articular (30%), systemic (20%)) (Prognosis: Pauci > Poly > Systemic)
    • Rash
    • Rheumatoid factor
    • Iridocyclitis
    • C-spine issues
    • Pericarditis
    • Tenosynovitis
    • Intermittent fevers
    • Morning stiffness
  362. List the 3 factors to make the diagnosis of Juvenile idiopathic arthritis
    • Persistent arthritis in any one joint for ?6 weeks
    • Onset of disease by age 16 years
    • Exclusion of other conditions that cause arthritis
    • NB: Differentiate from Leukemia because leukemia usually has SEVERE pain out of proportion to the swelling
  363. List 8 DDx for patients with JIA
    • JIA
    • Infection
    • Malignancy (Leukemia)
    • Enthesitis-related arthritis
    • Acute rheumatic fever (worry about carditis***)
    • Inflammatory bowel disease associated arthritis
    • SLE
    • Idiopathic muscle pain
  364. List 8 associated conditions with DMD
    • Calf pseudohypertrophy
    • Scoliosis
    • Equinovarus
    • Joint contractures
    • Cardiomyopathy
    • Static encephalopathy
    • Respiratory compromise
    • Malignant hyperthermia
  365. List 8 symptoms of long-term corticosteroid use
    • Osteonecrosis
    • Weight gain
    • Cushinoid appearance
    • GI symptoms
    • Mood lability
    • Headaches
    • Short stature
    • Cataracts
  366. List 12 diseases/factors that are risk factors for carpal tunnel syndrome
    • Pregnancy
    • Female
    • Obesity
    • RA
    • Hypothyroidism
    • Alcohol
    • Advanced age
    • Chronic renal failure
    • Smoking
    • Repetitive motion activities
    • Mucopolysaccharidosis
    • Amyloidosis
  367. List risk factors for myelodysplasia
    • Folate deficiency
    • Maternal diabetes
    • Maternal hyperthermia
    • Valproic acid
  368. List 13 issues with myelodysplasia
    • Pathologic fractures due to osteopenia
    • Scoliosis
    • Congenital kyphosis
    • Hip dislocations
    • Hip flexion contractures
    • Adductor contractures
    • Tibial torsion
    • Foot deformities
    • Arnold-chiari malformations
    • Hydrocephalus
    • Tethered cord
    • Neurologic bladder issues
    • Latex allergies
  369. List 6 causes of trigger finger
    • Diabetes
    • RA
    • Amyloidosis
    • Gout
    • Idiopathic
    • Dupuytren?s contracture
  370. List 8 Symptoms of vertebrobasilar insufficiency
    • Vertigo
    • Diploplia
    • Graying of vision
    • Blurred vision
    • Knee buckling
    • Dysphagia
    • Nausea and vomiting
    • Slurred speach
  371. List 10 stabilizers of the DRUJ
    • Osseous anatomy (dorsal and palmar rim)
    • DRUJ capsule
    • Volar and dorsal radioulnar ligs.
    • TFCC
    • Pronator quadratus
    • ECU tendon sheath
    • ECU tendon
    • Interosseous membrane
    • Ulnar triquetral lig.
    • Ulnar-lunate lig.
  372. List 5 differences between JUVENILE hallux valgus and ADULT hallux valgus
    • Bilateral and familial
    • Increased IMA
    • Pain usually not primary complaint
    • Increased DMAA
    • Often associated with flexible flatfoot
  373. Predicted SAQs for 2009 exam
  374. List 5 risk factors for plantar fasciitis (think of these that stress the plantar fascia!!!!)
    • Obesity
    • Pes planus
    • Pes cavus
    • Tight Achilles tendon
    • Weight bearing endurance activity
    • NB: want to rehab with plantar fascia specific stretches and Achilles specific stretches
  375. List risk factors for fracture non-union:
    • Host factors
    • Diabetes
    • Smoking
    • Vascular disease
    • Alcohol abuse
    • Advanced age
    • Medications: NSAIDs, prednisone
    • Infection
    • Malnutrition
    • Radiation treatment
    • NF1
    • Fracture pattern
    • Large soft tissue injury
    • Large soft tissue dissection
    • Inadequate stability
  376. List the indices for poor wound healing:
    • ABIs <0.45 mm Hg
    • Toe pressures <40 mm Hg
    • TCO2 < 30 mm Hg
    • Total protein <6.0 g/dl
    • Albumin < 2.5 g/dl
    • WBC < 1500
  377. List the 9 poor prognostic factors for calcaneus fractures ORIF
    • Worker?s compensation
    • Manual laborer
    • Male
    • Age > 50
    • Obesity
    • Smoker
    • Polytrauma
    • Bilateral fractures
    • Vasculopathy
  378. List 2 radiographic findings of patients with OCD of the capitellum
    • Fragmentation of the capitellum
    • Enlargement of the radial head
  379. List the 7 diagnostic factors for rheumatoid arthritis (Need at least 4 for diagnosis)
    • Positive rheumatoid factor
    • Hand involvement
    • Rheumatoid nodules
    • Symmetrical/bilateral arthropathy
    • More than 3 joints involved
    • Morning stiffness (more than 1 hour)
    • Xray findings of erosions
  380. List the 3 nerves and associated muscle associated with scapular winging
    • Long thoracic nerve ? Serratus anterior ? medial winging ? Tx: Pec. Major transfer
    • Spinal accessory nerve (CN XI) ? Trapezius ? lateral winging ? Tx: Eden-Lange transfer to lateralize levetor scapulae and rhomboids
    • Dorsal scapular nerve ? Rhomboids and levator scapulae
    • NB: Fascioscapulohumeral dystrophy is autosomal dominant disease that also causes scapular winging because the trapezius, levator scapulae and rhomboids are relatively weak compared to the other muscles
    • NB: Scapular winging is anything that causes scapulothoracic dysfunction
  381. List 5 sites of compression of the long thoracic nerve that can cause medial winging (Serratus anterior)
    • Middle scalene muscle
    • Proximal to 1st rib
    • Between clavicle and 2nd rib
    • Inferior angle of scapula
    • Fascial sling at 1st intercostal space
  382. List 4 secondary causes of scapular winging
    • Subacromial bursitis
    • Adhesive capsulitis
    • Rotator cuff tears
    • Shoulder instability (especially posterior)
    • NB: Winging occurs because there is a decrease in GH joint motion with an increase in scapulothoracic motion to compensate, therefore those muscles get tired and lead to winging.
  383. List 7 causes of swan neck deformity
    • PIP synovitis
    • Volar plate attenuation
    • Transverse retinacular lig. Attenuation ? Leads to dorsally displaced lateral bands
    • FDS tendon injury
    • Mallet finger (Terminal extensor tendon injury)
    • MCP volar dislocation
    • Intrinsic tightness
  384. List 2 causes of boutonierre deformity (Elson test to diagnose a central slip rupture)
    • Central slip rupture
    • Triangular lig. Attenuation ? leads to volarly displaced lateral bands
  385. List the components of the superior shoulder suspensory complex
    • Lateral clavicle
    • AC joint
    • Acromion
    • Glenoid
    • Coracoid
    • Coraco-clavicular ligs.
    • +/- coraco-acromial lig
  386. List 3 cancers that need a bone marrow biopsy for staging
    • Lymphoma
    • Ewing?s sarcoma
    • Rhabdomyosarcoma
  387. List 7 indications for meniscal repair
    • Tears are > 1cm and < 4cm in length
    • Red-red zone tears
    • Vertical tears
    • Age < 40 years old
    • No mechanical axis malalignment
    • Acute tears (Less than 6 weeks old)
    • Associated with concomitant ACL reconstruction
  388. List 6 effective ways of reducing radiation exposure to the surgeon
    • Inverting xray beam
    • Lead aprons
    • Giving surgeon the foot pedal
    • Collimation (Meaning: Decreasing the field of view on the xray)
    • Increased distance between surgeon and beam
    • Using low-dose option
    • List the steps for Ponsetti technique for clubfoot treatment
    • Cavus (1 week) ? align forefoot with hindfoot ? need to supinate
    • Next casts for 6 weeks ? Treat the Cavus, adduction and varus by abducting foot with pressure on lateral talar head
    • Achilles tenotomy
    • Cast for 3 weeks with long leg casts and knees in 90-degrees of external rotation
    • Denis-Brown bars affected limb at 70-degrees ER and normal foot at 40-degrees of ER, shoulder width apart
    • Full-time fore 3 months
    • Then Night-time for 3 years
    • NB: Main cause of recurrence is compliance
    • For recurrence or older presentation always try casting FIRST
    • U/S of hips to rule out DDH ? 10% association
  389. List DDx for congenital vertical talus (50% associated with a neuromuscular or genetic disorder)
    • Arthrogryposis
    • Myelodysplasia
    • Neurofibromatosis
    • Cerebral palsy
  390. List 9 side effects of anabolic steroids
    • Gynecomastia
    • Growth retardation
    • Hypercholesterolemia
    • Aggressive behaviour
    • Testicular atrophy
    • Deepening of female voice
    • Acne
    • Hirsuitism
    • Decreased threshold for tendon rupture
  391. List 6 factors associated with catatrosphic wear
    • PE thickness less than 8 mm
    • Flat poly design
    • Sliding wear/Increased femoral roll back
    • Gamma irradiation in oxygen
    • Varus alignment
    • PE processing
  392. List 6 negative predictive factors (need for a second surgery) with tibial nailing from SPRINT trial
    • High energy mechanism of injury
    • Presence of a fracture gap (< 1cm)
    • Reamed tibial nailing in open fractures (Reamed tibial nails were better in closed fractures)
    • Need for complex soft tissue reconstruction
    • Stainless steal nails compared to titanium nails
    • Immediate weight bearing after nailing
    • NB: The last 2 are due to autodynamization
  393. List 9 factors associated with a negative outcome in major lower extremity trauma (LEAP study). NB ? no functional difference between limb-salvage and amputation at 2 and 7 years f/u ? High incidence of psychological disorders after the trauma (Depression and PTSD)!
    • Older age
    • Female sex
    • Nonwhite race
    • Lower level of education
    • Living in a poor household
    • Low self-efficacy (was predictive or return to work or not)
    • Poor self-reported pre-injury health status
    • Current or past smoker
    • Involvement with the legal system for obtaining disability payments
  394. List 9 Findings from the SPORT trial for 3 spine conditions: Invertebral disk herniation / Degenerative spondylolisthesis / Lumbar spinal stenosis
    • There were different findings between the Intention-to-treat analysis and the As-treated analysis
    • There was NO specific protocol for non-surgical management
    • There was NO consistent surgical management for all the 3 surgical pathologies
    • For IDH: Slightly better outcomes with surgery than non-op: However both groups improved dramatically
    • For Degenerative spondy.: Much better outcomes with surgery than non-op at 4 years F/U
    • For Lumbar spinal stenosis: Much better outcomes with surgery than non-op at 4 years F/U
    • Both surgical and non-surgical treatment options pose acceptable risks to the patient
    • No patient in the non-operative group went on to develop cauda equina syndrome or a progressive neurologic deficit!!! (Important point)
    • NB: Complications: Dural tears: 3-10% / Wound infection: 2-3% / Re-operation: 10-15%
  395. List 12 risk factors for heterotopic ossification
    • Male
    • DISH
    • Ankylosing spondylytis
    • Previous HO
    • Post-traumatic OA
    • Hip fusion
    • TBI
    • Cementless components
    • Paget?s disease
    • Parkinson?s disease
    • Heterotopic OA
    • Excessive osteophytosis
  396. List the 6 components for the Spinal Instability Neoplastic Score (SINS) (0 to 18)
    • NB: A good way to think of this scoring system is that it has all the components of the Mirels score (Appearance, location, pain, size)
    • (Score 0 ? 6: Stable lesion; 7 ? 12: Possible instability; 13 ? 18: Definite instability)
    • Location of the tumor
    • Pain
    • Appearance of the lesion (Lytic, blastic, mixed)
    • Radiographic spinal alignment
    • Vertebral body collapse
    • Posterolateral involvement of the spinal elements
  397. List the 3 components for the Thoraco-Lumbar Injury Classification and Severity score (TLICS)
    • NB: <4 ? conservative / 4 ? conservative or surgical / >4 - surgical
    • Injury morphology (Compression vs translation/rotation vs distraction)
    • Status of the posterior ligamentous complex
    • Neurologic status of the patient
    • NB: The TLICS score is the first score to incorporate the neurologic status of the patient
  398. Injury Severity Score (ISS) ? 0 to 75
    • Based on the Abbreviated Injury Scale (AIS) score
    • Use the 3 most injured areas, Square each one and add them to get the final score
    • If one area has a score 6 than automatically get a 75. 6 means an non-survivable injury
    • ISS score of more than 15 means a significant injury
    • 6 body regions
    • Head
    • Face
    • Chest
    • Abdomen
    • Extremities and Pelvis
    • External
  399. List 12 the ?red flags? for spine pain
    • History of cancer
    • Bowel and bladder issues
    • Night pain
    • Constant pain at rest
    • Older than 55
    • Younger than 20
    • Fever
    • Spine structural deformity occurred
    • On steroids
    • Drug abuser or have HIV, immunosuppression
    • Recent trauma
    • Thoracic pain
  400. List the 5 ?yellow flags? for back pain ? Psychosocial issues
    • Negative attitude to the back pain
    • Fear avoidance behavior and reduced activity
    • Expectation that passive rather than active Tx will be beneficial
    • Tendency to depression, low morale, social withdrawal
    • Social or financial problems
  401. List the 4 components of the WOMAC score
    • Pain
    • Stiffness
    • Physical function
    • Total score
  402. List the components of the CAROC fracture risk assessment
    • Age
    • Gender
    • Femoral neck BMD
    • Steroid use
  403. List the components for the FRAX (WHO) fracture risk assessment
    • Country
    • Age
    • Gender
    • Femoral neck BMD
    • Height
    • Weight
    • Steroid use
    • Smoker
    • Alcohol use
    • Rheumatoid arthritis
    • Previous Hx of fracture
    • Family history of hip fracture
    • Any cause for secondary osteoporosis
  404. List 4 things that affect the POWER of a study
    • Sample size
    • Effect size
    • Acceptable level of a type 1 error (<0.05)
    • Variability amongst the data
    • NB: Higher power when have a Large sample size, Large effect size, and low variability
  405. List the components of the spiral cord (PSLG)
    • Pretendinous band
    • Spiral band
    • Lateral digital sheath
    • Grayson?s ligament
  406. List the 6 cords that make up Dupuytrens
    • Pretendinous cord
    • Central cord
    • Spiral cord
    • Natatory cord
    • Lateral cord
    • Retrovascular cord
  407. List the cords associated with each joint contracture
    • MCP: Pretendinous and spiral cords
    • PIP: Spiral, Central, Lateral cords
    • DIP: Lateral and retrovascular cords
    • Web space contracture: Natatory cord
  408. List 4 risk factors for Dupuytren?s diathesis
    • Age of onset (age less than 50)
    • Bilateral disease
    • Family history
    • Ectopic lesions (lesions outside the palm, eg. Garrod?s nodes (dorsal hand knuckle pads); Peyronie?s disease (penile fibromatosis); Ledderhose disease (Plantar fascia fibromatosis))
  409. List the 5 components of the Canada Health Act (PUPCA) - 1984
    • Public administration
    • Universality
    • Portability
    • Comprehensiveness
    • Accessability
  410. List 6 drugs that can cause osteoporosis
    • Steroids
    • Dilantin
    • Lithium
    • Methotrexate
    • Heparin
    • Cyclosporine
  411. List 5 complications from pavlik harness treatment
    • Pavlik?s harness disease
    • Femoral nerve palsy
    • AVN
    • Skin breakdown
    • Brachial plexus palsy from shoulder straps
  412. List 3 important criteria with pavlik harness
    • Anterior straps for flexion to 100-degrees
    • Posterior straps are to prevent adduction (do not tighten)
    • Want abduction less than 50-degrees (otherwise risk AVN)
    • NB: Do not keep baby in pavlik harness more than 3 weeks if nor reduced clinically or on U/S
    • Risk of AVN and Pavlik harness disease (Erosion of posterior acetabulum)
    • After age 6 months, harness has a 50% failure rate
  413. List the 5 diagnostic labs/criteria for pediatric septic arthritis
    • Temp >38.5 (best predictor)
    • CRP > 20 (second best predictor)
    • WBC > 12
    • ESR > 40
    • Inability to bear weight
  414. List ways that TB of the spine differs from pyogenic infections
    • TB originates in the metaphysis of the vertebral bodies and spreads under the ALL
    • Large anterior abscesses
    • Discs are preserved
    • Severe kyphosis more common
  415. List 5 risk factors for PTT insufficiency
    • Obesity
    • Female
    • Older athletes
    • Hypertension
    • Inflammatory conditions
  416. List 5 good prognostic factors for calcaneus ORIF
    • Significant intra-articular displacement
    • Flattened bohler?s angle
    • Female
    • Age less than 29
    • No worker?s compensation involved
  417. List the Levels of Evidence in order of BEST to WORST
    • Blinded, Randomized control trial
    • Prospective cohort
    • Case-control / Retrospective cohort
    • Case series
    • Expert opinion
  418. List 6 risk factors for post-radiation fracture
    • Female gender
    • Age
    • Osteoporosis
    • Periosteal stripping during surgery
    • Anterior femoral compartment resection
    • Radiation dose given
  419. List 4 findings to valgus extension overload of the elbow
    • Incompetence of anterior band of MCL
    • Posteromedial osteophyte of olecranon
    • Posteromedial impingement of ulno-humeral joint
    • Increased pressures at radio-capitellar joint leading to cartilage damage
  420. List the 8 domains of the SF-36
    • Vitality
    • Physical functioning
    • Bodily pain
    • General health perceptions
    • Physical role functioning
    • Emotional role functioning
    • Social role functioning
    • Mental health
  421. List 3 findings of anterior cord syndrome
    • Loss of motor function; legs more than arms (corticospinal tracts)
    • Loss of pain and temperature and light touch (spinothalamic tracts)
    • Sparring of vibration, proprioception and deep touch (Posterior columns)
  422. List the 3 findings of Wallenberg/PICA/Lat. Medullary syndrome ? Occurs from insufficiency of the vertebral artery or posterior inferior cerebellar artery (PICA)
    • Ipsilateral face pain and temperature deficit and cranial nerve deficit
    • Contralateral trunk and extremities pain and temperature deficit
    • Horner?s syndrome, nystagmus, vertigo, dysphagia
  423. List top 7 DDx for tumor >40 years old
    • Mets
    • Multiple myeloma
    • Lymphoma
    • Chondrosarcoma
    • Malignant fibrous histiocytoma
    • Fibrosarcoma
    • Infection
  424. List the 4 DDx for bubbly looking lesions in the anterior tibial cortex
    • Fibrous dysplasia (observe)
    • NOF (observe)
    • Osteofibrous dysplasia (can observe ? benign)
    • Adamantinoma (Malignant lesions! Tx with wide resection +/- reconstruction, Need to do a CT-chest to rule out METS!!)
  425. List the top 5 DDx for scary looking lesions in pediatrics
    • Osteosarcoma
    • Ewing?s sarcoma
    • Hematologic malignancies (Lymphoma / Leukemia)
    • EG
    • Infection
  426. List the top 3 DDx for a benign looking periosteal reaction
    • Stress fracture
    • Osteoid osteoma
    • Infection (osteomyelitis)
  427. List the top 6 DDx for benign aggressive bone tumors (think neocortex)
    • Giant cell tumor
    • ABC
    • Chondroblastoma
    • Chondromyxoid fibroma
    • Osteoblastoma
    • Can also put EG in there too if it looks aggressive
  428. List the 5 DDx for fluid-fluid levels seen in a lesion on MRI
    • ABC
    • Telangiectatic osteosarcoma
    • Giant cell tumor
    • Secondary ABC
    • Fracture through a simple cyst
  429. List 4 types of adjuvant treatment that have been reported for GCT
    • Liquid nitrogen
    • Phenol
    • Hydrogen peroxide
    • Argon beam
    • NB: Treatment of choice for GCT is extended curettage and bone graft or cement. Can do wide resection for recurrent cases
  430. List 8 conditions that can have an intrinsic-plus hand (Extrinsics are weak and Intrinsics ok)
    • Trauma
    • Vascular injury/problem
    • Compartment syndrome
    • Rheumatoid arthritis
    • Stroke
    • Cerebral palsy
    • TBI
    • Parkinson?s disease
  431. List 7 risk factors for sciatic nerve injury during THA
    • Revision
    • DDH case
    • Limb lengthening
    • Obesity
    • Female
    • Post-traumatic OA
    • Surgeon self-reports procedure as difficult
  432. List the modified Jones criteria for Acute Rheumatic Fever (Need to have a Streptoccocal infection and 2 major or 1 major and 2 minor for diagnosis) ? The associated arthritis is typically acute and lasts for hours to weeks at a time; which is different from JIA which is subacute and lasts for months. *** Need to assess for carditis***
    • Arthritis is the most common symptom of ARF
    • Major criteria (Think JONES ? J=joint; O=Heart/carditis; N=nodules; E=erythema; S=sydenham?s chorea)
    • Carditis
    • Migratory polyarthritis
    • Chorea
    • Erythema marginatum
    • Subcutaneous nodules
    • Minor criteria
    • Fever
    • Arthralgia
    • Elevated ESR and CRP level
    • Prolonged PR interval on ECG
  433. List 4 Atraumatic causes of hip instability
    • Down?s syndrome
    • DDH
    • Marfan?s syndrome
    • Ehlers-Danlos syndrome
  434. List 5 fall prevention strategies for the elderly (obviously important to prevent the elderly from falling to prevent fractures)
    • Delirium prevention
    • Nutrition
    • Medications
    • Eye care
    • Exercise and balance training
  435. List the 5 components of the Beighton classification for hyperlaxity (Score of ?4 is indicative of joint laxity)
    • Small finger hyperextension
    • Thumb apposition to the forearm
    • Elbow hyperextension
    • Knee hyperextension
    • Trunk flexion with knees fully extended
  436. List the 2 types of Galeazzi fractures and their mechanisms of injury
    • Type 1 ? Apex volar: Dorsal displacement of distal radius and VOLAR displacement of the ulna ? Mech. Axial loading with forearm in SUPINATION
    • Type 2 ? Apex dorsal: Volar displacement of the distal radius and DORSAL displacement of the ulna ? Mech. Axial loading with forearm in PRONATION
  437. List the 6 diagnostic criteria for psoriatic arthritis
    • Current evidence of psoriasis
    • Past or family history of psoriasis
    • Current nail lesions
    • Negative rheumatoid factor
    • Dactylytis or history of dactylytis
    • Fluffy periostitis detected on radiographs
  438. List 6 perioperative considerations for psoriatic arthritis surgery
    • Plaques around surgical site ? have increased bacteria in them
    • Soft tissue contractures
    • Staging of procedures with multiple joint involvement
    • Peri-articular osteopenia
    • Increased infection rate
    • Immune modulators
  439. List the order from best to worst for nerve conduits (needs ?3 cm of a gap to be used)
    • Caprolactone
    • Collagen
    • PGA
  440. List 7 possible deformities associated with Sprengel deformity (highest to lowest)
    • Scoliosis
    • Klippel-Fiel syndrome
    • Rib anomalies
    • Omovertebral bone
    • Spina bifida
    • Torticollis
    • Clavicle anomalies
  441. List 4 possible complications associated with Sprengel deformity surgery (highest to lowest)
    • Hypertrophic scar
    • Brachial plexus injury
    • Regrowth of the superior pole of the scapula
    • Scapular winging
  442. List the Cavendish classification for Sprengel deformity (1, 2s non-op / 3, 4s surgery)
    • Very mild (no deformity seen with shirt on)
    • Mild (lump in neck seen with shirt on)
    • Moderate (elevation of 2 to 5 cm of the scapula)
    • Severe (superior angle of scapula almost on occiput)
  443. List 9 musculoskeletal problems with hemophilia
    • Acute hemarthosis
    • Joint contractures
    • Compartment syndrome
    • Pseudotumors
    • Chronic hemarthrosis
    • Arthritis
    • Nerve palsies
    • Heterotopic ossification
    • Septic arthritis
  444. List 8 contraindications for negative-pressure wound therapy
    • Necrotic tissue with eschar present
    • Untreated osteomyelitis
    • Nonenteric and unexplored fistulas
    • Malignancy in the wound
    • Exposed vasculature
    • Exposed nerves
    • Exposed anastomotic site
    • Exposed organs
  445. List the 7 components of the Wells score for PE
    • Clinical signs and symptoms of DVT
    • An alternative diagnosis is less likely than PE
    • HR more than 100
    • Immobilization or surgery within the last 4 weeks
    • Previous DVT/PE
    • Hemoptysis
    • Malignancy
  446. List 3 disorders with Caf?-au-laits spots
    • Neurofibromatosis type 1 (Coast of California ? smooth borders)
    • McCune-Albright?s disease (Coast of Maine ? irregular borders)
    • Jaffe-Campanacci disease (Coast of Maine ? irregular borders)
  447. List 9 diseases that can be treated with bisphosphonates
    • Osteoporosis
    • Metastatic disease
    • Paget?s disease
    • Osteogenesis imperfecta
    • Fibrous dysplasia
    • Hypercalcemia
    • Multiple myeloma
    • Primary hyperparathyroidism
    • Early stages of osteonecrosis
  448. List 4 complications with bisphosphonate use
    • Esophageal erosion / gastritis
    • Osteonecrosis of the jaw
    • Atrial fibrillation in women
    • Atypical femur fractures
    • Hypocalcemia
    • NB: Severe renal failure is a contraindication for bisphosphonates since the primary mode of bisphosphonate excretion is renal
  449. List 3 complications associated with post-traumatic pelvic embolization
    • Gluteal necrosis (following complete internal iliac artery embolization- probably due to bilateral internal iliac embolization)
    • Post-operative deep wound infections (2013 data from Tampa and Baltimore)
    • Impotence
  450. List 4 criteria that increase stress shielding
    • Larger diameter stems
    • Stiffer metal (eg. Co-Cr)
    • Solid, round stems
    • Extensive porous coating (distal bone loading)
  451. List 6 criteria for adequate bone ingrowth for a cementless stem
    • Pore size 50 to 300 micrometers
    • 40 ? 50% porosity
    • Optimal pore depth
    • Gap between metal and bone less than 50 micrometers
    • Initial rigid fixation (press fit vs line to line)
    • 50 to 150 micrometers of micromotion (if more will lead to fibrous ingrowth)
  452. List 6 x-ray findings suggestive of a dysplastic sacrum
    • Upper sacrum is collinear with cranial aspect of iliac crests (sacrum should be recessed within the pelvis, lower than the iliac crests
    • Mammillary processes within the alar region
    • Upper sacral neuroforamina are larger and non-circular
    • Residual intervertebral disks
    • More acute alar slope
    • Anterior cortical indentation
  453. List the 4 components of the Mirel score (Score >8: should operate, Score=8 up to surgeon, Score ?7 can do non-op)
    • Appearance of the lesion (Blastic, Mixed, Lytic)
    • Location of the lesion (Upper extremity, Lower extremity, Peritrochanteric)
    • Size of the lesion
    • Pain
  454. List the 6 components of the Tokuhashi score (lower score is worse) (Revised scoring system found that score 0 ? 8= less than 6 months survival; 9 ? 11= more than 6 months; 12 ? 15= more than 1 year survival)
    • General condition
    • Number of extraspinal bone mets
    • Number of Mets in spine
    • Mets in major internal organs
    • Primary site of cancer
    • Myelopathy
  455. List the order of survival for bone mets from highest to lowest and lytic vs blastic (BLT and Kosher Pickle)
    • Thyroid (48 months) (Lytic)
    • Prostate (40 months) (Blastic)
    • Breast (24 months) (Mixed)
    • Kidney (20 months) (Lytic)
    • Lung (6 months) (Lytic)
    • NB: Mets below the elbow or knee are usually LUNG mets
  456. List radiosensitive tumors
    • Blood borne tumors
    • Multiple myeloma (plastmacytoma)
    • Lymphoma
    • Leukemia
    • Prostate cancer
  457. List the 7 static restrains for the shoulder
    • Osseous anatomy
    • Negative intra-articular pressur
    • Concavity-compression
    • Capsule
    • Labrum
    • Superior, Middle, Inferior gleno-humeral ligs.
    • Coraco-humeral lig
  458. List the 4 groups of dynamic shoulder restraints
    • Rotator cuff muscles
    • Deltoid
    • Biceps
    • Periscapular muscles
  459. List 3 tissues that are best seen with Proton-Density MRI
    • Articular cartilage
    • Meniscus
    • Labrum
  460. List the 4 classes of shock and percentage of blood volume loss
    • Class1 = less than 15% loss
    • Class 2 = 15 to 30% loss
    • Class 3 = 30 to 40% loss
    • Class 4 = more than 40% loss
  461. List 5 factors for best prognosis for nerve repair
    • Children
    • Sharp, clean cuts to the nerve
    • Early repair
    • Direct repair
    • Healthy, clean vascular bud
  462. List the 4 conditions associated with Horner?s syndrome (M-A-P-E)
    • Myosis
    • Anhydrosis
    • Ptosis
    • Enophthalmos
  463. List the order from lateral to medial of structures exiting the greater sciatic notch BELOW the piriformis (POPS IQ)
    • Pudendal nerve
    • Nerve to Obturator internus
    • Posterior cutaneous nerve of the leg
    • Sciatic nerve
    • Inferior gluteal
    • Nerve to Quadratus femoris
  464. List the 3 stages of complex regional pain syndrome
    • Acute (0 to 3 months)
    • Dystrophic (3 to 6 months)
    • Atrophic (6 to 12 months)
    • NB: Lower extremity has a worse prognosis than upper extremity. Key is to identify and treat them early
  465. List the 3 Pedowitz criteria for Chronic extertional compartment syndrome
    • Resting pressure > 15 mm Hg
    • 1 minute post-exercise > 30 mm Hg
    • 5 minutes post-exercise > 20 mm Hg
  466. List classification for bony bar (growth arrest)
    • Peripheral
    • Central
    • Linear
  467. List 3 classification systems for sacral fractures
    • Denis (zone 1, 2, 3: Lateral, through, medial to the sacral neural foramens)
    • Roy-Camille for Denis zone 3 fractures (measured on the sagittal CT) (Types 1 to 4)
    • Isler (in relation to the L5-S1 facet joint (Lateral, through the facet, medial to the facet)
  468. List the 3 stages of adhesive capsulitis
    • Painful
    • Stiff
    • Thawing
    • NB: If no improvement by 3 to 4 months consider surgery
  469. List 5 ways to determine proper femoral component rotation in TKA
    • Trochlear groove ? Whiteside?s line
    • Posterior condyles
    • Trans-epicondylar axis
    • Gap balance using tensioners under the LFC and MFC
    • Tibial alignment axis using the tibial cut guide in 90-degrees of flexion
    • NB: want to externally rotate the femoral component about 3-degrees to create a rectangular flexion gap. Need to because the tibia is normally in 3-degrees on varus but we cut perpendicular to the mechanical axis (not anatomic axis)
  470. List 2 negative prognostic factors for kids with CP to walk
    • Presence of 2 or more primitive reflexes
    • Unable to sit independently by age 2
  471. List 20 causes of acute compartment syndrome in the upper extremity
    • Fracture
    • Crush injury
    • Injection injury
    • Ring avulsion
    • Suction injury
    • Penetrating trauma
    • Constricting dressings
    • Casts
    • Burns
    • Infection
    • Bleeding disorders
    • Spider bite
    • Snake bite
    • Arterial injury
    • Repurfusion
    • In utero compression
    • Extravasation of infusions
    • Injection of illicit drugs
    • Regional anesthesia
    • Prolonged compression
    • NB: Most common cause in adults is distal radius fractures
    • Most common cause in children is supracondylar fractures
  472. List 6 sources of autogenous bone graft in the lower extremity
    • Ilium
    • Greater trochanter
    • Proximal tibia
    • Distal tibia
    • Distal femur
    • Calcaneus
    • NB: - Cancellous bone graft is easily vascularized due to its porosity and rapidly incorporated
    • Cortical bone graft provides excellent structural support and used for mechanical support and osteoconduction. However it is slower to revascularize.
  473. List the 3 phases of distraction osteogenesis
    • Latency (7 to 10 days after the corticotomy is completed)
    • Distraction
    • Consolidation (usually twice as long as the distraction phase)
    • External fixation index: Time that the fixator is on, which is usually 30 days per 1 cm of length gained using ilizarov methods
    • Bone healing index: Time to union (months) / Amount of lengthening (cm)
    • Average about 2.5 complications per lengthening.
  474. List 14 risk factors for poor bone formation during distraction osteogenesis
    • Host-related factors
    • Use of NSAIDs
    • Congenital etiology
    • Systemic illness (diabetes, OI)
    • Local related factors
    • Scarred soft tissue envelope
    • Overlying infection
    • Prior radiation Tx
    • Congenital pseudoarthrosis
    • Surgical factors
    • Compromised soft tissue coverage at osteotomy site
    • Poor location selection of osteotomy
    • Poor osteotomy techniques (thermal necrosis using an oscillating saw)
    • Persistent gap of > 1 cm at osteotomy site during latency period
    • Mechanically unstable frame applied
    • Short latency period (< 5 days)
    • Rapid distraction (> 2 mm/day)
  475. List the 5 parts to the classification for FDP avulsion injuries (Jersey finger)
    • Retraction to the palm (lumbrical origin) ? vincula disrupted and need to fix within 7 to 20 days
    • Retraction to the PIP (MOST COMMON) ? vincula intact. Can wait up to 6 weeks to fix
    • Retraction to A4 pulley with a large bone fragment attached and incarcerated in the A4 pulley ? vincula intact
    • Bone avulsion retracted to A4 pulley and tendon is avulsed from the bone fragment with retraction to finger or palm ? variable vincula status depending on tendon retraction
    • Bony avulsion with comminuted P3 fracture ? variable vincula status depending on tendon retraction
  476. List 4 non-surgical management options for aseptic tibial non-union (FEEL)
    • Functional bracing
    • Electrical stimulation (E-Stim)
    • Extracorporeal shock wave therapy
    • Low intensity pulsed ultrasound (LIPUS)
    • NB: Extracorporeal shock wave therapy has been shown to be as good as surgery for stable hypertrophic nonunions (Cacchio A, et al. JBJS Am 2009;91(11):2589-2597.)
  477. List the 4 most common bursitis in the body
    • Olecranon
    • Pre-patellar
    • Trochanteric
    • Retrocalcaneal
  478. List 8 recommendations for safe use of drills, pins and surgical wires
    • Use sharp drill bits
    • Ensure flutes of drill are clean
    • Use drill at FULL speed
    • Use oscillate to avoid soft-tissue injury
    • Start the drill PERPENDICULAR to the bone
    • Drill with as much axial force as can be performed safely
    • Use irrigation when drilling (especially when using ?4.5 mm)
    • Avoid long drilling times
  479. List 3 risk factors for tuberosity non-union in 3 and 4-part proximal humerus fractures treated with hemi
    • Age more than 75
    • Poor prosthesis position
    • Poor greater tuberosity placement
  480. List 3 best places for screw placement in scapula for RTSA baseplate
    • Base of coracoid
    • Scapular spine
    • Lateral scapular pillar (Inferior)
  481. List 2 ways to ensure proper version for proximal humerus hemi (To be placed in 20 to 30-degrees of retroversion)
    • Transepicondylar axis of distal humerus
    • Bicipital groove ? place the lateral fin of the prosthesis 30-degrees posterior to the posterior margin of the bicipital groove
    • Forearm relationship
  482. List the 4 types of Brachial plexus blocks for upper extremity surgery
    • Interscalene block ? most commonly used ? good for shoulder surgery
    • Supraclavicular block ? doesn?t cover well the cape of the shoulder ? therefore good for upper arm surgery distal to shoulder ? Large lung volumes is a relative contraindication
    • Infraclavicular block ? good for elbow, forearm, wrist and hand
    • Axillary block ? good for elbow, forearm, wrist and hand ? Better than interscalene or supraclavicular for elbow surgery
    • NB: Obesity leads to less successful blocks and more complications
    • Complications significantly and inversely related to the experience of the anesthetist
    • Complications: Systemic toxicity, Phrenic nerve injury, Nerve injury, Pneumothorax, Vascular puncture, etc.
  483. List 8 risk factors for post-arthroscopic glenohumeral arthritis
    • Infection
    • Direct mechanical injury to cartilage
    • Prominent Suture anchors and knots
    • Thermal capsulorrhaphy
    • Intra-articular pain pumps
    • Osmolarity of irrigation fluid
    • Local anesthetic
    • Epinephrine
  484. PI = SS + PT
    • Normal PI = 51-degrees
    • Normal SS = 40-degrees
    • Normal PT = 11-degrees
    • (PI usually is equal to lumbar lordosis +/- 9-degrees)
    • (Normal PT is less than 25-degrees)
  485. List 7 poor prognostic factors for Ewing?s sarcoma
    • Size
    • Grade
    • Pelvic location
    • <90% response to chemo
    • Elevated LDH
    • Atypical translocations
    • Presence of mets
  486. List 4 classic indications for prophylactic nailing for tumor
    • size > 2.5 cm
    • > 50% cortical involvement
    • Pain after radiotherapy
    • Lesser trochanter avulsion
  487. List 3 risk factors for metallosis in patients with MOM resurfacing
    • Female gender
    • Smaller head size
    • Increased acetabular inclination
  488. List 4 indications for hemiresection interpositional arthroplasty of the DRUJ
    • Rheumatoid arthritis in an elderly patient
    • OA of the DRUJ
    • Ulnocarpal impaction syndrome
    • Painful instability of the DRUJ
  489. List 5 indications for a Total elbow arthroplasty
    • Rheumatoid arthritis
    • Primary osteoarthritis (patient should be > 65 years old
    • Post-traumatic osteoarthritis (advanced)
    • Complex distal humerus fracture in elderly
    • Chronic instability
  490. List 3 indications for a reverse total shoulder arthroplasty (need an intact deltoid)
    • Cuff tear arthropathy
    • Large tear with persistent pseudoparalysis
    • Complex proximal humerus fracture
  491. Adult DDH: List 3 deformities of the acetabulum
    • Shallow, lateralized and anteverted
    • Deficient anterior and superior wall
    • Underdeveloped teardrop
  492. Adult DDH: List 6 deformities of proximal femur
    • Small head
    • Short neck
    • Excessive anteversion
    • Coxa valga
    • Posterior GT
    • Narrow diaphysis (Mismatch between metaphysis and diaphysis: hence need for modular prosthesis)
  493. List the Crowe classification for DDH (Vertical distance of the interteardrop line to inferior aspect of head/neck junction over the vertical distance of the normal contralateral femoral head ? NB if other femoral head abnormal use 20% of the vertical height of the pelvis)
    • < 50%
    • 50 to 75%
    • 70 to 100%
    • >100%
  494. List the 2 main thoughts for causes of pseudotumors
    • Excessive wear causing wear debris (most likely explanation)
    • Hypersensitivity reaction
  495. List the 6 main complications from the metal debris
    • Metallosis
    • Osteolysis
    • Aseptic loosening
    • Unexplained groin pain
    • Periprosthetic effusions
    • Pseudotumours (large granulomatous tumours)
    • NB: There is NO evidence to suggest that all effusions eventually develop into granulomatous masses or lead to extensive necrosis with time. Revisions for pseudotumours lead to instability problems ? may need to revise to a constrained liner
  496. List the 4 various terms used in the literature for pseudotumors
    • Metallosis
    • Aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)
    • Pseudotumors
    • Adverse reactions to metal debris (most recent term)
  497. List 10 risk factors for pseudotumor/metallosis development
    • Female
    • Short stature
    • Hip dysplasia
    • Component design
    • Metallurgy
    • Inclination
    • Combined anteversion
    • Edge loading (Found to be a major problem for pseudotumor formation)
    • Impingement
    • Subluxation
  498. List 4 complications of pseudotumors
    • Soft tissue and muscle necrosis (worry about abductors)
    • Bone damage / loss
    • Pathologic fractures
    • Hip dislocations
  499. List 3 complications of hip impingement (Cam, Pincer, combined)
    • Labral tears
    • Cartilage delamination
    • Early degenerative joint disease
  500. List 3 ways to measure a Cam deformity
    • Alpha angle (normal is <50-degrees)
    • Beta angle (normal is >30-degrees)
    • Anterior head-neck offset (normal is >10 mm)
  501. List 7 complications from use of a tourniquet for extremity surgery
    • Muscle injury
    • Nerve injury
    • Pressure sores and burns
    • Metabolic abnormalities
    • DVT / PE
    • Compartment syndrome
    • Post-tourniquet syndrome
    • Prolonged swelling of the extremity
    • Pain
    • Stiffness
    • Palor
    • Weakness
    • Numbness
  502. List 9 anatomic risk factors for progression of spondylolisthesis
    • Lumbosacral kyphosis
    • Trapezoidal L5
    • Sacral dysplasia
    • Sacral kyphosis
    • Bifid posterior arch
    • Subluxation of the facet joints
    • Dysplasia of the posterior elements
    • Small transverse processes
    • Dome shaped sacral endplate
  503. List 8 dysmorphic facial features
    • Low set ears
    • Flat nasal bridge
    • Small mouth with large protruding tongue
    • Flat face
    • Flat philtrum
    • Frontal bossing
    • Epicanthal folds
    • Micrognathia
    • Webbed neck
    • NB: Can also find several dysmorphic features involving patients arms, trunk, legs, spine, etc.
  504. List the 4 ?Growth Friendly? options for spine deformities
    • Growing rods
    • Vertical Expandable Prosthetic Titanium Rib (VEPTR)
    • Guided-growth (Luque-Trolley; Shilla procedure)
    • Compression-based (Tethers, Staples)
  505. List 6 renal anomalies associated with VACTERL
    • Horseshoe shaped kinder
    • Hypoplastic kidney
    • Kidney agenesis
    • Dysplastic kidney
    • Urine outflow abnormality
    • Urine reflux
  506. List 5 cardiac abnormalities with VACTERL
    • Atrial septal defect
    • Ventricular septal defect
    • Tetrallogy of Fallot
    • Transposition of the great vessels
    • Patent ductus arteriosus
  507. List 9 contraindications for VEPTR
    • Lack of bone strength in the ribs or spine to support the VEPTR (eg. OI)
    • Do not have ribs where the VEPTR should go
    • Do not have frontal ribs for attachment
    • No functioning diaphragm
    • Not enough soft tissue to cover the device
    • Patients younger than 6 months of age
    • Skeletally mature patients (14 for girls; 16 for boys)
    • Known allergy to the device material
    • Active infection at the surgical site
    • NB: VEPTR has circumferential fixation to the ribs proximally and distal fixation to ribs, the spine (via lamina), or the pelvis (Rib to rib; rib to spine, rib to pelvis)
    • Do NOT choose the first rib as your superior anchor due to the risk of brachial plexus injury!!!
  508. List 6 importance components to the surgical treatment of osteomyelitis
    • Adequate debridement
    • Obliteration of dead space
    • Restoration of blood supply
    • Adequate soft tissue coverage
    • Stabilization
    • Reconstruction
    • NB: Paprika sign: debridement of the dead bone down to PUNCTATE BLEEDING
  509. List the 4 stages to the Cierny-Mader classification of osteomyelitis
    • Medullary ? Involes only medullary canal (needs dead space management)
    • Superficial ? Involves only cortex (needs soft tissue coverage)
    • Local ? Involves partial thickness of the bone including both cortical and intramedullary (Needs dead space management, soft tissue coverage and bone graft)
    • Diffuse ? Involves entire thickness of the bone (Needs dead space management, soft tissue coverage, bone graft and skeletal stabilization)
  510. List the 3 types of hosts described with osteomyelitis
    • A hosts (healthy patients, no real comorbidities)
    • B hosts (contain 1 or more compromising local and/or systemic factors
    • C hosts (Severely compromised where radical treatment for cure is worse than the disease itself)
  511. List the 3 reduction techniques for hip dislocations
    • Allis maneuver - (pt supine, knee flexed to 90-degrees, hip flexed to 90 degrees, with in-line traction and gentle adduction and internal rotation, assistant places counter pressure on pelvis)
    • Stimson maneuver - (gravity method ? pt is prone, with lower limbs hanging at end of table, assistant does counter pressure on sacrum, hold knee and ankle flexed to 90 degrees and apply downward pressure with gentle rotation)
    • Bigelow maneuver - (Pt supine, assistant with counter pressure on pelvis, knee and ankle flexed, opposite forearm under knee, apply in-line traction with adduction and internal rotation on abdomen, lever hip with abduction, ER and extension)
  512. List 3 ways to increase offset of a femoral stem
    • Increase the neck length
    • Decrease the neck-shaft angle (ie more varus)
    • Medialize the trunion of the stem
  513. List 8 risk factors for femoral neck fracture after resurfacing
    • Female gender
    • Femoral neck notching
    • Varus positioning of the femoral component
    • Osteopenia
    • Large femoral neck cysts
    • Smaller necks
    • Head AVN
    • Femoral neck impingement on malpositioned acetabulum cup
  514. List the 3 types of PCL reconstruction
    • Single bundle reconstruction (try to reconstruct the anterolateral bundle because it is larger)
    • Double bundle reconstruction
    • Tibial inlay reconstruction (through a posterior approach to the knee)
  515. List the 4 types of proximal tibiofibular joint dislocations
    • Atraumatic subluxation
    • Anterolateral (most common)
    • Posteromedial
    • Superior (occurs with ankle injuries)
  516. List 3 surgical treatment options for proximal tibiofibular joint dislocations
    • Joint arthrodesis (associated with late ankle pain and instability)
    • Fibular head resection (associated with knee instability and ankle pain)
    • Joint capsule reconstruction
    • Use posterior part of biceps femoris tendon and strip of anterior compartment fascia
    • Use part of IT band for reconstruction
  517. List the 3 parts to the Wright and Cofield classification for TSA periprosthetic humerus fractures
    • Type A ? fracture starts at distal tip of stem and extends proximally (Stem may be loose)
    • Type B ? fracture starts at distal tip of stem with some distal extent
    • Type C ? Fracture is DISTAL to the stem (good for non-op treatment)
  518. List the 5 components of the nexus criteria for cervical spine trauma
    • No posterior midline tenderness
    • No evidence of intoxication
    • A normal level of alertness
    • No focal neurologic deficit
    • No painful distracting injuries
    • NB: If all of these criteria are satisfied, then no need for xray workup to clear c-spine
    • If any are present then need to do xrays
  519. List the 3 parts to the Canadian c-spine rules
    • Any high risk factor which mandates radiography? ? If yes to any one then needs xrays / If NO then move on to part 2
    • Age ?65 years old
    • Dangerous mechanism of injury
    • Paresthesias in extremities
    • Any low risk factors which allows safe assessment of range-of-motin? ? If no then needs xrays / If YES move on to part 3
    • Simple rearend MVC
    • Sitting position in ED
    • Ambulatory at any time
    • Delayed onset of neck pain (not immediate onset of neck pain)
    • Absence of midline c-spine tenderness
    • Able to actively rotate neck (45-degrees left and right)? ? If unable to then needs xrays
    • NB: If patient fits all 3 parts then do not need to do xrays
  520. List the 4 types of rotator cuff tear morphology
    • Crescent
    • U-shaped
    • L-shaped and reverse L-shaped
    • Massive and immobile tear
  521. List 7 indications for bullet removal from a GSW
    • Intra-articular location
    • Bullet in the spinal canal
    • In the globe of the eye
    • Bullet causing nerve compression or nerve root compression
    • Bullet in the lumen of a vessel that can cause ischemia
    • Bullet fragment causing lead poisoning
    • For medico-legal purposes
  522. List the 2 types of GSW
    • Low velocity (most hand guns except for magnums) <2000 ft/sec
    • High velocity (Military assault rifles, hunting rifles, shotguns) >2000 ft/sec
  523. List 10 adjuncts to think about during ATLS
    • Intubation
    • Cricothyroidotomy / Needle cricothyroidotomy
    • Needle thoracotomy for tension pneumo
    • Chest tube for pneumo/hemothorax
    • Pericardiocentesis for cardiac tamponade with 3-way stopcock
    • FAST (Perihepatic space, perisplenic space, pelvis and pericardium)
    • Peritoneal lavage (positive if >10 cc blood, GI contents, also try with 1 L warm NS then shake, then send to lab, positive if >100 000 RBC/ml or >500 WBC/ml)
    • Pelvic binder/wrap ? centered of GTs and clamped anteriorly
    • Angio-embolization
    • Retrograde urethrogram for blood at meatus or high riding prostate (Use 60 cc of radio-opaque die)
  524. List 2 indications to call thoracic surgery after chest tube placement
    • >1500 cc of blood removed from chest immediately after chest tube placement
    • >200 cc/hr for 4 hours blood removed from chest after chest tube placement
  525. List 9 immediately life threatening injuries to diagnose and treat during primary survey of ATLS
    • Inadequate airway protection
    • Airway obstruction
    • Tension pneumothorax
    • Open pneumothorax
    • Flail chest with hypoxia
    • Massive hemothorax
    • Cardiac tamponade
    • Severe hypothermia
    • Severe shock from hemorrhage with no response to fluids
  526. List 8 physiologic changes to think about during pregnancy
    • Increase in blood volume (plasma more than RBC mass)
    • Increase in cardiac output
    • Increase minute ventilation
    • Increase uterus size
    • Hypercoagulable state
    • Decrease in residual lung volume
    • Decrease GI motility
    • Dilutional anemia
  527. List 11 things to think about during trauma in pregnancy
    • Do ATLS as per normal ATLS (BEST chance for fetus survival is mother survival)
    • Multidisciplinary (Obstetrics, Neonatology, Anesthesia, Radiology)
    • Left lateral decibutus position
    • Shield fetus with lead for radiogrpahs (Ct-abdo and Ct-lumbar spine highest exposure)
    • Major risk of radiation exposure is during 1st trimester during organogenesis
    • MRI has no effect on fetus
    • Fetal monitoring at all times
    • General anesthesia has increased risk of spontaneous abortions during 1st and 2nd trimesters ? spinal and epidural are safe
    • Pregnancy-related osteoporosis during 3rd trimester is possible ? can lead to fractures
    • Ancef and tetanus are ok to give!!!
    • Ok to give prophylactic Fragmin for DVT prophylaxis (DO NOT GIVE WARFARIN ? it crosses the blood-placenta barrier)
  528. List 4 musculoskeletal effects/issues of smoking and its relation to surgery
    • Decrease BMD and increase risk of sustaining a fracture and tendon injury
    • Can be partially reversed with long-term cessation
    • Increase risk of perioperative complications, nonunion, delayed union, infection, soft-tissue and wound complications
    • Need to give informed consent of these higher operative risks with cigarette smoking
    • Inform patients of the benefits of temporary smoking cessation perioperatively and offer smoking cessation programs
    • NB: Cotinine is the substance that is checked in urine to assess for recent cigarette smoking
  529. List the 4 main knee ligaments from weakest to strongest
    • LCL (750 N)
    • ACL (2200 N)
    • PCL (2500 N)
    • MCL (4000 N)
  530. List 4 ways to predict final LLD in peds
    • Moseley straight line method
    • Menelaus arithmetic method
    • Growth remaining method (Green and Anderson)
    • Multiplier method (Paley) ? use app on smart phone
  531. List the 4 types of Aitken classification for PFFD (NEED to rule out VACTERL)
    • A ? Femoral head present with normal acetabulum
    • B ? Femoral head present with mildly dysplastic acetabulum
    • C ? Femoral head absent with severely dysplastic acetabulum
    • D ? Femoral head absent with absent acetabulum
    • NB: Bilateral PFFD ? treat with braces / prosthetics (No role for surgery)
    • Unilateral PFFD with LLD < 30% - treat hip pathology and lengthenings PRN
    • Unilateral PFFD with LLD > 30% - treat with amputation / fusion / van ness rotationplasty
  532. List the 5 types of Jones classification for tibial hemimelia (autosomal dominant)
    • Type 1A ? Absent tibia ? NO knee extensor mechanism
    • Type 1B ? Small proximal tibia anlage present ? Knee extensor mechanism ok
    • Type 2 ? Proximal tibia present ? Knee extensor mechanism ok
    • Type 3 ? Distal tibia present ? NO knee extensor mechanism
    • Type 4 ? Distal tib/fib diastasis ? Need symes amputation
  533. List 4 associated findings with tibial hemimelia (autosomal dominant)
    • Lobster/claw hand
    • Equinovarus foot deformity
    • Preaxial polydactyly
    • Knee flexion contractures
    • NB: Fibular hemimelia has NO inheritance pattern and they do NOT need a workup for VACTERL
  534. List 6 symptoms of basilar invagination
    • Posterior occipital headaches
    • Nystagmus
    • Dysphagia
    • Weakness
    • Loss of sensation
    • Cranial nerve disturbance
  535. List the Birch classification for fibular hemimelia
    • Functional foot present (?3 rays)
    • 1 to 5% LLD
    • 6 to 10% LLD
    • 11 to 30% LLD
    • Non-functional foot
    • Good functional upper extremities
    • Upper extremities deficiencies
  536. List 5 DDx for equinovarus foot deformity
    • Cerebral palsy (Spastic hemiplegia)
    • Duchenne muscular dystrophy
    • Myelodysplasia
    • Persistent/recurrent clubfoot
    • Tibial hemimelia
  537. List the 2 tests to diagnose CMT (Most common form of CMT is autosomal dominant; other forms are autosomal recessive and X-linked)
    • EMG
    • Genetic testing for PMP22 gene mutations and duplication of chromosome 17
  538. List 4 musculoskeletal conditions to worry about in CMT (Hereditary sensori-motor neuropathy)
    • Cavovarus foot deformity
    • Hammer toes
    • Hip dysplasia
    • Scoliosis
  539. List 6 musculoskeletal conditions associated with cerebral palsy
    • Upper extremity deformities
    • Scoliosis
    • Hip dislocations
    • Joint contractures
    • Pelvic obliquity
    • Foot deformities:
    • Equinovarus (in spastic Hemiplegia)
    • Planovalgus (in spastic diplegia and quadriplegia)
  540. List 4 pre-op workup for Down syndrome
    • C-spine flex-ex views (Need to do fusion of ADI > 10 mm)
    • Heart echo and cardiology consult (heart abnormalities)
    • Endocrine consult (hypothyroidism and diabetes)
    • Hip x-ray for dysplasia
  541. List 9 musculoskeletal abnormalities in Down syndrome
    • Generalized ligamentous laxity
    • O-C1 instability
    • C1-C2 instability
    • Scoliosis
    • Spondylolisthesis
    • Hip dislocation
    • Patella dislocation
    • Pes planovalgus
    • Hallux valgus
  542. List 6 associations with sacral agenesis (Highly associated with maternal diabetes; Needs GI, GU, cardio workup)
    • GI problems
    • GU problems
    • Cardiovascular problems
    • Progressive kyphosis
    • Motor deficit
    • Sensation intact
  543. List 9 principles and adjuncts for repairing a dural tear (Dural tears occur in about 3% of ALL spine surgeries combined)
    • Want wide exposure to see the whole tear
    • Suction fluid over paddies to not suck nerve rootlets
    • Push nerve rootlets back in with a penfield
    • Primary repair with 6-0 prolene ? want a WATERTIGHT closure
    • Fibrin glue (Tisseal)
    • Fat autograft
    • Fascial autograft
    • Bedrest x 48 to 72 hours
    • Subarachnoid drain if needed to suck 200-300 cc per day for about 4 days
    • NB: To see if tear is repaired intraoperatively ? do a Valsalva maneuver and look to see if the nice pulsations return to the dural sac after dural closure
    • NB: Tests to diagnose a dural tear post-op: Beta-transferrin or an MRI
  544. List 5 options for the treatment of large segmental bone loss
    • Induced membrane technique (Masquelet Technique)
    • Bone transport and distraction osteogenesis
    • Vascularized fibular autografting
    • Massive cancellous autograft transfer
    • Synthetic calcium-based fillers
    • NB: Can also do acute shortening followed by lengthening for defects less than 3 cm
  545. List 4 advantages for the Induced-membrane technique for the treatment of segmental bone loss
    • Prevention of graft resorption
    • Maintenance of graft position
    • Prevention of soft-tissue interposition
    • Promotes neovascularization and corticalization of the graft
  546. List 10 key surgical points for the Induced-Membrane technique to manage segmental bone loss
    • Use PMMA mixed with antibiotics (1g of vanco and 3.6 g of tobramycin per 40g bag of cement)
    • Place the cement in the later stages of hardening decrease heat necrosis of the bone and decrease cancellous mixing to take it out easily after
    • Place the cement in the defect with overhang over the cortical ends
    • Keep spacer in for about 6 weeks (4 to 8 weeks)
    • Incise the membrane longitudinally
    • Can remove the cement in a piecemeal fashion which will protect the membrane
    • Bone graft the site with CANCELLOUS AUTOGRAFT from either the posterioror anterior ilium or can use RIA from the femur diaphysis
    • Can also use cancellous allograft or DBX as adjuncts
    • Then suture the membrane over the graft
    • There are reports of defects of 4 to 25cm treated successfully
  547. List 4 reduction maneuvers to help achieve a closed reduction for a pediatric radial head/neck fracture (Need to do a closed reduction if more than 5 mm translated or >30-degrees angulated / If can?t get a closed reduction, need to proceed to an open reduction through a posterolateral kocher approach)
    • Israeli technique (With elbow in 90-degrees of flexion and full supination apply direct pressure to the radial head from lateral to medial while taking the forearm into full pronation)
    • Elastic bandage technique (Wrap bandage around forearm and arm starting at wrist all the way up the arm ? can sometimes lead to a reduction
    • K-wire as a joystick percutaneously
    • Elastic nail through distal radius to help flip the radial head back on (Metaizeau technique)
    • NB: Want to try to get a closed reduction because open reductions have a worse prognosis
  548. List the 7 structures released in a Medial foot release for a clubfoot
    • Take down abductor hallucis
    • Lancinate ligament
    • Plantar fascia
    • Spring ligament
    • Master knot of Henry
    • Talonavicular joint capsule
    • Superficial deltoid ligament
    • Lengthen tib. Post / FHL / FDL
    • NB: Need to identify and protect the medial and lateral plantar nerves
  549. List the 5 or 8 structures released for a posterior release of the foot and ankle
    • Achilles lengthening (z-lengthening)
    • Posterior talofibular ligament
    • Posterior tibiofibular ligament
    • Ankle joint capsule
    • Subtalar joint capsule
    • Can also lengthen the Tib. Post / FHL / FDL if not already done
  550. List the 3 structures released for a lateral release of the foot
    • Calcaneofibular ligament
    • Calcaneocuboid joint capsule
    • Release the peroneal sheath
  551. List 3 ways to place thoracolumbar pedicle screws
    • Intersection technique (Most commonly used) ? intersection between mid-potion of the transverse process and the mid to lateral portion of the facet joint
    • The mammillary process technique
    • The pars interarticularis technique
    • NB: The mammillary process technique is the most lateral technique, and the pars interarticularis technique is the most medial technique
    • NB: The pedicles increase in size as you go from superior to inferior
    • NB: The medial angulation of the pedicles is high at T1, T2, T3 then straight at T4 and then progressive angulation from L1 to L5
  552. List the 4-step algorithm for osteosarcoma and Ewing?s sarcoma
    • After full local and systemic workup and biopsy, start with 8 to 12 weeks of neoadjuvant chemotherapy
    • Re-stage locally and systemically
    • Wide resection and reconstruction for limb salvage (Surgery done after re-staging and 4 weeks after last round of chemotherapy
    • Adjuvant chemotherapy for 6 to 12 months (Started 2 weeks after surgery if wound is ok)
    • NB: The adjuvant chemotherapy is the same type as pre-op UNLESS there is less than 90% of necrosis response ? then will probably have to modify the type and duration of the chemotherapy!!
    • NB: The chemo is typically doxorubicin, methotrexate, cisplatin, ifosfamide
  553. List the 2 advantages for preoperative radiotherapy for soft tissue sarcoma (give 50 Gy - 2Gy in 25 fractionated doses ? surgery is then done 3 to 6 weeks after the radiotherpay)
    • Less radiation (50 Gy)
    • Less incidence of fibrosis, edema and stiffness
    • NB: Disadvantage is the increased incidence of wound complications (35%) because you are operating through an irradiated tissue bed
    • NB: Most centers in Canada now do preoperative radiotherapy and willing to accept the 20% risk of wound complications with preoperative radiotherapy
    • NB: Need to get a new MRI to restage the tumor size after radiation (about 2 weeks after the radiation)
  554. List the 2 advantages for postoperative radiotherapy for soft tissue sarcoma (give 66 Gy)
    • Decreased wound dehiscence
    • Decreased wound infection
  555. List 3 ways to deal with a deficient posterior glenoid during TSA (NB: TSA have an 85% survivorship at 15 years)
    • Eccentric reaming (most common method used)
    • Posterior bone grafting
    • Posterior implant augments
  556. List the 5 spaces to release during a revision TSA (NB: Very important to identify the axillary nerve at the inferior margin of the subscapularis to protect it)
    • Subdeltoid space adhesions
    • Subacromial space adhesions
    • Coracohumeral ligament release
    • Subscapularis muscle ? do a 360-degree release (superior, anterior, inferior and posterior)
    • Superior and inferior capsule
  557. List the 5 specialties needed to consult for spinal muscular atrophy
    • Neurologist
    • Respirologist
    • Gastroenterologist
    • Physiotherapist
    • Occupational therapist
    • NB: SMA is diagnosed with genetics testing via a deletion in the SMN1 gene.
    • Need to worry about lung issues and GI issues
    • 3 types with increasing severity
    • Think of SMA in patients with delayed milestones
    • MSK pathologies are scoliosis (fuse T2 to pelvis) and hip dislocations (leave dislocated)
  558. List 7 contraindications for a Bernese periacetabular osteotomy
    • Moderate to severe OA
    • Older age
    • Major hip incongruity
    • Obesity
    • Major restriction of hip ROM unless a proximal femur osteotomy is planned to correct it
    • Major medical comorbidities
    • Patient noncompliance
  559. List 4 indications for submuscular plating in pediatric femur fractures (typically used for patients aged 5 to 11 years old)
    • Length unstable diaphyseal fractures (shortening of more than 2 to 3 cm)
    • Proximal subtrochanteric fractures
    • Distal femur fractures
    • Patients older than 11 years old or heavier than 49 kg who have a canal too small for an intramedullary nail
  560. List the 4 reduction criteria when treating a pediatric femur fracture with an immediate hip SPICA (used for patients aged 7 months to 5 years old)
    • < 10-degrees of coronal malalignment
    • < 20-degrees of sagittal malalignment
    • < 2 cm of shortening
    • < 10-degrees of rotational malalignment
    • NB: Hip SPICAs are contraindicated in polytrauma, open fractures and > 2-3 cm of shortening (Length unstable fractures)
    • NB: Other options include: Ex-fix, submuscular plating, titanium elastic nails (TENs)
    • NB: Can also do traction with delayed SPICA casting for length unstable fractures. Apply the SPICA after about 3 weeks of traction once the fracture becomes a bit ?sticky?
  561. List the 4 acceptable closed reduction values for pediatric tibia fractures
    • >50% bony apposition
    • <5 to 10-degrees of coronal malalignment
    • <5 to 10-degrees of sagittal malalignment
    • <1 cm of shortening
    • NB: if indices inapprorpitate than do surgery: ex-fix, plating, k-wire fixation, elastic nailing
  562. List the 3 indications for physeal bridge resection
    • Less than 50% of the physis involved
    • More than 2 years of growth remaining
    • More than 2 cm of growth remaining
    • NB: MRI is the BEST test to size and map the physeal bar!!!
  563. List the 4 unacceptable reduction criteria for pediatric BBFF
    • Angulation >15 degrees, rotation >45 degrees in children <10
    • Angulation >10 degrees, rotation >30 degrees in children >10
    • Bayonet apposition in children older than 10 years
    • Both bone forearm fractures in children> 13
    • 2013 ? Short answer predictions Note: This is not an exhaustive list
Author
egusnowski
ID
350944
Card Set
Prediction of short answer Qs
Description
Short answer questions
Updated