-
List extra-MSK manifestations of Ankylosing Spondylitis
- Inflammatory bowel disease
- Uveitis
- Psoriasis
- Pulmonary fibrosis
- Aortitis
- Genitourinary problems
-
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
-
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
-
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
-
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
-
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
-
List the 4 major seronegative spondyloarthropathies
- Ankylosing spondylitis
- Psoriatic arthritis
- Reiter?s syndrome (Triad of: Conjunctivitis / Arthritis / Nongonococcal urethritis)
- Arthritis of inflammatory bowel disease
-
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).
-
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
-
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)
-
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
-
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)
-
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)
-
List things that can elevate Rheumatoid factor
- Aging
- Cirrhosis
- SLE
- Sjorgens
- Endocarditis
- TB, Syphillis, Hep C
- Sarcoidosis
- Idiopathic pulmonary fibrosis
-
List Spine Manifestations of Neurofibromatosis
- Rib pencilling
- Dural ectasia
- Sharp short segments
-
List Osseous Manifestations of neurofibromatosis
- Bone scalloping
- Penciling of ribs
- Sharp vertebral end plates
- Tibial pseudoarthrosis
- Nonossifying fibromas
- Scoliosis
-
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
-
List Secondary causes of Trigger Finger
- RA
- Gout
- HTN
- Carpal Tunnel
- Diabetes
- Dupuytren?s disease
- De Quervain?s tenosynovitis
-
List Causes of Secondary osteoporosis
- Hyperthyroid
- Hypothyroid
- Steroids
- Immobilization
- Heparin
- Phenytoin
-
List tumours associated with Proteus syndrome
- Lipomas
- Bilateral ovarian cystadenomas
- Monomorphic adenoma of the parotid gland
- Vascular malformations
-
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
-
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
-
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)
-
List tumours that can spread to regional lymph nodes (SCARE)
- Synovial sarcoma
- Clear cell sarcoma
- Angiosarcoma
- Rhabdomyosarcoma
- Epithelial sarcoma
-
List 3 soft tissue tumours responsive to chemotherapy (all others are resistant)
- Rhabdomyosarcoma
- Synovial sarcoma
- Fibrosarcoma
-
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
-
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)
-
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
-
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
-
List indications for growing rods in pediatric spine
- Flexible curve
- Curve progression > 50 degrees
- Significant growth remaining
-
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
-
List Short-Term Postoperative Complications with Scoliosis Surgery
- Ileus
- Infection
- Postoperative syndrome of inappropriate ADH secretion
- Superior mesenteric artery syndrome
- Pneumonia
- Atelectasis
-
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
-
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
-
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
-
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
-
List Contraindications for Hip Arthrodesis
- Obesity
- Systemic arthritis (RA)
- Contralateral hip dysfunction
- Ipsilateral knee OA or dysfunction
- Lumbosacral disease
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
List 8 causes of vertebral plana (MELTS)
- Langerhans cell histiocytosis (EG)
- Trauma/TB
- Osteoporosis
- Multiple myeloma
- Metastatic tumor
- Ewing?s sarcoma
- Lymphoma
- Steroids
-
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
-
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
-
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
-
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
-
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
-
List features of de novo adult spinal deformity
- Confined to the lumbar spine
- No rotation
- Smaller Cobb angles
- Fewer vertebral segments involved
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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)
-
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
-
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
-
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
-
List etiologies for osteonecrosis of the humeral head
- Steroid use
- EtOH
- Caisson disease
- SLE
- Hemophilia
- Lipid storage diseases
- Trauma
-
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
-
List Severe Injuries Associated with clavicle fractures
- Pneumothorax
- Scapula-thoracic dissociation
- Brachial plexus injuries
- Vascular injuries
- Rib fractures
- Scapular fractures
-
Indications for AC joint debridement arthroscopically
- Response on AC joint injection
- Edema MRI on distal clavicle resection
- Clinical tenderness on exam
-
List factors that lead to less favorable outcomes after rotator cuff surgery
- Increasing patient age
- Workers compensation
- MRI tear characteristics
-
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
-
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
-
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
-
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
-
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
-
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
-
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)
-
List Risk Factors for developing Cerebral Palsy
- Low gestational age
- Poor socioeconomic status
- Intrauterine infection
- Maternal thyroid dysfunction
- Multiple gestations
- Low birth weight
-
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
-
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
-
List the non-MSK findings in Arthrogryposis
- Bowel atresia
- Facial hemangioma
- Abdominal wall defects
- Gastroschisis
- Inguinal hernias
- Cryptoorchidism
- Labial hypoplasia in females
- Micrognathia
-
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
-
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)
-
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
-
List tumours with chromosomal alterations
- Osteosarcoma
- Ewings sarcoma
- Alveolar rhabdomyosarcoma
- Myxoid liposarcoma
- Synovial sarcoma
- Clear cell sarcoma
-
List 4 sytemic conditions associated with basilar invagination in peds
- Achondroplasia
- Morquio
- SED, spondyloepiphyseal dysplasia
- Osteogenesis imperfecta
-
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
-
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
-
List the GMFCS Classification for CP
- No restrictions
- Assistance devices
- Cannot go up stairs
- Wheel chair in the community
- Wheelchair
-
List the three hip at risk signs for CP
- Hip abduction less than 30 degrees
- Migration index > 25%
- Hip flexion contracture >30-degrees
-
List causes of acetabular protrusio
- Marfans
- Osteogenesis imperfecta
- Paget?s disease
- Rheumatoid arthritis
- Ankylosing spondylitis
- Otto pelvis
-
Name the 3 Lateral Ankle Ligaments
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
-
List the Structures that make up the ankle syndesmosis
- Anterior inferior talofibular ligament (AITFL)
- Posterior inferior talofibular ligament (PITFL)
- Interosseous ligament
-
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
-
List the Prerequisities for lengthening a patient with LLD
- > 4 cm difference
- stable joints (above and below)
- able to eliminate any braces post lengthening
-
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
-
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
-
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
-
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)
-
List the 3 main types of malignant transformation in fibrous dysplasia
- Osteosarcoma
- Fibrosarcoma
- Chondrosarcoma
-
List contraindications to electrical stimulation in fracture non-unions
- Fracture gap > 1 cm
- Pseudoarthrosis
- Mobile nonunion
-
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
-
List the signs of fat embolism syndrome (Triad is hypoxia, mental status changes and petechia)
- Petechiae
- Tachypnea
- Tachycardia
- Mental status changes
- Hypoxemia
-
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)
-
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)
-
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
-
Describe the negative prognostic factors associated with calcaneal fractures
- Male
- Polytrauma
- Worker?s compensation
- Advanced age (>50)
- Obesity
- Bilateral fractures
- Manual labour job
- Smoking
-
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
-
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
-
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
-
List the obstacles to reducing a medial subtalar dislocation
- Extensor digitorum brevis
- Talonavicular capsule
- Inferior extensor retinaculum
- Peroneal tendons
-
List the obstacles to reducing a lateral talar dislocation
- Posterior tibial tendon (most common)
- Bony fragment (OCD from the talus)
- FHL
- Flexor digitorum longus
-
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
-
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
-
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
-
List syndromes associated with Caf?-au-lait spots
- McCune-Albright
- Neurofibromatosis
- Jaffe-Campanacci syndrome
-
List 5 primary tumours that can be associated with an ABC
- GCT
- Chondromyxoid fibroma
- Fibrous dysplasia
- Chondroblastoma
- NOF
-
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
-
List diseases associated with a neuropathic joint
- Syphilis
- Diabetes
- EtOH
- Syringomyelia
- Spinal cord tumours
- Syphilis
- Leprosy
-
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
-
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
-
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
-
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
-
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
-
List associated conditions with Dupuytren?s disease
- Alcoholism
- Epilepsy
- Diabetes
- AIDS
- Vascular disorders
-
List structures that make up Spiral Cord (PSLG)
- Pretendinous band
- Spiral band
- Lateral digital sheet
- Greyson?s ligament
-
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
-
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)
-
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
-
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
-
List order of loss of function after a nerve is injured (Some People Think That Puppies Meow)
- Motor
- Proprioception
- Touch
- Temperature
- Pain
- Sympathetic
-
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
-
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
-
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
-
List 4 local host factors that increase the likelihood of an infection
- Neuropathy
- Decreased vascularity
- Trauma
- Presence of prosthetic joints
-
List the way in which human joints decrease the force of friction
- Synovial fluid
- Fluid-film lubrication
- Elastic deformation of articular cartilage
-
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
-
List the 4 layers of articular cartilage
- Superficial
- Middle
- Deep
- Tidemark
- Calcified
- Subchondral bone
-
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
-
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)
-
List 4 Pre-requisities to primary nerve repair
- Skeletal stability
- Well vascularized repair bed
- Adequate soft tissue coverage
- Clean wound
-
List Factors that decrease rate of neurotransmission
- Cold
- Increased age of the patient
- Loss of axons
- Demyelination
-
List Contraindications to hip arthroscopy
- Morbid obesity
- Protrusio
- Joint anklylosis
- HO
- Advanced OA
-
List indications for an acetabular osteotomy
- Young physiologic age
- Pre-OA state
- Normal hip ROM
- Correctable structural abnormality
-
Describe the position for knee fusion (assuming < 2 cm LLD)
- 5-7 degrees of valgus
- 15 degrees of flexion
-
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
-
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
-
Signs or Symptoms of a PE
- hemoptysis
- hypoxia
- hypotension
- tachycardia
- chest wall pain
- cyanosis
- dyspnea
- SOB
- Anxiety
-
List 5 signs that an uncemented femoral stem is loose
- Calcar hypertrophy
- IM pedestal
- > 2mm, migration
- implant fracture
- absence of stress shielding
-
Describe the AAOS classfication for Acetabular bone loss
- Segmental
- Cavitary
- Combined
- Pelvic discontinuity
- Arthrodesis
-
Describe the AAOS classification for Femoral bone loss
- Segmental
- Cavitary
- Cavitary
- Ectasia
- Combined
- Malalignment
- Stenosis
- Fracture
-
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
-
List XR signs of infection of a total joint arthroplasty
- Periosteal reaction
- Scattered foci of osteolysis
- Bone resorption
-
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
-
List the 3 essential elements to informed consent
- Information
- Voluntariness
- Comprehension
-
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
-
List 3 Spine Manifestations with Achondroplasia
- Foramen magnum stenosis
- Lumbar spinal stenosis
- Thoracolumbar kyphosis
-
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
-
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
-
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
-
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
-
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
-
List syndromes with atlantoaxial instability
- Pseudoachondroplasia
- SED
- MPS
- Trisomy 21
- McKusick type metaphyseal dysplasia
-
List conditions that have uveitis
- Ankylosing spondylitis
- Juvenile rheumatoid arthritis
- Reactive arthritis (Reiter?s syndrome) = conjuctivitis
-
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
-
List 3 ways in research protocols to limit bias
- Randomization
- Concealment of treatment allocation
- Blinding
-
List Structures in the Posterolateral corner of the knee
- LCL
- Posterior capsule
- Arcuate ligament
- Popliteus tendon
- Popliteofibular ligament
- Fabellofibular ligament
- Biceps femoris
- IT band
-
List Structures with Type I collagen
- Bone
- Annular fibrosis (disk)
- ACL
- Menisci
-
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
-
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
-
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
-
List 3 obstacles to reduction of a proximal humerus fracture in a child
- Long head of the biceps
- Periosteum
- Glenohumeral joint capsule
-
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
-
List risk factors for pediatric Acute Hematogenous Osteomyelitis
- Diabetes
- Varicella infection
- Rheumatoid arthritis
- Hemoglobinopathies
- Chronic renal disease
- Immune comprimise
-
What is SAPHO syndrome and what it is associated with? (ans chronic recurrent multifocoal osteomyelitis)
- Synovitis
- Acne
- Pustulosis
- Hyperostosis
- Osteitis
-
List XR signs of distal radius epiphysiolysis
- Widened physis
- Blurred physis
- Metaphyseal changes ? sclerosis
- Volar, radial fragmentation of the growth plate
-
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
-
List the embryological classification of congenital hand anomalies
- Failure of formation
- Duplication
- Failure of differentiation
- Overgrowth
- Undergrowth
- Congenital constriction band
- Generalized skeletal abnormalities
-
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
-
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
-
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
-
List 4 Syndromes associated with syndactyly (C-A-P-S)
- Carpenter syndrome
- Apert syndrome
- Poland syndrome
- Streeter?s dysplasia
-
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)
-
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
-
What are the obstacles to successful concentric closed reduction in DDH
- Iliopsoas
- Medial capsule
- Labrum
- Transverse acetabular ligament
- Hyperthrophied ligamentum teres
- Pulvinar
- Hip adductors
-
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
-
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
-
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
-
List Non-operative Rx for accessory navicular
- Doughnut shaped orthosis
- Short leg cast
- NSAIDs
-
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
-
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
-
List indications for surgery with a turf toes
- Loose bodies in the MTP joint
- Retraction of the sesamoids
- Traumatic bunions
- Sesamoid fractures with diastasis
-
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)
-
List 4 structures that make up the ankle syndesmosis
- Anteriorinferior tibiofibular ligament
- Posteriorinferior tibiofibular ligament
- Interosseous syndesmotic ligament
- Transverse tibiofibular ligament
-
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
-
List the 6 components in the tarsal tunnel
- Posterior tibial tendon
- FDL
- FHL
- Posterior tibial artery
- Posterior tibial vein
- Tibial nerve
-
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)
-
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
-
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
-
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.
-
Boileau et al. Gammont reverse prosthesis: Design, rationale, and biomechanics. J Shoulder Elbow Surg 2005;14:147S
-
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
-
Belanger TA, Rowe DE. Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. JAAOS 2001 (Jul-Aug)
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
Describe the Stages of SLAC
- STAGE I: radiostyloid involvement
- STAGE II: radioscaphoid OA
- STAGE III: capitolunate migration and OA
- STAGE IV: pancarpal OA
-
Describe the Stages of SNAC
- STAGE I: radiostyloid OA
- STAGE II: scaphoid-capitate OA
- STAGE III: periscaphoid OA
-
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
-
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)
-
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
-
List 4 radiographic signs of hemophilic arthropathy of the knee
- Widened intercondylar notch
- Flatenned femoral condyles
- Widened femoral condyles
- Osteopenia
-
What are the 3 components of a triplane fracture?
- Coronal metaphyseal fracture
- Transverse physeal fracture
- Saggital epiphyseal fracture
-
List 5 contraindications to hip arthrodesis
- Obesity
- Inflammatory arthritis
- Lumbosacral disease
- Contralateral hip dysfunction
- Ipsilateral knee arthritis, deformity or instability
-
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
-
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
-
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
-
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
-
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
-
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
-
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.
-
List 3 contraindications to using Hamstring autograft for ACL reconstruction
- Generalized hyperlaxity
- Previous injury / trauma to the hamstring tendons
- High level sprinter
-
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
-
List 4 tumors that occur in the posterior elements of the spine
- ABC
- Osteoid osteoma
- Osteoblastoma
- Osteochondroma
-
List 7 tumors that occur in the anterior elements of the spine
- GCT
- Langerhans cell histiocytosis (EG)
- Multiple myeloma
- Lymphoma
- Hemangioma
- Mets
- Chordoma
-
What is the order of the short external rotators from superior to inferior
- Piriformis
- Superior gemellus
- Obturator internus
- Inferior gemellus
- Obturator externus
-
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
-
List 5 soft tissue sarcomas that metastasize to lymph nodes (SCARE)
- Clear cell sarcoma
- Angiosarcoma
- Rhabdomyosarcoma
- Synovial sarcoma
- Epithelioid sarcoma
-
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
-
List 4 endocrine abnormalities related to SCFE
- Hypothyroidism
- Renal osteodystrophy
- Hypogonadism
- Growth hormone abnormality
-
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
-
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
-
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
-
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
-
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
-
List highest to lowest Young?s modulus
- Ceramics
- Cobalt chrome
- Stainless steel
- Titanium
- Cortical bone
- PMMA
- Polyethylene
- Cancellous bone
- Tendon/ligament
- Cartilage
-
List the order of worsening of myelodysplasia
- Spina bifida occulta
- Meningocele
- Myelomeningocele
- Rachischisis
-
List 3 spinal manifestations of achondroplasia
- Foramen magnum stenosis
- Lumbar stenosis
- Thoracolumbar kyphosis
-
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)
-
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)
-
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
-
Risks of THA in sickle cell anemia
- Higher infection rate
- Higher dislocation rate
- Higher rate of early revisions
-
List the 3 components of Virchow?s triad
- Stasis
- Hypercoagulability
- Endothelial damage
-
List the triad of death
- Hypothermia
- Acidosis
- Coagulopathy
-
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
-
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
-
List 3 acceptable reduction for humeral shaft fractures
- < 30-degrees varus / valgus
- < 20-degrees A-P angulation
- < 3 cm shortening
-
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
-
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
-
List essential components for a scale
- Validated
- Sensitive
- Reproducible
- Responsive
-
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
-
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)
-
List causes for spontaneous ankylosis of the hip
- Trauma
- Infection
- Ankylosing spondylitis
- Juvenile idiopathic arthritis
- Hemophilia
-
List the contents of the rotator interval
- Coracohumeral ligament
- Superior glenohumeral ligament
- Joint capsule
- Long head of biceps tendon
-
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
-
List 4 patient factors that can increase surgical site infections
- Diabetes
- Obesity
- Prior history of surgical site infection
- MRSA colonization
-
List 7 types of elder abuse
- Physical
- Sexual
- Emotional
- Financial
- Neglect
- Self-neglect
- Abandonment
-
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
-
List 4 caretaker characteristics for elder abuse
- Financial dependence on elder
- Substance abuse
- Mental illness
- Perception of caretaking as a burden
-
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
-
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
-
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
-
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
-
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
-
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
-
List DDX of pediatric malignant spine tumors
- Osteosarcoma
- Ewing?s sarcoma
- Lymphoma
- Metastatic neuroblastoma
-
List the MSTS classification for benign bone tumors
- Benign latent
- Benign active
- Benign aggressive
-
List 4 ways tumors are discovered in children
- Pain
- Palpable mass
- Pathologic fracture
- Incidental
-
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)
-
List 4 conditions with an increased risk of malignant hyperthermia
- Duchene muscular dystrophy
- Arthrogryposis
- Osteogenesis imperfecta
- Turner syndrome
-
List 4 reasons why axillary nerve repair works well
- Short nerve to muscle
- Proximal
- Monofascicular
- Composed primarily of motor fibers
-
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)
-
List 5 histological characteristics of high-grade neoplasms:
- Poor differentiation
- High cell/matrix ratio
- High mitotic rate
- Necrosis
- Microvascular invasion
-
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
-
List the 6 components for the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC)
- CRP
- WBC
- Hg level
- Sodium
- Creatinine
- Glucose
-
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
-
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
-
List predictors of distal radius instability following closed reduction (Leone, Bhandari et al 2004)
- Age
- Radial shortening
- Radial inclination
- Dorsal/volar tilt
-
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
-
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
-
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
-
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
-
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)
-
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
-
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
-
List the 4 criteria associated with a SICK scapula syndrome
- Scapula malposition
- Inferior-medial scapula border prominence
- Coracoid pain
- Scapula dysKenisis
-
List the 7 CanMEDS principles
- Medical expert
- Manager
- Communicator
- Scholar
- Collaborator
- Professional
- Health advocate
-
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
-
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
-
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
-
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
-
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
-
List 5 structures at risk when placing C1-C2 transarticular screws (Magerl)
- Vertebral artery
- C2 nerve root
- Hypoglossal nerve
- Internal carotid artery
- Spinal cord
-
List 4 types of C2 screws
- C2 pedicle screws
- C2 pars screws
- C2 translaminar screws
- C1-C2 transarticular screws
-
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
-
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
-
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)
-
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
-
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
-
List 5 conditions that mimic bilateral LCP
- SED
- MED
- Sickle cell disease
- Gaucher?s disease
- Hypothyroidism
-
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
-
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)
-
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
-
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
-
List the 4 principles of ethics
- Beneficience
- Non-Malefecence
- Autonomy
- Justice
-
List 3 benefits for corticosteroid use in DMD
- Prolonged walking ability
- Delayed decline in pulmonary function
- Reduction in the need for scoliosis surgery
-
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
-
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
-
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)
-
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
-
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
-
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 ?)
-
Lists based off of the 2012 to 2010 MCQ exams
-
List 7 indications for TLIF or PLIF
- Recurrent disc herniation
- Spondylolisthesis
- Degenerative disc disease
- Degenerative scoliosis
- Pseudoarthrosis
- Postlaminectomy instability
- Trauma
-
List 4 conditions associated with spondylolisthesis
- Spina bifida occulta
- Thoracic hyperkyphosis
- Scheuermann?s kyphosis
- Down syndrome
-
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)
-
List 4 diseases associated with cervical kyphosis
- Larsen?s syndrome
- Diastrophic dysplasia
- Conradi?s syndrome
- NF type 1
-
List 6 types of torticollis
- Congenital muscular torticollis
- C1-C2 rotatory subluxation
- Klippel-fiel syndrome
- Neurogenic torticollis
- Ocular torticollis
- Sandifer syndrome
-
List 6 blocks to reduction for a lateral subtalar joint dislocation (think medial structures)
- Tibialis posterior
- FHL
- FDL
- Capsule
- Impacted fracture
- Flexor retinaculum
-
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
-
List 5 conditions associated with a risk factor for chondrosarcoma
- Enchondromas
- Ollier?s disease
- Maffucci?s syndrome
- Osteochondromas
- Multiple hereditary osteochondromatosis
-
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
-
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
-
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
-
List highest to lowest Young?s modulus
- Ceramics
- Cobalt chrome
- Stainless steel
- Titanium
- Cortical bone
- PMMA
- Polyethylene
- Cancellous bone
- Tendon/ligament
- Cartilage
-
List the 4 principles of ethics for research trials
- Beneficience
- Non-Malefecence
- Autonomy
- Justice
-
List the 3 structures within the carotid sheath
- Internal jugular vein
- Common carotid artery
- Vagus nerve
-
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)
-
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
-
List 4 poor prognostic factors for UBC treatment
- Age less than 10
- Radiographically active
- Large lesion
- Multiloculated
-
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
-
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
-
List 5 diseases associated with radial clubhand
- Fanconi?s anemia
- Holt-Oram syndrome
- TAR (Thrombocytopenia absent-radius)
- VACTERL
- VATER
-
List 6 different types of plate function
- Compression
- Bridge
- Buttress/antiglide
- Neutralization
- Tension
- Internal external fixator
-
List the 7 CanMEDs principles
- Manager
- Professional
- Communicator
- Health advocate
- Collaborator
- Scholar
- Medical expert
-
List the 4 joints with an intra-articular metaphyseal component
-
List the classic triad of McCunne-Albright syndrome
- Caf?-au-lait spots (Coast of Maine)
- Precocious puberty
- Polyostotic fibrous dysplasia
-
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
-
List the order in nerve function return after repair (Some ? People ? Think ? That ? Puppies ? Meow)
- Sympathetic
- Pain
- Temperature
- Touch
- Proprioception
- Motor
-
List 5 causes of snapping hip syndrome
- IT band
- Iliopsoas tendon
- Rectus femoris
- Labrum
- Intra-articular loose bodies
-
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
-
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)
-
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
-
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
-
List 4 tumors in the posterior elements of the spine
- ABC
- Osteoid osteoma
- Osteoblastoma
- Osteochondroma
-
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
-
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
-
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
-
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)
-
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
-
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
-
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)
-
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
-
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
-
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
-
List 8 associated conditions with DMD
- Calf pseudohypertrophy
- Scoliosis
- Equinovarus
- Joint contractures
- Cardiomyopathy
- Static encephalopathy
- Respiratory compromise
- Malignant hyperthermia
-
List 8 symptoms of long-term corticosteroid use
- Osteonecrosis
- Weight gain
- Cushinoid appearance
- GI symptoms
- Mood lability
- Headaches
- Short stature
- Cataracts
-
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
-
List risk factors for myelodysplasia
- Folate deficiency
- Maternal diabetes
- Maternal hyperthermia
- Valproic acid
-
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
-
List 6 causes of trigger finger
- Diabetes
- RA
- Amyloidosis
- Gout
- Idiopathic
- Dupuytren?s contracture
-
List 8 Symptoms of vertebrobasilar insufficiency
- Vertigo
- Diploplia
- Graying of vision
- Blurred vision
- Knee buckling
- Dysphagia
- Nausea and vomiting
- Slurred speach
-
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.
-
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
-
Predicted SAQs for 2009 exam
-
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
-
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
-
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
-
List the 9 poor prognostic factors for calcaneus fractures ORIF
- Worker?s compensation
- Manual laborer
- Male
- Age > 50
- Obesity
- Smoker
- Polytrauma
- Bilateral fractures
- Vasculopathy
-
List 2 radiographic findings of patients with OCD of the capitellum
- Fragmentation of the capitellum
- Enlargement of the radial head
-
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
-
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
-
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
-
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.
-
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
-
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
-
List the components of the superior shoulder suspensory complex
- Lateral clavicle
- AC joint
- Acromion
- Glenoid
- Coracoid
- Coraco-clavicular ligs.
- +/- coraco-acromial lig
-
List 3 cancers that need a bone marrow biopsy for staging
- Lymphoma
- Ewing?s sarcoma
- Rhabdomyosarcoma
-
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
-
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
-
List DDx for congenital vertical talus (50% associated with a neuromuscular or genetic disorder)
- Arthrogryposis
- Myelodysplasia
- Neurofibromatosis
- Cerebral palsy
-
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
-
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
-
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
-
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
-
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%
-
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
-
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
-
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
-
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
-
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
-
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
-
List the 4 components of the WOMAC score
- Pain
- Stiffness
- Physical function
- Total score
-
List the components of the CAROC fracture risk assessment
- Age
- Gender
- Femoral neck BMD
- Steroid use
-
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
-
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
-
List the components of the spiral cord (PSLG)
- Pretendinous band
- Spiral band
- Lateral digital sheath
- Grayson?s ligament
-
List the 6 cords that make up Dupuytrens
- Pretendinous cord
- Central cord
- Spiral cord
- Natatory cord
- Lateral cord
- Retrovascular cord
-
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
-
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))
-
List the 5 components of the Canada Health Act (PUPCA) - 1984
- Public administration
- Universality
- Portability
- Comprehensiveness
- Accessability
-
List 6 drugs that can cause osteoporosis
- Steroids
- Dilantin
- Lithium
- Methotrexate
- Heparin
- Cyclosporine
-
List 5 complications from pavlik harness treatment
- Pavlik?s harness disease
- Femoral nerve palsy
- AVN
- Skin breakdown
- Brachial plexus palsy from shoulder straps
-
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
-
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
-
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
-
List 5 risk factors for PTT insufficiency
- Obesity
- Female
- Older athletes
- Hypertension
- Inflammatory conditions
-
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
-
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
-
List 6 risk factors for post-radiation fracture
- Female gender
- Age
- Osteoporosis
- Periosteal stripping during surgery
- Anterior femoral compartment resection
- Radiation dose given
-
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
-
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
-
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)
-
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
-
List top 7 DDx for tumor >40 years old
- Mets
- Multiple myeloma
- Lymphoma
- Chondrosarcoma
- Malignant fibrous histiocytoma
- Fibrosarcoma
- Infection
-
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!!)
-
List the top 5 DDx for scary looking lesions in pediatrics
- Osteosarcoma
- Ewing?s sarcoma
- Hematologic malignancies (Lymphoma / Leukemia)
- EG
- Infection
-
List the top 3 DDx for a benign looking periosteal reaction
- Stress fracture
- Osteoid osteoma
- Infection (osteomyelitis)
-
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
-
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
-
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
-
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
-
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
-
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
-
List 4 Atraumatic causes of hip instability
- Down?s syndrome
- DDH
- Marfan?s syndrome
- Ehlers-Danlos syndrome
-
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
-
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
-
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
-
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
-
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
-
List the order from best to worst for nerve conduits (needs ?3 cm of a gap to be used)
-
List 7 possible deformities associated with Sprengel deformity (highest to lowest)
- Scoliosis
- Klippel-Fiel syndrome
- Rib anomalies
- Omovertebral bone
- Spina bifida
- Torticollis
- Clavicle anomalies
-
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
-
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)
-
List 9 musculoskeletal problems with hemophilia
- Acute hemarthosis
- Joint contractures
- Compartment syndrome
- Pseudotumors
- Chronic hemarthrosis
- Arthritis
- Nerve palsies
- Heterotopic ossification
- Septic arthritis
-
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
-
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
-
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)
-
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
-
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
-
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
-
List 4 criteria that increase stress shielding
- Larger diameter stems
- Stiffer metal (eg. Co-Cr)
- Solid, round stems
- Extensive porous coating (distal bone loading)
-
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)
-
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
-
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
-
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
-
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
-
List radiosensitive tumors
- Blood borne tumors
- Multiple myeloma (plastmacytoma)
- Lymphoma
- Leukemia
- Prostate cancer
-
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
-
List the 4 groups of dynamic shoulder restraints
- Rotator cuff muscles
- Deltoid
- Biceps
- Periscapular muscles
-
List 3 tissues that are best seen with Proton-Density MRI
- Articular cartilage
- Meniscus
- Labrum
-
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
-
List 5 factors for best prognosis for nerve repair
- Children
- Sharp, clean cuts to the nerve
- Early repair
- Direct repair
- Healthy, clean vascular bud
-
List the 4 conditions associated with Horner?s syndrome (M-A-P-E)
- Myosis
- Anhydrosis
- Ptosis
- Enophthalmos
-
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
-
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
-
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
-
List classification for bony bar (growth arrest)
-
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)
-
List the 3 stages of adhesive capsulitis
- Painful
- Stiff
- Thawing
- NB: If no improvement by 3 to 4 months consider surgery
-
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)
-
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
-
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
-
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.
-
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.
-
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)
-
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
-
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.)
-
List the 4 most common bursitis in the body
- Olecranon
- Pre-patellar
- Trochanteric
- Retrocalcaneal
-
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
-
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
-
List 3 best places for screw placement in scapula for RTSA baseplate
- Base of coracoid
- Scapular spine
- Lateral scapular pillar (Inferior)
-
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
-
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.
-
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
-
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)
-
List 7 poor prognostic factors for Ewing?s sarcoma
- Size
- Grade
- Pelvic location
- <90% response to chemo
- Elevated LDH
- Atypical translocations
- Presence of mets
-
List 4 classic indications for prophylactic nailing for tumor
- size > 2.5 cm
- > 50% cortical involvement
- Pain after radiotherapy
- Lesser trochanter avulsion
-
List 3 risk factors for metallosis in patients with MOM resurfacing
- Female gender
- Smaller head size
- Increased acetabular inclination
-
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
-
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
-
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
-
Adult DDH: List 3 deformities of the acetabulum
- Shallow, lateralized and anteverted
- Deficient anterior and superior wall
- Underdeveloped teardrop
-
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)
-
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%
-
List the 2 main thoughts for causes of pseudotumors
- Excessive wear causing wear debris (most likely explanation)
- Hypersensitivity reaction
-
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
-
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)
-
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
-
List 4 complications of pseudotumors
- Soft tissue and muscle necrosis (worry about abductors)
- Bone damage / loss
- Pathologic fractures
- Hip dislocations
-
List 3 complications of hip impingement (Cam, Pincer, combined)
- Labral tears
- Cartilage delamination
- Early degenerative joint disease
-
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)
-
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
-
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
-
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.
-
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)
-
List 6 renal anomalies associated with VACTERL
- Horseshoe shaped kinder
- Hypoplastic kidney
- Kidney agenesis
- Dysplastic kidney
- Urine outflow abnormality
- Urine reflux
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List 5 cardiac abnormalities with VACTERL
- Atrial septal defect
- Ventricular septal defect
- Tetrallogy of Fallot
- Transposition of the great vessels
- Patent ductus arteriosus
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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!!!
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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
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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)
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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)
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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)
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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
-
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
-
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)
-
List the 4 types of proximal tibiofibular joint dislocations
- Atraumatic subluxation
- Anterolateral (most common)
- Posteromedial
- Superior (occurs with ankle injuries)
-
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
-
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)
-
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
-
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
-
List the 4 types of rotator cuff tear morphology
- Crescent
- U-shaped
- L-shaped and reverse L-shaped
- Massive and immobile tear
-
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
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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
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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)
-
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
-
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
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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
-
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)
-
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
-
List the 4 main knee ligaments from weakest to strongest
- LCL (750 N)
- ACL (2200 N)
- PCL (2500 N)
- MCL (4000 N)
-
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
-
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
-
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
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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
-
List 6 symptoms of basilar invagination
- Posterior occipital headaches
- Nystagmus
- Dysphagia
- Weakness
- Loss of sensation
- Cranial nerve disturbance
-
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
-
List 5 DDx for equinovarus foot deformity
- Cerebral palsy (Spastic hemiplegia)
- Duchenne muscular dystrophy
- Myelodysplasia
- Persistent/recurrent clubfoot
- Tibial hemimelia
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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
-
List 4 musculoskeletal conditions to worry about in CMT (Hereditary sensori-motor neuropathy)
- Cavovarus foot deformity
- Hammer toes
- Hip dysplasia
- Scoliosis
-
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)
-
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
-
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
-
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
-
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
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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
-
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
-
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
-
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
-
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
-
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
-
List the 3 structures released for a lateral release of the foot
- Calcaneofibular ligament
- Calcaneocuboid joint capsule
- Release the peroneal sheath
-
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
-
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
-
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)
-
List the 2 advantages for postoperative radiotherapy for soft tissue sarcoma (give 66 Gy)
- Decreased wound dehiscence
- Decreased wound infection
-
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
-
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
-
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)
-
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
-
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
-
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?
-
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
-
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!!!
-
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
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