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Honey Badger 2103 > Short Answer 2012 > Flashcards

Short Answer 2012 Flashcards

1
Q

Complications of pediatric radial head fracture (list 4)

A
  1. Loss of motion (expected) pron»sup(flex/ext less)
  2. Radial head overgrowth (2nd 20%to 40%)
  3. Notching of the radial neck secondary to scar tissue
  4. Premature physeal closure (usually 5mm short)
  5. Angular deformities (increased cubitus valgus +10)
  6. Nonunion (radial neck is rare)
  7. Osteonecrosis 10-20% all, 25% for open reductions
  8. Radioulnar synostosis &raquo_space;open reduction >5 days
  9. Nerve injuries
    partial ulnar & PIN may occurb/c fracture
    PIN usually sx expl/percutaneous reduction.
  10. Compartment Syndrome
  11. Myositis ossificans supinator most common
  12. Osteomyelitis(Rare)
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2
Q

Principles of plafond fixation other than soft tissue issues (list 4)

A
  1. restoration of length
  2. reconstruction of the metaphyseal shell
  3. bone grafting
  4. reattachment of the metaphysis to the diaphysis
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3
Q

Indications foracute scaphoid ORIF (4)

A
  1. proximal pole fractures
  2. vertical oblique fracture
  3. displaced
    a. fracture gap >1mm on any view
    b. SL angle >60 degrees
    c. radiolunate angle >15 degrees
    d. intrascaphoid angle >35 degrees
  4. comminution
  5. scaphoid fracture with perilunate dislocation
  6. delayed presentation (>4 weeks)
  7. patient who wants faster return to work/sport
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4
Q

Complications for hemilithotomy positioning in fixing femur diaphyseal fracture (list 4)

A
  1. Well leg compartment syndrome (best answer)
  2. Pudendal nerve palsy
    a. range from 1.9% to 27.6% due to excessive and/or prolonged traction against the perineal post
    b. Erectile dysfunction (ED) assoc pudendal nerve palsy
  3. Sciatic or common peroneal nerve palsy of well leg
  4. Perineal Soft Tissue injury
    a. traction table–induced genitoperineal skin necrosis
  5. Malrotation and mal-alignment
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5
Q

What are the three components of terrible triad (list 3)

A
  1. Radial Head #
  2. Coronoid #
  3. Elbow Dislocation (usually posterolateral)
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6
Q

Complications in tibial tubercle fracture (list 4)

A
  1. Compartment Syndrome
  2. Recurvatum
  3. Screw Prominence
  4. Stiffness
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7
Q

List ossification order for distal humerus

A

CRMTOL

  1. Capitellum
  2. Radial Head
  3. Medial Epicondyle
  4. Trochlea
  5. Olecranon
  6. Lateral Epicondyle
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8
Q

List factors contributing to progression of tibia vara (Blount’s) (list 3)

A
  1. Increased metaphyseal-diaphyseal angle
  2. Epiphyseal-metaphyseal angle
  3. Osseous physeal bar
    Clinical
  4. Overweight
  5. Lateral thrust with ambulation
  6. Increased instability to varus stress with the knee flexed 20°, as compared with the instability at full extension, and this is related to secondary laxity of the medial collateral ligament.
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9
Q

List operative options for chronic posterior shoulder dislocation to address reverse hill-sachs (list 4)

A
  1. Lesser Tuberosity transfer into bone defect (Modified McLaughlin procedure)
  2. Hemiarthroplasty/resurfacing/TSA >40%
  3. Osteochondral allograft
  4. Humeral Rotational osteotomy
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10
Q

What is needed in order to establish causative factor in a study (list 3?4?)

A

1.
2.
3.
4.

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11
Q

List causes for cavovarus foot in adults (list 6?8?)

A

Neurologic
1. Hereditary motor and sensory neuropathies (CMT)
2. Cerebral palsy
3. After effects of cerebral injury (stroke)
4. Anterior horn cell disease (spinal root injury)
5. Spinal cord lesions
Traumatic
6. Compartment syndrome
7. Talar neck malunion
8. Peroneal nerve injury
9. Knee dislocation (neurovascular injury)
10. Residual clubfoot
11. Idiopathic
12. Polio
13. Spinal Motor Atrophy

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12
Q

List clinical and radiological indications for cervical spine instability (list 6?8?)

A
  1. Neurological deficits
  2. AADI > 5mm = instability > 7mm (alar ligament rupture) >9 gross instability N=3mm
  3. Flex/Ext views with >3.5mm movement in AADI
  4. Subaxial subluxation >4mm or >20% of vertebral body
  5. Kyphosis >11 degrees
  6. Bilateral Jumped facets (PLL ruptured unstable even after reduced)
  7. Large teardrop fragment lateral X-ray
  8. Facet #
  9. Disrupted discoligamentous complex integrity – widened disc space
  10. Fracture in the presence of AS or DISH
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13
Q

List radiological findings in pseudosubluxation of cervical spine (list 3?4?)

A
  1. Anterolisthesis of C2 on C3 (most common) or C3 on C4
    a. Up to 4mm or 40% translation
    2) Swischuk’s line intact and smooth
    a. Draw spinolaminar line from C1-C3
    b. Spinolaminar point on C2 falls within 1.5mm of Swischuk’s line
    Lovell & Winter’s says 1mm normal, 2mm pathologic
    3) Absence of soft tissue swelling
    4) Reduction of subluxation with extension
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14
Q

Other than “buttress plate techniques” list other plating techniques (list 4)

A
  1. Tension band plating
  2. Compression plating
  3. Neutralizing plate
  4. Bridge plating
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15
Q

List findings in Brown-Sequard spinal injury (3 neurological)

A
  1. Ipsilateral loss of motor function
  2. Ipsilateral loss of deep touch, proprioception, & vibration sense
  3. Contralateral loss of pain & temperature (~2 levels below injury)
  4. May have loss of ipsilateral autonomic function (Horner syndrome)
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16
Q

List types of posterior surgical management for fusion of C1-C2 (list 3)

A
  1. Wiring techniques (Gallie, Brooks techniques)
  2. Trans-articular screws (Magerl technique)
  3. C1 lateral mass & C2 pedicle screws (Harms technique)
  4. C1 lateral mass & C2 translaminar screws
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17
Q

List ways to decrease complications of halo in pediatric population (list 3)

A
  1. Increase number of pins (6-8 pins vs. 4 pins in adult)
  2. Decrease torque of Halo pins (2-4 inch-lbs or finger-tight vs. 8inch-lbs in adult)
  3. CT skull 1st to aid in pin placement
    Helps avoid cranial sutures
    Helps avoid thin regions of skull
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18
Q

List conditions that cause bright signal change for gadolinium MRI (list 3)

A

1) Epidural fibrosis/scar (discectomy/laminectomy)
2) Infection (osteomyelitis+/-discitis, sinus tract, abscess)
a. Abscesses peripherally enhance
3) Tumors
a. area to biopsy;not necrotic area (doesn’t enhance)
b. Post-op to assess for tumor recurrence
4) Atlantodental joint in rheumatoid arthritis
a. Joint effusion will enhance, pannus will not

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19
Q

List factors contributing to congenital kyphosis progression (list 3)

A
  1. Rapid growth of spine
    a. Birth to 3 years
    b. Adolescent growth spurt
  2. Mixed (failure of formation & segmentation) or failure of formation defect
  3. Multiple adjacent vertebrae (vs. single level anomaly)
  4. Lots of growth remaining
20
Q

List factors preventing full extension post ACL reconstruction (list 3)

A
  1. ACL reconstruction performed before full ROM regained
  2. Arthrofibrosis (too early inflammation still present)
  3. Cyclops lesion
  4. Improper tunnel placement
    Tibial tunnel too anterior -Impinges on femoral notch.
21
Q

List structures of PLC of knee (list 4)

A
  1. LCL
  2. Popliteus tendon
  3. Popliteofibular ligament
  4. Posterolateral joint capsule

Other supporting structures (secondary components)

5) IT Band
6) Biceps femoris
7) Fabellofibular ligament
8) Lateral gastrocs
9) Lateral capsular ligament

22
Q

List factors of Mirels classification for assessment of prophylactic fixation of tumor (4)

A
  1. Location of lesion (UE/LE/Peritrochanteric)
  2. Pain (Min, Mod, Functional)
  3. Type of lesion (Blastic/Mixed/Lytic)
  4. Size of lesion (2/3)
23
Q

List minimally invasive procedures for CVT (list 3?4?)

A
  1. K-wiring of talonavicular joint through small medial incision
  2. Selective capsulotomies of talonavicular joint and anterior aspect of subtalar joint
  3. Percutaneus Achilles tenotomy
  4. In the presence of pre-op casting (reverse Ponsetti technique)
24
Q

List procedures for carpal-radial ROM preserving (but not carpal bone motion
preserving) surgeries for SLAC stage II wrist (list 2)

A
  1. Proximal row carpectomy

2. Scaphoidectomy & 4-corner fusion

25
Q

List radiological clues for ankle syndesmotic injury (list 4)

A
  1. tibiofibular clear space 6mm on AP or > 42% fibular width
  2. tibiofibular overlap >1mm on mortise
    Tibiofibular overlap measured 1 cm above plafond
26
Q

List factors to prevent “over-stuffing” of radial head replacement (list 3)

A
  1. Radius - Rebuild #’d radial head on side table to determine native radial head size
  2. Length - Height of prosthesis should be the same as the semilunar notch
  3. Should be congruent and have smooth motion with the capitellum through full ROM
  4. Look at ulnohumeral gapping medially
    a. (Lateral UH joint space widening is not diagnostic of radial head arthroplasty overstuffing JHS 2007)
  5. X-ray - compare to contra-lateral side, should line up to semilunar notch
27
Q

List causes for persistent groin pain in patients who had THA (list 6)

A

1) Infection
2) Aseptic loosening (acetabular or femoral)
3) Mechanical subluxation
4) Impingement
5) Stress fracture (pubic ramis, Periprosthetic)
6) Avulsion apophysitis (ASIS, AIIS)
7) Osteitis pubis/pubic symphysis
8) Muscle strain (Adductor, Iliopsoas, Rectus femoris)
9) Tendonopathy (Adductor, Rectus abdominus)
10) Bursitis (iliopsoas, Iliopectineal)
11) Nerve entrapment (Ilioinguinal, genitofemoral, Obturator)
12) Arterial stenosis/ Aneurysm (iliac, gluteal, femoral)
13) Referred pain (lumbar spine, SI joint)

28
Q

What are structures to release in varus knee during TKA (list 5)

A

1) Osteophytes
2) Capsule and meniscus
3) Deep MCL
4) PMC (Semi-membranosus and capsule)
5) Superficial MCL (subperiosteal release not complete)
6) PCL
7) Medial Gastroc
8) Posterior oblique ligament

29
Q

List structures of superior shoulder suspensory complex (list 6)

A

1) Acromion
2) AC joint
3) Distal clavicle
4) Coracoclavicular ligaments
5) Coracoid
6) Glenoid
7) CA ligament (not in original description)

30
Q

List indications for humerus shaft fracture ORIF (list 5)

A 
Absolute indications:
1)	Open #
2)	Vascular injury
3)	Brachial Plexus injury
Relative indications;
4)	Polytrauma (for early WB)
5)	Bilateral humerus #s
6)	Floating Elbow
7)	Pathologic #
8)	Burns or S.T. injury that precludes bracing
9)	Fracture characteristics (long oblique proximal, intra-articular, distraction at fracture site)
31
Q

Formula for Pelvic inicidence?

A

Pelvic Incidence = sacral slope + pelvic tilt
PI= SS + PT
line from the center of the S1 endplate to the center of the femoral head
a second line perpendicular to the S1 endplate, intersecting the point in the center of the S1 endplate
the angle is the pelvic incidence

32
Q

4 causes Superior Mesenteric Artery Syndrome in AIS adolescent Idiopathic scoliosis surgery?

A
  1. spinal elongation, which decreases the aortomesenteric angle
  2. Postoperative weight loss
  3. Anatomical variants:
    • high insertion of the duodenum at the ligament of Treitz
      - low origin of the superior mesenteric artery
  4. compression of the duodenum due to peritoneal adhesions
33
Q

List 4 contraindications to HTO for varus knee? (4)

A

1) Severe medial compartment articular damage
2) Tri-compartmental or Patellofemoral OA
4) Decreased ROM (less than 5 – 120 flexion )
5) Age > 65
6) Infection
7) Rheumatoid/inflammatory arthritis

34
Q

List 4 components of WOMAC scale? (4)

A
  1. Pain
  2. Stiffness
  3. Physical function
  4. Social function
35
Q

List 6 other organ systems that are affected in congenital scoliosis? (6)

A

1) Limb Anomalies (most common assoc (in cong scoli): spine, hips, feet, sprengel)
2) Renal Anomalies, GU anomalies (get screening U/S or MRI – 20%)
3) Cardiac anomalies (Get screening ECHO – 26%: VSD > ASD > PDA, TOF)
4) Gastrointestinal system (anal atresia, trachea/esophageal anomalies)
5) Neural Axis (spinal dysraphism 20-40%: tethered cord most common)
6) Auditory (esp Cervical scoli)
7) Respiratory System (Thoracic Insufficiency Syndrome) – not specifically mentioned as affected BUT will be a consequence of…

36
Q

Who are at higher risk for the development of superior mesenteric artery syndrome following correction of spinal deformity (3-4)

A
  1. body mass index that is in less than the twenty-fifth percentile for their age
  2. those with a stiffer thoracic curve (<60% correction on bending radiographs)
  3. a laterally displaced lumbar curve (Lenke B or C)
    4.
37
Q

List 3 stages of muscle injury recovery?

A

1) Inflammation
- hematoma
- myofibrils contract
2) Repair
- macrophages remove injured tissue
- new cells are generated from satellite cells
- new vascular ingrowth
- production of connective tissue scar
3) Remodeling
- maturation of regenerated myofibers
- reorganization of scar

38
Q

List 4 changes in muscle with endurance training? (4)

A

Early
1. fewer motor units required to maintain given force
2. increased activation of synergistic muscles
Late
1. increased mitochondrial size and number
2. increased aerobic enzyme activity
3. increased muscular capillary density
4. increased type I fiber concentration

Cardiovascular changes
adapts to provide O2 to muscles at a higher rate
1. increased stroke volume
2. increased ventricle size

39
Q

List 5-6 key components of pre-op surgical checklist?

A

1) Patient confirms ID,Consent,Procedure,Site
2) Correct site and side (marked)
3) Anesthesia machine and medication check completed
4) Pulse oximeter on and functioning
5) Difficult airway or aspiration risk identified
6) Anticipation of blood loss
7) Anticipated critical events
8) Essential imaging displayed

40
Q

List Five things to do in systemic staging of Ewings sarcoma? (5)

A

1) Bone Scan
2) CT Chest (pulmonary mets)
3) Bone Marrow Biopsy (rule out marrow mets)
4) Blood work (CBC, ESR, CRP, ALP, Lactate Dehydrogenase) *ESR increased in up to 50%
5) MRI of complete bone involved (look for skip lesions, ST involvement)
* this is technically local involvement

41
Q

Three things to do to prevent procurvatum in proximal tibial fracture fixation? (3)

A

1) use an appropriate nail – Herzog curve should be proximal to the fracture, to minimize the deforming forces (if the curve passes distal to the fracture, a wedge effect may translate the distal segment posteriorly as the nail is seated)
2) nail the knee in extension – (15 degrees flexion) – this neutralizes the force of the patellar ligament on the proximal fragment (which otherwise pulls it into procurvatum)
3) posterior blocking (Poller) screws
4) reduce the fracture before reaming & maintain reduction with
unicortical plate
Clamp with reduction clamps
5) ex-fix, femoral distractor
7) multiple proximal locking screws to prevent loss of reduction

42
Q

List 2 anatomic reasons why proximal femur is predisposed to SCFE?

A

1) decreased femoral anteversion (N=11,mean is 0 in obese adolescents) increases shear stress
2) vertical orientation of physis – 8-11 degrees more vertical compared to normal adolescents

3) hormonal changes = increased height of zone of hypertrophy

43
Q

Four principles/procedures to use in 11yo with open physis and ACL deficiency (4)

A

1) complete transphyseal soft-tissue reconstruction
2) all-intraepiphyseal
3) hamstring graft passed under the intermeniscal ligament and then over the top on the femur
4) partial transphyseal
- vertical transphyseal tibial tunnel
- over the top femur or transepiphyseal femur

44
Q

Name the following dermatomes:

1. Nipple Line
2. Umbilicus 
3. Groin 
4. Medial Calf
A
  1. T4
  2. T10
  3. L1
  4. L4
45
Q

List 4 successful things to non-operatively manage carpal tunnel (4)

A

1) local steroid injections
2) oral steroids
3) splinting
4) ultrasounds

46
Q

List Five features associated with increased risk of peri-operative mortality in hip fractures (5)

A
  1. delayed surgery
  2. advanced age
  3. male gender
    nursing home or facility residence
    poor pre-op walking capacity
    poor ADLs
    higher ASA grading
    poor mental state
    multiple comorbidities
    dementia or cognitive impairment
    diabetes
    cancer
    cardiac disease

Honey Badger 2103 (9 decks)

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