2016 (All) Flashcards by M Almasri

Definitions of Scheurman’s Kyphosis.

Treatment?

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Criteria for ORIF of a pars defect (spondylolysis)

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Where is EG most commonly found in the spine?

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What is the most common painful pediatric malignancy in the spine?

Treatment?

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Risk factors for Spinal Infection (10)

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Treatment of spinal infections and indications to operate

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Indications for fixation of a Humeral GT # (4)

Displacement >5mm
Displacement >3mm in an overhead worker
Failure of nonop managment
Open fracture
GT radio >0.5

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Three types of Humeral GT #s

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Which flexor tendon zone has the worst prognosis for repair?

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List the flexor tendon zones of the hand (6)

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Where does FDP Bifurcate?

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Complications of flexor tendon Repairs

Wound Issues
Tendonorraphy Rupture
Bowstringing
Intrinsict Tightness
Nail sensitivity
Intrinsic plus deformity
DIP contracture

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Sunderland Classification of Nerve Injury

Sneddon?

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When do you explore the peroneal nerve after injury?

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Name 4 medications that need to be regally dosed?

Hepatically Dosed (4)

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What tendon transfer do you perform for peroneal n. Palsy?

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What are grafting options fo peroneal nerve laceration?

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Criteria for good risk prediction tool (5)

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Preop consideration fo patient with renal failure (7)

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What GI conviction is a contraindication to surgery?

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DDx of osteochodnral lesion of talus (7)

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Indications for fresh allograft in OCD lesions of talus (4)

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Increased risks associated with GA vs neuraxial technique for anesthesia in TKA.

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When is it safe to admin LMHW after epidural catheter?

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When would you not want a nerve block in the setting of TKA for a patient?

What does the literature say for arthroscopic debridement for OA in: 1. Knee 2. Shoulder 3. Elbow 4. Hip

Advantages of XLIF (lateral inter body fusion) over PLIF and TLIF (3)

Disadvantage to XLIF (lateral inter body fusion)

Contraindications to lateral lumbar Intra body fusion (4)

Indications for lumbar Interbody Fusion ( 5)

Where is the “safe zone” of acces for a retroperitoneal approach to the lumbar spine?

Factors contributing to ankle arthritis (5)

Outcomes of total ankle vs arthrodesis

Contraindications to ankle arthroplasty (8)

Contraindication for arthroscopic assisted arthrodesis of the ankle

Patient presents with transphyseal fracture of the distal humerus \<1 year of age. What do you need to rule out?

CHILD ABUSE.

Presentation of pediatric patients with injury.

Radiographic signs of transphyseal distal humerus fracture in a child

Treatment of transphyseal distal humerus fractures.

Complications of transphyseal distal humerus fractures.

Presentation of Metal Hypersensitity reaction following TKA

PRP use in F&A regarding: osseus healing, Achilles tendinopathy & plantar fasciitis

* Osseus

Factors influencing strength of soft-issue to bone fixation construct (4)

Which implant the ha sthe highest yeild and cyclic load tasting in soft tissue to bone healing constructs?

Mode of failure for: Interference Screw Cortical Button Transfixation Pins Suture Anchors Staples

Which mode of distal biceps fixation has the lowest rate of complications?

Mangement of UCL injuries

Techniques that have improved outcome in UCL reconstruction in the elbow (3)

Most common complication following UCL reconstruction int he elbow

Figure of 8 vs docking technique in UCL reconstruction of the elbow

Describe thre foot strike patterns in running

1. Forefoot strike 1. Inistsially land over forefoot 2. More cushioning, foot intrinsics contract cushions forefoot, gastrocs eccentrically contracts cushioning proximal joints 2. Midfoot strike - whole foot on ground at once 3. Rearfoot strike - land on heal and weigh rolls foreward 1.

Fractures of the forefoot and midfoot strike vs rearfoot strike in running.

Injuries in barefoot running

Indications for TTC Fusion (9)

Patient factors negatively affecting results of TTC fusion (9)

Bone grafting options in TTC arthrodesis

When can you use cannulated screw fixation in TTC arthrodesis?

TTC nail vs plate fixation in TTC fusion

Equivalent biomechanical outcomes

Benefits of TTC nail in TTC arthrodesis

* Load sharing, can weightbare earlier * Decrease incision sizes. Dont use when deformity of distal tibia

Outcomes of unplanned resection of soft tissue sarcomas (5)

* Greater

Greater Trochanter pain sydrome encompasses which 3 entities?

Imaging modalities to work up greater trochanteric pain syndrome

Indications and option for surgical management of greater trochanter pain syndrome

* 613 month

Independent predictors of in-hospital mortality and postop complicatiosn in primary TKA (5)

Consideration for Parkinson’s patients undergoing TKA

What is the Rosenberg View?

Xrays you should order for preop plannting of TKA, and what do they show.

* 3 ft standing

What is the result of raising the jointline in TKA? Lowering it?

How do you avoid cam-post impingment in TKA?

Cause of increased Q angle in TKA (7)

1. Internal rotation of femoral component 2. Internal rotation of tibial component 3. Medialiation of femoral component 4. Medialization of tibial component 5. lateralization of patellar implant 6. \>7 degree valgus femoral cuT

What size tibial defect can be filled with cement?

What degree of coronal deformity can be balanced in the knee using soft tissue releases?

Navigated vs non-nag TKA

Strength loss post patellectomy

Principles for ERTL transtibial amputation

* B

ERTL vs trantibial BKA

* ERTL

Gene related to ank spond

Features of ankle spond

When is an ank spond patient at high risk of iatrogenic nerve injuries?

Spinal changes in ank spond

Non orthopaedic and orthopaedic features of ank spond

Outcomes of operative intervention in spine fractures in ank spond

Complications of spine surgery specific to ank spond

Course and branches of axillary n.

3 technical difficulties of subscap sparing (subscap split) approach for arthropalsty

Ideal adjunct treatment for spinal cord injury would have which 3 components?

Name the meniscofemoral ligaments (2)

Which PCL bundle is larger? Stronger?

How do you grade PCL injury?

What would you see commonly with chronic PCL on long leg standing films?

Op vs nonop isolated PCL injury in an athlete

Fixation techniques PCL: Single vs double bundle? Fixation technique for avulsion?

Single vs double - no differec

What position do fuse: MCP and PIP of second finger as you go more ulnar? thumb cmc?

Finger arthritis vs fusion in: post traumatic OA? Septic arthritis? Psoriatic arthitis? SLE? RA? Scleroderma?

Complication post finger fusion

Most common mutation in OI

Medical therapy for OI (3)

Meds not recommended for treatment of OI

Considerations for nailing in patients with OI (4)

What % of # are in the spine, for adult OI patients?

50%

Complications of hip scope for trauma

chondral injury fluid extravasation -\> abdo compartment syndrome, resp failure, death transient traction neuropraxia (pudendal nerve \> LFCN) HO 1-6.3% VTE 1.4%

Rates of AVN after hip dislocation with fracture

Rates of HO following open vs arthroscopic hip procedure

Definition of proximal junctional kyphosis

Risk factors for proximal junctional kyphosis

Strategies to decrease occurrence of Proximal junctional kyphosis

What anatomic changes are associated with glenoid dysplasia?

Management of glenoid dysplasia

What procedure shoudl you avoid in patients with glenoid dysplasia?

How much glenoid bone stock is required to put in a glenoid component in shoudler arthroplasty?

How much glenoid retroversion can be corrected with eccentric reaming?

What type of corrosion in implicated in trunnosis?

Factors associated with increased failure of MOM articulation and trunnion wear (7)

Things to check when revision for trunnosis

When would you do a femoral component revision in trunnionosis

What is the trajectory of a cortical pedicle screw?

Other fixation options for lumbar spine fusion (besides traditional pedicle screws). When are they useful?

Complications after injection for tennis elbow

1. PLRI 2. Fat Atrophy (common) 3. Skin hypopigmentatin (common)

When do you apply a halo postop for pediatric spine surgery?

* Age \<8 * Unreliable patient

When inserting occipital screws- what do you do if you drill and cause a CSF leak?

Tamponade the hole with a screw.

Main blood supply to navicular?

Classification of navicular fractures

Risk factors for navicular stress # (3)

Conservative management of navicular #

Indications to fix navicular body fracture (6)

Complications of navicular fracture

Techniques to avoid anterior perforation of femur during nailing (4)

Long vs Short nail (when to use), complications

When is an elbow dislocation considered chronic?

Salvage procedures for chronic elbow dislocation

Indications for triceps lengthening in chronic elbow dislocation. (3)

Structures to release in chronic elbow dislocation.

Indications for ulnar nerve transposition in chronic elbow dislocation

Goals of supramalleolar osteotomy (4)

Indications for supramalleolar osteotomy

1. Assymetric varus

Contraindications to supramalleolar osteotomy (6)

When’d o you require a fibular osteotomy when performing a SMO?

Complications of a SMO

When do you do a dome osteotomy for SMO

Standard technique and alignment goal for varus and valgus SMO

* Varus- Medial opening wedge * Valgus- medial closing wedge * Aim for 2-4 degrees tibiotalar valgus Can do lateral osteotomies, just more difficult with fibula there.

DDX of patient with lumbar pain postop decompression or fusion procedure

* Decompression * Samelevel * Infection * Stenosis * Farcture * Instabilty/Deformity * Ajacent Level * Stenosis * Instabily * Deformity * F

Risk factors for postop infection in spine surgery

Indications for surgical management of postop spine infection (3)

What do you do with hardware when doing an I&D for spine infection postop.

What is the rate of recurrence of stenosis postop lumbar spine decompression?

Where do most postop lumbar spine fractures occur?

Treatment for postop # in lumbar spine six (op and nonop)

What is the benefit of S2-Alar-Illica Screws?

Factors increasing chance of fusion in lumbar spine surgery

Risk factors for pseudoarthrosis in spinal surgery

What can you do to optimize fusion rates in revision spine surgery for psuedoarthrsis?

What is flat back syndome? Causes? (3) Treatment?

Failure risk with vertical femoral tunnel in ACL surgery using transtibial techinque

Where do you put your femoral tunnel in a single bundle ACL reconstruction?

Landmarks for tibial tunnel during single bundle ACL reconstruction

Double bundle vs single bundle ACL

Theoretic risks of using independent femoral drilling compared to a transtibial approach

Potential advantages to IM clavicle fixation (4)

What kind of ossification does the clavicle undergo?

Comment on the blood supply to the femur during developement

* Early - epiphysis and metaphysis have separate blood supply * Then becomes a vascular network around the proximal femur * Epiphipseal vessesl cross the growth plate **extraosseously** and pierce the epiphysis becoming **retinacular vessels**

At risk structures around the clavicle (3)

* Brachial plexus - 1cm away * Subclavian a. - 1.2 cm away * Subclavian v. - 0.9mm away

General thought on wiring and kwire fixaton of the clavicle/

Too many hardware compliations. Wires can migrate to the heart and lungs and cause death. Newer generation IM nails/screws are preferred for IM fixation of clavicles

Branches of the profunda femoris a.

* MFCA * LFCA * Perforating A. * Muscluar branches * Desceding retinacular a.

Componenets of the cruciate anastamosis.

* Inferior gluteal a. * Transverse MFCA * Transverse LFCA * Profuda femoris a.

On field management of athletet with a suspected c-spine injury

* Immobilize in rigid collar * Rigid backbone * Leave helmet in place. Defer removal until i a controlled environment.

When do you surgically fix a facet fracture? burst fracture?

* Fix all injuries with injured PLC * Neurological injuries * Unstable * Facet * Displaced \>1 cm * Involve \> 40% lateral mass * Burst: same as above * Relative contradincicaiton for C7 burst to be treated nonop, mointor for risk of substantial kyphosis

Contraindications to participation in intense athletic activty after cspine fracture (9) Reletive contraindications (4)

1. Occipital-cervical arthrodesis 2. AA instability 3. Residual subaxial arthrodesis 4. Substantial sagital malalignment 5. Narrowing of spinal canal as result of retropulsed fragment 6. Residual new deficits 7. Loss of cervical ROM 8. Spear tackler's spine * Canal vertebral body ration (pavlov) \<0.8 * Straight or kyphotic alignement * Post traumatic radiographic abnormality * Documation of spear tackling technique Relative 1. Upper c-spien fracture malunion 2. C1 ring fracture nonunion 3. Two level cervical arthrodesis 4. Congential abnormality (ie os sodentiodum)

Torg-Pavlov Ratio

Diameter cervical canal/diameter of cervical body. \<0.8 = stenosis

Which appraoch ot the hip puts the inferior gluteal a. and n. at risk?

Split of glut max in kocher langenbeck

Which vessels are damaged during a piriformis start nail?

Superior retinacular vessels of ascending cervical braches

Which artery does teh artyer of ligmentum teres arise from ?

Mostly obtuartor (some from MFCA, some have contributions from both)

How much supracetbaularu distace should you leave when doing a PAO? Why?

2- 2.5 cm to allow sufficien profusion of the acetabulum (where all the acetabular vessels are)

Bloody supply to the acetabulum

* Central axis * Acetabular a. (from obturator) * Supplies 3 main ossification centres of the triradiate * Peripheral Ring * SGA * IGA * Ischial A. (internal pudendal)

Imbalances seen in swimmer's shoulder (2)

* Overdeveloped lat dorsi and Pec Major * Increased adduciton and internal rotation force * Scapular dyskinesia

Pathologies seen in swimmer's shoulder

* Os acromilae * Labral pathology * Surpascapuarl Neuropathy * GIRD * **Subacromial Impingment** * Hyperlaxity * Scapular dyskinesia * Overdeveloped Pec Major and Lat Dorsi * Overpowers serratus and subscap * Asynchronous trap firing = superior migration of hte humeral head

Which one surgery, when done for the appropriate pathology, has swimmers most constatily abck at pre-injury level of performance?

Decompression of suprascapular n.

Nonop management of swimmer's shoulder

* Sleeper stretches * Strengthening of serratus, RTC, straps and rhomboids * Proper stroke form and slow return to sports

Tissue densities in ultrasound

* Tendons/bones = hyperechoic (white) * Muscles - hypoechoic (grey) * Fluid/cysts - anechoic (black) * Peripheal n, ligments - mixed

What can you use to reliabely diagnose a stener's lesion of the thumb?

Ultrasound! 100p acurate and I guess an MRI

How do you assess integrety of pulleys in the finger using ultrasound?

Look at degree of bowstringing. 3mm in extension or 5mm in flexion = complete pulley disruption

Benefit of ultrasound use in the hand and wrist.

* Usesfl preop for identifying extent of retraction of tendons * Can dynamically evaluate structures (ie ECU subluxation

Evidence of ultrasound guided vs blind injection in the hand and wrist.

* Minimal evidence of improved outcomes * Studies aren't great

Success rates of bracing for AIS

* Worn \>13hrs/day = 90-93% successful * \<6 horus - 41% sucessful * NNT for bracing =3 (BRAIST Study) * No effect on QOL

Mechanicsm of action of bracing in AIS

* 3 point mould * Elongation * Push * Movement

Which AIS patients can you brace? Goal of brace correction? How long to wear?

* Can brace * 20-40 degree curve * Risser 0-3 * Goal : correction of 30-70% (roughly 50%) * Weak at least 12 hr/day (16-18 ideal)

Overall evidence for physio for coruve correction in scoliosis.

Some evidence for Schroth method specifically, everything else has no evidence.

Principles of skill acquisition through simulation training (4)

1. Transferability 2. Retention - higher retention = better performance on gameday 3. Repeated practice (multiple repetitions better than one long intensive session) 4. Prevent Decay (manual practice influences cognitive knowledge)

Which patients have worse outcomes for primary TKA?

* Obese * DM * Cirrhosis * Hep C * Chronic pain, anxity, depression No difference found in delaying patients for surgery, so go ahead and optimize them.

No evidence supporting these in TKA (6)

1. Patient specific implants 2. PS over CR or otherwise 3. Navigation 4. ABx cement 5. Drains 6. CPM machine (early mobilization)

Most common sports with cervical spine injuries

* US * Football * Wrestling * Gymnastics * Canada - hockey * Europe - rugby motorcross didn't make the cut.

Fixation indication for odontoid #

* \>5mm displacement * \>10 degrees angulation * Comminuted

What must be ruled out in an athlete with a stinger, who has neurosymptoms worse in one extremity or that do not rapidly resolve?

rule out transient cervical cord neuropraxia

What threshold of midsagittal intervertebral disc space is associated with increased risk of SCI

greater than or equal to 8mm

Which levels do disc herniations occur more commonly in NFL players

C3-4, C5-6 (C6-7 most common in general population)

Is it safe to return to sports after single level ACDF?

What changes are seen in a spear-tackler’s spine?

What is the most common primary bone tumour of the hand?

Ejc0

What shoudl you see on xrays of an enchrondroma?

Well

Tagkigawa classification of Enchondromas

Associations with Mafucci Syndrome

DDx of benign hand tumours

1. Enchondroma 2. Chondroblastoma 3. Osteoblastoma 4. Hemmorhagic epitheliod and spindle cell hemangioma

DDx of malignant hand tumours (6)

DDx of non-tumour, but tumour-like lesions of the hand (7)

Most frequent site of metastasis in the hand

Which cancers most commonly metastasize to the hand?

How do you treat low grade chondrosarcoma vs enchondroma of the hand?

Treatment of pathologic fracture of an enchrondroma of the hand

Adjunctive treatments in Enchondroma currettage

Complications post-curretage of an enchondroma

Rate of HO in traumatic amputation

Causative organism of septic arthritis in children \<1 year of age

Most common organism for septic arthritis and abcess in sickle cell patients

Complications increased with MRSA infection

What should be monitored as an indicator of a pediatric patient’s response to antibiotics

What pathogens do you need to consider as a source of infection in pediatric patient who are immunocompromised or from endemic regions?

New marker we can monitor in the serum for pediatric infections

DDx of limp and pain/fever in a kid (6)

Kocher Criteria

What is a common triad seen in JIA?

Surgical indications of pediatric osteomyelitis (3)

Goals of treatment for adults with neuromuscular conditions (Parkinson’s, MS, CP, myopathies)

Name and describe 4 deformities seen in Parkinson’s patients

Surgical consideratiosn in a spinal surger for a patient with Parkinsons

Common causes for revision of spinal surgery in Parkinson’s patients

Targets for spinopelvic correction in Parkinsons

Postop considerations for spinal surgery in Parkinson’s Patients

Factors affecting delivery of care to inmates

1. Saftey takes priority over health issues 2. Inmate transfers 3. noncomplicance and lack of cooperation from patient 4. delay + interruption in care 5. lack of services ie rehab

Indications for a distal femoral traction pin

Contraindications to femoral traction pin

Indications for proximal tibia traction pin contraindications?

* Distal 2/3 femoral shaft fracture. *

Optimal position of calc pin

5 factors associated with successfully closed reduction of a pediatric dislocated hip

Safe zone for closed reduction in Paeds DDH

3 risk factors for AVN in a closed reduction DDH

Incidence of AVN after open reduction via a medial approach

Surviourship of a salter osteotomy

Which have fastest onset of growth modulation, staples or plates?

Indications fo hemiepiphyseodeiss in blounts

How much angular correction can you expect in guided growth of the femur? Tibia? With tension band plating.

Indications for tension band plating for crouched gait (CP

Contraindications to tension band plating

Which patiens are tension band plating ideal for\>

Complications of tension band plating

Risk factors for failure of tension band plates

Causes of perioperative vision loss

What kind of ischemic optic neuropathy is most associated with spine surgery, anterior or posterior?

Risk factors for POVL

Treatment of perioperative vision loss

What is the threshold for strain before you get a fibrous nonunion?

factors affecting implant stiffness

Factors associated with risk of nonunion

Guidelines for bridge plating

Downside to using titanium plates

What layers separate in morel-lavalee lesion?

Stagesof a morel-lavalee lesion evolution

1. Dermis separates from underlying fasci 2. Exanguination from lymphatic and vasculature produces collection of blood, lymph and fatty debris 3. Lesion enlarges as serosang fluid replaces above 4. if left untreated, inflammation leads to pseudocapsule

Indications for debridement of a morel-lavalee lesion

Arthroplasty in patients \>80 vs \<80

Risk that increase in arthroplasty for patients \>80

Hospitalist involvement in elderly total joint patients has shown to:

Indications for cortical bone trajectory pedicle screws

Contraindications to cortical trajectory pedicle screws

Benefit of cortical based trajectory screws

Which side of the knee has the more robust profusion

Contraindicatiosn to VAC dressings in open knee wounds

Main risk associated with partia thickness skin graft

Flap options for knee coverage

Downside of using a free flap

Ways to gauge rotation off forearm xrays

Acceptable reduction parameters for forearm fractures in peds

Surgical for BBFF in Paeds (6)

Advantages of flexible nails in pediatric BBFF

Disadvantages of flexible nails in pediatric BBFF

ORIF vs flexibel nailing BBFF

Single vs double bone nailing Paeds BBFF

Complications of flexible nailing

Risk factors for increased complication in nailing of BBFF

General approach to treatment by by age BBFF

Failure rate for massive RTC repair

Synthetic grafts vs biologic graft in RTCR

Concerns with synthetic grafts in RTCR

Teatime of lumbar facet cysts

Surgical indication for treatment of lumbar facet cyst

What is the most common location for lumbar facet cysts?

3 stages of lumbar facet cyst pathogenesis

Symptoms of lumbar facet cysts

Shoudl you fuse after surgical decompression of lumbar facet cysts?

Complications of surgical management of lumbar facet cysts

Ethology of spinal stenosis

* Degenerative * congential

What is the best measure of symptoms for spinal pathology

Clause of spinal stenosis by location

Jersey finger

Treatment of jersey finger

Indications for repair of multiple pulley ruptures of fingers

Which pulley sdo climbers injure? baseball pitchers?

3 types of ECU instabilty

What position is ECU unstable in?

Treatment of ECU subluxation

What position do you test for UCL injury of the thumb

Classification of UCL thumb injuries

Indication fo operative mangement of thumb UCL injury

Risk factors for patellar tendonopathy

Treatment of patellar tendonopathy

Nonop - only good evidence of eccentric exercises. Everything else has no evidence Op - tenotomy patellar tendon, debride and re-repair. (Same as insertional Achilles tendonopathy)