Deck 1 Flashcards
(183 cards)
1
Q
external rotation stress test of an SE2 fracture is testing the competence of what?
A
deltoid ligament
2
Q
what does axillary nerve innervate?
A
deltoid and teres minor
3
Q
if you think pathology is osteofibrous dysplasia, make sure it is not:
A
adamantinoma
4
Q
if you have severe back pain causing you to miss work, what %age of patients return to work by 6 weeks? 12 weeks?
A
60-70% by 6 weeks
90% by 12 weeks
5
Q
extenral rotation of shoulder with arm at side tests:
A
infraspinatus (suprascapular nerve)
6
Q
gout crystals are:
A
negatively birefringent (yellow appearing)
7
Q
innervation of the brachialis
A
majority = musculocutaneous nerve
inferolateral = radial nerve
8
Q
what ligaments originate on the lateral process of talus:
A
- lateral talocalcaneal
- ATFL
- PTFL
you can excise it without creating instability
9
Q
the most common site of spontaneous entrapment of the PIN is:
A
in the Arcade of Frohse
- this is the most superficial and distal layer of the supinator muscle
10
Q
Myelopathy in setting of C1-2 instability for RA patients, the best outcome is associated with a PADI of:
A
> 10mm (will achieve some improvement)
> 14mm (all in the Boden study achieved complete recovery)
11
Q
Treatment of mallet finger without bony subluxation:
A
splint in extension
if there is subluxation, do a trans-articular pin
12
Q
Define: MIS Watson-Jones Approach
A
incision from the greater troch to the ASIS
- interval between the medius and the TFL
13
Q
anatomy of the iliopectineal fascia
A
- it is the iliopsoas sheath
- separates the psoas and femoral nerve from the iliac medial vessels
- must be taken down to enter the true pelvis
14
Q
Define: Relative Risk
A
incidence of disease in study group / incidence of disease in control group
15
Q
major complication of thenar flaps?
A
if used in digits 2 or 3, can cause PIPJ stiffness. therefore, make sure MPJ and DIPJ are flexed maximally
16
Q
what nerve can be injured during anterior exposure of C2-3?
A
hypoglossal
- exits the ansa cervicalis at C2-3 level
17
Q
if your’e doing a distal clavicle excision, you should also be doing a :
A
diagnostic arthroscopy
- literature reports high rate of concomitant intra-articular pathology
18
Q
the short head of the biceps (hamstrings) is innervated by:
A
peroneal division of the sciatic nerve
19
Q
define skeletal maturity
A
2 years post-menarchal
Risser 4
<1cm height change over 1 year
20
Q
significance of mecA gene?
A
this gene is mutant in antibiotic resistant staph aureus
21
Q
which antibiotics are inhibited by active efflux pumps?
A
- erythromycin
- tetracycline
22
Q
anatomy of the median nerve at the wrist
A
- immediately ulnar to FCR
- palmar cutaneous branch is between FCR and PL
23
Q
which peripheral nerve has the best and worst recovery potential after graft reconstruction within 6 months of injury?
A
best = radial worst = peroneal
24
Q
this hand tumor will show hemosiderin on histology
A
giant cell tumor of tendon sheath
25
osteosarcomas need chemo except for:
parosteal osteosarcoma.
| low grade tumor generally speaking and needs no chemo, with low risk of recurrence
26
what happens if you fix a buford compmlex?
you limit shoulder external rotation
27
Biomechanics of uniortical locking plating vs fixed angle blade plate for distal femur fx?
- unicortical locking plate has LESS torsional strength but MORE axial strength than the blade plate
28
characteristic findings of high turnover renal osteodystrophy?
- elevated phosphate
| - elevated PTH --> can cause primary hyperparathyroidism via PTH hyperplasia which essentialy becomes an adenoma
29
Outcomes differences between humeral nailing and humeral plating?
- higher risk of shoulder impingement with nailing
30
what asolescent condition is scapho-trapezio-trapezoidal pinning indicated for?
Kienbock's in adolescents
31
surgical treatment for Wassel type II and IIIA
- web space deepening
| - opponensplasty
32
surgical treatment for Wassel type IIIB, IV, and IV
amputation and pollicisation
| - the reason is the MCP joint is deficient in these groups
33
if you have a soft tissue sarcoma, first staging study is:
chest CT
34
difference between CRPS types I and II:
```
I = sympathetic dystrophy
II = identifiable nerve lesions
```
TENS thereapy useful for type II
gentle PT useful for type I
35
difference between odds ratio and relative risk?
Odds ratio is used in prostpective case-control studies
Relative risk is used in cohort studies
36
optimal treatment for basilar thumb OA?
no difference between trapeziectomy and trapeziectomy + PL interpositional arthroplasty (level 1 evidence)
37
what generates more heat - fiberglass or plaster?
fiberglass
38
treatment of standard osteosarcoma?
neoadjuvant chemo + wide resection + adjuvant chemo
39
FDP advancement causing quadrigia occurs at this distance:
1cm advanced
40
difference between Leddy type I and type II lesions:
type I is FDP avulsion wiht retraction to palm
type II is FDP avulsion with retraction tot he PIPJ
- fix type I injuries sooner than II (1 week compared with "a few weeks")
41
what makes titanium allows resistant to corrosion?
self-passivation
| - they form a thin layer of titanium-oxide on surface, preventing corrosion
42
physical changes that occur in polyethylene after oxidation?
- decreased strength
- decreased ductility
- INCREASE elastic modulus
thereofre it is more brittle and prone to crack
43
tendon transfer options for varus ankle deformity?
- SPLATT (requires a functional TA tendon)
- transfer of posterior tibialis - good if TA is non functional and the varus is caused predominantly by the posterior tibialis itself.
44
treatment of pediatric chondroblastoma?
curettage and bone grafting
45
Drug: Adalimumab
anti-TNF alpha agent
| approved for use in RA and ankylosing spondylitis
46
Drug: Rituximab
CD20+ mAb against B cells
| - treats moderate to severa RA refractory to standard anti-TNFs
47
Drug: Denosumab
(Prolia)
- RANKL mAb, mimics Osteoprotegrin
- treats osteoporosis
also called Xgeva, for treatment of metastatic disease
48
Drug: Tofacitinib
oral Janus Kinase inhibitor
| - treats RA refractory to standard anti-TNFs
49
Drug: Imatinib
tyrosine kinase inhibitor treating Philadelphia chromosome + CML
50
greatest risk to the medial femoral circumflex artery during surgical hip dislocation is:
during anteroinferior capsular release
51
by what age does physiologic lower extremity bowing resolve?
36 months
52
secondary blood supply to the femoral head is largely via:
the inferior gluteal nerve, which anastomoses with the medial femoral circumflex artery
53
what material in orthopaedis has the highest modulus of elasticity?
```
ceramic
followed by:
- CoCr
- Stainless
- Titanium
- Cortical Bone
```
54
most common cause of compression of the SPN?
a fascial band 12cm proximal to the medial malleolus
55
the true anterior approach to the ankle is between:
EHL and EDL
56
embolize these two highly vascularized cancer mets:
renal cell and Thyroid
57
what is treatment of giant cell tumor of bone?
extensive curettage, adjuvant therapy (argon beam), and bone grafting/cementation
58
the biologic response to polyethylene particulate wear is dependent upon:
the number of particles
59
radiographic measurements for atlas fractures:
lateral mass displacement (7mm is critical)
ADI (>5mm means rupture of all ligaments)
60
major cause of neuromonitoring findings during anterior cervical surgery?
progressive brachial plexopathy due to taping down the shoulders for exposure
61
rate of missed femoral neck fractures in the setting of femoral shaft fracture?
10% -- this includes after looking at a CT of the hip
- always check intraop
- some of these displace late
(Tornetta's study)
62
Synovial changes in RA:
- increased cellular density in the intimal lining
- decreased apoptosis of the intimal lining
- increased angiogenesis
- increased inflammatory cell infiltration forming lymphoid follicles
63
interval for posterior approach to the shoulder?
teres minor and infraspinatus
64
AS vs DISH: post-trauma M&M for spine?
AS patients have higher risk of neurologic injury and complications.
no evidence of difference in mortality
65
complication following thermal capsulorrhaphy of the shoulder?
chondrolysis
66
blood flow to the palmar arches:
deep palmar arch = ulnar
| superficial palmar arch = radial
67
considerations in pediatric halo traction placement:
place 8-10 pins
| 1-5 in-lb of insertional torque
68
the downside of placing femoral tunnel at 12 o'clock is:
positive pivot shift and lower lysholm scores
69
why is definitive c-spine clearance important?
prolonged collar immobilizatin puts patient at risk for decubitus ulcers. risk increases with:
- ICU admission
- mechanical ventilation
- need for cervical MRI
- prolonged time to c-spine clearance and brace removal
70
anterior tarsal tunnel syndrome
compression of the DPN beneath the EHL and EDL
71
fracture characteristics that are protective factors against AVN of proximal humerus fractures
- medial calcar length >8mm
- integrity of the medial hinge
- basic fracture patterns
72
treatment of type I odontoid fracture:
non-op
| semi-rigid cervical orthosis
73
treatment of type II odontoid fracture:
controversial
- non-op in rigid cervical orthosis
- halo
- posterior cervical fusion
- anterior odontoid screw
- ---the odontoid screw shows lowest rates of nonunion and malunion
74
risk factors for nonunion in type II odontoid fractures
- age >50
- displacement >6mm
- angulation >10 deg
- smoking history
75
for treatment of PJI, what is optimal bone cement/abx composition?
40g cement
1g vanco
3.6g tobra
this optimizes the elution of both antibiotics
- commercially available abx bone cement does not have high enough concentration to treat infection, it is for ppx only
76
external landmarks for cervical spine:
```
C1-2 = angle of mandible
C4 = upper thyroid cartilage
C5 = lower thyroid cartilage
C6 = cricoid cartilage
```
77
cat scratch disease key words:
- bartonella henselae
- granulomatous infection
- cervical and epitrochlear nodes
- cat exposure
78
risk of rupture of BTB auto vs allo:
in young athletes, 4x risk of rupture in allo compared with auto
- may be related to graft processing technique
79
indication for resection of an isolated talocalcaneal coalition:
<50% of the subtalar joint involved
| no hindfoot deformity
80
essential strain values for fracture healing:
```
<2% = primary healing
2-10% = secondary healing
```
81
benefits of Low Intensity Pulsed Ultrasound treatment:
LIPUS at 30mW will decrease time to union for:
- radial shaft
- distal radius
- scaphoid
- tibial shafts treated in casts
82
how does capacitative coupling (bone stimulators) improve bone healing
by activating voltage-gated calcium channels and upregulating the fracture repair process
83
pathoanatomy of the floating toe deformity
weil osteotomy pushes the intrinsics proximal and dorsal to the axis of rotation of the DIP joint, causing persistent DIP Extension
84
forearm axis of rotation is:
from radial head to the ulnar head (fovea)
85
treatment of partial flexor tendon lacerations (<60% tendon width)
laceration debridement and early range of motion
86
dural ectasia is seen in:
- Marfan's
- NF1
- Ehler's Danlos
- AS
87
in osteosarcoma, what has worse prognosis? bone or pulmonary mets?
bone mets
| <10% 5-year survival rate
88
two components to hypothenar hammer syndrome:
- thrombosis
- aneurysm
if just thrombosis, treat conservatively (thrombolysis). if aneurysm, need resection + graft vs repair
89
3 types of bunionettes
I: enlarged 5th MT head
II: congenital bow of the 5th MT, normal 4-5 IMA (distal MT osteotomy)
III: increased 4-5 IMA (most common) - diaphyseal osteotomy
90
lysosomal enzymes of osteoclasts which resorb bone:
- cathepsin K
- MMPs
- carbonic anhydrase
91
Risk factors for osteonecrosis:
- trauma (15-50% of fem neck)
- corticosteroids
- ETOH abuse
- coagulation disorders (protein C/S deficiency)
- hemoglobinopathies (sickle cell)
- dysbaric phenomena (Caisson's)
- autoimmune disease (lupus)
- lysosomal storage disease
- smoking
- hyperlipidemia
92
T1 MRI findings of femoral head AVN:
single-density line delineating the necrotic-viable bone interface
93
DDX for hip AVN should include:
transient osteoporosis of the hip
- pregnant women and older men
- severe hip pain
- antalgic gait
- MRI with bone marrow edema in the femoral neck and metaphysis
- self-limiting condition
94
Modified Kerboul Method for Hip AVN:
evaluates extent of AVN by sagittal and midcoronal cuts of MRI
- combined angle of the necrotic area
- combined necrotic angle <190 - no collapse
- >240 had 100% collapse rate
95
What is the fate of asymptomatic hips with AVN?
Hernigou et. al. showed 88% became symptomatic and 73% collapse by 10 years after presentation
the remaining studies demonstrate near universal gradual progression without treatment
96
Utility of Alendronate for Osteonecrosis of femoral head
two randomized trials showed different results... so the jury is out
97
vascularized medial femoral condyle bone graft for scaphoid nonunion utilizes what pedicle?
superomedial geniculate artery pedicle
98
type II collagen disorders manifest as:
epiphyseal dysplasias
99
main inflammatory mediator of nerve root pain with an HNP
TNF-alpha
100
adamantinoma histology is:
biphasic apttern of spindle cells and glandular tissue
101
physical examination findings of saggital band ruptures
can't actively extend the MCP joint, but when passively extended, the extension can be actively held
this is because the EDC tendon will subluxate out with the mCP in flexion and is dysfunctional
102
blood supply to scaphoid
dorsal carpal branch of radial artery (80%)
branch of volar radial artery (distal 20%)
103
SNAC Wrist Classification
1: arthrosis of the radioscaphoid articulation
2: +scaphocapitate arthrosis
3. +periscaphoid arthrosis (involving lunate)
104
Treatment for Stage II and III SNAC Wrist
PRC (can't do if capitate head is arthritic) or scaphoidectomy and 4 corner fusion
105
SLAC wrist classification
1: radial styloid beaking
2: radioscaphoid arthrosis
3: capitolunate arthrosis with proximal migration of capitate
106
Treatment for stage 1 SLAC:
radial styloidectomy and scaphoid stabilization
107
Treatment for stage 2 SLAC:
PRC (can't if there is capitate arthrosis)
| scaphoid excision and 4 corner fusion
108
treatment for stage 3 SLAC:
scaphoid excision and 4 corner fusion
wrist fusion
109
most important risk factor for redisplacement of distalr adius fractures in children:
initial degree of translational displacement is the greatest risk factor
110
treatment of clear cell chondrosarcoma:
wide resection alone
111
Schwannoma pathology
alternating antoni patterns
Antoni A = dense spindle cells
Antoni B = loose cellular + myxoid stroma
112
pathoanatomy of a crossover 2nd toe
- first, attenuation of the lateral collateral ligament
- second, plantar plate rupture
- manifests with dorsal elevation and medial deviation of the proximal phalanx
113
principles of delayed reconstruction of pelvic ring injuries
requires anterior reduction and fixation, followed by posterior fixation with iliosacral screws
114
Brown Sequard Syndrome
cord injury with ipsilateral motor loss
| contralateral pain and temperature sensory loss
115
what is the mechanism of formation of a metal-on-metal arthroplasty Pseudotumor
prosthesis edge loading and loss of fluid film lubrication
116
familial d resistant rickets
x linked inheritance
| characterized by NORMAL 1,25 vitamin D
117
name the volar extrinsic ligaments from radial to ulnar
- radiocaphocapitate
- long radiolunate
- short radiolunate
118
patient older than 65 years with complex distal humerus fracture benefits from:
total elbow arthroplasty
119
cause of retrograde ejaculation after ALIF
inflammation or injury to the superior hypogastric plexus near the aortic bifurcation
120
What is Bassett's ligament?
a fascicle of the AITFL which can cause talar impingement
| - can be resected for pain improvement and does not destabilize the syndesmosis
121
most common site of scaphoid fractures in children
distal 1/3
| - the distal pole ossifies first making it higher risk
122
what structure must be released in order to perform a volar plate arthroplasty?
collateral ligament
123
order of releases to address PIP flexion contracture:
- appropriate pulley takedown and tendon retraction
- check rein ligaments
- accessory collateral ligaments
- volar plate
- proper collateral ligaments
124
Cierny-Mader classification of osteomyelitis
Stages
1: confined to medullary cavity
2: only cortical bone
3: infection of cortical and medullary bone
4: involves entire thickness of bone with loss of bone stability
modifier
A: no systemic or local immune compromise
B: one or more immune compromising factor
C: severely immunocompromised
125
bundles of the PCL
anteromedial and posterolateral
126
Normal IMA should be:
<13 degrees
127
moderate to severe HVA angle is:
HVA 26-40
128
congruent DMMA is:
<15
129
absolute contraindication to TTC fusion is:
severe peripheral vascular disease
130
what structure lies directly anterior to your C1 lateral mass screws:
internal carotid artery
131
does laterality of approach affect the risk of recurrent laryngeal nerve injury during ACDF?
no
132
role of the triangular ligament
dorsal on the middle phalanx, distal to central slip
- keeps the lateral bands dorsal
- if attenuated, the lateral bands move volar and cause a swan neck deformity
133
Anakinra
anti- IL-1
134
for bone, as strain rate increases, what happens to elastic modulus and ultimate strength:
they both increase due to the viscoelastic properties of bone
135
what is isotropic vs anisotropic
isotropic - mechanical properties are the same regardless of orientation of applied loads
anisotropic - properties depend on the directionality and property of applied loads
136
what MRI finding most concistently corresponds to a copmlete spinal cord injury?
6mm hematoma within the spinal cord
137
how do you differentiate between a femoral neuropathy and a lumbar radiculopathy (L2-4)?
test adduction (obturator nerve function)
138
second impact syndrome is:
a 2nd head injury prior to the resolution of the 1st head injury. can lead to sudden death. preventable by stopping return to play
139
course of the lateral femoral cutaneous nerve:
L2-3 dorsal roots
pierces the psoas, courses along its lateral border
runs along the surface of iliacus
exits pelvis beneath the inguinal ligament
pierces the fascia lata
140
what is most common vessel injured during lumbar spine surgery
common iliac artery
141
what hip scope portal puts the LFCN at greatest risk?
anterior portal
142
middle or ring finger metacarpal amputations necessitate:
gap closure
- index or small finger centralization
- transvere intermetacarpal ligament reconstruction
143
indication to use vascularized bone graft in scaphoid nonunion?
evidence of proximal pole AVN
| - if not, then use standard bone graft
144
msot common foot bone injured in children under 5 years
1st metatarsal
145
characteristic of a juvenile bunion?
metatarsus primus varus
146
how does sunshine help vitamin d?
allows skin 7-dehydrocholesterol to convert to cholecalciferol!
147
how do you treat ABC?
wide resection.
| recurrence 5-50% and associated with young age,
148
Pedicle for the radial forearm free flap is:
radial artery
- bifurcates from the braachial artery
- exits between the muscle bellies of the FCR and BR
149
12:22 translocation
clear cell sarcoma
150
2:13 translocation
alveolar rhabdomyosarcoma
151
12;16 translocation
myxoid liposarcoma
152
most common nerve injured in distal bicep tendon repairs:
LABCN
153
radiographic features of a NOF:
lower extremity, metaphyseal
- lytic,
- eccentric
- well marginated
- expansile of cortex
no intralesional calcification
154
most common bacterium in dog/cat bites
pasteurella
155
what is rib phase
in infantile scoliosis, the convex rib head position with respect to the apical vertebrae
- phase 1: no overlap
- phase 2: rib overlap with apical vertebrae - high risk for progression of curve in phase 2
156
what is the best HO ppx radiation protocol for THA?
preop 600-800 centigrey within 24 hours of surgery preop or 72 hours post-op
157
most common location of thoracic disc herniations?
lower thoracic spine
| - perhaps due to specific mechanics of the thoracolumbar junction
158
MRI underestimates TT-TG by how much
4mm
159
Caton Deschamps
Normal is 0.6-1.2
| ratio of the length of the patellar tendon/length of patellar articular surface
160
Maximum length that can be bridged by a nerve conduit
3mm
161
Pycnodysostosis
lysosomal storage disease from Cathepsin K mutation
short stubby fingers
late tooth formation
dense bones (osteopetrosis)
162
following peripheral nerve injury, recovery occurs first in:
sympathetic activity
163
clonazepam (benzodiazepine) side effect:
osteoporosis
164
sclerostin:
inhibits bone formation
| - will decrease as you supplement vitamin D and build bone
165
compared to fresh frozen, freeze dried allograft has what structural property:
decreased strength to torsion and bending
166
the osteoconductive effect of ceramic void filler is dependent upon:
porosity - bigger pores have better osteoconductivity
167
aspirin affects coagulation by:
blocking thromboxane a2
168
what is the dominant contributing factor to intervertebral disk degeneartion
genetics
the Twin Spine Study demonstrated genetic predisoposition probably is a greater contributor than work related or physical activity related load application to the lumbar spine. even smoking had only a modest effect on increasing the risk of degeneration among discordant twins
169
mechanism of action of fondaparinux:
indirect factor X inhibition
170
mechanism of action of apixaban, rivaroxaban
direct factor X inhibition
171
which nuclear transcription factor is most important in tendon formation?
scleraxis
172
this biomaterial has the highest rate of bacterial adherence
titanium alloy
173
in an irreducible metacarpal dislocation, what is the most likely superimposed structure blocking reduction?
the volar plate
174
what is the bone graft of choice for scaphoid waist nonunions with distal pole AVN and carpal collapse?
vascularized medial femoral condyle autograft
175
what is the incidence of EPL rupture following non-op distal radius fractures?
5%
| most occur ~6 weeks after injury
176
Froment's sign tests:
adductor pollicis
| - weakness means ulnar neuropathy
177
what is pronator syndrome
median nerve entrapment in the:
- ligament of struthers
- Pronator teres heads
- FDS arch
- bicipital aponeurosis (lacertus fibrosus)
presents like CTS but with no provocative signs of median neuropathy at the wrist
pure sensory neuropathy
178
etiology of AIN syndrome:
transient neuritis
vague forearm pain and dysfunction of the FPL
- improves with benign neglect
179
nuances of deQuervain's decompression
- incision on dorsal aspect of the tendons to prevent subluxation
- decompress the EPB sub-sheath to prevent recurrence
180
thompson approach to the radius
dorsal
- proximal = EDC and ECRB
- distal = ECRB and EPL
181
RUNX2 induces:
osteogenic differentiation
182
SOX9 induces:
chondrogenic differentiation
183
wnt-beta catenin induces:
osteogenic differentiation
