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Flashcards in JAAOS lists Deck (155)
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1

When can bisphosphonates be considered? (6)

1. Vertebral compression fracture with Osteoporosis

2. Fragility fracture with osteoporosis

3. Pagets

4. MM

5. OI

6. AVN

7. metastic disease (reduces skeletal events)

2

What are contributing factors to squeaking seen not only in COC but also MOM? (5)

1. component malposition

2. edge loading

3. impingement

4. third-body particles

5. loss of lubrication

3

How does improper acetabular component orientation affect outcome of THA? (8)

1. Increases dislocation rates

2. component impingement

3. Increased bearing surface wear

4. Increased number of revision surgeries

5. Leg length discrepancy increases

6. Alteration of hip biomechanics

7. Increased pelvic osteolysis

8. Increased risk of acetabular component migration

4

What are the 5 moderate strength recommendations concerning distal radius fractures?

  • Recommendations for surgical treatment
    • Dorsal angulation >10 degrees
    • shortening >3mm
    • step off >2mm
  • use a real cast for non op
  • give vitamin c.

5

Fracture displacement in calcanei fractures typically results in these findings which can be problematic if malunion occurs. (5)

Loss of hindfoot height

Varus heel position,

Widening of the hindfoot

Possible subfibular impingement

Irritation of the peroneal tendon and/or sural nerve

6

What is the sole strong recommendation concerning vertebral osteoporotic compression fracture?

Don't do a vertebroplasty.

7

4 complications of lateral humeral condyle fracture

1. Cubitus valgus

2. Tardy ulnar palsy

3. Fishtail (due to osteonecrosis)

4. Cubitus varus

8

Who wants to know the 4 moderate grade recommendations concerning RTC?

1. NSAIDS and physio for incomplete tears

2. No routine acromioplasty

3. Don't use xenograft patches

4. Workers comp will do worse

9

What are the "most recognized" complications of TEA? (6)

1. implant loosening

2. periprosthetic fracture

3. implant failure

4. infection

5. triceps insufficiency

6. nerve palsy

10

List 8 complications of rTSA

1. neurologic injury

2. periprosthetic fracture

3. hematoma

4. infection

5. scapular notching

6. dislocation

7. mechanical baseplate failure

8. acromial fracture

11

List three distinct pathological types of knee osteonecrosis.

1. secondary ON

2. spontaneous ON of the knee

3. postarthroscopic ON

12

4 indications for an HTO of in a varus knee

1. varus alignment of the knee associated with medial compartment arthrosis

2. knee instability

3. medial compartment overload following meniscectomy 

4. osteochondral defects requiring resurfacing procedures

13

Concerning healed in situ pinning of SCFE, a proportion of these patients progress to symptomatic femoral acetabular impingement. List 3 surgical treatment options.

1. arthroscopic femoral neck osteochondroplasty

2. a limited anterior hip approach or surgical hip dislocation

3. flexion intertrochanteric osteotomy

14

Concerning arthroscopic release of arthrofibrosis of the knee what four areas do you want to address?

1. the anterior interval

2. posterior capsule

3. peripatellar

4. suprapatellar regions

15

List contraindications to TAR (7)

uncorrectable deformity

severe osteoporosis

talus osteonecrosis

charcot joint

ankle instability obesity

young laborers increase the risk of failure and revision

16

List factors contributing to chronic ankle instability

Mechanical Pathologic laxity

Arthrokinetic restriction

Synovial changes

Degenerative changes

Functional Impaired

proprioception Impaired

neuromuscular control Impaired

postural control

Strength deficits

17

List 5 risk factors for progression of sponylolisthesis (5)

>50% slip

>50 deg slip angle

dysplastic

young age

female

18

Risk factors of pseudoarthrosis of sponylolisthesis (6)

Sacral slope > 45 deg

Hypermobile

L5/S1 Decompression

Sacral dysplasia

Spina bifida

Secondary changes of S1 from slip

19

Risk factors for child abuse (8)

low income

unemployed

single parent homes

abuse of parents

drug abuse

recent job loss of parent

children with disabilities (cerebral palsy, premature)

step children

20

Poor prognostic factors with Ewings

Location - spine and pelvic tumors (distal tumors have a better prognosis)

Size - tumors greater than 100cm3 or >8cm

Age >14 yo

Male

LDH >200IU

CRP/WBC elevation may be associted with mets and higher tumor burden

< 95% necrosis with chemotherapy

p53 mutation in addition to t(11:22) translocation

Relapse at < 2years

21

Complications of radiotherapy in a young person (5)

fragility fractures

limb length discrepancy

joint contracture

muscle atrophy

pathological fractures secondary malignancy (sarcoma, usually at 10 years, 20% will develop by 20 years)

22

Indications for immediate surgical fixation SCH# (8)

Open fracture

Dysvascular limb

Skin puckering

Floating elbow

Median nerve palsy

Evolving compartment syndrome

Young age

Cognitive disability

23

Surgical indications for disci tis (6)

◦ abcess ◦ neurologic deficits (for any reason) ◦ progressive deformity ◦ gross spinal instability ◦ persistent infection despite antibiotic (BW still elevated)

24

Indications for medical treatment of a spinal epidural abcess

◦ no neurologic deficits ◦ small abscess ◦ patient capable of close clinical follow-up ◦ those who are not candidates for surgery due to medical comorbidities

25

Contraindications for limb salvage procedure (7)

◦ Major neurovascular structures encased by tumor when vascular bypass is not feasible ◦ Pathologic fracture with hematoma violating compartment boundary ◦ Inappropriately performed biopsy or biopsy-site complications ◦ Severe infection in the surgical field ◦ Immature skeletal age with predicted leg-length discrepancy >8 cm ◦ Extensive muscle or soft-tissue involvement ◦ Poor response to preoperative chemotherapy

26

Indication to get c-spine imaging for a RA patient (5)

◦ Cervical symptoms > 6 months ◦ neurological signs ◦ procedure and no imaging 2 years ◦ rapid deterioration in function ◦ rapid deterioration of carpal and tarsal bones

27

Indications for surgical fixation of an RA spine (8)

◦ progressive neurological deficit ◦ pain refractory to medication ◦ radiographic risk factors for neurological injury ◦ PADI < 14mm with AAI ◦ odontoid migration > 5mm above magregor's line ◦ Canal diameter < 14mm in SAS ◦ AAI or cord stenosis ◦ cervicomedullary angle 135

28

Radiographic features of enchondroma vs low grade chondrosarcoma on plain radiographs (8)

◦ Low grade features Dense calcifications with rings and spiclues Uniform calcification Eccentric, lobular growth of soft tissue ◦ High grade features Faint, amorphous calcification Large noncalcified areas Lysis within a previously calcified area Concentric growth of soft tissue mass

29

Clinical and radiographic features of MHE conversion to chondrosarcoma (4)

◦ acute onset of pain ◦ Adults with growing osteosarcoma ◦ Average age is 31 ◦ Cartilage cap > 2cm

30

Indications for fusion of first MTP in hallux valgus

Gout Rheumatoid arthritis Down's syndrome cerebral palsy Severe DJD Ehler-Danlos Resection arthroplasty