Mixed Flashcards
(1925 cards)
1
Q
which is associated with increased liklihood of stress shielding in cementless THA
A
distally fitted stems
2
Q
what neurotinazation/nerve transfer is used for elbow function
A
oberlin- ulnar nerve to biceps
3
Q
what is the judet approach to the scapular
A
infraspinatus (suprascapular nerve)
teres minor (axillary nerve)
4
Q
what is bunnells test
A
differentiates intrinsic tightness and extrinsic tightness
- positive test when PIP flexion is less with MCP extension than with MCP flexion
5
Q
what makes up the comma sign in a RTC tear
A
SGHL and CHL
6
Q
what is the mechanism of injury for a Tillaux fracture
Triplane fx?
A
EXT rotation and supination
triplane fx = younger patient
7
Q
what are the components of the SCAT 5 sideline concussion test
A
- memory recall
- orientation
- concentration (repeating 5 #s backwards)
8
Q
what is the energy expenditure increase for a syme amp
A
15%
9
Q
what is the treatment for a tarsal navicular stress fracture
A
NWB cast immobilization, NOT surgery
10
Q
when do you use an ANOVA test
A
3 or more groups with parametric data
11
Q
in scurvy, what zone of the physis is widened?
what zone is affected?
A
widened= prov calcification
affected- spongiosa
12
Q
in hip fusion, how much increase in energy expenditure is necessary
A
30%
13
Q
what is the mechanism for peroneal tendon injury/SPR injury?
A
DORSIflexion and INVERSION
14
Q
what is the malignant transformation rate of osteochondroma in solary lesions vs MHE
A
1% vs 5-10%
15
Q
what is the complication associated with percutanous plating of distal femoral fractures
A
rotational malalignment
16
Q
at what stages can you perform core decompression in hip AVN
A
stages 0, 1, and 2
NO collapse
17
Q
what are the operative indications for a thumb UCL injury
A
- > 20 degrees varus/valgus laxity
- > 35 degrees opening
- stenar lesions
18
Q
what are 4 lab values to distinguish MSSA osteo from MRSA osteo?
A
- temperature > 38.0 C,
- white blood-cell count > 12000 cells/µL,
- hematocrit < 34%,
- C-reactive protein > 13 mg/L
19
Q
how is the posterior condylar axis rotated in reference to the transepicondylar axis?
A
- 3 degrees INTERNALLY rotated
- i.e. the lateral condyle is more anterior
20
Q
should you perform routine arthrocentesis in hemophilia patients?
A
NO
21
Q
which lysosomal storage disease is associated with odontoid hypoplasia?
A
22
Q
who is more likely to get H.O. post TKA
A
men, obese, prior trauma, hypertrophic arthritis
23
Q
what position of the anke when casting it leads to the lowest compartment pressures of the leg
A
0-37 degrees of plantarflexion
24
Q
how do you treat claw toes with flexibile deformity
A
tendon transfers
25
what type of cartilage results from microfracture surgery in OCD of the femur?
- fibrocartilage
26
how does a golf club deformity occur in distal femoral plating?
placing the plate too posterior
27
for PIP osteoarthritis, when do you do a fusion vs a silicone arthroplasty
must have good bone stock and ligaments for arthroplasty
28
what is the genetic mutation in Ehlers danlos sydrome and what is affected
COL5A1 or 2
type 5 collagen
29
how long after a humeral shaft fracture, if there is no evidence of callous, is a non union considered likely?
6 weeks
30
which has higher complication rates, IMN or plating for humeral shaft fractures
IMN
31
what is the complication associated with posterior gap instability in a posterior stabilized knee
posterior knee dislocation
32
what type of bisphosphonate is used in fractures in cerebral palsy
IV pamidronate
used when \>3 fractures or -2.0 Z score
33
what is the best view to determine anterior acetabular coverage in the dysplastic hip?
false profile view
34
what causes midflexion instability in TKA
joint line modification
35
why do patients have an apparent feeling of a longer leg post THA
ABDUCTOR weakness
36
which type of lymphocytes are seen in MoM pseudotumors?
both B and T lymphocytes
37
which inserts more proximal on the radial tuberosity; the long or the short head of the biceps
the long head, the short head inserts more distally
38
what type of acetabular osteotomy is best in hip dysplasia if the hip is NOT concentrically reduced?
Chiari or shelf
39
which ligaments resist internal rotation with the knee extended?
POL \> ACL
40
compared to AIS, what types of complications are more common in surgery for Marfans scoliosis
- fixation failure for a variety of reasons
- pseudo
- infection
- dural tear
41
how many grades of strength will be lost in a tendon transfer
1
42
gracilius flap
- med femoral circumflex artery
- ant division of obdurator nerve
43
contraindications to varus tibial osteotomy
- inflammatory arthritis
- obesity
- flexion contracture \> 15 degrees
- unable to flex past 90 degrees
- correction of 12-20 needed
- PF arthritis
- ligament instability
44
what is treatment for crossover toe
weil distal oblique shortening osteotomy w/ plantar plate repair
and flexor to extensor transfer
45
what is the most reliable predictor of being able to walk in cerebral palsy
able to sit by 2 y/o
46
describe the 2 blood supplies to the scaphoid
primary (prox 80%) = dorsal carpal branch of radial artery
secondary (distal 20%) = superficial palmar arch
47
which collagen is involved in trigger finger
Type 3
48
how do you treat AVN of femoral head in sickle cell
- partial weight bearing to start
- THA if failed non op
49
where is the spur sign best seen on and what does it indicate
obdurator oblique,
both column
50
when do you give tetanus immunoglobilin
only in dirty wounds with no known vaccine history or if vaccine was not given or incomplete
51
What is responsible for the tensile strength of bone?
compressive stregth?
tensile = collagen
compressive= proteoglycans
52
which is the imaging modality of choice following post reduction of hip dislocations in pediatrics
MRI
- entrapped labrum and capsule better seen
- osteochondral fragments better seen on CT though
53
how do you treat hip dx/subluxation in SMA?
do nothing, they are usually painless
54
which positions should a patient avoid after an anterior approach for THA
- bridging, extension, ext rotation, adduction
55
how many days after an open fx can you go before final fixation
- aim for 7 days
56
what is the difference between a Vancouver B1 vs B2 in femoral periprosthetic fxs
B1 = stable implant
57
what additional treatment can you use for plantar fasciitis pain refractory to other modalities
- extra corpal shock wave therapy
58
which vascular structure is usually identified and ligated in a standard deltopec approach
the anterior humeral circumflex artery
59
how long does Kohlers Disease take to resolve
1-3 years
60
what is at risk in the 1U and 1R CMC portals
superficial sensory branch of radial nerve
61
which metals contain nickel and should be avoided in TJA in patient with an allergy
cobalt chrome, stainless steal; NOT in titanium
62
if an osteochondroma causes forearm issues, what is the best treatment
exision
63
what is the approach for the lateral approach to the hip?
what is a common complication?
vastus lateralus and glut med
- Het. ossification
64
how soon should you reduce a hip dx before increased risk of AVN
6 hours
65
what leads to mid flexion instability in TKA
anterior or proximal placement of femoral component
66
what is the treatment for MCP hyperextension with thumb basilar arthritis
- \< 10 degrees= nothing
- 10-20 = pinning and tendon transfer
- 20-40= volar capsulodesis
- \>50 = fusion
67
what is mortons foot
when the 2nd MT is long relative to the 1st MT
68
what is one way to differentiate between cubital tunnel vs ulnar tunnel compression?
- dorsal sensation; only lost in cubital tunnel due to dorsal ulnar cutaneous nerve branching off prior to ulnar tunnel
69
what percentage of peroneal nerve palsies after TKA resolve over time?
50%
risk factors: flexion, valgus, epidurals, tourniquet time \> 120 mins
70
what is the correct insole/shoe bottom type for ankle arthritis
rocker bottom soled shoe
71
the achondroplasia, what is the natural course of TL kyposis?
spontaneous resolution by 12-18 months
72
what structures exit the greater sciatic notch
- piriformis
- sup glut art/nerve
- pudendal nerve/art/vein
- nerve to obdurater internus
- post cut nerve of thigh
- nerve to quadratus femoris
- sciatic
- inferior glut art/nerve
73
what is the cutoff for acute vs "chronic" sagittal band ruptures
1 week
74
in coronal TKA balancing ,what is the max degrees of correction allowed
\< 20 degrees
75
what is hours of brace wear required to stop 90-93% of curve progression in AIS
12-14 hours
76
in spastic foot deformities, how long should one attempt non op mgmt before performing tendon transfers
6 months
77
describe the two type of lunate injuries
- lunate dislocation
- perilunate dislocation
78
what is the best treatment for fast return to play in hook of hamate fractures?
excision
79
what structures are at risk during post portal placement in shoulder scope and where?
- axillary = too inferior
- suprascapular = too medial
80
describe PM tibial bowing: what is it associated with?
apex is posterior medial; calcaneovalgus foot and LLD, MAY require epiophysiodesis
81
what are two things seen on histo of osteoarthritis
- breakdown of the tidemark
- decrease in chondrocytes
82
anakinra
anti IL-1
83
what is the non-union rate for zone 2 5th MT fractures?
33%
84
how do you decrease scapular notching in rTSA?
place baseplate INFERIOR
85
86
which tendon is used for TA recon?
EHL
87
how is baclofen administered and why?
intrathecal, to avoid cognitive effect
88
what is the starting point for a tibial nail in prox 1/3rd fx
- medial aspect of lateral tibial spine (contain in tibia)
- start more lateral to avoid valgus
89
what is the gene responsible for cleidocranial dysplasia
RUNX2
90
how do you tell the difference between the long radiolunate and short radiolunate ligaments
the long radiolunate is more RADIAL
91
free iliac bone flap
- deep circumflex iliac artery
- metaphyseal
92
what is the approach for a medial epicondyle fracture in peds
brachialis/triceps interval
93
how do corticosteroids function?
function by direct binding to nuclear steroid receptors to interrupt the inflammatory cascade through mRNA changes.
94
what is the optimal pore size to increase biologic fixation
50-400 microns
95
what are 3 indications to cement a femoral stem
1. ) osteoporosis
2. ) irradiated bone
3. ) Dorr C stovepipe femur
96
what does steroids admin within 8 hours of SCI accomplish?
decreased hemmorage only, no difference in cord edema or functional outcome
97
in osteolysis, which cell releases TNF alpha
macrophages
98
how to you treat acetabular protrusio in Marfans patients (that have failed non op mgmt)
- younger--\> valgus osteotomy
- older--\> THA
99
what is first line treatment for an acute plantar fasica rupture
casting 3-6 weeks
100
in macrodactyly, which digit is most common, and what is the most common form of surgical treatment
index
- epiophysiodesis once finger reaches adult length
101
top reason for replant failure and how soon?
thrombosis due to vasospasm; w/in first 12 hours
102
why should you avoid dissection in the posterior aspect of the lateral condyle in pediatric lateral condyle fx fixation?
source of vascularization
103
at the level of the calc, which is higher, the PB or PL?
PB
104
what is the range of femoral head size that won't affect wear?
22-46 mm
105
what zone does type X cartilage grow in?
zone of hypertrophy
106
what inherited condition has a strong association with extra abdominal desmoid tumors?
Familial adenomatous polyposis
107
what is the #1 contraindication to regional nerve blocks for shoulder surgery?
lung disease
108
compared to THA, how does MOM resurfacing compare in complications
increase in: op time, exposure, revisions, loosening, fracture
wear rates are EQUAL
109
what are the muscles innervated by AIN?
- FPL
- FDP to index and middle
- pronator quadratus
110
what is hysteresis
when the loading curve does not match the unloading curve,
the difference between the two is the energy dissapated
111
what structures are at risk from anterior pins when pinning a proximal humerus fracture
biceps tendon, mctn, cephalic vein
112
what is the correct positioning for ankle arthrodesis
plantigrade, 10 degrees external rotation, 5 degrees valgus, post. positioning of talus on tibial plafond
113
how do you determine flexor tendon repair requires 2 stages with a hunter rod?
- pass a catheter to see if pully is in tact and/or not scarred down
114
how do you treat recurrent clubfoot?
recasting, but if over 2, recast then tendon transfers (TA and TAL)
115
what is the treatment for Apert Syndrome
1. ) relase of border digits at 1 year old
2. ) Release of middle digits at 1.5 years
116
when do you fix periprosthetic greater troch fractures
displacment \> 2 cm
117
which metal is highly susceptible to fretting and pitting?
stainless steel
118
treatment algorithm in acetabular bone loss during revision THA
- rim remaining (2/3rds is cutoff)
cage vs cup
- bone loss (50% is cutoff)
cup with augments or not
- pelvic discontinuity
triflange cup vs cage cup construct (depends on bone loss)
119
for lawn/farm injuries, why is penicillin added?
to cover clostridium
120
following a muscle injury, which creates more scar tissue; immobilization or motion?
- motion
immobilization leads to less scar tissue
121
what are the most common sites of compression in cubital tunnel syndrome
- 2 heads of the FCU
- osbornes ligament
- arcade of struthers
122
when comparing retrograde nails vs locking plates for periprosthetic fx of TKA, what is true regarding unions?
equal non union rate; but decreased malunion with plate
123
which collagens are most associated in Phase 1 and 2 respectively in tendon/ligament healing?
phase 1 = type 3
phase 2= type 1 collagen
124
what is the cutoff for doing a wafer procedure vs an ulnar shortening osteotomy with chronic TFCC tears
2 mm
125
how do you perform a triceps reflecting approach
- take all off, repair with transosseus tunnels, immobilize 4-6 weeks
126
when do you perform a supramalleolar osteotomy for ankle OA
- young patient with normal ROM and medial OA
127
which associated tab fx may need a combined approach
t shaped
128
what are the contents of the PLC?
static- LCL, popliteus, popfib ligament, lat capsule dynamic- biceps femoris, pop muscle, IT band, lat head of gastroc
129
following TKA, when there is patellar maltracking, what is the best imaging modality to assess rotational profile?
CT scan
130
in obstetric brachial plexopathies, what is the treatment for recalcitrant post ganglionic injuries vs pre-ganglionic injuries
post= nerve grafting
pre= nerve transfer or neurotization
131
what is first line treatment for RA?
Second line?
Third line?
1st- corticosteroids
2nd- DMARDs
3rd- antibodies
132
what digit is affected in camptodactyly and what causes it?
PIP small finger flexion contracture; aberrant FDS insertion or aberrant lumbrical insertion
133
what is NF2 associated with?
bilateral vesibular schwannomas
134
what artery is injured in an ACL tear leading to hemarthrosis
middle geniculate artery
135
what does a 25 modifier mean?
seperate and unrelated eval on the day of surgery
136
what is the most common bacteria in fight bite infections?
polymicrobial
137
what causes increased force in the scaphoid fossa, wrist flexion or extension
wrist extension; hence why scaphoid fractures occur with wrist extended
138
in the wrist ,which ligaments are stronger, volar or dorsal?
volar
139
which primary tumors are most likely to cause mets that end up in distal extremities?
lung and renal
140
what is the kaplan approach to the elbow
medial
- EDC (PIN) and ECRB (radial)
- PIN at risk
141
which approach for THA is associated with the lowest dislocation rate?
direct later/hardinge
142
what is the approach to an ulnar shaft fracture
FCU and anconeus
143
which part of the scapholunate ligament is strongest
dorsal- prevents translation
144
how does PTH work in relation to osteoblast and osteoclasts?
PTH binds to osteoblasts releasing IL-1 which activates OSTEOCLASTS
145
what is the correct position to avoid positional hypotension in a pregnant trauma patient
left lateral decubitus: IVC is oriented more on the right side in the abdomen
146
what is the hallmark for inflammatory midfoot arthritis
symmetric joint arthritis
147
what is the workup for hypothenar hand syndrome?
what is mandatory for diagnosis?
1. ) doppler
2. ) distal brachial index
3. ) Angiography (MANDATORY)
148
what is the proper way to treat claw toes from CMT disease?
jones procedure- transfer of ET to metatarsal neck and fusion of toes
149
after it pierces the lateral intermuscular septum, what does the radial nerve run between
the brachialis and brachioradialis
150
what nerve is at risk in the lateral approach to calc ORIF
sural nerve
151
what is the abx for:
- farm injury
- fresh water
- salt water
- high dose penicillin
- flouro
- flouro plus doxy
152
what amount of shortening is acceptable following closed reduction of pediatric tibial shaft fractures?\>
less than 1 cm
153
what is the main goal of the modified Ertl in bka
enhanced prosthetic bearing
154
what is the absolute indication for operative tx for a mallet finger
unstable volar subluxation
155
which sesamoid of the toe is most commonly injured
the tibial sesamoid
156
what is at risk in the 1-2 wrist portal
- superficial branch of radial nerve
- radial artery
157
how soon after TTC does a diabetic foot ulcer generally recur?
1 month
158
what type of cells are involved in metal on metal wear?
lymophocytes
159
what is the hallmark for ewings sarcoma in a histiologic stain?
CD99 + (or MIC2)
160
Describe the different dermatomes and innervation of the anterior vs posterior axillary nerve
anterior- ant 1/3 of skin posterior- post 2/3rd of skin, teres minor
161
what is the tolerance for shortening in all MC shaft fractures
2-5mm
162
which joint is involved in stage 2 SLAC wrist?
- tx
scaphoid and scaphoid facet of radius
- PRC vs 4 corner fusion
163
When deciding on different methods of Type II Odontoid fixation, what is important to look for?
abnormal vertebral arteries
164
what is the criteria for operating in flexor tendon laceraton
\>75% cut = repair with core suture
\> 50-60 with catching = repair with epitendinous only
\<60%- non op
165
what is this histo of?
renal cell carcinoma
166
what are the walls/roof/floor of cubital tunnel
roof = FCU fasica and osbrones ligament
floor= post/transverse bands of MCL and joint capsule
walls= medial epicondyle and olecranon
167
what is joggers foot
compression of the MEDIAL plantar nerve, usually by orthotics,
at the knot of henry, where the FHL is above the FDL
168
what area of primitivie origin does sacral choromda calls share?
the notochord
169
when using a groin flap for thenar coverage, what artery provides circulation?
superficial circumflex iliac artery; LFCN at risk
170
what is the intramuscular plane to the anterior approach to the ankle?
EDL and EHL
171
how does MRSA avoid abx?
Drug resistance to this class of antibiotics is achieved via a genetic mutation of mecA encoding an altered penicillin binding protein. The gene product of this mutation, PBPa has a low affinity for these antibiotics and cannot be inhibited by them
172
which muscle transfer is done for medial scapular winging
pec major w/ TFL attached to scapula to replace serratus anterior
173
what is a common complication of ankle arthrodesis
subtalar OA, 50% at 10 years
174
what is the most common site of compression for the AIN?
what are the others?
tendinous edge of the Pronater Teres
- FDS arcade, lacertous fibrosis, accessory head of FPL, accessory muscle of FDS to FDP, abberant muscles, thrombosed artery
175
which approach is better for morton's neuroma excision; dorsal or plantar and why?
plantar, dorsal is associated with incomplete excision of neuroma
176
what is the operative treatment for "chronic" sagittal band ruptures?
- repair if possible
- acute repair if a pro athlete
- if primary repair not possible, then do a tendon centralization or rerouting procedure
177
which exercises should be avoided after PCL recon
resisted hamstring curls
178
Describe the spine findings in Achon
- lumbar stenosis (congenital, LF hypertrophy), narrowed pedicle distance
- Foramen magnum stenosis
- T/L kyphosis
179
in CR and PS knee designs, how does each accomplish femoral rollback?
CR= PCL pulls femur back
PS= cam hits post and pushes femur back
180
what is the treatment for lumbrical plus?
FDP repair vs lumbrical release
181
what are the two different best non op treatments for plantatar fasciitis, and when do you use them?
- acute = stretching and prefab insert
- chronic= night splints
182
what is the collagen composition of tendons?
85% type 1
5% type III
183
what percentage of patients with arthrogryposis are non ambulatory
25%
184
what are common technical errors in TAA
- prosthesis too lateral
- prosthesis too small
- failure to correct alignment deformity
185
Which of the radiographic images is best for detecting anterior acetabular deficiency in the dysplastic hip
false profile
186
what is a predictor for a poor outcome at 3 months post lower extremity reconstruction after a bad injury?
depression
187
which joints have intraarticular bones and can get septic arthritis from osteo spread?
hip, shoulder, elbow, and ankle
- NOT KNEE
188
how does hypotensive epidural anesthesia work?
targets T2 dermatome and below
- blocks cardio accelerator fibers of sympathetic chain
189
what is the tendon that is transferred in surgery for flatfoot or PTT insufficiency
FDL
190
what is the range of motion necessary at the knee for normal gate
0-70
191
what are the strong AAOS recommendations for knee OA
- NSAIDS (not tylenol)
- tramadol
- rehab, wellness
192
what is the treatment for chondrosarcomas (based on grade)
grade I --\> curettage grade I (in pelvis) & grade II/III --\> wide surgical excision mesenchymal chondrosarc --\> wide excision + chemo
193
what does alpha defensin test, test for?
precense of an intra articular antimicrobial peptide
194
what is the crossover sign in the hip indicative of?
- retroverted acetabulum and FAI (pincer type)
195
what are the two things that are needed for a successful syme amputation
patent PT artery
STABLE heel pad, but doens't need to be sensate
196
what are the organic solvents that can lead to amputation in high pressure fingertip injuries?
paint, paint thinner, diesel fuel, jet fuel, oil
197
varus tilt of the ankle on xray is indicative of injury to what
CALCANEOfibular ligament (CFL)
198
besides CRP, what other marker is elevated in peds osteo?
procalcitonin
199
name a disadvantage to PCL retaining knees?
increased poly wear
200
what is the classification for femoral head fractures
1 - nwb
2 - wb
3 - femoral neck
4- acetabular wall
201
what artery is at risk during the volar approach for distal biceps rupture repair?
recurrent radial artery
202
what is Romosozumab?
anti sclerostin antibody; binds sclerostin which normally INHIBITS wnt pathway
- wnt pathway ACTIVATES osteoblasts and builds bones
- so by inhibiting sclerostin, the wnt pathway and ultimate osteoblast activity goes UP
203
in pediatric MRSA ostemyelitis, what age group is at risk for DVT?
\> 8 y/o
204
what is the treatment for ABC?
normal fracture care
or if symptomatic w/out fracture, curettage and adjuvant tx
205
which anticoagulant increases the risk of heparin induced thrombocytopenia (HIT)
heparin
206
when using an exfix for a distal radius fracture, how does one maintain the volar tilt
tightening the ex fix with volar translation of the lunate
207
which finger can handle a one staged tendon operation for a chronic rupture
thumb, FPL
208
what is the cause of dorsal bunions following the treatment of clubfoot
- dorsiflexion of the first MT due to strong TA
209
what does releasing the PCL in tka balancing equate to?
increasing flexion gap
same as excessive post femur resection
210
which muscles do the radial nerve innervate
ECRL, ECRB, and brachioradialis
211
CA125
ovarian cancer
212
when is revsion amp appropriate?
when ronguering down bone does NOT compromise bony suppor to nail bed
- MUST ablate nail matrix
213
what are the doses for adjuvant radiation for soft tissue sarcomas
50 gy preop
66 gy post op
214
what is the treatment for trunnionosis
revision to a ceramic head, titanium sleeve, and poly liner
215
Which pulley is involved in trigger finger
A1
216
what is the minimum porostiy % for optimal biologic fixation
50%
217
which ligament may be a cause in Madelungs deformity
Vickers ligament = radiolunate ligament
218
what is a contraindication for an ulnar shortening osteotomy in ulnar abutment syndrome
- DRUJ instability or degenerative changes
219
Which of the following is considered a disadvantage of knee disarticulation when compared with transfemoral amputation
assymetry of the knee joint
220
in prosethetic osteolysis, what does an increase in VEGF lead to?
increase in RANK and RANK L
221
which is usually found in higher concentration in metal ion wear?
cobalt \> chrome
4-5x more
222
what is the most common tendon ruptured in a rheumatoid wrist
extensor digit quinti
223
when do you operate on plantar fascitis
after 9 months of failed treatment
224
what is the interval for volar approach to the scaphoid
between the FCR and the radial artery
225
name the components of the TFCC
- ECU tendon - dorsal and volar radioulnar ligaments - articular disc - ulnar collateral ligament - meniscus homologue
226
what is postaxial polydactyly?
who it more common in?
extra pinky
- blacks
- IF seen in whites, do genetic screen for Ellis Van Creveld Syndrome
227
when is the surgical treatment for macrodactyly osteotomies and shortening?
when the THUMB or MULTIPILE DIGITS are involved
228
how do you treat an IP joint ulcer in a diabetic with an arthritis MTP joint?
- resect BASE of prox phalanx
aka a Keller arthroplasty
229
what is the best biomarker for rheumatoid arthritis
anti-CCP
- 90-95% specific
230
what is a fascicle
a collection of axons surrunded by endoneurium wrapped in perineurium
231
how do you treat knee flexion contractures \> 30 degrees in arthrogryposis
hamstring release at 6-9 months
232
what is the treatment for kohlers disease
a WALKING cast
233
what determines the deforming forces in a middle phalanx fracture
location of the fracture as compared to the insertion of the FDS
234
70% of THA dislocations happen within what time period
1st month
235
what tumors can be treated with radiation
- ewings
- lymphoma
- hemangioendothelioma
- solitary plastmacytoma
236
he initiating cellular event in development of posttraumatic osteoarthritis is attributed to which of the following
chondrocyte apoptosis
237
what should you perform preop for tarsal coalition resection and why
CT scan, to look for other coalitions
238
when using a rTSA for elderly patients for prox humerus fx, should you use cemented or uncemented implant
cemented implants due to poor bone stock
239
drops of what % in MEPs and SSEPs are concerning
MEPs = \> 50%
SSEPs = \> 75%
240
how much uncoverage can you have in THA in adult hip dysplasia
\< 30% is ok
241
242
what is the appropriate distance between pore gaps to increase biologic fixation
50 microns
243
in which patients is Madelungs deformity often seen?
female adolscent gymnasts
244
when do you use IV pamidronate in CP kids?
\> 3 fxs
or Z score \> -2.0
245
what nerve runs right next to the lat dorsi insertion
radial nerve
246
what are the motor deficits of cubital tunnel sydrome
weakened grasp and pinch
247
what nerve can be injured in the ORIF approach to thumb base fractures?
superficial radial nerve
248
what is the treatment for acetabulum protrusio in Marfan's syndrome?
- valgus osteomy vs THA
249
when do you use a reverse cross finger flap
in DORSAL defects
250
what determines chiari vs PAO in adult hip deformity
PAO only if joint is CONGRUENT
251
when is the medial circumflex at risk for injury?
(2 types)
- posterior approach when taking down quadratus femoris
- psoas tenotomy
252
what is the only preop condition is a predictor for post op anemia needed transfusion prior to THA
preop anemia/low hemoglobin
253
what does an avusion fracture of the arcuate complex look like and what is it associated with?
- avulsion fracture of the the fibular head
- cruciate ligament tear
254
what syndrome is often associated with congenital radioulnar synostosis?
kleinfelters syndrome, XXY
255
with a hip adbuction contracture, is there an apparent longer or shorter limb?
longer
256
which has better outcomes, medial or lateral uni knees?
equal
257
t(2:13)
rhabdomyosarcoma
258
what is the highest risk factor for HO
ISS score
259
what is the #1 complicatio for surgery for thoracic outlet syndrome
pneumothorax
260
name the two ligaments important in thumb base fractures
- dorsoradial ligament
- volar beak ligament
261
in peds, what is a distal humerus physeal seperation suspicious for?
child abuse
262
in CP patients with spastic and atheotic movements, what intervention is contraindicated?
dorsal root rhizotomy
263
scapular fx operative indications
25 % glenoid
5 mm glenoid depression
40 degrees scapular neck angulation
264
what is the most common metatarsal fractured in kids
1st metatarsal
265
which ganglion cysts recur more ofter after surgical resection
volar
266
what is the treatment for frostbite blisters?
debride clear, but only drain hemmoragic and leave in tact
267
what are the contents of the posterior tibial tunnel
- FHL, FDL, Post tib tendon, tib post artery, tibial nerve
268
what are the surgical indications for C1-2 fusion in down syndrome
\< 5mm ADI with symptoms
\>10 mm ADI
\<14mm PDI or SAC
269
what can skirted modular femoral heads lead to in THA?
impingement with ROM
270
what is the approach to a calc fx and what is at risk
lateral
- the calc branch of peroneal artery supplies flap and can die
271
in scoli surgery for Marfan syndrome, what 2 complications are the same as AIS surgery
- blood loss
- neuro complications
all the rest are increased in Marfans
272
when do you operate on a teratologic hip in Arthogryposis
\> 6 m/o
273
in THA in adult hip dysplasia, how much can you lengthen the leg before you worry about a sciatic nerve palsy
4 cm
274
patients with what disorder are prone to malignant hyperthermia from anesthesia and how do you treat it?
SMA, pretreat with dantrolene
275
in myelodysplasia, which level is associated with hip dx?
how do you treat it?
- L3 due to flexion/adduction
- non operative
276
when do you use impaction grafting in femoral revision THA?
in 3B and IV type defects
aka less than 4 cm of diaphyseal bone remaining OR unsupportive diaphsysis
277
in tx of bilateral congenital radiaulnar synostosis, what positon should the arms be derotated to?
dominant = 0-15 degrees
non dominant = NEUTRAL
278
in hip fusion, how much is gate efficiency decreased
60%
279
what does elsons test show
collateral band vs central slip injury:
in central slips, DIP remains stiff during attempted finger extension
280
what are the lengths for preop vs post op chemo
preop = 8-12 weeks
post op = 6-12 months
281
how does bisphosphinate fractures occur?
- extremely low bone turnover, and decreased overall absorption leads to fx
- seen by low urinary collagen type 1 cross-linked N-telopeptide, NTx
282
which flexor pulley is involved in trigger finger
A1
283
what is abnormal internal tibial torsion that needs correction at \> 8 y/o
15 degrees internal rotation requires correction
284
what is the inheritance pattern in Rett Syndrome and what gene is affected
X linked dominant (girls only because boys dont survive)
MECP2
285
in an inversion ankle injury, what can be confused with an ankle sprain
- avulsion of bifurcate injury from anterior process of calc
286
what rehab exercises can be done early in quad/patellar tendon repair
active FLEXION, passive extension
287
how does isoniazid work?
mycoalic acid synthesis disruptor
288
describe the 3 zones of the guyons canal
1- both
2- motor and medial
3- sensory and ulnar
289
what is the #1 sign/value of fat emobli syndrome
PaO2 \< 60mmhg
290
what joint is involved in an ulnar collateral ligament injury to the thumb?
the MCP joint
291
what is the affect of radiating polyethelyne have?
sterilization AND cross linking, increasing wear resistance
- processing removes free radicals but cross linking occurs only during irradation in oxygen depleted environment
292
which pelvic ring injury has the highest risk/need for blood transfusion
APC 3
293
how do you treat fixed hammer toe deformity
PIP joint resection arthroplasty
294
what is this histo of?
synovial sarc
295
what is the best initial treatment for a quad contusion?
ice, NSAIDs, and knee flexion past 90 to 120 degrees
296
what is surgical treatment for 2nd toe synovitis
- dorsal oblique shortening osteotomy
vs
girdlestone tendon transfer (done if NO long 2nd toe)
297
what is the criterior for nonop vs operative tx in thumb base fractures?
criterior for CRPP vs ORIF?
- 30 degrees angulation
- 1 mm displacement
298
ankle scope AM portal
medial mal and tib ant
- saphenous vein
299
at what age does hand dominance present?
in the 3rd year of life
300
what antibiotic is used to treat N. gonorrhea
ceftriaxone
301
how does gabapentin work?
Reduces hyper-excitability of voltage dependent presynaptic calcium channels
302
describe the course of the princeps pollicis artery
between the 1st dorsal interrosea and adductor pollicis
303
what is the mechanism of TXA
competetively inhibiplasminogen, which is what breaks down clots
= less bleeding
304
what is the interval the the modified judet approach to the scapula
infraspinatus and teres minor
305
how many screw holes are necessary for pubic symphysis fixation
4 or greater
306
what is the definition of effect size
Estimated magnitude of the difference in the means between two groups
307
what are some conditions the NOF are associated with?
Jaffe-Campanacci syndromecongenital syndrome of multiple non-ossifying fibromas and cafe au lait pigmentation mental retardationheart, eyes, gonads involved
neurofibromatosis
familial multifocal NOF
ABC
308
what are the primary stabilizers of the MCP joint and when are they tight
proper collateral
- in flexion
309
what role does integrins play in bone formation
binds osteoclasts to bone surfaces
310
which tests do you use to test lower and upper part of subscap
belly test = upper
lift off test = lower
311
describe a boutonniere deformity
flexion of IP, extension of DIP
312
what reverse the affects of LMWH
protamine sulfate
313
describe the fusion timing about the elbow
CTE-R-O-I
12-14
14-16
15-17
16-18
314
where does MPFL insert
between adductor tubercle and medial epicondyle
315
in RA, what is spared
basement membrane
316
what are the indications for prophylactic fixation of contralateral hip in SCFE
obesity, hypothyroid, 10-12 y/o, degree of displacement
317
what is the initial treatment for Stage I and II PTT disease?
non operative mgmt
- focus on MEDIAL arch posting
318
what are operative criteria for prox phalanx fractures
rotation, \> 2mm shortening, \> 10 degrees angulation
319
Rituximab
anti cd20
- stop 7 months before surgery
320
what are the 6 components to the LRINEC score for nec fasc?
- wbc
- sodium
- CRP
- hg
- creatinine
- glucose
321
in prosthetic osteolyisis, what does increase in TNF alpha lead to
increase in RANK
322
for hallux varus, what determines fusion vs other corrective options
- inability to correct deformity
- painful athritis
323
In the AJCC staging for soft tissue tumors, what are the 4 components to consider
grade (low, int, high)
size ( \<5, 5-10, \> 10)
lymph nodes
mets
324
at the end of dennis brown barr shoes of ponsetti technique what is often required in 30-50%
tib ant tendon transfer
325
describe the pathophys of compartment syndrome in regards to vascular flow
decreased venous outflow compared to arterial inflow
326
for quad tendon ruptures, which has the highest load to failure AND lowest gap formation
suture buttons over transosseous tunnels
327
what is the earliest age you should do surgery for equinus deformity in CP patients?
4-6 years old
328
does increasing femoral offset, increase Limb length?
NO
329
which is the most biomechanically stable way to fix a patella fracture
plate and screw construct
330
what is the function of the peroneus tertius?
dorsiflexion and eversion
331
what is the most common complication associated with endoscopic transthoracic diskectomies?
intercostal neuralgias
332
in achondroplasia, what can cause central apneic episodes and sudden death?
foramen magnum stenosis
333
what is the most common cause for radiocarpal instability
- distal radius non-union
334
when using steinmann pins for skeletal traction of DISTAL femurs, what is a potential complication
HO
335
what is the algorithm for vert artery injury in cervical spine surgery?
- clamp
- check for collateral circulation
- embolize or ligate
- repair later if possible
336
in addition to TAL or gastroc recession, what procedure can be added to offload the foot in recalcitrant diabetic ulcers
PL to PB transfer
337
what is the treatment for sickle cell crisis
hydroxyurea
338
when does braking times return to semi normal and full normal in ankle fractures
6 weeks
9 weeks
339
what is the treatment for flexible flat feet in pediatrics that has failed conservative mgmt
Evans osteotomy (calc. lengthening)
340
what is a stenar lesion
when the UCL is displaced above the adductor aponorosis
341
at what cord level of myelodysplasia is hip dx most common and why
L3--\> unopposed flexion/adduction
342
how do you treat a vancouver A post op fx
if \> 2cm, then ORIF
343
which tendon sheath is the pisiform located in?
the ECU tendon
344
how do you distinguish between a radial nerve palsy vs a PIN palsy
radial wrist deviation when attempted wrist extension in PIN palsy
- radial nerve innervates ECRL
345
describe the AJCC tumor staging system
Stage 1= low grade
Stage 2 = high grade
A vs B = 8 cm cutoff
Stage 3 = skip lesions
Stage 4 = mets (A = lung, B= other)
346
how do you differentiate osteoblastomas from osteoid ostomas
- size \> 2 cm
- posterior elements of spine
- not relieved by NSAIDs
- neurologic symptoms
347
what imaging must you always get in JRA?
cervical xrays to rule out AA instability
348
in the jeanmart method (Beta - alpha), which values are POSITIVES
and which values are NEGATIVE
positive = anteversion and ext rotation
negative = retroversion and internal rotation
349
in patients with dynamic supination after failed clubfoot casting, at what age should you perform a split ant. tendon transfer?
after 3 years old, when the cuneiform ossifies
350
what is the tendon transferred for chronic tib ant ruptures (\> 3 months out)
EHL
OR plantaris as autograft for reconstruction
351
what acts directly on osteoclasts to decrease their activity?
calcitonin
352
what medical treatment is used to OI
bisphosphnates, decreases osteoclast activity
353
what is the histo of mesenchymal chondrosarc and what is its tx
biphasic pattern with small round blue cells
chemo then wide resection
354
what type of spinal cord injury is muscle transfers only good for
COMPLETE
not for incomplete
355
what can synovial chondromatosis transform to in rare instances
chondrosarcoma
356
which of the following places the patient at greatest risk for persistent nonunion with revision surgical fixation of a ankle fusion
neuropathy
357
what is the treatment for Kienbochs disease in ADOLESCENTS
STT pinning
358
why is a through the knee amp bad in adults?
poor prosthesis fitting, NOT energy expenditure
359
what is anteriomedial tibial bowing associated with and what is its inheritance pattern
ball and socket ankle, absent lateral rays, DDH, genu valgum, LLD, cruciate ligament deficiency
none
360
which nerve is at risk in trigger thumb in peds
radial digital nerve
361
what is the main portal to start a wrist scope? where is it located? what is at risk?
3-4, 1 cm distal to listers tubercle, nothing
362
what is the innervation of the adductor pollicis
the ULNAR nerve
363
what is the kocher approach to the elbow
- lateral
- between ECU (PIN) and Anconeus (radial)
- LCL at risk
364
how do you treat osteoid osteomas in the spine
CAN do RFA
resect scoli lesions if needed
365
fibula flap
- peroneal artery
366
where does the peroneus tertius insert on?
the dorsal diaphysis of the 5th metatarsal
367
what should be added to methotrexate to treat RA if its not working
doxycycline
368
CA-19-9
pancreatic cancer
369
what is the cutoff for debridement vs tendon transfer in achilles tendonitis
\> 50% involvement
370
what are the nerve transfers for radial nerve palsey
PT to ECRB
FCR to EDC
PL to EPL
371
what abx have Pseudomonas coverage?
- cipro and levofloxacin
- ceftazimidine or cefipime
372
what percentage of femoral neck fractures are missed if fine CT ct is not used with concordant femoral shaft fractures
30-50 %
373
374
what is the proper placement for a femoral tunnel in ACL recon
6.1 mm posterior to resident's ridge and 1.7 mm proximal to the bifurcate ridge
375
in sprengels deformity, whichh shoulder motion is limited?
shoulder abduction and flexion
376
which talar OCD lesion is more likely to spontaneously heal: medial or lateral
medial
377
which fracture is most commonly associated with a combined ulnohumeral and radiocapitellar elbow dislocation in children
medial epicondyle fracture
378
in peds, what is the most common cause of death upon trauma admission and when does it occur
multiorgan failure
- upon admission
379
what is the most important ligament for reduction of the thumb
dorsoradial ligament
380
where are the AVN rates worse in scaphoid fractures?
proximal or distal
proximal
- prox 1/5th = 100%
- prox 1/3rd = 33%
381
what are some features of mafucci syndrome
- multiple enchondromas
- blueish angiomas with ploebiths
- 100% malignant transformation with CNS and GI tumors
382
what is the order of the volar ligaments visible from the 3/4 wrist portal
radioscaphocapitate; long radiolunate; short radiolunate
long THEN short (alphabetical order)
383
what disorders are commonly seen in the Hypertrophic zone of the physis
- SCFE
- Rickets
- fxs
- muccopolysacchorodosis
384
what is the cause for apparent LLD after THA?
weak ABductors
385
describe pagets disease of bone (process, stages, and genetics)
lytic/mixed/sclerotic; AD, 5q35-QTER
386
what is the difference between metal particle ratios in trunnionosis vs MoM pseudotumors?
MoM have equal cobalt to chrome particles
- trunnionosis = cobalt\> chrome
387
what is the cause of heel pain in plantar fascitis?
lateral calcaneal branch
NOT lateral plantar branch aka baxters nerve
388
what is the bending rigidity proportional to in an IM nail?
r^4 in solid
r^3 in hollow
389
390
at what abduction angle does metal on metal serum ions increase in THA?
55 degrees
391
which syndrome has a C shaped scoli curve
Rett Syndrome
392
what is the operative criteria for pelvic diastasis after pregnancy
\> 4 cm
393
which approach are sacral FRACTURES best treated with
posterior, not anterior
394
what is the key finding between a low ulnar nerve palsey (guyon canal) vs a high ulnar nerve palsy (cubital tunnel)
sensation to the dorsum of the hand, which is present in a low ulnar nerve palsy (guyons canal)
395
who is affected in SONK, and which condyle is affected more
women, medial
396
how do you treat a vancouver C (below stem) post op fx
ORIF only with cerclage wires
397
what percentage of diabetic ulcers have osteo if able to probe to bone?
67%
398
what does the recurrent branch of the median nerve innervate
the opponens pollicis
399
which TEA has longer survivorship, RA or OA?
RA
400
what are the two causes for PIP flexion in boutionnere deformity?
central slip rupture = extensor tendon not attached = PIP flexion
lateral/collateral bands from lumbricals become unapposed flexors = PIP flexion/DIP extension (triangular ligament becomes attenuated)
401
what is the cutoff for intermalleolar distances for intervention in pediatric genu valgum?
8 cm
402
what is a common complication to all elbow dx, simple or complex?
loss of terminal extension
403
what is this histo of?
PVNS
404
describe the difference between a shelf and chiari ostetomy
chiari = sliding ilium lateral
shelf= adding bone lateral
405
what are the only 2 FDA approved uses of BMP-2?
- acute tibial fractures
- single level ALIFs
406
what are the 2 nerve injuries most common in CTS surgery?
1. ) recurrent motor branch
2. ) proper palmer digitial nerve = 1st lumbrical weakness
407
in the lateral approach during THA, when is perioperative prosthetic fx most at risk broaching or final insertion
final insertion
(think quagmire "I just stuck it in and broke it")
408
what is the radial border for Guyons canal
the hamate
409
what is the orientation of the cervical facets as you go from cranial to caudal
posteriomedial to posterolateral
| (in to out)
410
which joint is spared in SLAC wrist
radiolunate joint
411
what is the best prevention for HO?
600-700 Gy w/72 hours of surgery
412
what do antibodies for sclerostin lead to?
- INCREASED bone mass
- SOST mutations leads to increased bone mass
- sclerostin leads to decrease in bone mass with the wnt and b catenin pathway
413
what is the controlling molecule for tendon collagen size
decorin
414
what is the CRP value in osteo that puts a patient at risk for DVT?
CRP \> 6
415
when treating prox humerus fractures with the exteneded AL acromial approach, what is at risk
the axillary nerve
416
who is more likely to get pseudotumors; men or women
women
417
in ligamentous chance injuries, how many levels should the construct be?
1 above and 1 below (i.e just L3-4 for an L3-4 disc injury)
418
what is a urine marker for osteolysis in periprosethetic wear?
N-telopeptide urine level
419
when do you operate on endochronaomas
- change on serial xrays
- pain
- fractures
treatment is curettage and grafting
420
when performing ankle arthrodesis for avn of the talus, what is the correct approach
the lateral transfibular approach;
allows access to both joints AND provides autograft
421
what TCPO2 is needed to heal an ulcer?
- amputation?
- 60 mm/hg
- 45 mm/hg
422
when is the medial plantar nerve at risk?
medial plantar approach to the TIBIAL sesamoid
423
is a radiograph enough to diagnose an osteoid osteoma/osteoblastoma?
no
usually need fine cut CT
424
what is responsible for bones compressive strength
Proteoglycans and hydoxyapatite
425
what is the gene associated with Apert Syndrome
FGFr2
426
in patella tendon rupture repairs, compare the load to failure and gap formation between:
transosseous tunnels vs suture anchors
suture anchors has higher load to failure AND less gap formation
427
what is the most common syndactyly digits?
middle and ring
428
when performing an MPFL recon, what position will make the knee too tight in flexion?
too proximal, above shottles point
429
how long should the spacer be in place before exchanged for bone graft in the masquelet technique
4-6 weeks
430
Describe how VitD increases serum Calcium?
1. ) increasing intestinal absorption
2. ) stimulates terminal differentiation of osteoclasts
431
which metastatic diseases are sensitive to radiation therapy
breast and prostate
- NOT GI or renal
432
is psoriatic arthritis RA and ANA (+) or (-)
negative
433
in LCPD, what blood issues are common
- coagulopathys
- protein S and C deficincies
434
describe the different types of congenital scoliosis
435
what is the medial approach to a coranoid fx
between the heads of the FCU
436
what does oxidation of poly do to its strength and modulus of elastity
decrease strength
INCREASE modulus of elasticy
437
in vaughn jackson syndrome, what is the order of failure?
ulnar to radial
438
What are the 4 ways that PTH increases serum Calcium
1. ) binding to osteoblasts = increase in IL 1 and osteoclast activity
2. ) Activates enzyme in kidney to convert to 1,25 vit D
3. ) increase Calcium absorptions,
4. ) decrease phosphate absorption in kidney
439
how are LPVNS vs DPVNS treated?
LVPNS= arthroscopic removal and synovectomy
DPVNS= arthroscopic anterior removal and OPEN posterior removal
440
what is the treatment for adamantoma
wide surgical resection
441
besides varus malunions, what is the other most common type of malunion in talar neck fractures?
dorsal malunion
442
which metastatic lesion to bone is least sensitive to radiation
renal
443
order of importance in digits to replant
thumb, long, ring, little, index
444
when doing an arthroscopic iliopsoas tenotomy, which way should you rotate the leg and why?
external
- rotate the NV femoral bundle AWAY
445
when is a split thickness SG good to use?
full thickness?
- split = dorsal wounds
- full = volar wounds and fingertips
446
what is the cause of lumbrical plus finger?
rupture of FDP/loss of FDP
so lumbrical takes over and pulls on lateral bands which pull on central slip = IP extension
447
what is the major difference between retrograde vs antegrade nailing of a femur fracture?
hip vs knee pain; faster OR set up times, but not operative times
448
transphyseal humerus fractures go in what direction and have what complication
radius/ulna PosterioMEDIAL
cubitus VARUS due to avn of med epicondyle or malunion
449
how much calcium should an osteoporotic patient be taking in daily
1000-1500 daily
450
when do you do automatic controlateral hip pinning for SCFEs
\< 10 years
- endocrine
- obese
451
what is the distance from the top of the humeral head to:
sup edge of pec tendon?
greater tuberosity?
5.6 cm
10 mm
452
what is forefoot varus; supination or pronation
SUPINATION
453
how do you diagnose a nerve injury post surgically in the foot?
with a lidocaine injection
454
what is at risk in the 6R and 6U wrist portals
dorsal ulnar nerve sensory branch
455
what is the most common cause of patella baja post op TKA?
previous proximal tibia medial wedge opening osteotomy
456
what exam is best for medial/deltoid ligament integrity?
gravity stress view
457
which has a greater likliehood for sural nerve injury; open or percutaneous achilles tendon repair
percutaneous
458
what are some treatments for osteopetrosis
bone marrow transplant, calcitriol (1,25 vit d)
459
which is affected more in age osteoporosis; trabecular or cortical bone
trabecular
460
bone is weakest to what type of force
shear
461
what is the recurrence rate of giant cell tumor of tendon sheath?
what is a factor which increases likliehood of recurrence
5-50%
- tendon involvement
462
best types of tibial osteotomy
dome \> lateral closing \> medial opening
463
what type collagen is defective in Ehler Danlos
Type 5/V
464
what condition is associated with a GAA repeat on chromosome 9q13
Freidreichs Ataxia
465
what is the cause of congenital trigger thumb
thickened FPL with notta's nodule
466
describe positions of casting for medial vs lateral condyle fractures
medial--\> pronation lateral--\> supination
467
in SLAC wrist, which joint is spared
the radiolunate joint
468
describe the course of the LFCN
- L2-3 nerve roots
- pierces psoas
- rides iliacus
- courses under inguinal ligament
469
what is the incidence of a disease?
the number of NEW cases in a given time period
470
what is the most common finger to have a digital artery aneurysm in?
thumb
471
when does the secondary ossification center appear for the odontoid?
when does it fuse
3 years
12 years
472
what are EMG characteristics of denervation?
- fibrillations
- positive sharp waves
- fasiculations
473
What is the most proximal level of amputation that a child can undergo and still maintain a normal walking speed without significantly increasing their energy cost
through knee amputation
474
what is the treatment for perilunate dx \< 8 weeks
\> 8 weeks
closed reduction and ligament repair
- PRC vs total wrist arthrodesis
475
what is at risk between the sartorius and tensor fascia latae in the Anterior approach to the hip?
ascending branches of the lateral circumflex artery
476
in what position of the wrist is force through the scaphoid fossa greatest
extension
477
what is the most common problem after a lateral closing wedge osteotomy to correct cubital varus?
a lateral prominence
478
what is the treatment for a grade III MCL tears with associated ACL tears?
brace and non op tx for MCL tear, wait and perform ACL tear later
479
who is affected by idiopathic transient osteoporosis of the hip
- men
- women in the third trimester
480
what is the difference between impairment vs disability
impairment = loss of function
disability= inability to meet social or professional criteria due to impairment
481
what is a normal base deficit?
-2 to +2
482
what wrist arthroscopy portal is just distal to lister's tubercle
3-4
483
what cardiovascular issues are present in OI
mitral valve prolapse, aortic regurg
484
in PIP fx/dx, which is more important, articular joint congruity or stability
stability
485
what is the best surgical approach for a Pipkin IV fracture?
troch flip osteotomy
486
the vancouver classification system for INTRAOP femur fx
A- prox
B- diaphyseal
C- distal
1- perf
2- crack
3- unstable
487
what percentage of cervical decompression surgeries lead to a C5 palsey?
5-7%
488
what is the neurologic presentation of chordoma
normally no motor/sensory deficits, only BOWEL and BLADDER issues
489
in what position is the sciatic nerve in the least amount of stretch
hip EXTENSION and knee FLEXION
490
what nerve root can be injured in a
491
physical exam findings in hallux rigidus
- inverted gait
- decrease push off
492
what part of the insertion does the distal biceps rupture occur
on the radial aspect of the radial tuberosity
493
what is congenital clasped thumb and when does it present
thumb contracture
3 to 4 months old
494
when performing an adductor release for CP hips, what must you watch out for and what is the consequence of this error?
- obdurator neurectomy; ABDUCTION contracture
495
when treating prox phalanx fractures with ORIF, what is scarred usually and limits PIP joint flexion
extensor tendons
496
name the 2 branches of the sciatic nerve in the thigh
- tibial (all muscles and long head biceps femoris)
peroneal- (only branches to SHORT head of biceps)
497
how does indomethacin work?
acts on lipoxygenase side of arachadonic pathway
- decrease leukotriene inflammatory markers
498
where are the insertion points for the deep radioulnar ligaments
superficial radioulnar ligaments
superficial = ulnar styloid
deep = ulnar fovea
499
what is the mechanism of calcitoninin
inhibits osteoclast formation
- blocks reabsoption of phosphate in kidneys
- blocks calcium reabsorption in kidneys
put CALCIUM IN bones
500
which knee dislocation direction is most commonly associated with a peroneal nerve injury?
anterior or anteriormedial
501
what is the final position of casting for clubfoot correction
70 degrees of abduction, which is overcorrection
502
Describe the process of aging of the intervertebral disc
increase in: KS to CS ratio, lactate, degradation enzymes, density of fibroblast-like cells decrease in: water content, # of viable cells, proteoglycans, pH
503
what is this a picture of
sickle cell
504
what is Vaughn Jackson Syndrome
Rheumatoid arthritis leads to --\> DRUJ instability --\> volar carpal subluxation --\> prominent ulnar head --\> rupture of extensor tendons ulnar to radial --\> EDM is first
505
what is the D zone test used for?
to check for clindamycin resistance
506
injury to what plexus causes retrograde ejaculation
superior hypogastric
507
what is the cutoff for deformity needing osteotomies in TKA?
10 degrees in the coronal plane
15 degrees in the sagittal plane
508
what is the deformity in hammer toe?
PIP flexion
DIP extension
509
what deformity can occur with fibular and tibial sesamoid removal
cock up toe deformity
510
describe the innervation of the FDP
ring and small = ulnar
index and long = AIN of median
511
what are the benefits of open vs arthroscopic tx of recurrent shoulder instability
arthroscopic- ROM slightly higher open- return to work/sports higher, less recurrent instabilitiy
512
when fusing the DIP joints for OA, which position do you fuse the joints in?
2nd and 3rd in EXTENSION
4th and 5th in FLEXION
513
what is the IM angle cutoff in bunionette surgery for distal chevron osteotomy vs. oblique rotational osteotomy
12 degrees
\< 12 degrees = distal chevron
\> 12 degrees = oblique rotational
514
which Risser signs is associated with the fastest rate of growth?
Risser 0
515
what distinguishses SMA from DMD
absent DTR
516
for stage 2 SLAC wrist, which has more complications; PRC or scaphoid excision and 4 corner fusion
4 corner fusion
517
what is this histo of and how should it be treated?
Renal cell carcinoma
preop embolization
518
in the anterolateral approach to the ankle/distal tibia, which nerve is at risk for injury?
deep peroneal nerve in the anterior compartment
519
what type of deformity occurs with pediatric femoral shaft fractures?
genu recurvatum
520
how to treat 2nd MT transfer metatarsalgia following hallux valgus correction
weil shortening osteotomy with extensor tendon release
521
in hypoparathyroidism after thyroidectomy, what is the treatment?
Vit D and Ca2 supplementation
522
what is the timing for repair for brachial plexus injury
1 week for penetrating trauma
3-6 weeks
up to to 6months but no later
523
where do the medial circumflex artery and the first branch of the profundii anastamose
just medial to glut max,
careful when taking down glut max
524
what are the two most common mechanisms of stress fxs following uni knees
- violating posterior cortex with guide pin
- UNDERsizing tibial component
525
what is the difference between a type 2 and type 2a hangmans fractures?
type 2= anterior displacement, treat with extension
type 2 a= no displacement, only vertical angulation, treat with axial load
526
what do desmoid tumors stain positive for?
estrogen receptor beta
527
what is SURGICAL treatment for pagets
osteotomy and PLATE fixation
528
what can you injure with an olecranon osteotomy
AIN
529
what is the most common malignant disease associated with pagetoid disease? what are the other 2?
osteosarc; spindle cell sarcoma and chondrosarc
530
why do metal on metal hip resurfacings have the same amount of wear regardless of head sizse
as head size increases, so does sliding distance which should equal more wear,
but the sliding speed also increases as the head size increases which pulls in my fluid and leads to more lubrication
531
what is the arterial supply to the talus
- post tib artery via artery of tarsal canal
- ant tib for head and neck
- deltoid branch (only one left in diplaced fx)
532
in what condition should you not use Forteo and why?
Pagets disease; increased risk of osteosarc
533
what is the most common site of compression in the radial tunnel of the PIN
- Arcade of Froshe = proximal edge of supinator
534
535
what abx are used to cover pseudomonas in puncture wound osteo?
ciprofloxacin or levofloxacin (except in children)
alternative antibiotics: ceftazidime or cefepime
536
at what point in aerobic activity does the body switch from glycogen to fatty acids metobolism
90 minutes
537
which tendon healing is involved with scarring
extrinsic
538
what is the most sensitive test for a tear of the posterior horn of the medial meniscus?
medial joint line tenderness
539
what is the treatment algorithm for bunionettes
- lateral condylectomy
- distal metatarsal osteotomy (IM = 8-12 degrees)
- rotational diaphyseal osteotomy (IM \> 12 degrees)
540
name the two type of Level I evidence studies
meta-analysis and RCT with \>80% follow up
541
describe the relationship of the ulnar artery to the ulnar nerve at the wrist
artery is lateral to the artery
542
what does an error in signaling with BMP4 lead to?
Fibrousdysplasia ossificans proliferous (FOP) aka stone mans disease
543
how much must a FDP be shortened to cause quadrigia effect
1 cm
544
how do you measure limb length
ASIS to medial mal
545
according to the FRAX score, what is the criteria for starting anti-resorptive therapy?
- T score between -1 and -2
AND
- 10 year probability of having a hip fracture \> 3%
- 10 year prob of major osteoporotic fx \> 20%
546
when is the obturator artery at risk? (2 situations)
- Ant. Inf screw placement
- acetabular retractors
547
in multiple myeloma, what causes lytic destruction
RANKL, IL-6 and MIP-1alpha
548
what is a mortons extension orthotic designed to prevent
DORSAL MTP motion
549
what is the gene mutation of P53 associated with in 20%
- periosteal osteosarc
550
in what zone is a boutonniere deformity injury from
zone 3 of extensor tendons
551
what percentage of sickle cell patients with avn hip on MRI will go on to femoral head collapse
\> 75%
552
in puncture wounds to the foot, which is the most common cause of osteo vs soft tissue infection
soft tissue= staph
osteo= pseudomonas
553
what combination of metal on poly THA is not recommended
titanium and poly
554
distal humeral physeal seperation is pathpneumonic for what in a child
child abuse/ non accidental trauma
555
why is there a high rate of non-union in the hook of hamate fractures
absent ulnar vessel in 30% of patient
556
what muscle does the ulnar artery run under
flexor carpi ulnaris
557
excessive adduction of the acetabular femoral component leads to which two complications?
- impingement in flexion
- anterior dislocation
558
compared to IMN, what are the disadvantages to ORIF of tibia fractures
increased radiation, ROH
559
which approach allows the entire plafond to be visualized
anterolateral
560
how do you treat claw toes with fixed deformity
- resection arthroplasty
vs
- girdlestone weil osteotomy (if in all 4 toes)
561
what is the most common cause for litigation in THA
limb lengthening
562
what pelvic ring injury has the highest mortality rate
APC-3
563
Describe the digital nerves and vasculature in reference to eachother
nerve is volar, vessels dorsal
564
who has more pseudotumor formation after MoM THA; men or women
women
565
what is the deformity seen in proximal 1/3rd tibia fractures
procurvatum and VALGUS
566
at the knot of henry at the ankle, descripe the relationship of the FDL and FHL
- FHL is higher than FDL
- stays dorsal to FDL and NV bundle as it travels distally
567
how quickly should pediatric hip dislocations be reduced
less than 6 hours
568
Which of the following pharmacologic agents is associated with the highest risk of bleeding and thrombocytopenia:
heparin or coumadin
heparin
due to HIT
569
how long does the fibroblastic phase of healing last?
5-28 days
570
what is a moberg procedure
a closing wedge dorsiflexion osteotomy for the 1st MT
571
what are 3 signs of preganglionic injury
- winged scapula
- horners syndrome
- NO tinels sign
572
which layer of the nerve cushions against pressure
the EPINEURIUM,
the outer layer
573
when is a funnel plot used?
to detect bias studies in a systematic review
574
what must you give with all nailbed/nail injuries
tetanus and abx
575
what is the non op treatment of hip AVN
alendronate
576
how many threads across the physis should you have in SCFE
5 threads
577
what is the treatment for trunionosis
revision to a ceramic head, titanium sleeve, and new polyethylene liner
578
what is the treatment for AIN?
how successful is it?
- splint in 90 degrees flexion for 8-12 weeks
- if fail, surgery
- 75 %
579
in a pelvic ex fix, what nerve can be damaged from AIIS pin insertion
LFCN
580
what is the most common complication in pediatric transosseous amputations?
bony overgrowth
581
what is the best way to manufacture polyethylene?
direct compression molding, avoid machining, and do NOT add calcium stereate
582
does chordoma present with metastatic disease?
yes
30-50% of the time
583
what are the components of the TFCC?
disc, meniscus homologue, dorsal and volar radiolunar ligaments, ECU tendon subsheath
584
in turf toe, where does the capsuloligamentous complex tear from?
proximal phalanx
585
how long does brake time return to normal after lower extremity injury?
6 weeks after weight bearing
9 weeks after ORIF ankle
586
what disease is associated with a deletion of the Xp21 gene?
Duchenne's muscular dystrophy
587
describe the role of PTHrP and IHH on the growth plate
chondrocytes secrete IHH which cause other chondrocytes to produce PTHrP which slows the maturation of chondrocytes in the growth plate down
588
what are lesion in the calc in teens usually?
chondroblastoma vs UBC
589
what must be disrupted for VISI deformity to occur
volar radiotriquetral ligament
590
do you need to add a k wire for seymore fracture treatment
NO
591
how do you treat dynamic supination after clubfoot treatment?
whole or split ant tibial tendon transfer
592
what is medical treatment for multiple myeloma?
surgical?
multiagent chemotherapy +/- stem cell transplantation +/- bisphosphonates
- surgical = stabilization plus radiation
593
what histo is characterized by characterized by foamy, vacuolated, physaliferous cell
chordoma
594
what is the treatment for congenital clasped thumb?
splinting for all at 6 months
if failed splinting:
type 1- EIP transfer
type 2- EIP transfer vs recon
type 3- recon
recon is done at 3-5 YEARS old
595
which type of MPFL injury is more common? bony avulsion of soft tissue avulsion
soft tissue avulsion
596
what is the best type of conduit for nerve repairs
collagen
597
when do you perform amputation for frostbite?
after demarcation, can take 1-3 months
598
in distal femur periprosthetic fractures, what deformity can occur with a retrograde nail and why/
hyperextension deformity due to starting point being pushed POSTERIOR
599
which 2 pulleys are the most important in the fingers?
A2 and A4
600
what is the treatment for EG
- observation
- curettage and bone grafting in some cases
601
what is the appropriate treatment for ankle fractures in diabetics
ORIF with multiple quadacortic screws even without a syndesmotic injury
602
what is one disadvantage of the transfemoral or extented troch osteotomy approach in revision THA surgery?
decreases the torque amount to failure by 50% compared to native bone
603
what vascular injury is associated with scapulothoracic injury
subclavian artery
604
who is at risk for intraoperative calcar fractures during THA?
women
605
when do you operate on genu valgum
\> 15-20 degrees and \> 6 y/o
\< 10 y/o = tethering
\> 10 = osteotomy
606
describe the two gait abnormalities in knee OA
- adductor limp
- knee flexion, toe walking, and shortened stride
607
what type of injury to the medial patella femoral ligament is most common in lateral dislocations
SOFT tissue injury, more so than midsubstance or bony avulsions
608
what are the two ways to get a saggital band rupture
traumatic - punching
chronic inflammatory- RA
609
what are the advantages of ant/inf plating of clavicles compared to superior plating
- less prominence - longer screws - decreased subclavian injury - BUT need to detach deltoid
610
in a medial femoral condyle graft, what is the vascular pedicle
Longitudinal branch of the descending geniculate artery
611
what is the treatment for tibial non-unions following nailing
EXCHANGE nailing
- only plate and graft if signifcant bone loss, or failed attempt at revision
612
what is the best view to evaluate medial epicondylar elbow fractures?
distal humerus axial views
613
in what two surgical situations is the acromial branch of the thoracoacromial artery likely to be injured
- at the superior edge of the deltopec interval
- releasing the coracoacromial ligament
614
when is peak bone mass reached? does it matter gender or location?
end of 3rd decade but its variable, females vs males, appendicular BEFORE axial
615
what movements causes a fracture of the anterior process of the calcaneus
inversion and plantarflexion
616
when do you perform a dorsal chielectomy vs moberb procedure for hallux rigidus
- when fail to achieve 30-40 degrees dorsiflexion
- runners
617
what the avg degrees of rotation on a post condylar axis cut
3 degrees INTERNAL rotation;
rotate the femoral component EXTERNALLY to match the post condy axis
618
619
which nerve injury does NOT involve wallerian degen
- neuropraxia
620
what procedure do you perform in hallux valgus for a hypermobile joint
lapidus procedure
621
what is bassetts ligament
inferior portion of the anteroinferior tibiofibular ligament, can cause talar impingement and pain
622
describe the collagen fibrils and chondrocytes in the superficial and deep zone
superficial: both oriented parallel to joint, chondrocytes round and flat
deep: both oriented perpendicular to joint, chondrocytes spherical in nature
623
what is associated with Fancomi's anemia?
- what is the treatment
- absent radius
- bone marrow transplant
624
which ligament is absent in madelungs deformity?
long radiolunate
625
what does a mutation in the FGFR2 gene cause?
Aperts
626
how do you calculate the ISS?
the sum of the squares of the THREE highest scores
627
for rotator cuff arthropathy, when do you choose a hemiarthroplasty over a rTSA
Hemi = glenoid bone loss and/or deltoid dysfunction
628
in a chopart/midfoot amputation, which are the two tendons that need be transferred
1. ) tib ant to talar neck (MOST important)
2. ) PB to calc
629
in calcaneus fractures involving the posterior facet, which fragment traditionally stays put and which one moves and why?
- medial stays put (constant fragment)
- lateral moves due to its attachment to the sustentaculum tali
630
what are the methods of action of PTH on bone?
increase serum Ca via osteoclasts
- osteoblast secrete il1 and 6, increase in osteoclast
- MCSF on osteoblast = increase in rankLigand
631
what provides A/P stability to the SC joint?
superior stability?
AP = post capsule
sup = anterior sc ligament
632
what the gold standard for diagnosing TFCC tears?
second best?
arthroscope
MRI
633
what medications are second line for AS?
TNF alpha inhibitors: infliximab, entanercept, adalimumab
634
what is the inheritance pattern of osteopetrosis?
autosomal recessive
635
what is the operative indications for congenital radialunlar synostosis
\> 60 degrees pronation
bilateral involvement
636
in neutral variance, what are the loads shared by the radius and ulna
radius = 80%
ulna = 20%
637
in PIP fracture dx, do you use distraction splinting vs hemihamate recon?
distraction = pilon comminuated
recon= chronic unstable
638
what does sclerositin do
- inhibits osteoblast formation
- bone formation
- stops inhibition of ostoblast/cyte apoptosis
639
what is the most common complication after a tibial tubercle fx regardless of tx?
recurvatum; due to anterior physis arrest
640
Describe the Cierney-Mader Classification for Osteomyelitis
1- medullary only
2- cortical only
3- both
4- entire bone
A- no comorbities
B- one or more comorbidities
C- severely immunocompromised
641
how does indomethacin work?
inhibits IG-1
642
when would you do a PAO vs a salvage (shelf or Chiari) osteotomy
PAO= congruent joint
Salvage= unreduced hip
643
What systemic complicaton is avoided by doing RTC repair surgery in the lateral decub position vs beach chair?
cerebral hypoperfusion presenting as an abducens nerve palsey
644
what are the EKG findings of hypercalcemia due to hyperPTH?
shortened QT interval
645
which metastatic cancer to bone is the least receptive to external beam radiation
renalnhgbbbbbbb
646
what else inserts on the medial calc tubercle with the plantar fascia
- abductor hallicus
- FDB
- quadratus plantar
647
what does chondroidmixoid fibroma look like on histo and what is its treatment
- stellate cells
- lobules of fibromixoid tissue
648
which tumor stains positive for vimentin and epithelial membrane antigen on immunohistochemistry?
synovial sarcoma
649
in Gauchers disease, which is the enzyme that is deficient and what accumulates
beta glucocerebrosidase
- sphingolipids
650
how long after surgery does braking time return to normal for the following:
TKA and THA
ORIF ankle
Long nail/plate
TKA- 4-6 weeks
THA- less than 4 weeks
ORIF ankle- 8-9 weeks TOTAL
long nail or plate= 6 weeks TOTAL (6 weeks after weightbearing and this assumes immediate weightbearing)
651
what is one very specific example to use a TTO during revision TKA?
patella baja
652
what artery contributes second most to the femoral head
inferior gluteal artery
653
what is the most common complication following surgery to treat MTP dx?
floating toe
- after a oblique shortening Weil osteotomy
654
when do you give broad spectrum abx for bullets in spine
ONLY when it has passed through bowel first
655
when do you remove flex nails for peds both bone forearm fxs
3-4 MONTHS
656
what does the EMG show in radial tunnel syndrome?
NOTHING, PIN doesnt show changes
657
metacarpal transposition
- little finger for 4th ray resection
- index for middle ray resection
658
what are the 2 images that MUST be obtained in osteosarc workup?
- MRI
- Chest CT
659
Premature arrest following growth plate injury is attributed to what mechanism
vascular invasion across the physis
660
what makes up the bicipital sling
supraspinatus
SGHL
CHL
supscap
661
what pediatric injury is associated with combined ulnohumeral and radiocapiteller elbow dx?
medial epicondyle fractures
662
what direction is the most common radial head dislocation in 60% of monteggia fractures
anterior
663
which ligaments are stronger in the wrist, dorsal or volar
volar
664
what does a mutation in PHEX gene cause?
Vit D resistant rickets (inability of tubules to absorb phosphate)
665
what percentage of patients will have relief with a steriod injection for carpal tunnel syndrome and for how long?
80%, 20% at 1 year
666
what is the rate of proximal humerus AVN in:
- 4 part fractures
- 4 part fx/dx
- 45%
- 100%
667
how do you treat hip dislocations in myelodysplasia?
observation
668
t:(12:16)
mixoid liposarcoma
669
what is the innervation of the adductor magnus (important for the medial approach to the hip)
adductor portion is supplied by the posterior division of the obturator nerve
ischial portion by the tibial portion of the sciatic nerve
670
how should post op rehab change in a quad snip approach vs standard medial parapatellar approach?
NO change
671
for tendon transfers, what is the most important function?
leave important function
- elbow flexion
- wrist extension/finger flexion
672
describe the course of the radial nerve
medial to lateral
- 20 cm prox to MEDIAL epi
- 14 cm prox to LATERAL epi
- exits post compt 10 cm prox to radiocapiteller joint
runs between BRACHIALIS and BRACHIORADIALIS
673
which way does the pelvis tilt durin gait after abductor injury (trendleberg gait)
AWAY from the affected hip
674
where does the obdurator nerve provide sensation to
the middle thigh
675
what is the most common fracture seen in association with a scapular fracture
a rib fracture
676
why do you fuse to the pelvis in long scoli constructs
maintenance of correction, NOT decreased pseudo rates
677
from flexion to extension, what is the distal femurs kinomatics
distal femur pivots about a medial axis of the knee
678
describe the lateral pillar classification of LCP disease and treatment for each
- A (no lateral pillar involvement) = non op - B and C = derotation and pelvic osteotomy
679
label this
680
describe the appropriate recommendations for seating of children in car?
681
what is the common reason for failure of weaver-dunn recon for ac joint pathology
horizontal stability (A to P translation)
682
which site for iliac crest harvesting as more complications: anterior or posterior
anterior
683
which 2 ligaments are involved in a LisFranc injury
1- IO ligament between 1st cuneiform and 2 MT
2. PLantar ligament between first cuneiform and 2nd and 3rd metatarsals
684
in the posterolateral approach to the tibia, what two muscles lie posterior to IOM and must be elevated
FDL and PT,
NOT FHL which lies on back of fibula
685
what muscles are split in a Harding direct lat approach to THA? what is the complication?
vast lateralus, Glut med, and glut min; abductor limp
686
where is junctional corrosion seen in THA?
modular components
- leads to pseudotumors
687
what nerve can be injured during IM nailing of a jones fracture
doralateral branch of the sural nerve
688
which decreases JRF on the acetabular side?
- medializing COR
- weight loss
- trendelenberg gait
689
what type of stitch is used for inside out meniscial repairs
vertical mattress
690
what is the most common place for enchondromas
the hand
691
what is the interval for TAA
between the tib ant and EHL
692
what is the most common neurosx manifestation of myelodysplasia
Type 2 Arnold Chiari Malformation
693
what starting point in a piriformis entry nail creates a fracture of the anterior cortex?
both:
anterior = hook stress and bursting
posterior= perforation due to radius of curvature mismatch
694
when do you use epiphysiodesis vs limb lengthening in terms of limb length discrepencies?
2-5 cm = epiphysiodesi
\> 5 cm = limb lenthening
695
what is at risk for a single incision fasciotomy release
SPN and Common peroneal
696
does iliac crest bone grafting help in the treatment of clavicular non unions when compared to local autograft?
no
697
# define the origin of:
LABCTN
MABCTN
PANCTN
lateral= MCTN
medial= brachial plexus
posterior= radial
698
in femur fractures, are proximal or distal fractures more at risk for internal rotation deformities?
proximal; distal are more at risk for external rotation deformity
699
in a GSW with a known neurotmesis, what is the optimal time to repair?
1-3 weeks
700
what is the treatment for pagets disease
bisphosphonate therapy
701
what is bilateral Legg Calve Perthes disease indiciative of
multiple epiphyseal dysplasia
702
Placing the starting point for an antegrade femoral nail too anterior to the axis of the medullary canal can most commonly lead to what intraoperative complication
fracture of proximal segment due to increase in hoop stresses
703
when differentiating between charcot joint vs infection, what is the best test and why?
WBC bone scan;
but MRI is still best for detecting infection period
704
what are contraindications for UKA?
- valgus deformity \> 5 degrees
- Varus deformity \> 10 degrees
- inflammatory arthritis
- meniscial surgery in other compartment
- flexion contracture
705
which nerve has excellent recovery
which nerves have moderate recovery potentional?
which has poor recovery potential?
- radial, MCTN, femoral
- median, ulnar, tibia
- peroneal
706
what are two factors which increase stress shielding in femoral stem design?
- stiff femoral stem
- extensively porous coated stems
707
what is the mechanism of action of vancomycin?
The mechanism of action of vancomycin is binding to D-Ala-D-Ala moieties to inhibit bacterial cell wall synthesis.
708
which plate causes peroneal irritation in fibula fractures
lateral or posteriolateral
posterior
709
in MUA after TKA, what gains are best made?
with knees that dont flex completely (\<90degrees)
little gain made in extension
710
which concussion test is performed on field and which one is computerized and performed after?
SCAT5 and ImPACT
711
which total hip arthoplasty implants are associated with an increase in stress shielding?
- large femoral heads
- distal fit cobolt chrome femoral stems
712
where in the foot are ABCs commonly seen?
metatarsals
713
which type of chondrosarcoma presents with a fx
dedifferentiated chondrosarcoma
714
when is radial head resection an ok alternative to ORIF?
in the setting of a painful non-union
715
what is this disease
olliers disease
716
what is the translocation for rhabdoalveolarmyosarcoma
t(2:13)
717
in the hand and foot, what actions to the INTRINSICS control?
MCP/MTP FLEXION, and IP extension
718
what is the most common complication for surgical correction of duputrens?
hematoma
719
what is the AVN rate of scaphoid fractures no matter the treatment
15-50%
720
what values for lactate and base deficit = adequate resusciation
\< 2.5
in between -2 to +2
721
when treating scoli in CP patients, do you perform a routine preop MRI?
NO
722
in all forms of treatment of thumb CMC arthritis, which is the most important step and can be done alone
trapeziectomy
723
what are the risks for 2 incision fasciotomy
- AL = SPN
- PM = saphenous vein
- must detach soleus to enter deep posterior contents
724
what urine markers are elevated in Pagets disease of bone?
hydroxyproline & N-telopeptides, alpha-C-telopeptides
725
what are the ABIs and toe pressure needed to heal a diabetic ulcer
ABI \> .45
Toe pressure \> 60 mm hg
726
lateral arm flap
- post radial collateral artery
727
what is the cutoff for performing surgery on congenital trigger thumb
2 years old, unlikely to spontaneously resolve after that
728
how should small wound dehisence be treated in ORIF to calc?
which approach has less compications?
- pt, immobilization, non surgical mgmt
- sinus tarsi approach
729
what approach in TKA has been shown to lead to an increase in component malpositioning compared to the stanard mediaparapatellear approach?
quad sparing/subvastus
730
what are the contents of the anterior tibial tunnel
- EHL, EDL, dorsalis pedis artery
- deep peroneal nerve
731
732
what is congenital clasped thumb often seen in conjunction with
- congenital vertical talus
- congenital talipes equinovarus
- arthrogryposis
733
what does the spur sign indicate
both column tab fracture; intact ilium
734
in congenital pseudo of the tibia, what is the two treatment options
- if no fracture, then PTB brace or clamshell orthosis
- if fracture, then resect pseudo and fix
735
what is the most common complication of a extensor centralization realignment for saggital band ruptures
MCP flexion contracture
736
Lead toxicity affects growth by inhibiting which of the following growth factor
PTHrP
737
max ischemia times allowed for replant of digits
warm \< 12 hr
cold \< 24 hr
738
what does gauchers disease lead to an accumulation of, and how does it present orthopedically?
glucocerebroside; erlenmeyer flask (thinned cortices and bone pain)
739
in what part of the spine do GCT occur?
vertebral body NOT posterior elements
740
which gene regulates osteophyte formation in OA
indian hedge hog gene
741
following spontaneous avn of the navicular bone, which joints should be fused
talonavicular
navicularcuneiform
742
what is responsible for providing the tensile strength of bone?
compressive?
tensile = Type 1 cartilage
compressive = proteoglycans and calcium hydroxyapatite
743
for ulnocarpal abutment syndrome, when do you do shortening/wafer procedures, and when do you do ulnar hemiresection arthroplasties?
if DRUJ arthritis, must do resection arthroplasty,
if DRUJ is incongruent but not arthritis, may do shortening,
may do wafter procedure accompanied by DRUJ repair
744
when should you excise myositis ossificans
atleast 6-12 months, let it mature
745
Vitronectin is an important receptor involved in which of the following functions
osteoclasts attaching to bone
746
does sex affect the risk of peroneal nerve palsey in THA?
yes
women\> men
747
in the digital arteries, which side it the dominant artery on?
the medial side of the digit
748
what is the criteria for fragment excision and triceps advancement for olecranon fxs
elderly patients with LESS than 50% involvement
749
what is the treatment algorithm for revision THA/acetabular sided?
\>2/3 rim remaining = cup with screws \<2/3 rim remaining = graft plus recon cage pelvic discontinuity = triflange cup
750
what is the treatment for seymore fx
ABX, open reduction, removal of soft tissue, pinning, repair of nailbed
751
what gets entrapped in irreducible subtalar dislocations?
lateral--\> ptt tendon medial --\> extensor digitorum brevis
752
what is the most important factor in predicting lateral overgrowth after lateral condyle fracture
degree of initial displacement
753
how does gabapentin work?
stops the release of presynaptic chemicals by shutting down calcium channels
754
which direction are Cerebral palsey hip dislocations
755
where does the sartorius insert
on the pes anserine
756
in aging vs OA, describe Chondrocytes vs PG
PG decrease in both
Chondrocyte decrease in aging, but increase in sie
PG size increase in OA
757
increased abduction of the acetabular component leads to which type of dx?
post and superior
758
what layer of the physis does a SHI fx go through in a distal femur fracture?
MULTIPLE, not just zone of hypertrophy
759
what is the best surgical approach for the use of TEA in fractures?
triceps sparing
760
what foot deformity is ankle sprains associated with?
subtle cavovarus foot
761
what component adjustment in THA leads to an abductor lurch
decreasing femoral offset
762
what does the use of neuroaxial anesthesia help with in TJA?
decreased blood loss
763
how do you recognize chondromixoid fibromas? treatment?
stellate type cell, fibromixoid tissue, males, metaphyseal; curettage and grafting
764
what type of scapular winging is associated with preganglionic brachial plexus injury
medial due to rhomboid and serratus anterior paralysis
765
what does the AAOS recommend against for knee OA
accupuncture, braces, shoe inserts, glucosamine and chondroitin, needle lavage
766
when performing valgus producing tibial osteotomies in smokers, should one do a closing or opening ?
closing, less risk of nonunion
767
why does a rocker bottom deformity occur in failed clubfoot treatment
correcting equinus before varus
768
what is the protocol for non op patella fxs
wbat in extension
- flexion at 2-3 weeks
769
what muscles are effected in an AIN injury from an extension supracondylar fracture
FPL, FDP ring and long, pronator quadratus
770
which ligament provides support/sling for the scaphoid
radioscaphocapitate
771
if b/l sesamoid disease, what does that indicate
- Reiters, Psoriatic Arthirtis, RA
772
how do you treat claw toes
if flexible= EDB tenotomy, EHL lengthening, FHL to extensor
if rigid= the above + resection versus osteotomy (osteotomy for lesser toes)
773
what is the most common type of traumatic knee dx and what structures are injured
anterior
- PCL
- peroneal nerve injury
- intimal tear of the artery
774
what does endochondroma look like on histology
- blue gray lobulated hyaline cartilage
- hypocellular blue balls of cartilage
775
which type of tumor are people with Rothmund Thomspon syndrome predisposed to?
osteosarcoma
776
which ligament when disrupted leads to DISI deformity
scapholunate
777
describe the retro/anteversion patterns in:
FAI
SCFE
DDH
FAI= retroverted
SCFE- retroverted
DDH- anteverted
778
what receptor are all extra abdominal desmoid tumors positive for?
estrogen receceptor beta
779
what dorsal compartment is the PIN located in?
4
780
what is the benefit of dermabond vs suture repair of a nailbed?
quicker repair time ONLY
781
when does braking time return to normal after THA?
4-6 weeks
782
annealing PE =?
more free radicals (increased oxidation) but better mechanical properties
783
in flatfoot, what is strong?
weak?
peroneus brevis
post tib
784
which pins are more reliant on flouro to place; AIIS or iliac crest
AIIS
785
what does a mutation in TNSALP cause
hypophosphatasia
786
what the approach to open reduction of a hip fx in ped
posterior
787
where is the most common site for endochroma
the hand
788
which layer of the nerve provides extension of the blood brain barrier
the perineurium
789
what are the two treatment options for multiple myeloma of the spine?
- radiation for pain and no collapse
- kyphoplasty for COLLAPSE
790
where is the proper placement of radial head plating?
arc from radial tuberosity to listers tubercle with forearm in neutral
NOT past bicipital tuberosity to avoid PIN
791
what is the treatment for endochrondromas
- non op with serial xrays
792
what view is best to rule out joint penetration in tab perc fixation
obdurator oblique outlet view
793
why do you perform ateriography with suspected buegers disease
to rule out other diseases that mimic it
794
what tendons are interposed for tarsal coalition surgery?
- CN = EDB
- TC = FHL
795
what is the course of the superficial radial nerve?
seperate from the radial nerve after it pierces the two heads of the supinator and then travels alongside the dorsal aspect of the brachioradialis with the radial artery in the dorsal compartment
796
what is the Kocher interval for ORIF radial head?
anconeus and ECU
797
what is the operative criteria for radial clubhand?
- at what age(s)?
- must have elbow ROM and biceps to perform HAND CENTRALIZATION
- done at 6-12 months, with thumb recon done at 18 months
798
what type of alignment is a supramalleolar osteotomy used for in ankle arthritis
VARUS alignment
799
how do you treat hip sub/dx from an L3 myelodysplasia patient?
- nothing, observation only
NO surgery
800
what is the double density sign for a calc fx indicate
rotation of the LATERAL portion of the posterior facet
801
what is the histo of clear cell chondrosarcoma
large and vacuolated chondrocytes
802
in aging cartilage and disc, what happens to the ration of CS to KS
KS: CS increases
think alpabetical order
K is older than C
803
75% of LCPD patients have what issue?
coagulopathy
804
if you have AIN compression, what can also cause intrinsic weakness
martin gruber anastamosis
805
what is the criteria to use IV pamindrate in CP patients?
when Z score is \> -2.0
806
how do you treat a low median nerve palsey (loss of thumb opposition)
EIP to APB
807
describe serum ion concentrations after MOM implantation
ramp up period, then steady state
808
what percentage of sciatic nerve palsies recover after THA?
30-40%
809
what type of THA should be used to treat AVN; cemented or uncemented
uncemented
810
how does charcot foot differ in its care after total contact casting than regular diabetic ulceration
CROW walker, then DOUBLE rocker bottom soled shoes instead of single rocker bottom shoe
811
what are the indications for surgical treatment of scoliosis in Duchennes muscular dystrophy patients?
FVC \< 35%
Curve 20-30 degrees in non ambulatory patient
812
what is the time cutoff for acute vs chronic SL injuries
aka repair vs recon?
18 months
813
what is the lateral center edge angle that = adult hip dysplasia
\< 20 degrees
814
what is the radiograph view of choice for diagnosing a congenital vertical talus
forced plantar flexion lateral
815
what is the treatment for kohlers disease
a WALKING cast
816
what is the first step in treating congenital vertical talus and why?
- serial manipulation and casting
- to stretch the dorsolateral soft tissues
817
what is the order from most to least of HO risk for approaches for acetabular fractures
extending IF \> KL \> IO
818
what are they two nerves which can be damaged during the ilioinquinal approach to the acetabulum?
- LFCN
- Obdurator nerve
819
what % of uncoverage can you accept in THA for adult hip dysplasia
30
820
if you have a peroneal nerve palsey post TKA, how long should you wait until you get an EMG if it doesnt resolve
3 months
821
what is the most important variable for recovery in incomplete spinal cord injuries
severity of injury
NOT time to surgery
822
what pathway to NSAIDS block?
arachidonic acid to thromboxanes and prostaglandins
823
what is the treatment protocol for DDH
- \< 6 m/o = pavlik x 3 weeks, then brace if that fail
6-18 months = closed reduction and casting
\> 18 months = open reduction
2 y/o = open reduction and femoral osteotomy
4 y/o = open reduction and pelvic osteotomy
824
which ligament must you preserve in a PRC for tx of stage 2 SLAC wrist
radioscaphocapitate ligament
825
in Mult. Epi. Dysplasia, what is the most common joint affected, and how does it progress, and what is it's treatment
bilateral hips, often resolves by adulthood, THA if bad OA by 30 y/o
826
what is a risk factor for AVN following SCFE and treatment
inability to ambulate prior to presentation
827
which traumatic knee dx has the highest rate of popliteal artery injury
posterior
828
which zone of guyons canal does ulnary artery thrombosis affect?
zone 3
829
where is orthogonal plating usually performed in distal humerus fractures
POSTEROLATERAL and MEDIAL surfaces.
830
ankle scope portal, AC
dorsalis pedis
dont use
831
what is the minimum patella thickness needed to avoid fracture?
12 mm, must be \>12 mm
832
wartenbergs syndrome is compression of which nerve between which two muscles
radial sensory between brachioradialis and ECRL
833
in tibial deficiency, what are the operative treatments and when do you do each
- knee disartic = with no quad function
- syme = with quad function
834
how does shin splints show on bone scan compared to tibial stress fractures
diffuse longitudinal uptake in the posterior cortex
835
Which of the following structures are slowly adapting skin receptors that detect pressure, texture, and low frequency vibration and are best evaluated by static two-point discrimination
Merkels receptors
836
what is the most common complication of treatment of an intra-articular distal humerus fx through a posterior approach (with osteotomy)
25% loss of elbow strength
837
what factors lead to an increase in osteoclast activity in myeloma?
IL-6 and MIP-1A
838
in sacral agenesis, which is spared at the affected level; motor or sensory
sensory
839
in adults, what size cartilage cap of an osteochondroma can lead to increased risk of transformation
2-3 cm
840
what does baxters nerve innervate and what is its course
abductor digit minimi
anterior to medial tuberosity between QP and FDB
841
what is the action of acetominophen?
inhibits prostaglandin synthesis
842
what is this histo of?
low grade chondrosarcoma
843
how soon after an acute low back injury do most adults go back to work?
60% at 6 weeks
90% at 12 weeks
844
which AC joint ligaments are strongest?
2nd strongest?
which stability to they provide
posterior then superior
anterior to posterior
845
what is the treatment algorithm for MTP dislocation/instability
non op; then tendon lengthening plus capsular release, if not successful, then MT (weil) shortening osteotomy
846
what is the bleeding times seen in hemophilia?
prolonged aPTT
normal PT
847
in what week of utero does radius and ulna seperate
7th week
848
what is the inheritance pattern of duputryens contractures
Autosomal dominant
849
which is painful, adamantinoma or osteofibrous dysplasia?
adamantinoma
850
when do most VTE occur post op?
2-6 weeks
851
Which of the following statements about polytrauma and organ failure is most correct when comparing children to adults
adults have a more robust response, affecting the PULMONARY system first
852
what does the histology of PARosteal osteosarc show
- NORMAL trabeculae with spindle cells inbetween
- MDM2 amplification and Ring chromosomes
can confuse with fibrous dysplasia
853
using the distraction osteogenesis technique, how many MM per day do you lengthen
1 mm
854
what is a nromal lactate level?
\< 2.5
855
when do you treat UBCs with internal fixation
in fracture of PROXIMAL FEMUR
856
what is the most common EARLY cause of failure in patellafemoral arthroplasty?
LATE failure?
maltracking/instability
progression to arthritis of other knee compartments for late
857
what is the test to look for Fanconis Anemia
chromsomal breakage analysis
858
in tibial eminence fx, what is interposed?
medial meniscus
859
what is the treatment for ALL soft tissue sarcomas
wide surgical resection AND radiation
860
Differentiate between the 3 types of SMA
1: 3-6 months, 2 year life expectancy 2: 6-12 months, 5th decade of life 3: 2-15 YEARS, full life expectancy, wheelchair as an adult
861
how do highly congruent liners work in TKA?
they create a MEDIAL pivot point due to medial concavity
862
when do you operate on internal tibial torsion?
when \> 15 degrees internal rotation on foot thigh angle in \> 6-8 y/o
863
what is the appropriate amount of torque for halo pins in kids
1-5 lbs
864
how do you treat T/L kyphosis in Achon?
observe, normally resolves by walking age
865
what is the best approach to MCL recon
split the pronator mass and docking technique
866
which of the following would place branches of the femoral nerve and deep femoral artery at greatest risk during placement of the interlocking screw
A to P
BELOW the lesser troch
867
what is the strongest risk factor for compartment syndrome for the lower leg
age (12-19)
868
what is the treatment for SICK syndrome
pec minor stretching
869
when is a SPLATT utilized and how?
when there is a varus foot deformity in spastic cases
splits the ATT and puts the lateral half to the lateral cuboid
870
what determines the apex direction in middle phalanx fractures
relationship to FDS insertion
- distal = volar
- prox = dorsal
871
what are the benefits of perc screw fixation in scaphoid fxs?
what is the complication associated with them?
faster time to union in prox pole fractures
- penetration into subchondral bone
872
in supination what is strong?
weak?
ant tibial
- peroneus longus
873
what can GCT transform to?
malignant fibrosarcoma
874
what is the difference between SYT-SSX 2 vs SYT-SSX1
fewer metastases,
monophasic histology,
a better prognosis,
and lower incidence.
875
when do you threat hypothenar hand syndrome OPERATIVELY?
- thrombosis only \< 2 weeks = endovascuar fibrinolyitcs
- thrombosis plus aneurysm = ligation if DBI GREATER than .7
- excision and recon = DBI \< .7
876
what are the 2 types of carpal instability nondissociative
- radiocarpal
- midcarpal
877
in down syndrome, what is the normal ADI, and how much motion is tolerable
\<5 mm
5-10mm
878
which direction is a CP hip dislocation
posterior and superior
due to the pull of adductors and flexors
879
fasciculations are a sign of upper or lower motor neuron disorder?
lower
880
which immunoglobulin does RF targe in rheumatoid disease?
IgG
881
when do you non op scaphoid fxs and how do you treat them?
\< 1 mm displacement and no deformity
LAC vs spica for atleaste 8 weeks
882
what does congenital BILATERAL hallux valgus usually indicate and what gene is defective?
Stone mans disease
gain-of-function mutation in the ACVR1 protein
883
when do you perform a distraction arthroplasty for ankle OA
- young patient with good ROM
884
what drives the formation of PVNS
overexpression of CSF-1
885
what are the indications for hemi or rTSA in proximal humerus fractures?
highly comminuted fractures,
a compromised rotator cuff, articular surface disruption,
a short metaphyseal hinge,
initial varus angulation \> 20 degrees,
and fracture dislocation
886
what is the difference between CRPS type 1 vs type 2?
type 2 = known nerve injury
887
what is a potential complication of total ankle arthroplasty
syndesmotic non-union
888
what type of limb deformites are seen in MHE
valgus deformities
889
which area of the spine has the lowest ratio of cortical to cancellous bone
the sacrum
890
which bacteria stain purple and why?
Gram positive; the cell wall is resistant to the solvent which would wash away the purple dye
891
what view is helpful in determing L5 nerve root avoidance when placing an SI screw
LATERAL
892
what is heel triad pain?
- PTT deficiency, tarsal tunnel syndrome, plantar fasciitis
893
which has the highest rate of H.O. of all acetabulum approaches?
the extended iliofemoral
894
what tumors are treated with CHEMO + resection
MEDO
malignant fibrous histocytoma
ewings
dedifferentiated chondrosarc
osteosarc
895
what medication has been shown to decrease osteolysis after TJA?
bisphosphinates
896
describe the safe zone for halo pin placement
- OTS from medial to lateral
- supraorbital, supratrochlear, SAFE
897
what type of DMARD is Rituximab?
anti CD20 B cell monoclonal antibody
898
what causes compression of baxters nerve
the lateral plantar nerve, a branch of the tibial nerve,
is compressed by the abductor hallucis and medial side of the quadratus plantae
899
what is the age cutoff for recasting a failed clubfoot
2 years old
900
what makes up the biceps sling and is damaged in biceps subluxation
- supscap, supraspinatus, coracohumeral ligament, and superior glenohumarl ligament
901
which race receives TJA the least?
black males
902
what are tyrosine kinase inhibitors used for?
imatinib (Gleevec) for chronic myelogenous leukemia
gefitinib (EGFR inhibitor, Iressa) for lung, breast cancer
erlotinib (EGFR inhibitor, Tarceva) for NSCLC and pancreatic cancer
903
what are the hand intrinsic muscles innervated by the ulnar nerve
- adductor pollicis
- interossei
- 4th and 5th lumbrical
- deep head of FPB
904
how does Clindamycin work
blocks 50s subunit
905
what type of gait is classified by rectus femoris firing out of phase during SWING phase
stiff knee gait
906
soleus flap
- middle third of tibia
- 3 arteries (peroneal, PT, popliteal)
907
what are the two muscles the compress the lateral plantar nerve/baxters nerve
- abductor hallucis longus and quadratus plantae
908
What is the inheritance pattern of endochondromatosis?
none
909
in tibial tubercle fractures requiring surgery; CRPP vs ORIF?
ALWAY ORIF to address intra-articular pathology
910
what is the location of the peroneal longus compared to brevis?
LIPS
long is posterior and superior at lat mal
- inferior at calc
911
what is more common in JRA: RF + or -
Negative in 85%, but (+) is associated with worst outcomes
912
which pathology has a higher rate of neurologic injuries: AS or DISH
AS
913
what is the first muscle to come back after a radial nerve palsy
brachioradialis
914
how do you distinguish between hook of hamate fracture vs pisiform fracture
hook of hamate = big extension and higher up
pisiform = lower and a small protrusion, more normal bone like
915
how do you treat Type II and III bunionettes?
either distal chevron osteotomy (if IM \< 12 degrees) or oblique osteotomy (if IM \> 12 degrees) But NEVER proximal osteotomy
916
what percentage of traumatic arthrotomies are identified with 155cc injections?
175 cc?
94%
99%
917
what is required in the workup of alveolar rhabdomyosarcoma
bone marrow biopsy
918
of the 2 tibial tubercle ossification centers, which is the last to close?
primary/proximal
or
secondary/distal
secondary/distal
919
what else is zone 3 5th MT fractures associated with?
cavovarus feet and sensory neuropathies
920
in what type of arthritis is oncholysis and pitting of the nail seen
psoriatic arthritis
921
in distal femur periprosthetic fractures, what is the difference between lateral locked plating vs IMN
lateral lock plating has equal non union but LESS malunion
922
what may also need to be released in recurrent trigger finger?
A0 pulley
both of FDS
A3 pulley
923
describe pediatric fractures and non union patterns
Fractures and Humeral Deformity:
- Pediatric proximal humerus fractures: Risk of varus malunion, causing late impingment.
- Humeral shaft fractures: Risk of varus malunion, generally well tolerated.
- SCH fractures: cubitus varus due to malunion, or less commonly, cubitus valgus due to malunion (tardy ulnar nerve possible complication)
- Peds distal humeral physeal seperation: cubitus varus due to medial condyle AVN (since dislocation usually posteromedially)
- Lateral condyle Fracture - Cubitus valgus due to nonunion (tardy ulnar nerve palsy)
- Medial condyle Fracture: no relationship w/ elbow deformity. Hence why we accept relatively large amounts of displacement
924
what do you need for a syme amputation
post tibial artery
925
what is the interval for the ant. approach to the hip?
TFL and Sart
Glut med and rect. femoris
sup gluteal nerve and femoral nerve
926
what tendon transfer is used in cavovarus correction
peroneal longus to peroneal brevis
927
what is the ABI to indicate a vascular injury?
\< .9
928
when is the only time you use a dorsal ORIF approach?
- in a displaced proximal pole fx
NOT w/ humpback deformity or waist fxs
929
what approach is best utilized to deal with medial wall comminution/quadalateral wall
modified stoppa approach
930
what two ligaments are disrupted in VISI deformity
1- lunotriquetral IO ligament
2- radiotriquetral
931
which metatarsals should be included in standard lis franc fixation with no lateral column instability
1, 2, and 3
932
how do you treat thumb defects and what are the size cutoffs?
- moberg advancement \< 2 cm
- FDMA \> 2 cm
- NV island flap \> 4 cm
933
what structures block reduction of a:
lateral subtalar dx
medial subtalar dx
- T D and Harry
- EDB, peroneals, talonavicular joint capsule
934
what are 3 risks during THA for hip dysplasia
- component loosening
- dislocation
- sciatic nerve palsy
- 30% non union w/ subtroch osteotomy
935
what is the most important band of the forearm IOM
the central band
936
at the carpal tunnel, what is the relationship of the median nerve to the FCR?
immediately ULNAR
937
which study design is prospective and which is retrospective between
case controls
and
cohort
cohort= prospective
case control = retrospective
938
in pediatric patients with scoliosis due to a bone lesion, how do you distinguish between OO and OB?
size and pain- OB is larger and usually painLESS
939
when is the superficial peroneal nerve at risk?
- ANTEROlateral arthroscopic ankle portal
- ORIF Weber C
- inversion ankle injuries
940
what are risk factors for failure of graft with ACL recon with hamstring autograft?
size \<8mm
age \< 20 y/o
941
in perilunate dx, how is the SL angle affected?
increased
- \> 70 degrees
942
in patients with elbow flexion contractures post obstetric injury, what is the cutoff for serial night time splinting vs casting?
\<40 degrees = splinting
\>40 degrees = casting
943
what is the interval for a medial meniscus inside out repair?
retract the sartorious, retract semit and gracilus, retract medial head of gastroc medially
944
what is the treatment for intrinsic plus hand?
stretching
- operative: muscle belly slide vs intrinsic release
945
what type of cartilage is xyoflex good for?
type I and III,
but does NOT hurt type IV which is in the basement membrane of the NV bundles
946
what is transfer metatarsalgia in hallux valgus surgery and how is it treated
shortening of the 1st metatarsal too much
weill shortening osteotomy w/ extensor tendon release
947
what antibiotic can be used to treat osteo from a nail puncture wound
ceftazidime
pseudamons coverage
948
in pediatric elbow dislocations, what are the most common fractures and what is the most common nerve injury
medial epicondyle
ulnar nerve
949
in an olecranon fracture in an elderly osteoporotic patient, how much of the olecranon can be excised without sacrificing stabilty
40%
technically 50-70%
950
what innervates the ECU?
the PIN
not ulnar nerve
951
name 3 characteristics of adult dyplasia of the hip
- coxa valga
- femoral anteversion
- posterior displacement of greater troch
952
what are the loads to failure for different ACL grafts
BTB- 2600 (vs 1725): Quad Ham- 4000 (vs 1725)
953
when should you perform tendon tenolysis after flexor tendon repair when adhesions occur?
4-6 months
954
what is the AJCC staging system based on
- Grade
- Size
- Nodes
- Mets
955
what are the differences between medial vs lateral talar OCD lesions
medial = no trauma, larger, less symptomatic
lateral = smaller, trauma history, more central, don't heal
956
what disease of the bone may be caused by viruses?
what are the viruses?
Pagets
RSV and PMV
957
what Sanders/Tanner Whitehouse phase is associated with the most spine growth/peak curve
3
958
what is the most common source of ganglion cysts in the wrist
DORSAL SL interosseous ligament
959
in which patients is a distraction interposition arthroplasty of the elbow appropriate
young, laborers with end stage arthritis who otherwise would get a TEA if they were older
960
which conditions often present with absent cruciate ligaments of the knee?
- fibular hemimelia
- proximal femoral focal deficiency
961
Sclerostin and dickkopf-1 (Dkk-1) are direct inhibitors of what pathway related to bone and/or cartilage regulation
wnt/beta catenin pathway
962
what is the imbalance in claw hand and resulting deformity?
weak intrinsics and strong extrinsics
- MCP extension, IP flexion
963
what are the landmarks in the cervical spine for an anterior approach
Hyoid- C3
Thyroid- C4-5
Crycoid- C6
964
what is the position of hip fusion
20-35 degrees of hip flexion
0-5 degrees adduction
5-10 degrees of external rotation
965
when treating intra articular distal femur fractures, what view is best to check for screw violation into the joint?
A/P of the knee with 30 degrees of INTERNAL rotation
966
which FD tendon has nodules on it in trigger finger
FDP
967
what is the least thickness of PE allowed to prevent poor wear/failure
8 mm
968
how long after a RTC repair can you initiate formal muscle strengthening of ANY muscles around the shoulder
6-8 weeks
969
what pediatric conditions associated with hip dx are usually treated non op
bilateral dx in ARTHROGRYPOSIS
myelodysplastic hip dx
970
what can be added to methotrexate to help treat RA?
doxycycline
971
which nerve injury involves endoneurium injury
- neurotomesis
972
what injury is common in dancers with delayed menarche
a second metatarsal base fracture
973
in the thumb, what nerve runs closest to the A1 pulley
radial digital nerve (2.4mm away)
974
how does factor V leidin hypercoaguability work?
Factor V assists in the clotting cascade, protein C inactivates it. In factor V leidin, the factor V is alters and protein C can NOT bind to it and inactive it
975
what type of hypersensitivity is seen in metal allergias in TJA
delayed Type 4
- use titanium as it does not contain nickel
976
what is the operative criteria for pelvic ring fractures in children?
over 2 cm displacement
instability alone (i.e type 4) injury is NOT enough to require operative intervention
977
what is used to prevent cardiac toxicity in doxirubicin administration
dexrazoxane
978
what is the cause of dorsal bunions in clubfoot correction?
pull of tib ant and FHB with weak PL
treat with tib ant lengthing, FHL transfer to plantar aspect of MT head
979
what motion causes peroneal tendon subluxation
DORSIFLEXION and EVERSION
980
what is the treatment for spindle cell sarcoma?
how does it look on histology?
- same as osteosarc: neoadjuvant chemo, wide resection, chemo
- storiform pattern
981
treatment for distal femoral fractures in peds?
- smooth k wires if crossing physis
- lag SCREWS in rest
982
from medial to lateral, describe the muscles of the posterior compartment of the mid thigh
gracilias, adductor longus, adductor magnus, semimembranosous, semitendonosis, biceps femoris (long), biceps femoris (short)
983
what are the reversal agents for Coumadin
Vit K (2-3 days)
FFP= immediately
984
what are FAK and Erb2 examples of
oncogenes
985
how long must you wait post procedure to remove heterotopic ossification
6 months
986
what is the blood supply to the abductor digiti minimi, and what can it also be used for?
ulnar artery; pedicle flap
987
what is one determinant to going anterior or posterior for burst fractures
level of injury
L1 or higher = anterior
988
what are the outcomes of nonop mgmt of 1 part proximal humerus fractures
- \>90% union
- decrease ROM
- return to baseline functional status at 1 year
989
in what Zone is an FDP injury and repair done that causes quadrigia
Zone 1
990
name some associated conditions with osteopetrosis
CN palsies, anemia, coxa vara
991
in kids, what are the 1st and 2nd most common primary bone malignancies?
soft tissue?
- osteosarc THEN ewings
- rhabdomyosarcoma
992
at what percentage of bone loss does osteopenia become evident on radiographs
40%
993
what is the role of glucagon, and is it anabolic or catobolic
maintain blood glucose by MOBILIZING nutrients stored in tissue
- catabolic
994
what is the treatment for ACUTE talar osteochondral defects
- non op \< 1 cm
- surgical fixation \> 1 cm
995
which is the last physis to close in the tibia?
the tibial tubercle which is physis #2
- proximal to distal
996
what is the interval to the posterior approach to the proximal radius (Thompson approach)
extensor carpi radialus BREVIS, EDC
997
what are the deforming forces in a Rolando fracture?
abductor pollicis longus and adductor pollicis
998
what is the earliest radiographic finding of pediatric discitis/osteo
loss of lumbar lordosis
999
which is the only elementary tab fracture to involve both columns
transverse
1000
in charcot foot, which 2 types of footwear should be utilized after total contact casting and in what order?
CROW walker
- then DOUBLE rocker bottom
1001
which structure is at risk during PCL repair, especially with the knee in extension?
popliteal artery
1002
misplacing the femoral tunnels in an ACL recon and in what direction causes what types of instability
Anteromedial too = Anterior drawer (A/P instability)
Posteriorlateral = Pivot shift (rotational instability)
1003
what is the most common nerve injury in montaggia fractures?
PIN injury
1004
what is the surgical treatment for pseudotumor formation
revision to ceramic on poly components
1005
if you cut the MCL during TKA, what is treatment?
suture repair of MCL, normal PS knee implantation, hinged brace x 6 weeks
1006
name the gene mutation in Achon and what part of the physis it affects
FGFR3, proliferative zone
1007
what is this histo of?
Eosininophilic granuloma
1008
what percentage of children with spondylolisis progress to spondys and/or need surgery
15%
1009
tx for pronator syndrome
non op for 3-6 months (splinting)
- surgery after failed non op: release in all 5 places
1010
what affect do bisphosphinates have on spinal fusion
decreased rates of fusion
(large fusion mass but less fusion rate)
1011
in the acute phase of buegers disease, what are the two types of cells involved
neutrophils and giant cells
1012
who gets knee OA more; men or women
women
1013
what is the proper dose of vitamin C to prevent CRPS
500 mg x 50 days
1014
which portal in hip arthroscopy puts the sciatic nerve at risk, and is internal or external rotation worse?
posterior
EXTERNAL rotation
1015
what is the product of rtPCR?
DNA
just like regular PCR, but uses mRNA as a starting point
1016
which is a dominant supressor and which is a recessive suppresor in:
P53
RB
RB = recessive
P53 = dominant
1017
5 sites of compression for pronator syndrome (median nerve compression)
1. Supracondylar process
2. LIGAMENT of struthers
3. Lacertus fibrosis
4. Ulnar and Humeral heads of PT
5. ) FDS aponeurotic arch
1018
treatment for cubital tunnel
- night splinting in 45 degrees of extension
- effective in 50%
1019
which abx to give with leech therapy
cipro or bactrim
1020
besides cosmetic deformity, what can cubital varus be associated with?
posteriorlateral elbow instability
1021
what is elsons test?
testing rupture of sagital bands vs central slip
- if DIP is floppy--\> sagital band rupture, central slip in tact
- If DIP extended--\> sagital bands intact, central slip ruptured
1022
Which antibiotic acts to inhibit protein synthesis by preventing the formation of the initiation complex between the 30S and 50S subunits of the ribosome
linezolid
1023
which type deformity is common after SH1 and 2 ankle fractures in peds?
external rotation
1024
what is the most worrisome complication in flexor tendon recon with a triple loop technique
phalangeal fracture
1025
what is preaxial polydactyly and which race is it more commonly seen
duplicated thumb; whites
1026
for a coronal sheer fracture of the capitellum, what is the proper surgical approach
supine with a lateral extensile approach
between the triceps and brachioradialis/ECRL
1027
which chondrosarcomas require adjuvant chemo?
mesenchymal chondrosarc
dedifferentiated chondrosarc
1028
what is the complicataion for all around pulley repairs?
prox phalanx fractures
1029
which portion of the DISI/ SL ligament is strongest
dorsal
1030
what is tested for in allograft tissues?
Hep B, C, HIV, and syphilis
1031
how long must you wait to excise HO after THA?
6 months
1032
children with this defect have a severe anaphylactic IgE mediated response to latex
myelodysplasias
1033
order of replant components in hand
bone, extensor tendon, artery, vein, flexor tendon, nerve, skin
1034
what is the difference between sacral agenisis and myelodysplasia in terms of sensation
sacral agenesis RETAINS sensation, myelopdysplasia does not
1035
following flexor tendon repair, what is the cutoff for scar size for resection vs grafting
1 cm
1036
surgery for cubital tunnel
cubital tunnel release +/- ulnar nerve transposition
- transpose in kids, athletes, and w/ snapping nerve
1037
in cauda equina, what is a poor prognosis preop?
loss of bladder, may or may NOT recover
1038
which supplements increase bleeding?
gingko, ginseng, garlic
1039
what is the difference in contracture correction at 1 day post collaganase injection vs day 7 manipulation
no difference
1040
which is a predictive indicataor in calc fractures that a patient will need a secondary subtalar fusion?
male work comp laborer with a bohler angle of 0
1041
which two conditions are associated with ACL deficiency
fibular hemimelia and proximal femoral focal deficit
1042
rank the effects of smoking on spine surgery from greatest to least
no smoking \> post op cessation \> preop cessation
1043
in chronic achilles tendon rupture, what is the cut off for VY advancement vs recon
2-5 vs \>5 cm
1044
if a diabetic ulcer is able to be probed to the bone, what % of them have osteomyelitis
60-70%
1045
what are the two criteria/cutoffs for treatment of OCD lesions of the talus?
size= 1 cm is cutoff
the presence of cartilage cap vs no cap
1046
how does vancomycin resistant bacteria achieve its resistance
altering a peptidoglycan unit
1047
what is the mainstay to treat DMD
corticosteroids (.75mg/kg/day)
1048
where does the AIN emerge
4-6cm distal to medial epicondyle
- travels between FDS and FDP and then between FPL and FDP
1049
what is olliers disease and what are its features
multiple enchondromas
- shortened and bowed bones
- 30% malignant transformation into chondrosarc
1050
name each muscle
1051
what percentage of sickle cell patients with avn on MRI go on to femoral head collapse
\> 75%
1052
what staging system best predicts the acceleration growth phase of the spine when evaluating scoli growth potential?
tanner whitehouse
1053
what are the two most important points for long term outcomes when fixing tibial plateau fractures
1- Joint stability
2- joint alignment
1054
in total ankle arthroplasty, how does one prevent future medial mal fx?
preventative pinning of medial mal
1055
what is the most common femoral stem intraoperative fracture seen
press fit in lateral approach
- due to underreaming
1056
what is the most important prognostic factor for nerve recovery
age
1057
what is the order of release for Valgus knee in TKA?
1. ) ostephytes
2. ) Post lat capsule
3. ) Popliteus vs IT band (pop = tight in flex, IT in ext)
4. ) LCL
1058
1059
after a GSW nerve transection, how long should one wait to repair the nerve directly
1-3 weeks
1060
what fusion gene products are seen in alveolor rhabdomyosarcoma
PAX3-FKHR and PAX7-FKHR
1061
what is the cutoff for acute vs chronic mallet finger injuries?
12 weeks
1062
when performing and arthroscopic SLAP tear repair, which nerve can be injured passing an instrument medial to the glenoid
suprascapular nerve
1063
in thumb base fxs, what is the result of excessive angulation?
hyperextension at the thumb MCP joint
1064
non op treatment for intraop acetabular fx
8-12 weeks PWB
1065
what is the constant fragment in a calc fracture
the sustantaculun tali; part of the anteromedial fragment
1066
which arthroscopic hip portal will lead to LFCN issues?
Anterior
NOT anterolateral
1067
what does endurance training do to tendons such as an achilles tendon
net increase in type 1 collagen
decrease in collagen crosslinks
1068
after a THA of the Right hip, how soon can one return to driving, and how quickly does reaction times return to preop levels?
- 3-4 weeks
- 4-6 weeks
1069
what is the max ischemia times allowed for replants prox to wrist?
warm \< 6 hr
cold \< 12 hr
1070
1071
Pagets is a disase of what cell?
osteoclasts
1072
what is the interval for TAA
EHL and tib ant
1073
where to you make the PM portal for ankle scope and what is at risk?
just medial to achilles
post tibial artery
1074
describe the relationship of the digital arteries to the nerves in the:
palm
digits
in palm- volar to nerves
in digits- dorsal to nerves
1075
what can be injured when drilling/screwing for calc fractures?
FHL; medial to posterior facet and inferior to medial facet
1076
what is the pathogenesis of ITOH
hyperemia = decreased venous outflow = increased IM pressure
1077
what is the operative criteria for central metatarsal shaft fractures
\> 4 mm translation
\> 10 degrees of sagittal deformity
1078
what affect does glucagon have on skeletal muscle
catabolic
1079
in elbow arthroscopy, which nerve is at risk in the proximal anterolateral portal?
radial nerve
1080
what nerve is at risk in a single incision lateral approach for fasciotomy for compartment syndrome
COMMON peroneal
not superficial
1081
how do the ratios of proteoglycans change in articular cartilage in age vs OA
age= KS:CS
OA= CS:KS
1082
how do you treat teratologic hip in Arthrogryposis
open reduction with femoral shortening osteotomy;
bracing and closed reduction do NOT work
1083
when do you operate on DIP fx/dx?
after 2 failed reduction attempts
- open and remove volar plate and fix FDP
1084
joint reactive forces are balance between what two forces
weight and abductor pull
1085
what is the most common soft tissue injury for shoulder dislocations below 40?
above 40?
\< 40 = ant inf labral tear (THEN subscap)
\> 40 = RTC tear
1086
who is more likely to develop a sciatic nerve palsy in THA; men or women
women
1087
which leg is usually involved in EXTERNAL tibial torsion?
what is the cutoff for surgery?
right leg
\>40 degrees over 8 y/o
1088
remelting PE =?
decreased free radicals but DECREASED mechanical properties
1089
in preaxial polydactyly, what are your 2 surgical options
- combination of both digits into 1
(DO THIS FOR TYPE 2 aka duplicated DP)
- comb + ablastion of lesser (usually radial) digit
1090
how do you test for a fixed posterior shoulder dislocation
lack of external rotation
1091
what makes up the acetabular tear drop, and when does it appear in normal hips?
quadralateral space and cotyloid fossa: 18 months
1092
when performing adductor releases for CP hip, what should you avoid and what is the complication if done
obdurator neurectomy--\> abductor contracture
1093
who is more likely to dislocate after a primary THA;men or women
women
1094
what are the recurrence rates for ganglion cysts based on treatments?
observation = 75% resolve in KIDS
aspiration = 50% recurr
surgery= 20% recur in volar cysts
1095
1096
if you accidently remove a soft tissue sarcoma and find out later that it is a sarcoma, what is the next best step in treatment
IMAGING
not wide surgical exision just yet
1097
describe the volumes and corresponding percentages for the saline load test
110 - 75%
145- 90%
155- 95%
175- 99%
1098
what is the most common vascular injury with scapulothoracic dissociation
subclavian artery
- axillary artery is second most common
1099
what conditions is radial clubhand also associated with?
- holt/oram
- fanconis anemia
- VACTERL
- VATER
1100
sterilization of PE is done how?
gamma radiation (higher doses are better)
1101
when should you not do RFA for osteoid ostoma/osteoblastoma
near the skin, nerves (fingers), and spine
1102
which pulley is the most important in the thumb?
the oblique pulley
1103
what molecules are found in ankle synovium after pilon fractures that may contribute to chondrocyte death and POA?
il-6 and MMPs
1104
what is the order for trigger finger release
A1 pulley, FDS ulnar slip, A3 pulley
but A3 then FDS in kids
1105
can you treat volar DIP dx with buddy taping like dorsal ones?
NO, need extension spliting
1106
when the thumb UCL is torn, what is the pathoanatomy?
torn off the prox phalanx
1107
which gene is lacking spinal muscluar atrophy
SMN1
1108
in a patient presenting with rickets like stature and BAD dentition, what disease is likely?
hypophosphatasia
1109
where is the sural nerve most commonly entrapped
12-15 mm DISTAL to the tip of the fibula
1110
what is the proper way to test MCL injuries
at 30 degrees flexion (superficial MCL only)
and full extension = associated cruciate ligament injury as well
1111
what is the pathophysiology of renal osteodystrophy
damaged kidneys =
decrease Calcium due to inability to convert Vit D to calitriol
hyperphosphatemia due to inability for kidney to get rid of phosphate
(uremia related phosphate retention is key step)
1112
what is the optimal position for ankle fusion
neutral dorsiflexion
5-10° of external rotation
5° of hindfoot valgus
5 mm of posterior talus translation
1113
what is the most important stabilizer of the shoulder with the arm in flexion and internal rotation
POSTERIOR band of the IGHL
1114
operative measures for an intraop acetabular
screws
jumbo cup
ORIF if post wall unstable
1115
1116
what is the correct age to perform a tib ant transfer to treat dynamic supination following clubfoot casting and why?
4 y/o
that is when the cuboid ossifies
1117
when does the remodeling phase of tendon healing start
\> 28 days
1118
what is the most common failure for meniscial transplant
late graft failure due to acellularity
1119
what is the antagonist to the anterior tibialis
peroneus longus
1120
what is the most common metatarsal injured in adults?
kids?
5th metatarsal in adults
1st metatarsal in kids
1121
what is the tendon transfer to correct claw fingers
ECRL/B/PL to A2 pulley
1122
describe the ossification center timing about the elbow
CRMTOL
1,3,5,7,9, 11
1123
in chronic osteomyelitis, which is the new outside bone?
which is the walled off infectious bone?
- involucrum
- sequestreum (small sequestered bone)
1124
what can be injured in INFIX placement
femoral nerve or LFCTN
1125
which artery is the main supply to the humeral head? is it larger or smaller on ateriogram
posterior humeral circumflex; larger
1126
what is the difference between IV-A and IV-B tumors?
IV-A= pulm mets
IV-B= other distant mets
1127
what is the treatment for a solitary plasmocytoma?
radiation
1128
what is giant cell tumor of hand histologically similar to?
PVNS,
NOT Giant cell tumor of bone
1129
what is the age cutoff for thenar flaps
30 y/o
1130
how much width should remain after saucerization of a discoid mensiscus?
6-8mm
1131
what does synovial sarcoma stain (+) for?
vimentin
epithelial membrane antigen
sporadic S-100
epithelial cells stain positive for keratin
1132
what is the best way to prevent HO?
700 gy given 4 hours preop or 72 hours post op
1133
what is the reverse pivot shift testing for, and describe it
for a PLC (posterlateral corner injury) NOT PCL
Flex knee to 90, tibia dislocates Posterlaterally
then apply valgus, ER force and extend knee
IT band goes from flexors to extendors
1134
what is this a gram stain of?
s. aureous
gram + in a 'bunch of grapes" clusters
1135
how long should you wait to use a shoe lift after a THA?
6 months
1136
what is the treatment for Kienbochs disease with NO collapse
- joint leveling procedure
- radius core decompression
1137
where is the medial circumflex artery and where is at risk?
- underneath the glut max tendon
- quadratus femoris
1138
which ligament is disrupted in VISI deformity?
dorsal radiotrequetral
1139
where is the most common location for a scaphoid fracture in adults?
kids?
waist (65%)
distal pole in kids
1140
which approach to tab fx has in increased risk of sciatic nerve injury and damage to medial femoral circ artery
- kocher langenbach
1141
ankle scope portal; PM
just medial to achilles tendon
- post tib artery
1142
in congenital vertical talus, what is the best bone to measure the talar navicular relationship before the age of 3 and why?
- the 1st metatarsal
- the navicular doesn't ossify until 3 years old
1143
what syndrome is Madelungs deformity often seen and what gene is affected
Leri-Weil Dyschondrosteosis
SHOX gene
1144
1145
in DISI deformity, which was does the scaphoid go?
which way does the lunate go?
- scaphoid = flexes
- lunate = extends
1146
which meniscus is often injured in tibial eminence fractures?
MEDIAL meniscus
1147
what two pediatric diseases benefit from bone marrow transplants
- Mucopolysaccoridosis (+ gauchers)
- Osteopetrosis (add in calcitriol)
1148
what must you preserve in a proximal row corpectomy?
radioscaphocapitate ligament
1149
what is surgical treatment options for a digital artery aneurysm and what does it depend on
ligation vs interpositional grafting
- COLLATERAL CIRCULATION
1150
which is the greatest predictor of a future fragility fracture?
- history of a PRIOR fragility fracture
especially an vertebral compression fracture
1151
what are the 5 steps of evidence based medicine
1) formulate an answerable question,
2) gather evidence,
3) appraise the evidence,
4) implement the evidence,
5) evaluate the process to determine the efficacy of the proposed treatment
1152
what is the treatment for a distal humerus physeal seperation in peds
CRPP + arthrogram
- Posterior approach
1153
in flexor tendon pulley reconstruction, which 2 are the most important to reconstruct and how so?
A2 is most important--\> triple loop deep to extensor mechanism
A4--\> double loop SUPERFICIAL to extensor mechanism
1154
what is the non op vs operative criteria for lateral condyle fractures in peds?
\< 2 mm = non op
2-4 mm = CRPP
\> 4 mm = ORIF
1155
what condition presents with a flat acetabular roof in peds?
achondroplasia
1156
describe the zones of the guyon canal
zone 1- motor and sensory
zone 2- (medial) and motor
zone 3- (lateral) and sensory
1157
what is the percent risk for avn following Peds femoral neck fracture?
20-30%
1158
what are two ways to differentiate adamantanoma vs OFD
age and pain
both higher in ADAMANTONOMA
1159
what are the two complications seen in TJA with pagets?
THA= excessive bleeding
TKA= malalignment
1160
what does "pubic" and "obdurator" mean in reference to each other
pubic = superior
obdurator= inferior
1161
what type of scoliosis is seen in Ehlers Danlos Syndrome
kyphoscoliosis
1162
how do you distinguish infract vs osteomyelitis in sickle cell
- MRI w/ Gad on T1
- Bone scan
1163
1164
what are the 3 most important criteria for operative options for a talar OCD lesion
1. ) subchondral bone (can fix)
2. ) cartilage cap (can't violate when drilling, also if gone and \> 1cm, must transplant)
3. ) size (1 cm cutoff)
1165
what % of threads should cross the physis in SCFE pinning?
40-60%
1166
what are the attachments of the transverse carpal ligament
scaphoid and trepezium
hook of hamate and pisiform
1167
what makes up the rotator cable and crescent
fibers of the supra and infra
1168
where do you make the PL ankle scope portal and what is at risk
located 2cm proximal to tip of lateral malleolus
medial to peroneal tendons and lateral to achilles tendon;
the sural nerve and short saphenous vein
1169
what causes midflexion instabiliy in TKA?
modification of the joint line
- full revision usually needed
1170
on a carpal tunnel view, how can you tell the difference between a hook of the hamate and pisiform fracture?
Pisiform is HIGHER and sticks out more than hook of hamate
hook of hamate is sharper, pisiform is more round
1171
what is the hallmark of AIN compression?
MOTOR deficits only
1172
what is the most common reason for need for revisions in TAA
SYNDESMOTIC non union
1173
when do you perform an EMG for brachial plexus injury
no later than 3-6 weeks
1174
how do you differentiate tumor calcinosis from other calcinonsis diseases?
- lobular
- NOT intraarticular
1175
what is the cause of tissue injury in frostbite?
- decrease in prostaglandin E2
- increase in prostaglandin F2A and Thrombin B2
1176
what do lateralized liners in THA increase the risk of?
component/acetabular loosening
1177
activation of which receptor stimulate adenylyl cyclase?
PTH
1178
what is the only difference in TJA with patella resurfacing vs not resurfacing
- decreased reoperation rate in resurfacing
1179
when is a troch osteotomy useful?
exposure of the acetabulum and removal of components in revision surgery
1180
why is there a high rate of VTE in sarcoma patients
tumor activation of X to Xa
1181
What is the Bridle procedure and when is it used?
PTT transfer to lateral cuniform, foot drop
1182
what makes up the corona mortis
1- external iliac
2- obturator
3- inf. epigastric
1183
what is the moderate AAOS recommendation for knee OA
weight loss
1184
mets to areas distal to the knees and elbows are most commonly from what types of cancer?
lung and renal
1185
when is pinch strength expected to return following carpal tunnel release
12 weeks
1186
lowering the joint line in TKA leads to what
- lack of full extension
- flexion instability
1187
what are the two most important factors in predicting septic arthritis in peds?
fever and CRP
1188
how far from wrist joint is the cutoff for radial shaft fractures with DRUJ injuries usually
7.5 cm
less than 7.5 cm = 55% DRUJ unstable
1189
what is the pathology of floating toe and how can it be avoided
interossei migrate dorsally and become extensors
- make cut parallel to floor and wafer out bone
1190
which side of the fracture should a plate be placed on and why?
tension side; eliminates stress on the plate and screws
1191
in the Enneking staging system, what are the 3 components
- low vs high grade
- intra vs extra compartmental
- mets
I = low
II = high
A = intra
B = extra
III = mets
1192
when discussing internal vs external rotation of a femoral shaft fracture when nailing a femur, which is it in reference to: the distal or proximal fragment
the distal fragment: line up the patella and malleoli, then see where the proximal fragment is, then the rotation of the whole femur is the OPPOSITE of that
1193
what is the most common fracture intraop during TKA?
medial femoral condyle
1194
when does the tip of the dens ossify?
finish fusing?
- 3 y/o
- 12 y/o
1195
what is the interval for the posteriomedial approach for tibial plateau fxs
pes anserine and medial head of gastroc
1196
what is the predominant cell in Duputrens and how does it cause the pathology
myofibroblast
- it has actin in the cell
- connects to other myofibroblasts via fibronectin
1197
in non displaced scaphoid fractures, which joints need to be immobilized to adaquetely treat the fracture?
just the wrist
1198
what is the difference between Raynauds Syndrome/Phenomenon
vs
Disease
in Disease, NO known cause
1199
what is the initial treatment step for a vertical sheer pelvic injury
skeletal traction
1200
which BMPs play a role in osteoblast differentiation
BMP 2, 6, and 9
1201
which tab fx has the "spur" sign on obturator oblique view
Associated both column
- characterized by dissociation of articular surface from inominate bone
1202
which drug is contraindicated in Pagets?
Fortea (teraperatide)
1203
what is associated with type III tibial tubercle injuries
meniscial tear
1204
what is the best treatment for UBCs of the calc
currettage and grafting
1205
what is the deficency TYPE 1 Vit D dependant rickets
an enzyme in the kidney, a
1206
/what is the inheritance pattern of tibial hemimelia
autosomal dominant, must get genetic counseling
1207
describe the changes in articular cartilage
increase in H2O, PG binding to HA, collagan abnormalities;
decrease in the # of proteoglycans
1208
when can you return to driving after THA?
3-4 weeks for right hip
less than 3-4 with left hip
1209
which is the only tibial tubercle fracture that can be treated non-op and for how long?
- Type 1
- 6 weeks in LLC in extension
1210
when nailing a subtroch bisphosphanate fracture, is there in increased or decreased iatrogenic fracture?
increased
1211
name some radiographic findings of THA aseptic loosening
lucency \> 2 mm
subsidence \> 1 cm
eccentric poly wear
1212
what is the cutoff for limb lengthening in THA in hip dysplasia that severely increases the risk of sciatic nerve palsy
4 cm
1213
Speed and Yerg test for which pathology, caused by what?
bicep tendinopathy/subluxation, caused by subscap tear
1214
where is the proximal femur cut in an castle resection interposition arthroplasty for CP hips?
AT the level of the LESSER TROCH
1215
what is this histo of?
osteomyelitis
1216
what does an avulsion fracture of the olecranon indicate?
osteogenesis imperfecta
1217
what is the hip deformity in bladder exstrophy
retroversion and ex rotation
1218
what forms the roof of the cubital tunnel
FCU fascia and Osborne's ligament (travels from the medial epicondyle to the olecranon)
1219
when do limb buds develop and when are they visable via ultrasound
4 weeks
8 weeks
1220
which type of injection is best for thumb CMC arthritis
ALL are equal
1221
in osteochondroma, when and how big is the cutoff where you get concerned for malignant transformation in regards to the cartilagenous cap?
adults
\> 2-3 mm
NOT PEDS
1222
what is the most common reason for failed ankle arthrodesis?
second?
- neuropathy
- vascular disease
1223
describes the anatomic pathway of the ilioinguinal nerve
Pierces the obliquus internus and then accompanies the spermatic cord or round ligament through the superficial inguinal ring
1224
what type of femoral version is associated with adult hip dysplasia
anterversion
1225
what disorders are commonly seen in the proliferative zone of the physis
- achon
- gigantism
- MHE
1226
which position to avoid in hip resurfacing
varus alignment
1227
what is the inheritance pattern of tarsal coalition
AD
1228
what holds the hallucual sesamoids together
the intersesamoid ligament
1229
whatwhat is the best abx for nec fasc
penums +/- vanco
1230
what is Stills disease
rapid onset JRA with multi joint, rash, fever, and splenomegaly
1231
what is the best fixation method for vertical shear medial mal fxs
antiglide plate with screws oriented PARALLEL to joint line (Not perpendicular to fracture site)
1232
what are the risk factors that increase femoral stress shielding
- stiff femoral stem \*\*
- increased stem diameter
- extensively porous coated stems
1233
when treating bony and ligamentous flex/distraction injuries in peds, which one can be perc-ed and which one needs fusion?
ligamentous= fusion
bony= perc
1234
do younger (than 41) or older people do better with microdiscs
older
1235
What is the most common reason for a FAILURE of return to sport post ACL repair?
lifestyle and psychological factors, NOT surgeon advice
1236
1237
what is the role of the posterlateral bundle of the ACL
resist ROTARY loads during knee EXTENSION
1238
when is colchicine best used?
- acute gouty attacks
AND
- prophylaxis between attacks
1239
what type of cartilage forms after Matrix-associated autologous chondrocyte implantation
type 1 and 2
1240
which joint is involved in stage 1 of SLAC wrist?
treatment?
scaphoid and radial styloid
- styloidectomy vs AIN/PIN denervation
1241
between stainless steel and cobolt chrome, which is susceptible to corrosion?
stainless steel
1242
what is the treatment for ganglion cysts in kids?
observation
76% resolve on their own
1243
which vascular structure crosses the field in a Smith-Peterson approach
ascending branch of the lateral circumflex artery
1244
what is a normal Bohlers angle?
angle of gisane?
20-40 degrees
120-140 degrees
1245
what is the IV abx used for fight bite?
amp/sulbactam = unasyn
1246
where does the flexor tendon sheath start and finish?
2-4th = DIP to A1 pulley
1247
what are the deforming forces in a proximal phalanx fractures
interrosei pull prox fragment into flexion
central slip pulls distal fragment into extension
1248
what is the treatment of hallux valgus in spastic patients
1st MT joint fusion
1249
which structure detect pressure, texture, and vibration, and how are they best evaluated
merkel's receptors; two point discrimination
1250
what are the 2 ways that steriord increases bone loss?
decrease Ca binding in intestine
inhibits osteoBLASTS
1251
Describe the mayfield classification of perilunate dx
1- scapholunate
2- lunocapitate
3- lunotriquetral
4- dorsal radial carpal liagments (lunate dx into carpal tunnel)
1252
what is the course of the INFERIOR gluteal artery and what does it supply?
along piriformis and leaves greater sciatic notch
- glut max and short ext rotators
1253
lat dorsi flap
used for lateral elbow
- thoracodorsal artery
1254
what is the blood supply to the femoral head in children under 18 months?
all 3; ligmentum teres, medial and lateral femoral circumflex arteries
1255
what is the role of the popliteal tendon
- internal tibial rotation
- resisting external tibial rotation
1256
what are absolute indications for replant
thumb, mult digits, kids, palm, prox to wrist
1257
what percentage of peroneal nerve palsies return to normal after THA?
30-40%
1258
what is first line treatment for ganglion cysts in adults?
- aspiration, but careful with volar
1259
what is the pneumonic for JUDET views
PIC and POW
- Iliac (external) oblique = post col, ant wall
- Obdurator (int) = post wall, ant column
1260
what is the treatment for FUNGAL osteo of the spine?
amphotericin B
1261
elevating joint line \> 8 mm leads to what
equivilant to patella baja
mid flexion instability
1262
what is the treatment for camptodactyly?
- type 1 = non op
type 2= non op vs FDS transfer to lateral bands vs FDS release (must be able to extend PIP fully)
likely operative if contracture \> 60 degrees
1263
what is a known factor for infection following fusion for neuromusclar scoliosis
- serum albumin \< 3.5
1264
when do most symptomatic VTE occur following TJA?
2-6 weeks
1265
what is a relative contraindictation to replant
zone 2
1266
which heals faster; intra or extra articular ligaments/tendons?
extra-articular
1267
when is a triflange cup mostly used?
for MASSIVE bone loss; very expensive to make and take significant time to make
1268
what are the contents of the 1st dorsal compartment and what is their relationship?
- APL and EPB
- EPB is more DORSAL then APL
1269
what is a diagnostic test for mortons neuroma
injection of common digital nerve
1270
describe the innervation of the biceps femoris
short head- peroneal tract of sciatic long head- tibial tract of sciatic
1271
how do you distinguish between a low and high median nerve palsey
- thumb opposition ONLY in low palsey
- finger flexors and thumb opposition in high
1272
in THA patients undergoing liner exchange and acetabular bone grafting instead of acetabular revision, what are they are risk for?
dislocation/instability
1273
which dysplasia is associated with a mutation on the DTDST gene on Chrom 5 and what is the functional deficit
Diastrophic dysplasia, sulfate transporter gene = undersulfation of cartilage proteoglycan
1274
how does hydroxyapatite fail in humans
- via MHC failure, not immune response failure
1275
in malignant workup, when do you do a chest ct vs ct chest abd pelvis?
chest CT only for soft tissue sarcoma
1276
what are the two most common causes for camptodactyly?
FDS insertion
aberrant lumbrical
1277
what is the operative criteria for pelvic ring fxs in peds?
\> 2-3 cm displacement, NOT stability
1278
what approach should be used to access the quadrilateral plate in acetabular fractures, and what type of fracture requires this exposure?
modified stoppa; associated both column
1279
what position do you fuse the 1st MTP joint in in hallux rigidus
- 10 degrees valgus
- 15 degrees dorsiflexion
- 4-8 mm toe clearance
1280
in open tibia fractures, what is the difference between reamed and unreamed nails?
faster time to union only
1281
situations when using a PCL sacrificing knee is good
- previous patellectomy
- inflammatory arthritis
1282
Which of the following contributes to the differentiation of mesenchymal progenitor cells towards adipose tissue
PPAR gamma
1283
what are the positives of PAO over a salvage
hyaline cartilage, preservation of the posterior column, high survivorship/preventation of THA @ 15 years
1284
which type of meniscial tear has a "double PCL sign"?
medial meniscial bucket handle tear
1285
when do the limb buds develop and when are they first able to be visualized on transvaginal ultrasound
4 weeks
8 weeks
1286
which disease carries a greater likliehood of malignant developments
olliers or mafuccis
mafuccis (50%)
oliers is only 25 %
1287
if you have a positive wound culture in a diabetic foot ulcer, is that a PPV for infection?
NO
1288
what should you avoid in achilles tendonitis
steriod injections
1289
at the end of the ponsetti, what is required in 90%
heel cord tenotomy
1290
1291
which nerve is at risk when placing the anterolateral portal for elbow arthroscopy
- the radial nerve
- portal is place 1 cm anterior and 3 cm proximal to lateral epicondyle
1292
in OCD lesions of the talus, which is traumatic and which is chronic
lateral OCD = acute, traumatic
medial = chronic, larger, and more posterior
1293
what is the way mets work in lytic lesions?
blastic lesions?
lytic = factors stimulate osteoblastic RANKL pathway
blastic- endothelin 1 increases osteoblast activity and the WNT/osteoblast pathway
1294
using a poly insert on a tibial baseplate causes what?
backside wear due to micromotion underneith poly and with tibia; leads to osteolysis
1295
what is this histo of?
malignant histiocytic pleomorphic sarcoma
1296
in high pressure injuries, what is the cutoff time to surgery before amputation rates increase significantly?
10 hours
1297
in Juvenile RA, what factors are + and what are -
ANA +
RF + in only 15%
must get cervical xrays!
1298
how does the LCL fail in a terrible triad injury
ligament avulsion of the humeral/lat epicondyle area
1299
what is the biopsy/histo of periosteal osteosarc
- some osteoid but cartilaginous and globular
- can be confused with chondrosarc
1300
in PTT deficiency, which joint is unable to be locked?
transverse tarsal joint
1301
which tendon is involved in calcificic tendonitis
supraspinatus
1302
how do anabolic steroids lead to an increase in muscle mass
increased production of messenger RNA
1303
what are the muscle imbalances in the Cavus aspect of clubfoot
intrinics, FHL, FDL over extensors
1304
after resecting the medial sesamoid, which structure needs to be reconstructed to avoid hallux valgus
FHB tendon
1305
of all the heat related illnesses, which is the only one with CNS involvement
heat STROKE
1306
what allergy does myelodysplasia patients have?
IgE mediated anaphylaxis to Latex
1307
what nerve run 3 cm medial to the insertion of the lat dorsi and is at risk for damage during lat dorsi transfers
radial nerve
1308
in a hip scope, which injury to what nerve from what portal can lead to thigh numbness
anterior portal, LFCN
1309
what is the only bmp which is NOT inductive
BMP 3
1310
what does a 24 modifier mean
unrelated eval during global period
1311
what is the winking owl sign?
when a pedicle is "absent" on xray--\> indicates mets
1312
when is the approriate timing for stage 2 of the masquelet technique?
4-6 weeks
1313
which has a higher rate of transformation; EXT1 or EXT2
EXT1
1314
what are the cutoffs for distances in nerve grafting
\> 5 cm = autograft
\< 5cm = allograft
20 mm= nerve conduit
1315
what are the 2 deformities possible in thumb CMC arthritis
IP flexion and MCP hyperextension
1316
what is the most common fracture in lateral subtalar dx?
cuboid
1317
what are factors important in prognostic outcomes for nerve repair
- age
- time to repair
- length of repair
- repair level
- post op therapy
1318
what is posteriomedial bowing associated with and what is its inheritance pattern
LLD and calcaneovalgus feet
none
1319
in stage 4 disease of thumb basilar arthritis, what must also be done in addition to trapeziectomy?
removal of proximal 1/3 of the trapezoid
1320
using a lateralized liner increases the risk of what?
component loosening
1321
which has a higher mortality rate; vertical shear or APC 3
APC 3
1322
what is a contraindication for valgus producing high tibial osteotomy
VARUS thrust
1323
what is the max timing to fixation for tibia/pelvis?
femur?
- 7-10 days
- 21 days
1324
what disease presents with blue sclera, soft teeth, and hearing loss
OI
1325
how do you differentiate between clubfoot vs congenital vertical talus on xray
- in clubfoot, the talus and calcaneus will be PARALLEL
1326
what workup needs to be done preop for Freidreichs Ataxia?
cardiac work up
1327
what is one way to distinguish SMA from Duchenne's Muscular Distrophy?
- Deep tendon reflexes
Present = DMD
Absent = SMA
1328
which cell secretes osteoprotegrin
osteoclasts themselves
1329
what are two methods to prevent HO after THA
oral indomethacin for 10 days
600-800 gy of radiation 24-48 hours post op
1330
what are the two most common reasons for failed distal radius reductions in peds
- cast index
- initial degree of displacement
1331
what is the timing for acute vs chronic injury in perilunate injuries
8 weeks
1332
how do you treat chronic lis franc injuries with midfoot arthrosis
midfoot fusion
1333
what is the treatment for an acute rupture of the plantar fascia?
casting
1334
what are the 4 criteria for SIRS
HR \> 90
WBC \> 4000
RR \>20
Temp \> 38 or \< 36
1335
CA15-3
breast cancer
1336
how many degrees of dorsiflexion is a chielectomy aimed at achieving?
what must you add if you dont reach that?
30 degrees
- moberg closing wedge osteotomy
1337
wheree does the tib ant insert, and which amputation requires it to be reattached
medial cuneiform; chopart/midfoot amputation
1338
routine use of antibiotic cement in primary TKA leads to an increase in what?
aseptic loosening
1339
what does FGF23 do?
1. ) decreases PO4 absorption in renal tubules = phosphate wasting
2. ) blunts Vit D affect on 1,25 conversion in kidney
1340
in a CR sacrificing knee, what gap is increased?
flexion gap
1341
what is the most common radiographic finding in CRPS around the knee?
osteopenia of the patella
1342
how soon can you remove distal radius plates without increasing risk of fracture
15 months
1343
how long after TKA does braking time return to normal
4 weeks for right light
\<4 weeks for left leg
1344
what are the four characteristic gates of CP?
- equinis
- crouch gate
- jump gate
- stiff knee gate
1345
what type of osteotomy should be done in a late SCFE deformity
- flex, int rotation, and valgus producing osteotomy
(Imhauser)
1346
what is the presence of HIV in hemiophiliacs?
10-15%
1347
how do you reverse clawing of the hand
FDS, ECRL to lateral bands of ulnar digits
1348
when does H.O. appear post TKA, and when does it mature
3-4 weeks
1-2 years
1349
where is fibercartiage located? (Type 1)
- pubic symphysis
- tendon/ligament junction with bone
- damaged/repaired articular cartilage
- annulus fibrosis of intervertebral disc
1350
what is a seymore fractures?
pediatric distal phalanx fx w/ physeal injury and nailbed injury WITH interposed soft tissue
1351
which type of osteotomy is preferred in a PCL deficient knee?
lateral closing or medial opening
medial opening- more posterior slope is obtained
1352
label A B and C
A= AOL
B= POL
C= transverse ligament
1353
who gets PARosteal osteosarc
women in their 30-40s
1354
what embryonic cells does the annulus of the disc arise from
sclerotomal cells
NP is notocord
1355
what additional tests need to be performed with thumb hypoplasia?
cardiac, kidney, and abdominal
1356
what is the main deformity in claw toes
MTP hyperextension
1357
which nerve is at risk during anchor placement for SLAP repair?
suprascapular nerve
1358
what are the migration index cutoffs for surgical treatment in CP hips?
40-60 = soft tissue (watch out for obdurator neurectomy = abduction contracture)
\> 60 degrees = PFO and dega shelf osteotomy
1359
what happens to the # of proteoglycans in aging disc and cartilage
they decrease
1360
what type of corrision occurs in fatigue cracks due to differences in oxygen tension?
crevice
1361
what is the ratio of PRBC:platelet:plasma in a massive transfusion protocol
1:1:1
1362
which cords cause contractures and where in the Duypetrens?
Central- MCP
Spiral- PIP
Retrovascular- DIP
Natatory- web space
1363
what allergy is seen commonly in patients with myelodysplasia?
IgE mediated anaphylaxis to Latex
1364
when do you used a modular fluted taper stem when revision THA
\< 4 cm of cortical bone remain
1365
what procedures are performed for each:
Reverse Hill Sachs
Hill Sachs
Reverse= McLaughlin - lesser tuberosity and subscap
Hill Sachs= rempliassage - posterior capsule/infraspinatus
1366
which approach to complex MCP dx has an increased risk to NV bundle injury
volar approach
1367
what are 2 reasons for refracture in jones fx?
\< 4.5 mm screw
RTP before union
1368
Spindled cells that are surrounded in mature osteoid that connect to other similar cells via canaliculi are best described as which of the following
osteocytes
1369
what is the average medial to lateral distance of the footprint of the supraspinatus insertion?
14 mm
1370
when correcting in hallux valgus, what are the 2 things to look for?
- IMA
- joint congruency (DMAA \> 15 = NOT congruent)
1371
treatment for acute mallet fingers?
volar extension splinting for 6-8 weeks for 24 hours a day
- expect a clinically insignificant 10 degree extensor lag
1372
what is jeanes sign vs froments sign
Jeannes = thumb MCP hyperextension
Froment = thumb IP flexion
BOTH due to weak adductor pollicis
1373
what is the most predominant proteoglycan found in tendons and what is its role?
- decorin
- responsible for fibril length
1374
how long can a bone scan be (+) for after TKA?
2 years
- diffuse uptake seen in CRPS
1375
1376
what structures make up the bicipital sling?
subscap, SGHL, CHL, transverse humeral ligament
1377
which malignancy has a high rate of mdm2 amplification and ring chromosome
PARosteal osteosarc
1378
what meds have been shown to decrease muscle fibrosis and increase muscle regen after an injury?
antiotension II blockade (Losartan)
1379
what are some technical errors that lead to intraoperative fracture in TAA
- medial \> lateral
- cut too medial
- too proximal
- prosthesis too big
- joint distraction with an ex fix
1380
what is the deforming force in hallux valgus
the adductor tendon
1381
what is the treatment for navicular stress fractures
casting and non weight bearing
1382
what is the classic sign on a lateral radiograph used to distinguished and isolated capitellum fx from one with trochlear extension?
the double arc sign
1383
in Parsonage-Turner, what will the EMG show?
sharp wave spikes and defibrillations, indicative of denervation
1384
wha are the 2 most common associated conditions with Freidreich's Ataxia
scoliosis and cavovarus feet
1385
Which factors are associated with Hemophilia A and B respectively?
A= 8
B= 9
1386
what are the two most common neurologic injuries during prepping for cervical spine surgery?
brachial plexopathy during shoulder taping and brachial plexopathy during neck extension
1387
t(12:12)
clear cell sarcoma
1388
which direction is the dx in a distal humerus physeal separation fx in peds
PM displacement of rad and uln compared to humerus
1389
how does COX-2 help in fracture healing?
causes mesenchymal cells to differentiate into osteoblasts
1390
what is a common complication following treatment for perilunate dx
transient ischemia of the lunate
- appears at 4 weeks
- non op
1391
what is pavliks disease?
erosion of pelvis superior to acetabulum
1392
describe posterior impingement of the shoulder
in lack cocking, the greater tuberosity causes impingement of the SUPRA/INFRA spinatus against the POSTERIOR LABRUM
- peel back phenomenon of the biceps tendon
1393
with T score between -1.0 and -2.5, name the 2 other criteria that would indicate the need to start pharmacologic treatment
- 10 year % of hip fx \> 3%
OR
- 10 year risk of other major osteoporotic fracture \> 20%
1394
decorin is the major controling molecule for?
tendon collagen fiber size
1395
what are the defining features of Idiopathic Transient Osteoporosis of the hip? (ITOH)
- diffuse marrow edema - rapid onset - no collapse - diffuse osteopenia on xray - unilateral - middle aged men
1396
what the most common cause of early failure in RTC repair?
tissue failure (aka suture pullout from the tendon)
1397
when would you want to use extensively coated femoral stems (which increase stress shielding)?
in revision settings, where proximal bone is deficient
1398
describe the course of the radial artery in the hand
1. ) BR and FCR
2. ) FCR and apl/epb
3. ) 2 heads of 1st dorsal interrosei
1399
what NVI is common among monteggia fractures
PIN
presents as radial deviation with wrist extension
1400
in hand/finger injuries in patients with DM, what has been associated more with amputation or need for amputation?
- renal failure
- deep polymicrobial or gram negative infections
1401
what is the main determinant in the # of particles created in osteolysis?
volumetric wear
v=3.14r (squared) w
1402
what is the treatment for an adducted little toe in children
dorsal and plantar incisions, EDL tenotomy and 5th MTP joint release
1403
What is the function of the teres major and what is it innervated by?
internal rotation of the humerus
lower subscap nerve
1404
in in rheumatoid patients taking etanercept and hydroxychloroquine, what are the recommendations prior to TJA?
- c/w hydrochlorquine
- stop etanercept 2 weeks prior to surgery
1405
Tendon fibroblasts detect applied strain through what mechanism
deflection of cell cilia
1406
in an ACDF approach, which structure is at risk of injury from retractor placement between esophagus and trachea
recurrent laryngeal nerve
1407
when must you surgically correct a congenital vertical talus by?
3 years old
1408
what is pagett schroeder syndrome
thoracic outlet sydnrome
young athletic male with increased scalene muscles
costaclavicular ligament
1409
which direction do the extensor tendons go when the sagital bands are ruptured?
ulnar
1410
what type of metal is better for femoral stem with cement
cobalt chrome \> titanium
1411
name the two synovial cells and their origins
Type A= macrophage
Type B= fibroblast- create synovial fluid
1412
what is the treatment for CHRONIC PIP joint fx/dx
volar plate arthroplasty vs hemi hemate
1413
what is the minimum size that can be used for IM fixation of a Jones fracture
no less than 4.5 mm
1414
what are knee ROM for:
ADL
Stairs
Rise from a chair
90 degrees for ADL
95 degrees for stairs
105 degrees from chair rise
1415
what is the best protocol for RTC surgery?
6 weeks of passive
then you can start active
1416
which arthritis condition shows "pencil in cup" deformity of DIP joints
Psoriatic arthritis
1417
in a neuropraxia, which structure is damaged?
only the myelin
- axon and endoneurium remain in tact
1418
what is the only way to avoid amputation in buegers disease
smoking cessation
- 94% avoid amputation
1419
which mucopolysaccharodosis is associated with odontoid hypoplasia
Morquio
1420
what causes Wartenbergs sign?
- ulnar nerve weaness to 3rd palmar interossei and small finger lumbrical
- accessory slip from ADQ
1421
what is the cause of Poland syndrome?
subclavian artery hypoplasia
1422
what is the appropriate surgical technique for morton's neuroma
DORSAL approach with resection of nerve 3 cm from IM ligament
1423
what is the most common reason for vascular injury in THA
improper retractor placement, not screw placement
-obdurator artery in the the TAL
1424
what does a boutonniere deformity occur
disruption of central slip leads to loss of extension, volar migration of lateral and colateral bands leads to flexion of PIP and extension of DIP
1425
what type of sacral fracture is more prone to failure?
a vertical one
1426
what is HLA-B27
a class I surface antigen encoded by the B locus in the major histocompatibility complex on chromosome 6
1427
ways to distinguish pronator syndrome from CTS
- aching forearm pain
- palmar cutaneous nerve branch
- NO night symptoms
1428
what is the most common complication of surgery for equinoplanovalgus feet in cerebral palsy?
overcorrection into varus
1429
risk factors for intraop acetabular fracture
underreaming \> 2mm
radiation
osteoporosis
1430
dorsomedial cutenous nerve is a terminal branch of what?
the superficial peroneal nerve
1431
Which of the following skeletal dysplasias is caused by a sex linked mutation of the short stature homeobox (SHOX) gene
Leri-Weil dyschondrosteosis
1432
where do you make the AL portal for ankle scope and what is at risk?
just medial to fibula and lateral to peroneal tertius;
SPN, the dorsal cutaneous branch
1433
what medication is used to treat sickle cell crisis
hydroxyurea
1434
describe the radial course at the:
wrist
hand
- between brachioradialis and FCR
- between FCR and APL/EBP tendons
then between 2 heads of 1 dorsal interossei
1435
what is the treatment for low grade osteosarcoma
surgery ONLY
no chemo
1436
what type of movement causes high ankle sprains/syndesmotic injury?
external rotation
1437
what is the most common reason for early revision in TKA?
Late revision (\> 2 years)
- infection
- aseptic loosening (tibial \> femoral)
1438
in closed treatment of PIP dx, which type of splinting is used if unstable dorsal dx?
volar dx?
extension BLOCK splinting
- extension splinting if volar dx
1439
which is the only BMP which is not osteoinductive?
BMP 3
1440
what force is bone weakest to?
shear
1441
how is syndactyly treated in poland syndrome
release of 1 digit at a time
1442
does activity level influence serum ion levels in MoM THA?
NO;
initial ramp up period, then steady state with no relation to activity level
1443
which antibiotic inhibits fracture healing?
1st gen flouroquinolones
1444
where do you make the AM portal for ankle arthroscopy and what is at risk?
between MM and Tib ant
- saphenous vein
1445
non union or large fragment of hook of hamate fx can lead to what type of instability
- small finger FDP
1446
what type of scoliotic curve is seen in Rett Syndrome
C shaped curve
1447
in CRPP of supracondyler fractures, which has more TORSIONAL and BENDING strength?
3 \> 2
1448
in thumb hypoplasia, what else must you test/screen for
heard, renal, abdominal abnormalities
1449
what associated injuries are seen 50% of the time in MCP dislocations?
MC and prox phalanx fractures
1450
how much can cemented or non cemented total hip migrate in their first year without risk of loosening
\< 1 mm
1-2 mm = increased risk of loosening
1451
what are the 3 risks of an anterior (ilioinguinal) approach
- femoral nerve
- LFCN
- corona mortis
1452
what structure resists INTERNAL rotation with the knee in extension
posterior oblique ligament
1453
how does a reverse cross finger flap compare to a cross finger flap
- the location of the hinge for the donor tissue is ADJACENT to the defect in a regular cross finger flap
1454
ankle scope portal; PL
- peroneal tendons and achilles
- sural nerve, saphenous vein
1455
what is this histo of?
synovial sarcoma
1456
what are the cardiac issues in ehlers danlos syndrome
aortic root dilatation
mitral valve regurg
1457
what is the order of medial release for varus knee in TKA balancing?
1. ) Deep MCL
2. ) ostephytes
3. ) PMC/ Post oblique ligament
4. ) Bone
5. ) PCL
6. ) SemiMEMBRANOSIS
7. Superficial MCL
(ant if tight in flexion/ post if tight in ext)
remember: layer 3, bone, PCL, layer 2 (sup MCL last)
1458
in pediatric distal femoral physeal fxs, what are the physeal arrest %s
SHI- 36%
SHII- 60%
SHIII- 50%
SHIV- 65%
1459
what is the best TKA design for post polio syndrome
rotatiing hinged knee design
1460
what is the appropriate way to dose analgesia in the morbidly obese
IV based on IDEAL body weight
1461
MED has multiple inheritance patterns, what are the genes involved in Auto Dom?
COMP, COL9A, Matrillin
1462
how many core sutures are necessary for tendon repair
4-6
1463
excising the PCL in TKA is similar to what other surgical technique
excessive removal of posterior femur
1464
what is the treatment for extra abdominal desmoid tumors
wide resection + radiation
or chemo if inoperable
1465
which tab fx has a "gull sign"
posterior wall
bad outcomes
common in elderly
1466
what is the cutoff for arthroscopic vs open repair of GT non union
1.5 cm displacement
1467
most common complication in hip resurfacing
early failure in \< 20 weeks post op
1468
when performing a femoral revision in THA with impact bone grafting, which type of stem should be used, cemented or cementless
cemented
1469
In adult degenerative scoliosis, Which image describes the radiographic parameter that most strongly correlates with visual analog pain scores and disability
T/L kyphosis; NOT thoracic or lumbar alone
1470
when is the lateral circumflex at risk of injury?
during anterior approach to the hip (Smith/Pet)
1471
what is an "OCD" lesion in an older person called?
how is it best treated if conservative mgmt fails?
SONK
- UKA
1472
which bone graft substitute dissapears quickest?
calcium sulfate
1473
where is the starting point for flex nails of the femur in peds?
2.5 cm proximal to distal femoral physis, medial and lateral
1474
besides sarcoma, what can GCT transform to?
secondary ABC
1475
what compartments develop arthritis after a PCL deficiency
medial and patellafemoral
1476
what does osteosarc look like on biosy
- lacey osteoid
- woven bone
- atypia
1477
what vessels lie superficial to the iliopsoas muscle?
common femoral vessels
1478
what additional precautions are taken during THA for osteopetrosis
shorter stems, reaming under flouro, no cement, extra screws
1479
when converting from a hip arthrodesis to a THA, what is often additionally needed?
- A glut max transfer to counteract weak abductors
1480
after clubfoot casting, which muscle can create dynamic swing phase supination?
the tibial anterior, converts from doriflexor to supinator
1481
is the TTC fusin nail superior to screw construct?
yes
with improved bending stiffness and rotational stability
1482
what is the blood supply to the scaphoid
80% dorsal carpal radial branch
20% superficial palmar arch
1483
who suffers worse mentally and work miss wise after traumatic lower extremity injuries; men or women
women
1484
what is the treatment for renal cell mets
wide resection and recon
1485
what happens when you place the tibial tunnel too anterior in ACL recon?
limited knee EXTENSION
1486
how does the distal tibial physis close?
- central, AM, PL, Lateral
1487
in closed irreducible PIP dx, what tissue is inteposed?
in open dx?
- closed = volar plate
- open = FDP tendon
1488
what must a surgeon do before performing pelvic packing?
stabilize pelvis with either C clamp or ex fix
1489
does previous uncomplicated spine surgery increase the risk of infection during a later spine surgery?
NO
1490
what is the most common complication when doing a liner exchange only in revision THA
dislocation
1491
where is type 3 cartilage found?
type 10?
type 3= skin, blood vessels, early tendon/ligament repair
type 10- deep calcified layer, endochondral ossification
1492
what are contraindications for TEA?
charcot joint
prior olecranon osteotomy
infection
1493
in what direction is the radial head in congenital radial head dislocation
posterior
1494
what is the difference between Pap 1 vs Pap 2 in acetabular classification for revision THA
type 1 = minimal bone loss, rim in tact
type 2= superior bone loss
1495
most common complication after tx of a sagittal band rupture?
MCP flexion contracture
1496
how do you treat septic arthritis of SCM?
SCM joint resection, NOT I/D
1497
what are the deforming forces in proximal phalanx fracture
prox frag into flexion by interossei
distal fragment into extension by central slip
1498
difference between high and low ulnar nerve palsey
in high = loss of ring finger and small finger FDP
low = more clawing, loss of power pinch
1499
what procedure do you perform for spastic MTP joint
1st mtp joint arthrodesis
1500
what is the most common single isolate in nec fasc
group A strep
1501
who is more likely to be transported to a level one trauma center?
blacks or white
blacks
1502
what is the most important lab to check in osteosarc
- alk phos
- increased is a bad sign
1503
functional recovery following nerve injury
- sympathetic, pain, temp, touch, proprio, motor
1504
what is the biggest risk factor for infection in gunshut injuries
vascular injury
1505
what is the cutoff for direct end to end repair of a nerve
5-8mm
1506
at what point in a humeral shaft fracture with no healing is the patient at risk for a non-union
6 weeks
1507
what is the only difference between flex nailing vs casting of tibial shaft fractures in peds?
- less immobilization with flex nails
NO DIFFERENCE in union rate
1508
what is the appropriate tx for an infected achilles tendon rupture/repair?
I/D ONLY
1509
what is the correct placement of pin for in situ pinning of SCFE?
What is the complication if placed in the incorrect position, and what is that position?
- Ant Sup
- AVN if place in post. sup aspect of femoral neck
1510
which is NOT a predictor of mod/severe pain of 6 months after a MSK injury
age or gender
1511
which artery is often absent in clubfoot
anterior tibial artery
1512
1513
in a screw, what is the pullout strength proportionate to?
outer diameter^2
1514
what is the cutoff for surgical bar resection of the physis
\< 50 % involvement
\> 2 years growth remaining
1515
what is the image of choice in ITOH and why?
MRI; radiographs lag 4-8 weeks behind radiographs
1516
whats the test to determine external snapping hip syndrome?
obers test
1517
what does alpha defensin test for
an intra-articular antimicrobial probe
1518
when do you perform release of syndactyly?
@ 1 year old
- at neonatal period if acrosyndactyly
ALL before school age
1519
how is hemophilia inherited and what clotting factors are affected
X linked recessive (boys only)
A= Factor 8
B = factor 9
1520
what is the role of callus at the fracture site in terms of biomechanical properties
- increases: moment of intertia, stiffness, and torsional strength
decreases: strain at fracture site
1521
what is the cutoff for non op vs operative treatment in PIP fx/dx?
40% joint involvement AND stability
1522
what are the two differentiaters when trying to decide how to treat OCD lesion of the knee
age- young = fixation/microfracture/auto/allo
old= osteotomy vs arthroplasty
size- \< 4 cm = microfracture vs AUTOgrafts
\> 4 cm = ALLOgraft
1523
Describe the features of Poland Syndrome
- syndactyly - chest wall hypoplasia - lack of SC head of pec major
1524
what affect does a thoracotomy in adult spinal surgery have on pulm function in the short term?
long term?
reduced
and reduced
1525
where are the 2 most common sites to take full thickness grafts from?
prox forearm and hypothenar eminence
1526
which brachial plexus palsy shows ABNORMAL histamine teset
post ganglionic
1527
when do you fuse the thumb cmc joint?
in what position?
heavy day laborers
- 35 degree abduction (palmer and thumb)
- 15 degrees pronation
1528
in wallerian degen, what is the rate or proximal bud regrowth
- 1mm/day following 1 month of stagnation
1529
what structures are at risk when placing A to P screws for a retrograde femoral nail
femoral nerve and deep femoral artery; must place at the level or proximal to lesser troch
1530
what are some distinguishing differences between Raynauds Disease vs Syndrome/Phenomenon
in disease: older women, bilateral, no ulcerations
1531
what do you give to counteract cisplatic toxicity
sodium thiosulfate
1532
what is the most important predictor of survival in osteosarc?
- stage of disesae
1533
Which of thestudy designs describes a randomized controlled trial in which two interventions are applied separately or in combination to study groups
factorial
the can receive treatment A, B, none, or Both
1534
gamma radiation in Oxygen leads to:
oxidization of PE following free radical formation which leads to poor wear and mechanical properties
1535
in conversion from hip arthrodesis to THA, what can be done to counter hip abductor weakness
glut max transfer
1536
what is the correct approach to treat femoral head fractures?
anterior
1537
what is responsible to valgus restraint to the thumb MCP joint in flexion?
extension?
- proper collateral injury
- accessory colateral injury in extension
1538
course of the ulnar nerve at the elbow
pierces the IM septum from A to P, 8 cm proximal to medial epicondyle
1539
what joint do you need to immobilize in scaphoid fractures?
WRIST only, thumb spica not necessary
1540
does a high DMAA mean an incongruent or congruent joint
CONGRUENT
the joint is not subluxed, but rather the whole bone has been angled due to the deformity
if a proximal osteotomy is done but the joint left congruent, then the joint will sublux
1541
in patients with EXT, do they have more or less heparan sulfate in their physis?
less
1542
what % of threads should pass the physis in SCFE pinning with full threaded screws
50%
1543
which ligament is involved in nursemaids elbow?
annular ligament
1544
what is a common post operative sequela of a distal humerus physeal seperation: cubital varus or cubital valgus
cubital varus
1545
what is the only thing that increase joint reaction forces across the hip?
valgus neck shaft angle
increases shear forces
1546
what does the sural nerve provide sensation to?
4th dorsal webspace
1547
what is the most common complication with retractor placement in the following THA approaches:
- smith pet
- anterolateral watson jones
- direct lateral
- Smith pete = LFCN
- anterlateral= femoral
direct lateral = superior glueteal nerve
1548
when is the sural nerve at risk?
- extensile approach to lateral calc
- screw placement for 5th MT stress fracture
- achillies tendon repair
- gastroc recession
1549
medial gastroc flap
- sural artery
1550
what type of stem is needed in troch osteotomy THA approaches?
diaphyseal fitting stem
1551
which artery runs with the radial nerve in the radial groove
the brachial profundi
NOT the brachial artery
1552
in extensor tendon ruptures following TKA, what is the cutoff for quad tendon rupture requiring repair vs non op
tear \> 30% means repair
1553
what is the most common organism in diabetic ulcer osteo?
polymicrobial
1554
what is the best way to do an A2 pulley repair
triple repair, deep to extensor tendon
1555
what is the malignant transformation of solitary osteo/endochondromas?
EXT?
- 1%
- 10%
1556
1557
how do you perform the pivot shift test and what is the mechanism and what is driving it?
internal rotation, flexion, valgus
- lat tibial plateau against lateral femoral condyle
- IT band forces it past the resistance and reduces the tibial plateau after 30 degrees of flexion
1558
which MRSA is defined by the presence of PVL?
Community acquired MRSA
1559
where does the ulnar artery run in guyons canal in relationship to the hook of hamate
directly anterior (above) it, in the last 2 cm
1560
how does PTH lead to osteoblast proliferation
via Jagged1 binding to Notch
1561
which artery terminates as the medial and lateral plantar arteries?
posterior tibial artery
1562
what is the most common way to injure the PCL
fall on a flexed knee with foot in PLANTARflexion
1563
what determines the phenotype of SMA?
SMN2 levels, ALL lack SMN1
1564
what is the best diagnositic test for radial tunnel syndrome?
injection NOT nerve studies
1565
when do you perform osteotomies for femoral anteversion?
if \< 10 degrees of external rotation are seen on exam
1566
what is the most common injury in pediatric atv accidents
head injury
1567
when can you diagnose amniotic band syndrome in utero via ultrasound
@ end of 1st trimester
1568
what do you give to counteract vinca alkaloid toxicitiy
- hot compresses and hyluronidase
1569
what is the most successful lawsuit in orthopedics
compartment syndrome/fasciotomy
1570
when do complication rates decrease after anterior THA?
100 procedures
1571
when utilizing a pavlik harness, what are the limits to avoid complication
flexion- 90 degrees abduction- 70 degrees
1572
when do you perform a syme amputation in diabetic ulcers
when forefoot infection/gangrene AND (+) post tib pulse
1573
what is the structures does the disection take place between in the superficial interval in the medial approach to the hip
adductor longus and gracilias
1574
how long to you immobilize flexor tendon injuries for in children
4 weeks
1575
in hip fusion, what complex must be intact and if it is not, what are the complications
glut med/abductor complex
- low back pain
- need for constrained components
1576
how much calcar should remain to avoid humeral head ischemia in prox hum fractures
no less than 8 mm
1577
what is the treatment for post polio syndrome
exercise to sub exhaustion levels
1578
what is the rate of vascular injury in ant or post knee dislocations
40-50%
1579
what is miserable malalignment?
EXTERNAL tibial torsion with femoral ANTEVERSION
1580
what is the presentation of sagittal band injury in flexion?
extension?
PE finding?
- ulnar deviation of tendons/digits in flexion
- bowstringing in extension
- unable to initate MCP extension
1581
what medication is added to methotrexate to RA treatment?
doxycycline
1582
what is the common reason for metallosis in hip resurfacing
edge loading
1583
how effective is non op mgmt of trigger finger?
50-90% with splinting
60-90% with injection
1584
what causes septic arthritis in neonates
group b strep
1585
what does the AIN innervate
- The FPL
- FDP (index and long)
- Pronator quadratus
1586
what is the most common complication following a weil shortening osteotomy
floating toe
1587
AFP
1588
which growth factor causes synovial proliferation and fibrosis?
TGF-Beta
1589
what are residents ridge and bifurcate ridge
residents ridge = lat intercondyler ridge
tunnel should be made 6 mm posterior to RR, and 1.7 mm PROXIMAL (above) bifurcate ridge
1590
which exam is best for syndesmotic injury testing
ext. rotation stress test
1591
which supplements decrease bleeding by decreasing the warfarin effect?
st johns wort, green tea, CoQ10
1592
in pediatric tibial shaft fractures, which has a higher union: flex nails or casting?
both equal
1593
what is the tectorial membrane a continuation of?
the PLL
1594
before starting bisphospanates, why should invasive dental work be completed
to avoid ONJ
1595
do you need to give preop abx for elective carpal tunnel release
no
1596
name 2 major differences in Beckers MD vs Duchenne's MD?
- Duchennes, later, less symptomatic
- Duchennes = more cardiomyopathy
1597
what type of bacteria is N. gonorrhea?
gram negative diplococci; intra/extra cellular mix
1598
what are the risks of anterior portal placement in shoulder scope
- cephalic vein = too LATERAL
- MCTN= too inferior
1599
wehat is the most common cause of infection in a foot puncture wound?
osteomyelitis?
- S. Aureus
- Pseudomonas
1600
what are the two most common complicatons for incorrect CLOSED treatment for a seyour fx
osteomyelitis and physeal arrest
1601
what is the cutoff for ISS where mortality \> 10%
15
1602
what is the most specific and sensitive test/marker for RA?
anti-CCP
1603
what is the complication associated with b/l femoral shaft fractures?
how do you treat the fractures?
pulmonary complications
UNreamed nails
1604
what is the most common early (first 6 months) complication in hip resurfacing?
femoral neck fracture
1605
How does Vit D resistant rickets work?
some mutation increases FGF23
increased FGF23 impairs Vit D effect on 1,25 in the kidney
it ALSO increase phosphate wasting in the kidney
1606
when are double rocker soled shoes the best option
midfoot prominences
1607
what other deformity is seen in conjuction with amniotic band syndrome?
clubfoot
1608
what spinal abnormality is associated with spinal abnormalities
sacral agenensis
1609
does post traumatic osteoarthritis increase the risk of dislocation after THA?
NO
1610
what is the common cause of congenital clasped thumb
- absent EPL, EPB or BOTH
1611
which cytokine INHIBITS osteolysis?
interferon gamma
1612
describe the appropriate recs for seating of children in the car
- rear facing seat up to 1 y/o or 20lbs
- front facing seat up to 4 y/o or 40 lbs
- booster seat until 6-8 y/o and 80lb
- rear seat up to 12
- 13 or older in front seat (airbag off if under 80lbs)
1613
gamma radiation in oxygen depleted environment leads to:
after free radical formation, cross linking occurs which leads to better wear properties but POORER mechanical properties
1614
what are risk factors for peroneal nerve palsy in TKA
- preop flex contracture \> 10 degrees
- history of lumbar lami or other nerve injury
- valgus deformity \> 12 degrees
- epidural anesthesia
1615
what vascular structure is at risk at the superior extent of than open deltopec approach
the acromial branch of the thoracoacromial artery
1616
what percent of femoral head fractures go on to AVN?
75-100%
1617
what are the transcutaneous O2 pressures
and
absolute toe pressures
needed to heal diabetic ulcers
TO2\> 30-40 mm Hg
Pressure \> 40 mm Hg
1618
what is the age cutoff for prophylactic pinning of b/l SCFES
10 and under for females
12 and under for boys
1619
what are the orthopedic manifestations of Gauchers disease
How do you treat the disease
Bone pain and deformities
osteonecrosis crisis
tx with enzyme replacement
1620
what is the only "strong" evidence by AAOS for knee OA
NSAIDS & tramadol
1621
/dddddd9df['name 3 things that go with radial clubhead (radial deficency)
- SHH gene
- absent thumb
- bilateral \> 50%
1622
what is the expected RTP following repair of turf toe?
3-4 months
1623
in patients with an obstetric brachial plexopathy with associated horner's syndrome, what is their % chance of spontaneous recovery?
\<10%
1624
describe the blood supply to the talus
1. ) post tib artery via artery of tarsal canal = main body supply
2. ) ant tib artery= neck and head
3. ) deltoid artery = body (only remaining supply when there is a fracture)
1625
what is the most important prognostic indicator in thumb hypoplasia
the stability of the CMC joint
1626
in an injury to the superior peroneal retinaculum, what is the foot position that CAUSES the injury, and what is the foot position to TEST for the injury?
- injury = dorsiflexion and inversion
- evaulation of injury = dorsiflexion and EVERSION
1627
what is at risk of the posterior inferior shoulder scope portal?
axillary nerve
1628
which muscle transfer is done for lateral scapular winging?
eden lange- levator scapula and rhomboids advanced
1629
what are the daily recommendations for calcium and vitamin D for those over 50 y/o
Calcium- 1200-1500
Vit D- 400-800
1630
following tibial plateau fractures, what is the best way to help chondocyte/cartiliage healing?
gentle compressive loading
1631
how to treat reperfusion injury in replants
allopurinol, blocks xanthiane production
1632
which side is congenital pseudoarthrosis of the clavicle seen on?
RIGHT sided and MEDIAL
- if left, then possibly situs invertus
1633
which is the only major joint where the physis is not intracaspular/articular?
the knee
1634
in proximal metaphyseal tibial fractures in peds, what are structures that can be interposed that prevent reduction?
- MCL, pes anserine, periostium
| (all MEDIAL structures)
1635
what is the position to fuse the shoulder in?
30-30-30
1636
what % of patients over 60 have a RTC tear
30-50%
1637
what inserts on the tubercle of the 5th metatarsal
peroneus brevis and plantar fascia
1638
how can you tell the difference between bucket handle tears of the medial vs lateral meniscus
medial = double pcl sign
lateral = double anterior horn sign
1639
what type of pelvic ring fractures are more common in children? APC or LC
LC
1640
what is the best way to increase stiffness of an ex fix
increase size of pin diameter
1641
what does lymphoma stain + for?
CD20 positive
CD45 positive
lymphocyte common antigen positive
1642
besides 11:22 translocation, what are the other genetic characteristics of Ewings Sarcoma
- p53 mutation
- overproliferation of Ki-67
- overexpression of Her2/neu
1643
which actions decrease JRF on the abductor side?
- increased femoral neck length
- increasing femoral offset
- lateralizing GT and abductors
- cane in the contralateral hand (reduces pull of abductors)
- carrying a weight in ipsilateral hand
1644
inhibits vitamin K 2,3-epoxide reductase
Coumadin
1645
for lateral epicondylitis, which conservative method is best
either PT or nothing; steroid injections have WORSE outcomes than doing nothing
1646
when lengthening femur, describe how you affect the Mechanical Axis (i.e. MAD) based on shortening/lengthening along the anatomical axis
lengthening = lateral MAD
shortening = medial MAD
1647
in cavus deformity, what is strong?
weak?
tib ant/post tib
peroneus brevis
1648
what are the highest doses of abx allowed in cement for spacers?
12. 5 g for tobra
10. 5 g for vanco
1649
weber c fibula fractures are associated with what mechanism
pronation
1650
what is tibial deficiency associated with and what is its inheritance pattern
AD, and AL tibial bowing
1651
what is the best way to diagnosis osteo in neonates?
Ultrasound
1652
what mobility limitations occur with SCFE
decreased: internal rotation, flexion, and abduction
1653
which position should a patient avoid after an anterlateral approach in THA?
extension, ext rotation, adduction
1654
which is worse predictor of outcome in RTC repair
smoking or age
age \> 65
1655
what are the 3 factors in determing treatmnt for TFCC tears
- acute vs chronic
- location of tear
- ulnar variance or not
1656
in what trimester should you test AFP for myelodysplasia
2nd
1657
what is the interval for the anterolateral approach to the hip
TFL and glut med
1658
what is the operative treatment for spastic equinovarus
- TAL with split anterior tendon transfer
- ant tib tendon is split and lateral half is moved to cuboid
1659
which ligament is essential to preserve in a PRC?
radioscaphocapitate
1660
in flexor tendon repair and subsequent re-rerupture, what is the cutoff for scar exicision vs grafting?
1 cm
1661
what is the difference between 1 vs 2 plate constructs for non unions of humeral shaft fractures
increased stiffness but equivilant healing rates
1662
which muscle group is the reason women get more ACL tears than men?
hamstrings NOT quads
1663
in sagittal band rupture, following repair, what is the most common complication?
MCP flexion contracture
1664
1665
what is the positition to fuse the 1st MTP in hallux rigidus
10 degrees valgus
15 degrees dorsiflexion
w/ 4-8mm of ground clearance
1666
how do you treat ulnar positive variance with associated DRUJ arthritis
- ulnar hemiresection arthroplasty with TFCC repair
- CANT do an ulnar shortening osteotomy
1667
what is a benefit of total ankle arthroplasty over ankle arthrodesis
increased gait speed and stride length
1668
what do airbags not protect against
pelvic ring injuries
1669
what are the EKG findings in a PE
- S wave changes in Lead 1
- Q wave changes in Lead 3
- T wave inversions in Lead 3
1670
where do you get a nail matrix transfer from?
adjacent finger vs 2nd toe
1671
in which stage of LCPD are the changes seen needed to classify the level of lateral pillar disease?
early
- 6 months
1672
contraindications for hip resurfacing
- poor bone stock
- young females
- renal failure
- coxa vara
1673
in humeral nails, what nerves are at risk with which screws
A/P = MCTN
Lat to med = radial nerve
1674
what is a relative contraindication for a hand centralization procedure in pediatrics?
age; must be atleast 12 months old in order to tolerate anesthesia
1675
what is the most common reason for revision in TKA in the early phase (\< 2years)?
the later phase (\>2 years)
early = infection
late = aseptic loosening
1676
when using biologic fixation (press fit) for femoral stems, what are factors which increase stability/maximize implant ingrowth?
- pore size = 50-300 um
- \>50% porosity
- gaps \< 50 um
- micromotion \< 150 um
1677
what is syndactyly
fusion of the digits
either soft tissue or full digits
1678
what is the order of humeral head ischemia factors in prox humerus fractures
calcar length less than 8 mm \> disrupted medial hinge \> humeral head angulation more than 45 degrees \> head-split fracture
1679
for humeral shaft fractures, what does IMN of the humerus have a higher rate of?
- shoulder pain, but equal function
- reoperation rate
1680
what is treatment for grade III/IV hallux rigidus in young vs older patients?
MTP fusion vs keller resection arthroplasty
1681
differences between DMD and Beckers MD
later onset
more cardio issues
decreased dystrophin, not absent
1682
how long can you wait to fix acetabulam fractures befrore you have negative outcomes?
3 weeks
1683
where is the pain from an os trigonom
lateral
medial would be FHL tendonitis
1684
what is the most common complication for patients undergoing THA with AVN of the hip?
perforation of the femoral canal during broaching
1685
what is the treatment for acute sagittal band rupture?
extension yoke splinting for 4-6 weeks
1686
how does one accidently create a cock up toe deformity in hallux valgus surgery
FHL injury
1687
1688
which approach to to tab fx can get ant/post column visualization
and what are the 2 major complications
- extended iliofemoral
- massive HO
- glut muscle necrosis
1689
1690
which nerve roots supply the LFCN
L2-3
1691
when is non op treatment the best option for TFCC tears
Type 1 a
initial treatment for all type IIs
1692
what is the treatment protocol for infantile blounts
- surgery if \> 16 degrees
- surgery if \> 4 y/o
1693
what is the anatomic position that causes superior retinacular disruption?
what is the position that leads to tendon subluxation?
DORSIflexion and INVERSION
- DORSIFLEXION and EVERSION
1694
where is PTH and Calcitonin produced?
PTH- Chief cells
Calcitonin- Parafollicular cells
1695
how far from the medial epicondyle does the ulnar nerve pierce the IM septum
8 cm
1696
groin flap
- sup circ iliiac artery
- LFCN at risk
1697
what conditions is associated with Erlenmeyer flask long bones, Rugger jersey spine, and blocked femoral metaphysis?
osteopetrosis
1698
what is the interval for a lateral inside out meniscus repair?
between the IT band and the biceps femoris, retract lateral head of gastroc posterior
1699
what are bad prognostic factors for LCPD
- \> 8 y/o
- lack of spherical head
- pillar B and C classification
1700
what is the brachialis sign in a supracondylar fracture
when the antecubital fossa shows skin dimpling, spike has pierced the brachialis
= urgent treatment necessary
1701
what is energy expenditure increase in BKA?
AKA?
10-40% (40% vasc)
70-100%
1702
which malignancies require only a chest CT and not CT C/A/P on work up?
soft tissue sarcomas and chondrosarcomas
1703
what are indications to do a hinged knee prosthesis?
hyperextension instability, such as polio, tumors, or charcot joint destruction
1704
where does the capsuloligamentous sesamoid complex tear off of in turf toe injuries
the proximal phalanx, NOT the metatarsal
1705
in valgus extension overload, where are the osteophytes formed
posterioMEDIAL
not lateral
1706
what is the minimum size skin bridges should be in TKA to avoid necrosis/
\>5-6 mm
1707
what does the recurrent branch of the median nerve control
thumb opposition
1708
what two lab findings are found in renal osteodystrophy?
decreased Calcium
increase phosphate
(increased PTH to counter the above two, so it is a SECONDARY hyperPTH)
1709
describe the 3 windows of the ilioinguinal approach to the acetabulum
1) Medial window: medial to external iliac artery & vein. 2) Middle window: between external iliac vessels and the iliopsoas (or iliopectineal fascia) 3) Lateral window: lateral to iliopsoas (or iliopectineal fascia). Note that some sources use the iliospoas as the structure that separates the middle from the lateral window
1710
what nerve can be injured with tibial shaft IM locking screws
saphenous nerve
1711
what is the acetabular tear drop composed of?
the quadrilateral surface and cotyloid fossa
1712
for closed humeral shaft fractures, at what point is gross motion and no callous seen considered a non-union?
6 weeks
1713
what is the structures does the disection take place between in the deep interval in the medial approach to the hip
adductor brevis
adductor magnus
1714
what is the best view to determine if an IMN is too proud proximally?
lateral view
1715
when do cam jump occur and how do you fix it
loose flexion gap, in extesion
- treat with ant drawer reduction, then surgery to fix flexion gap
1716
which metals should be used in someone who has a nickel allergy
Titanium
NOT cobalt chrome or stainless steel
1717
what factor released during surgery is thought to be involved in DVT?
thromboplastin
1718
what does a 22 modifier indicate
additional complexity during procedure
1719
what is this histo of?
chordoma
1720
what are the blue cell tumors
L - Lymphoma
E - Ewing Sarcoma
R - Rhabdomyosarcoma
N - Neuroblastoma (primitive neuroectodermal tumors)
M - Myeloma
1721
what tumors do Pagets patient get but less than \<1% of the time
osteosarcoma
1722
what 2 things do you need to do preop prior to scoli recon in Marfans syndrome
- MRI to look for dural ectasia
- cardiac workup
1723
what is the treatment for congenital vertical talus?
- genetic work up THEN
- if \< 3, release and pinning
- if \> 3 then triple arthrodesis
1724
what conditions is dural ectasia normally seen in?
Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis type I and ankylosing spondylitis.
1725
what is the interval to the direct anterior approach to the ankle
EHL and EDL
1726
1727
which bone cell is of myeloid origin?
protosteoclast to osteoclast
The REST are mesenchymal origin
1728
following infected TAA, what is the final outcome usually
NOT reimplantation as they do not do well in the setting of a previous infection
1729
how are juvenile bunions different than adult bunions?
- metatarsus primus = increased flexbility of the MTP joint
- less HVA than adults
- less medial prominence
1730
when do you treat hypothenar hand syndrome non-operatively
when there is thrombosis only for GREATER than 2 weeks
1731
does activity affect the level of serum ions in MOM hips?
no
1732
In SAD ankle fractures, what must you watch out for?
medial marginal articular impaction
1733
what is the appropriate bracing for ankle OA
- rocker bottom sole
- gauntlet ankle brace (Arizona brace)
1734
for sc joint dx, what is the treatment algorithm
acute (\< 3 weeks) = closed reduction +/- anesthesia
acute or chronic WITH SYMPTOMS = open reduction
chronic and painful = medial clavicle excision
1735
what nerves should be used in nerve autografting and when?
- nerve deficit over 5 cm
* medial and lateral antebrachial cutaneous
* posterior interosseus nerve terminal branches
* sural
1736
what is the % chance of septic arthritis with 2/4 Kocher Criteria?
40%
1737
which athletes get FHL tendonitis
ballet dancers
1738
what is the most common cause for failure of De Quervains tenosynotivits surgery
failure to fully release EPB subsheath
1739
what does phosphoethanloamine in the urine indicate
hypophosphatasia
1740
ankle scope AL portal
between lateral mal and SPN/peroneus tertius
1741
how do you differentiate between PARosteal osteosarc and fibrous dysplasia
- xrays are different
- histo is similar
1742
what is the kerboul combined necrotic angle at high risk for progression to AVN
\>240 degrees
1743
How does Vit D increase serum Ca?
decrease serum Ca?
binds Ca in intestine and increases absorption
activates osteoclasts
1744
should you lateralize or medialize the patella prosthesis in TKA for the best stability?
MEDIALIZE
if you lateralize, you will push the patella medial and increase Q angle and subsequent maltracking may occur
1745
what arteries can be damaged by removing dog ears from a bka?
sural and saphenous
1746
what is the age cutoff for repeat casting for failed clubfoot treatment
2 years old
1747
what is the cutoff for bailing on a pavlik harness? what should be done next
3 weeks; switch to abduction brace for one more 3 week trial
1748
label this
A= radial collateral ligament
B = annular ligament
C= LCL
1749
if a patient has bilateral syndactyly, when do you perform releases?
- together if \< 18 months old
- seperate if \> 18 months old
1750
describe the correct way to do an olecranon osteotomy
2 cm from bare area, apex distal, medially angulated screws
1751
at what point in time is Cozen's phenomenon observed?
when is the max deformity occur?
when does it usually resolve?
5-15 months
12-24 months
3 years
1752
how many narcotic pills should you prescribe for trigger finger surgery?
0
1753
what markers have been shown to be elevated in patients with subacromial bursititis?
metalloproteases
1754
when do you treat dorsal PIP dx with extension block splinting and NOT buddy taping
if unstable after reduction
1755
which tendons are utilized in transfers for chronic achilles tendonopathy?
FHL, FDL, or PB
1756
which gene is associated with Marfan syndrome
FBN1 on chromsome 15
1757
by how much does an epitendinous suture increase strength of repair in a flexor tendon?
10-50%
1758
what is the treatment for chronic diabetic ulceration at the big toe IP joint
keller resection, aka resect base of prox phalanx
1759
what are the characteristic lab findings of hypophosphotasia
- DECREASED serum alk phos - increased calcium and phosphate TNSALP gene mutation auto recessive
1760
in radial head ORIF, which are the positions of the forearm for exposure and for hardware placement
exposure = pronate
hardware = neutral
1761
what is the correct approach to ORIF of a humeral shaft fracture
modified posterior approach with elevation of triceps, and NOT triceps splitting
1762
what do vertebral hemangiomas look like on xray/ct
"jail cell" like striations
1763
what does this show?
periosteal scalloping of a GCT
1764
what muscles are used for opponplasty of the thumb?
FDS or ADM
1765
what is the blood supply to the heel pad
the medial calcaneal branch of the post tib artery
1766
what other malignancy besides osteosarc can Pagets transform to?
spindle cell sarcoma
1767
for oligotrophic nonunions in osteoporotic patients, which is the top cause?
Vit D deficiency
NOT calcium deficiency
1768
what is the tendon transfer for wrist drop?
1769
in patients with spina bifida, and meningomyeolocele, does hip status correlate with functional outcome?
no, spinal level and contractures are better associated with functional outcomes
1770
what block is used in shoulder scope and what can be injured?
Scalene block
phrenic nerve
1771
what does estrogen increase the risk of?
heart disease and breast cancer
1772
what are the two nerves at risk for medial condyle fx fixation and why?
ulnar nerve
radial nerve (bicortical screw fixation)
1773
in and old patient with multiple injuries, what is the highest risk of 1 year mortality?
need for mechanical vent
1774
what are the two main arteries that supply the growth plate?
Perichondral artery & epiphyseal artery
1775
how long does the inflammatory phase of tendon healing last?
0-5 days
1776
which sagittal band is more commonly injured?
radial \> ulnar
9 to 1 ratio
1777
what innervates the adductor pollicis
ULNAR nerve
1778
where do the A1, A3, and A5 pulleys originate from
the volar plate
1779
what acetabular deformity is bladder extrophy associated with?
retroverted acetabulum
1780
what is used to activate platelets in PRP?
calcium chloride
1781
what is the most important pulley of the thumb
the oblique pully, prevents bowstringing of FPL
1782
what is the effect of peri-operative radiation in soft tissue sarcomas?
reduced risk of recurrence ONLY
survival is the same
1783
which approach to tab fx is needed to access medial wall comminuation
modified stoppa
must ligate corona mortis
1784
besides flattend facial features and hyperlaxity, what is the hallmark of Larsen's syndrome
cervical kyphosis +/- myelopathy
1785
how does vancomycin resistant enterococcus confer its resistance?
altered peptidoglycan subunit
1786
what is the triad of Hans Schuller Disease
multiple lytic skull lesions
diabetes insipidus
increased thirst and water intake
exopthalmos
1787
CEA
colorectal cancer
1788
what is the bending strength of a screw proportionate to?
(inner diameter)^3
1789
name the nerve at risk during arthroscopic repair of the following:
- posterior labrum
- SLAP
- post cap release for internal impingement
- MDI
post labrum and post capsular release- axillary
SLAP- suprascapular nerve
MDI- axillary
1790
how long after CRPP of a supracondylar fracture is elbow ROM expected to return to normal?
6 months
1791
imbalances in varus aspect of clubfoot
tib ant, post tib over peroneus brevis
1792
Which system of lacunar networks is used among osteocytes to communicate
canalicula
1793
complications of medial high tibial osteotomy
- peroneal nerve palsey
- patella baja
- non union
1794
what is the effect of stapling in growth modulation?
compressive strengths along the physis slows longitudinal growth
1795
what upper extremity muscular issue is seen in CMT
first dorsal interosseous wasting
1796
what angle is increased in developmental coxa vara
Hilgenreiner-epiphysieal angle
1797
when should you perform a patellectomy in a TKA with patella baja?
when width of patella is only 10-12 mm
USE cruciate retaining knee system
1798
what is the treatment algorithm for Raynauds Disease/Syndrome
- first lifestlye mgmt
- next meds
- then botox
- then surgery (sympathectomy)
1799
what is the union rate for REVISION ankle arthrodesis
85-90%
1800
in little leaguers shoulder what portion of the physis is disrupted and what view is best to see it
anterolateral
AP w/ ext rotation
1801
what is the expected non-union rate in non op tx of displaced midshaft clavicle fractures
10-15%
1802
the most important factor for failed closed reduction of DR fxs
initial displacement
1803
what is Rothmund Thomson Syndrome
RB gene
- AR inheritance RECQL4 gene
- sun sensitive facial rash without any hair
- high propensity for osteosarcs, gastric adenocarinoma, cutaneous BCC and SCC
1804
what exam finding found in myelopathic patients is also found in normal patients
hyperreflexia
NOT clonus
1805
what is the major source of nutrient/blood supply to the growth plate?
perichondral artery
1806
what is the interval for the volar approach to the scaphoid?
FCR and radial artery
1807
what is the main cause of tumor calcinosis and what genetic defect is present
HYPERphosphotasia
FGF23
1808
which is the most common compartment for PVNS?
ANTERIOR knee
1809
what test is used to distinguish bipartatite sesamoid vs fx
bone scan
1810
in TKA coronal balancing, what affect does releasing the popliteus tendon have?
increasing the lateral space in knee FLEXION
1811
what additonal workup must be done with an absent radius?
- CBC, renal ultrasound, and echo
1812
tissue from which area of of the limb bud can lead to mirror duplication?
zone of polarizing activity
1813
when do you use a rotating hinge design TKA
- hyperextension instability in polio or tumor resection
- neuropathic joint
1814
compared to surgery for AIS, what complications are similar in scoli surgery in Marfan's patients?
- blood loss
- post op neuro complications
- hospital length of stay
1815
how far is the axillary nerve from acromion
7cm
1816
who is at a greater risk of intraoperative calcar fracture; men or women
women
1817
what is the test for DMD?
serum CPK
NOT muscle biopsy
1818
how do you treat scfe in downs
pin both hips
1819
how do you get a rocker bottom foot in clubfoot correction
correcting equinus before varus
1820
in chronic achilles tears, what is the size cutoff for recon vy advancement vs tendon transfer
3 cm; \> 3cm = tendon transfer
1821
what is the characteristic feature of mixoid liposarcoma
a network of fine vessels on a mixoid background
1822
what are the risks for the medial approach to the hip
- obdurator nerve
- external pudendal nerve
- medial circumflex artery
1823
what is the most prevelant non-collagenous protein in bone?
osteocalcin
1824
how long should you reduce a pediatric hip dx to avoid AVN
6 hrs
- unlikely in children less than 5
- 3-15%
1825
what is the timing regarding Cozens phenomenom
start?
maximum deformity?
resolution?
- 5-15 months
- 12-18 months
- 3 years
1826
what is the most abundant non collagenous protein in bone?
osteocalcin
- produced by mature osteoblasts and is a marker for bone turnover
1827
which arch do the common digital arteries branch from?
the superficial arch
1828
what is a long term complication associated with biphosphinate use for pagets?
- osteonecrosis of the jaw
1829
what can fibrous dysplasia transform to?
osteosarcoma
1830
what complication can occur in De Quiervens surgery
injury to the superfical radial nerve
1831
when performing an iliopsoas tendon release, which way should the leg be rotated and why?
externally, to avoid the femoral NV bundle
1832
if a patient has capsular attenuation from prior thermal capsulorraphy, what is contraindicated
any revision done arthroscopically; must do open
1833
what are the components of the LRINEC
- hg
- wbc
- crp
- sodium
- creatinine
- glucose
1834
over what degree of screw divergence in one at risk for rerupture following ACL recon
\> 30 degrees
1835
in regards to spine trauma for DISH vs AS
describe their differences
AS= higher rates of neurologic injury and surgery
DISH= higher rates of mortality in CERVICAL trauma
both have equal rates of mortality in non cervical trauma
1836
in PIP dislocations, what deformities occur if dorsal dx?
volar dx?
dorsal = swan neck
volar = boutinerre
1837
what is the forces in spastic equinovarus
- gastroc soleous
- tib ant
1838
how any narctic pills should you prescribe for carpal tunnel, and dequervains surgery?
10
1839
what is characteristic of Stage III lymes disease?
- Arthritis
- cigarette paper skin
1840
what antibiotic can be added to methotrexate to treat RA
doxycycline
1841
what is the limit to the degree of retroversion one can safely eccentrically ream the glenoid in a TSA?
up to 13 degrees, greater than that and you must you grafting
1842
what is the treatment for a pisiform fracture
- SAC 30 degrees flexion and ulnar deviation
- pisiformectomy in non-union
1843
what are the 3 steps for determing the type of acetabular revision in THA?
1. ) Bone loss- 50% is cutoff
2. ) Rim- 2/3 competence is cutoff
3. ) Pelvic continuity or not
1844
what is mandatory in the workup for Ewings sarcoma
bone marrow biopsy
1845
what nerve is responsible for medial scapular winging, and what are its nerve roots
long thoracic
C5-C7
1846
what is the most common type of meniscial injury in tibial eminence fractures?
MEDIAL meniscus,
this is opposite from ACL tears where LATERAL mensical tears are more common
1847
what is the surgical treatment for trigger thumb and when can it be performed
- A1 pulley release NOT nodda's nodule resection
- after 2 y/o
1848
what is an oberlin transfer
FCU motor branch to upper/MCTN nerve
1849
what does the deep peroneal nerve innervate
EDB & EHB
1850
what is the wear rate per year for:
uncrosslinked poly
crosslinked poly
ceramic on ceramic
ceramic on poly
metal on metal
.1-.2 mm/yr
.5 to 2.5 micron/yr
0-150 micron/yr
2.5-5 micron/year
1851
what is the best way to treat post amputation neuroma pain?
targeted muscle reinnervation
1852
in thumb CMC dislocation, what ligament is torn and responsible for preventing dislocation, and in what direction
dorsalradial ligament
dorsal direction, prevents radial subluxation
1853
what are the deforming forces/innervations in a base of the thumb fracture?
abductor pollicus longus - PIN
extensor pollicus longus - PIN
adductor pollicis - ulnar
1854
in thumb ulnar collateral ligament injuries, which ligaments provide radial restraint in FLEXION?
EXTENSION?
flexion = PROPER UCL
extension = ACCESORY UCL
1855
what is the most important prognostic factor in survival of replantation of a digit
mechanism of injury
NOT smoking
1856
for defects of the first web space, what is the preferred coverage?
the posterior interosseous fasciocutaneous flap is an excellent option
1857
what is a free iliac crest bone graft based on (blood supply)
deep circumflex iliac artery
1858
what artery is a groin flap based on
superficial iliac circumflex artery
| (LFCTN at risk!)
1859
difference between a radial nerve palsy in the forearm vs PIN palsey
can extend wrist with radial deviation with PIN palsey
(radial nerve innervates ECRL)
1860
how do you tell the difference between a low and high ulnar nerve palsey
in high ulnar nerve palsy, there is a loss of ring and small finger FDP function
1861
how can you differentiate between a high median nerve palsey vs low median nerve palsy
high (includes AIN) EVERYTHING is out
in low, maintence of AIN muscles
1862
what are the 5 sites of compression in Pronator (median nerve at the elbow) syndrome
- supracondylar process
residual osseous structure on distal humerus present in 1% of population
- ligament of Struthers
travels from tip of supracondylar process to medial epicondyle
not to be confused with arcade of Struthers which is a site of ulnar compression neuropathy in cubital tunnel syndrome
- bicipital aponeurosis (a.k.a. lacertus fibrosus)
- between ulnar and humeral heads of pronator teres
- FDS aponeurotic arch
1863
where does the palmar cutaneous nerve lie at the wrist
lies between PL and FCR at level of the wrist flexion crease
1864
which of the following structures are slowly adapting skin receptors that detect pressure, texture, and low frequency vibration and are best evaluated by static two-point discrimination
MERKELS
1865
what are the hand intrinsics innervated by the ulnar nerve
- interossei
- 4th and 5th lumbricals
- Adductor policis
- Deep head of Flexor pollicus brevis
I LAF
1866
what is the only compressive neuropathy of the upper arm that is diagnosed by injection
PIN syndrome, inject into radial tunnel and if pain goes away and PIN palsy occurs, its a positive test
1867
does DEXA scan measure bone density in the axial or appendicular skeleton?
BOTH
1868
what is the treatment of hip dislocation in SMA syndrome?
leave alone
1869
what is gene mutation for MED?
COMP
collagen IX defect
1870
what is the genetic mutation in DMD?
an absence of the dystrophin protein which is found on the Xp21 gene
1871
what disorder shows Characteristic features include the "champagne glass" pelvis, squared iliac wings, and a flat acetabular roof.
achondorplasia
1872
what is the best diagnostic test to SCREEN for DMD?
DIAGNOSE?
screen = cpk
diagnose = muscle biopsy or genetic analysis
1873
what is the biggest prognistic factor for failure after a rotator cuff repair?
both age \> 65 and goutallier grade of 4
1874
when doing a PIP arthroplasty, which is the best approach, dorsal or volar
VOLAR
1875
in kienbachs disease, what is the role that carpal height plays in the disease pathology
associated with a DECREASE in carpal height
1876
what is the most common was to get carpal instability nondissociative?
distal radial non-unions
1877
in SLAC wrists, what are the 2 contraindications for performing a proximal row corpectomy?
1- capitolunate arthritis (PRC will not fix this arthritis)
2- incompetent radioscapholunate ligament (the hand will become unstable without it)
1878
in which direction does the radial head dislocation in congential radial head dislocation
posterior
1879
in what syndrome associated with radial clubhand is the thumb present
TAR
1880
in congenital radial head dx, when do you do non op vs radial head resection
with \<100 pronation/supination
1881
describe the spring ligament during landing and pushoff
tightens during PUSHOFF
loosens during LANDING
1882
where do retinacular cysts of the hand derive from
the pulleys, NOT the flexor tendon or sheath
1883
when do you operate on congenital radial ulnar synostosis?
\> 60 degrees of pronation
1884
what is amniotic band syndrome associated with and when can you officially diagnose it
clubfoot
end of 1st trimester
1885
what causes Poland syndrome
subclavian artery hypoplasia
1886
what is associated with congenital clapsed thumb
congenital vertical talus
club foot
arthrogryposis
1887
three lesions of the POSTERIOR elements of the spine
aneurysmal bone cyst
osteoid osteoma
osteoblastoma
1888
what is the best place to biopsy a distal femur lesion
posteromedial or posterolateral border of vastus medialis/lateralis muscle
1889
what is the treatment for symptomatic Melorheostosis
bisphosphanates
1890
in Paget patients, during total joint arthroplasty, what are the two most common complications
blood loss in THA
malalignment in TKA
remember the specific joint which has each complication
1891
traction pins placed where can lead to HO?
DISTAL FEMUR
not proximal tibia
proximal tiba can lead to recurvatum deformity
1892
what does Ewings stain + for?
CD99; MIC2
1893
in kids, when do you perform Pars repair vs fusion?
pars repair from L1-L4, below that, fusion
1894
what is this histo of?
high grade chondrosarc
1895
what nerve is at risk in the 3,4 and 4,5 wrist scope portals
the PIN
1896
where does the PTT originate from
tibia AND fibula
1897
what type of tumor is associated with NF2?
neuroliomma (Schwannoma)
1898
what is the most common solid tumor of childhood
neuroblastoma
1899
what is the treatment for leiomyosarcoma
normally just wide surgical excision
1900
what tumor has verocoy bodies on histology
neuroliomma/schwannoma
1901
what can be utilized to monitor malignant transformation of neurofibromas to MPNST in NF1
pet ct
1902
what is the difference between treatments for pediatric vs adult rhabdomyosarcoma
Peds = surgery + chemo
Adult = surgery + radiation
1903
what is this histo of and what is its treatment
hemangioma; observation to start
1904
what tumor stains positive for estrogen receptor beta and can be treated with a blockage of that
extra abdominal desmoid tumor
1905
what is the treatment for melanoma?
if \< 1 cm, local resection
if larger, lymph node biopy + resection and possible chemo
subungual requires AMPUTATION
1906
what molecules INHIBIT bone resporption
- OPG
- calcitonin
- TGF beta (via increase in OPG)
- estrogen via decrease in RANKL
- il10 (suppresses osteoclasts)
1907
how do tumor cells create lytic lesion through the rank pathway
BOTH RankL production
and PThrP production causing osteoblasts to secrete RANKL
1908
when do you use a double rocker bottom soled shoe?
diabetic charcot neuropathy
1909
what is the most common reason for pin site infection in pediatric supracondylar fractures?
age \< 4.5
NOT poor pin site care
1910
describe the medial ankle ligment complex
deep = prevents external rotation and valgus
superficial= only prevents VALGUS
1911
what muscle tendon do the sesamoids of the great toe sit in
FHB
medial and lateral FHB
1912
when and how do you treat hemivertabrate congenital scoliosis
resection and fusion
any progression
1913
how can you tell the difference between Kienbochs type 3a vs 3b and what is differential in treatment
3a = collapse but no flexion or rotation
3b= collapse AND rotation or flexion
must be treated with PRC or STT, can't do joint leveling procedures or revascularization
1914
what is a cotton osteotomy
a PLANTARFLEXION cunieform osteotomy, utilized to correct forefoot supination/varus
1915
what soft tissue injury is often associated with schatzker 2 tibial plateau fractures
peripheral lateral meniscus tears
1916
what is the most common sequelue of a displaced talar neck fracture
post traumatic arthritis, NOT AVN
1917
in proximal tibial shaft fractures, what does suprapateller nailing help avoid
apex anterior, NOT valgus deformity
1918
when nailing a tibia with a tourniquet on, what is the associated complication
pulmonary, NOT increased temps or necrosis
1919
with IMN of the tibia, what are the physical exam signs seen for a transient peroneal nerve palsy
- decreased sensation on dorsum of foot
- weakened EHL
1920
in nailing a tibia, where should the herzog curve of the nail be?
PROXIMAL to the fracture
1921
what is the #1 risk for development of osteonecrosis in a talar neck fracture
degree of initial displacement, and NOT fracture reduction
1922
what are the difference in fracture classifications for talar neck fractures?
joint dx
1= none
2= subtalar
3= subtalar + tibiotalar
4= " " + talonavicular
1923
in DISTAL 1/3 tibial shaft fractures, what is the common deformity when nailing it?
valgus
1924
what makes open distal tibia 3B fractures different than proximal or midshaft 3B fractures
they require FREE flaps, not rotational flaps for coverage
1925
how many
