ortho5 Flashcards
(194 cards)
1
Q
proximally what is the internervous plane for the anterior approach to the radius?
A
brachioradialis(radial n) pronator teres(median n)
2
Q
what type of instability direction in the pelvis could potentially be controlled with an external fixator? what can’t?
A
rotational not vertical
3
Q
major complication of pelvic injury that can be life-threatening?
A
hemorrhage
4
Q
anterior compression type pelvic ring injury, what structure is damaged first?
A
pubic symphysis
5
Q
in AP pelvis xr, what should the pubic symphysis line up with?
A
sacral spinous processes
6
Q
Between what two levels should top of symphysis/rami be on in outlet radiograph of the pelvis?
A
at the S2-S3 level
7
Q
Inlet view of proximal sacrum, outlet view of caudal sacrum clue to what type of fracture?
A
U typed sacral fracture
8
Q
what complication can you get with nonop rx of vertical shear sacral fracture?
A
leg length inequality
9
Q
percutaneous fixation with SI screws can lead to damage to what nvb?
A
superior gluteal
10
Q
this treatment is contraindicated for SLAC wrist with incompetent radioscaphocapitate ligament or capitolunate arthritis?
A
proximal row carpectomy
11
Q
what bones are excised in proximal row carpectomy?
A
scaphoid, lunate, triquetrum
12
Q
why protect the radioscaphocapitate ligament with a proximal row carpectomy?
A
prevent ulnar subluxation
13
Q
besides PRC, what other option for treating stage II/III SLAC wrist?
A
scaphoid excision and four corner fusion
14
Q
how treat stage III SLAC wrist/any form of pancarpal arthritis?
A
wrist fusion
15
Q
if MRI shows a rupture of the plantar plate of the 1st MTPj, what do next in terms of treatment?
A
immobilize in a boot
16
Q
what not lining up on oblique view of the foot with the third MT clues you into a lisfranc injury?
A
lateral base of the 3rd MT with lateral aspect of the lateral cuneiform
17
Q
Compared with a 32mm head of similar material and neck length, a 36mm head will exhibit which of the following when used with highly cross linked PE in terms of wear?
A
similar wear rate
18
Q
which ligament is a good anatomic landmark when placing the acetabular component in the appropriate position during a THA?
A
transverse acetabular ligament
19
Q
attenuation of what ligament a/w basilar thumb arthritis?
A
anterior oblique ligament (beak ligament)
20
Q
what deformity a/w thumb CMCJ arthritis at the MCPJ?
A
hyperextension
21
Q
what is the name of the classification of basilar thumb arthritis?
A
eaton and littler
22
Q
what condition can be concomitant with basilar thumb arthritis 50% of the time?
A
carpal tunnel syndrome
23
Q
what position want thumb when taking XR of basilar thumb arthritis?
A
hyperpronated
24
Q
what type of stability does the radial head help support?
A
valgus
25
what does the radial head articulate with?
capitellum
26
axial load in relatively more or less flexion a/w radial head fracture vs capitellum fracture?
more
27
radial head fracture treating nonop, what is one thing you can do to increase pain relief?
aspiration w/wout injection of a local anesthetic
28
persistent pain with nondisplaced radial head fracture being treated nonop may represent what?
capitellar fracture (osteochondral)
29
what does the greenspan view help you see?
radiocapitellar articulation
30
how get a greenspan view?
angle the beam 45 degrees cephalad of the elbow with elbow flexed 90 degrees
31
what type of fat pad sign more sensitive for nondisplaced radial head fracture?
posterior
32
why have to examine forearm with a radial head fracture?
look for essex lopresti lesion
33
what is essex lopresti lesion?
radial head fx/dx with associated IO ligament and DRUJ disruption
34
what do if trying to examine painful elbow due to radial head fracture?(2)
aspirate the elbow
| inject with lidocaine
35
what compartment does the EDM run in?
4th
36
where does the EDM originate from?
lateral epicondyle
37
Signs that are suggestive of *** include progressive radiolucent lines, change of implant position on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem
aseptic loosening
38
Signs that are suggestive of aseptic loosening include ***, change of implant position on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem
progressive radiolucent lines
39
Signs that are suggestive of aseptic loosening include progressive radiolucent lines, *** on sequential radiographs, a positive bone scan, and pedestal formation at the distal aspect of a femoral stem
change of implant position
40
Signs that are suggestive of aseptic loosening include progressive radiolucent lines, change of implant position on sequential radiographs, a ***, and pedestal formation at the distal aspect of a femoral stem
positive bone scan
41
Signs that are suggestive of aseptic loosening include progressive radiolucent lines, change of implant position on sequential radiographs, a positive bone scan, and * at ***the distal aspect of a femoral stem
pedestal formation
42
Revisions for THA <2 years from the time of surgery were most commonly due to ***
infection
43
history of prior ankle sprains usually affects what side of the ankle?
lateral
44
what is an extruded disc?
through annulus but confined by PLL
45
what is a sequestered disc?
disc material free in canal
46
what is the most common symptom with thoracic disc herniation?
axial back or chest pain
47
hyperreflexia
sustained clonus
positive Babinski sign
are all what type of symptom?
upper motor neuron signs
48
weakness, upper motor neuron signs, and gait changes examples of compression to what structure?
spinal cord
49
acute disc herniation with myelopathic findings attributable to the lesion, especially if there is progressive neurologic deterioration indication of what type of treatment for thoracic disc herniation?
surgical
50
someone with a vertically placed ACL graft, what sporting movement would they have instability with?
cutting
51
what bundle of the ACL helps with rotational stability?
posterolateral
52
what happens to the webspace in 1st CMC arthritis?
gets contracted
53
what are the different areas that can be affected in a proximal humerus fracture?
greater tuberosity
lesser tuberosity
articular segment
humeral shaft
54
what mm insert on the greater tuberosity of the humerus?
supraspinatus
infraspinatus
teres minor
55
what mm inserts on the lesser tuberosity of the humerus?
subscapularis
56
are the FDP tendons all separate from one another?
no, share common muscle belly
57
relatively how much angulation allowed for proximal both bone forearm fractures in kids?
less
58
ideal cast index is below what value?
.8
59
congenital dislocation of the radial head is often in what direction?
posterior
60
how is the radius often deformed in congenital radial head dislocation?(2)
short
| bowed
61
partial deficiency of growth of distal radial physis
excessive radial inclination and volar tilt
ulnar carpal impaction
all features of what disorder?
madelung deformity
62
what part of distal radius physis affected in madelung disease?
ulnar volar physis
63
how is madelung inherited?
autosomal dominant
64
how dupuytren inherited?
autosomal dominant with variable penetrance
65
any type of what joint contracture indication for sugery in dupuytren?
PIPJ
66
glenoid avulsion from scapular periosteum is what?
bankart lesion
67
what is seen in stage 2 kienboch according to the lichtman classification?
lunate sclerosis
68
what is needed to diagnose kienboch in stage 1 disease?
MRI
69
what bone migrates proximal in SLAC wrist?
capitate
70
*** should be included in the differential of trigger finger, where the collateral ligament or volar plate tethers on a prominent metacarpal head or osteophyte
MCP locking
71
Most radial structure of the carpal tunnel?
FPL
72
pentrating trauma to arterial wall replaced by organized hematoma and fibrous wall an example of what?
pseudoaneurysm
73
women in 3rd trimester of pregnancy can get what idiopathic disorder?
idiopathic transient osteoporosis of the hip
74
how does the joint space appear in idiopathic transient osteoporosis of the hip?
preserved
75
what needs to be excluded with diagnosis of idiopathic transient osteoporosis of the hip?
femoral neck stress fx
76
how treat transient osteoporosis of the hip in terms of wb?
protective weightbearing
77
most common cause of ulnar nerve compression in guyon canal?
ganglion cyst
78
what inn the APL?
PIN
79
what is a normal cervical canal diameter?
17mm
OB
80
what is the torg pavlov ratio?
canal/vertebral body width
81
normal torg pavlov ratio?
1.0
82
Formation of this structure is associated with a poor prognosis after revision of a failed metal-on-metal resurfacing hip arthroplasty to total hip arthroplasty?
pseudotumor
83
at the level of tibial bone resection during a TKA, behind what muscle does the common peroneal n lie?
lateral head of the gastrocnemius
84
how does the acetabular sourcil move during a PAO(2)?
anterior
| lateral
85
A to P how is the humeral head usually oriented?
retroverted
86
On what side is the construct placed when fixing something using tension band principle?
on the tension side
87
If suspecting burner/stinger, Bilateral symptoms or lower extremity symptoms are more suggestive of what?
spinal cord injury
88
what approach use to reduce C1/C2 distal femur fracture in preparation for a retrograde nail?
open medial or lateral parapatellar approach to the knee
89
Partial articular fractures (all B subgroups) and complex articular fractures (C-3 subgroups) should not be considered for *** femoral nailing.
retrograde
90
what use for femoral fractures where trying to restore length with nailing and can't do it manually?
femoral distractor
91
why prep out the whole hip for retrograde femoral nailing?
have field in case there is a femoral neck fracture
92
How is the starting wire positioned for retrograde femoral nailing on the AP?
just medial to the midline in the trochlear groove, in line with the femoral shaft
93
what can you use to gain control of proximal fracture fragment in subtrochanteric/proximal shaft fractures for retrograde femoral nailing to get the reduction?
5mm unicortical shanz pin
94
what do to the knee to relax the gastrocnemius muscle when trying to reduce a femoral shaft fracture that is in recurvatum?
flex the knee
95
what can you see in someone with a webspace collar button abscess on PE?
abduction/spread of the affected fingers
96
two br of the superior trunk of the brachial plexus are what?
suprascapular n and br to subclavius
97
have to do what before revising a TKA esp <2 yrs from the index surgery?
rule out infection
98
what ligament can get attenuated in CR knee leading to ligament/flexion instability?
PCL
99
when measuring nail sizes for retrograde femoral nail, if nail is between sizes what do you pick?
the smaller of the two sizes
100
Aseptic Lymphocyte-Dominated Vascular-Associated Lesions (ALVAL) are also known as what?
pseudotumors
101
population that does the best with hip resurfacing
young men w/ good bone stock
102
how does patella baja affect knee flexion?
decrease
103
*** is a key level in myelodysplasia because the quadriceps can function and allow independent ambulation around the community
L4
104
Following gunshot wounds, [upper extremity] nerve injuries exhibit the worst functional recovery.
ulnar
105
Semi-constrained knees or constrained condylar knees rely on a large *** to enhance varus/valgus stability
tibial post
106
Changing the mechanical axis of the knee or recuting the tibia in extreme varus or valgus should not be done to balance knee as it may increase risk of this complication***
aseptic loosening
107
In knees, Finally, in the patient with severe bone loss and gross instability, a *** may be necessary to achieve stability.
rotating hinge knee
108
what has better oral availability gabapentin or pregabalin?
pregabalin
109
what is mechanism of gabapentin/pregabalin?
reduce hyper-excitability of voltage dependent Ca2+ channels
110
what type of exercises do for rehab after total knee?
closed chain concentric exercises
111
in reverse oblique fractures, the major frx line extends from proximal-*** through intertroch-subtrochanteric region
medial to distal-lateral
112
what should tibiofibular overlap be greater than (including men)?
>6mm
113
*** in a revision knee allows for good exposure and is especially indicated if there is patella baja as it allows proximal translation of the tibial tubercle
tibial tubercle osteotomy
114
what is rate of infection relatively in revision TKA?
higher
115
what use to fill <1cm cavitary defect in revision TKA setting?
cement
116
Spine—reduced rate of spinal fusion in animal model leading to recommendation of withholding [this medication type] is recommended after surgery
bisphosphonate
117
what landmarks can use as intraop guide for safe placement of implant in radial head?(2)
arc bw radial styloid
| and lister
118
what is advantage of cervical disc replacement over fusion?
don't need to worry about pseudarthrosis
119
disease indication for cervical disc replacement?
single and double level cervical radiculopathy/myelopathy
120
why not plunge through the far cortex when drilling the proximal interlock in a retrograde nail?
sciatic back there
121
newborn where does the spinal cord end?
L3
122
what type of knee implant gets patellar clunk?
posterior stabilized
123
another word for hemipelvis?
innominate bone
124
what makes up the innominate bone?
ilium, ischium, pubis
125
what have to rule out with TKA stiffness?
infection
126
how treat persistent stiff tka?(2)
arthroscopic lysis of adhesions with manipulation under anesthesia
127
for more exposure in the deltopectoral approach, the superior 1cm of what tendon can be incised?
pectoralis major
128
what nerve is palpable at the anteroinferior border of the subscapularis?
axillary n
129
AP pelvis, the pelvic brim and IP line should intersect what landmark on the back of the pelvis?
superior margin of the S2 foramen
130
Unilateral lateral column damage results in *** muscle paralysis below the level of injury with spasticity, hyperreflexia, clonus, loss of superficial reflexes, and a positive Babinski sign.
ipsilateral
131
Unilateral lateral column damage results in ipsilateral muscle paralysis below the level of injury with spasticity, ***, clonus, loss of superficial reflexes, and a positive Babinski sign.
hyperreflexia
132
Injury to the dorsal column results in an *** loss of joint position sense, vibratory sense, and tactile discrimination below the level of injury.
ipsilateral
133
what is the prognosis for recovery from brown sequard type injury?
pretty good except hand recovery can be poor
134
what modality usually used to treat brown sequard syndrome?
nonsurgical
135
Among the spectrum of clinical presentations following failed metal-metal total hip replacements, *** damage from localized inflammation is one finding that can lead to hip instability.
abductor
136
This will require antibiotic therapy to cover ***, a gram-negative bacteria that is normal intestinal flora in leeches
aeromonas hydrophila
137
how patella position affected by lateral distal femoral osteotomy?
patella alta
138
how does horizontal femoral offset affect aseptic loosening?
more offset increase risk of loosening
139
The *** articulates with the ring and small metacarpals by two concave facets separated by a ridge
hamate
140
how rotate the forearm to see 5th CMCJ fx better? how many degree?
30 pronated view
141
lost reduction of 5th CMCJ can lead to problem with what hand function?
weak grip
142
how treat vancouver b2 fracture (ie what implants add[including relative length]/change) (2)?
femoral component revision
| application of plate that spans fracture by 2 cortical diameters
143
what is broken in a hangman fracture? (what part of vertebrae)
BL pars interarticularis
144
mechanism of hangman fracture(2)?
hyperextension
| secondary flexion
145
what is characteristic of type III hangman fracture?
BL facet dislocation C2-3
146
what is most common reason for knee arthrodesis?
salvage for failed TKA
147
What motion can MUA help increase if stiff after TKA?
flexion
148
There are many risk factors for postoperative stiffness after TKA the most important being ***
preoperative stiffness
149
The appropriate treatment for a transverse periprosthetic patella fracture with an intact extensor mechanism is ***(2)
closed treatment and immobilization in a long leg cast.
150
can you mobilize vertical periprosthetic patella fx after TKA immediately?
yes
151
what have to do to wrist to test radial n?
extend it
152
A 72-year-old woman has been experiencing decreased ability to use her hands for knitting. She states that her handwriting has been changing as well. Her primary care physician ordered a head and neck MRI that revealed canal stenosis throughout the cervical spine but no intracranial pathology. Signal changes were noted in the spinal cord just distal to the area of compression around C7-T1. Upon questioning, she states she has fallen more in recent months. An examination shows some mild hand weakness and a positive Hoffman sign result. What is the most appropriate treatment?(2)
Staged anterior cervical decompression and fusion followed by posterior laminectomy and instrumentation
153
what is the molecular cause of aseptic loosening?
particulate bone debris
154
what cell type is involved in aseptic loosening?
macrophage
155
aseptic loosening femoral condyles usually occurs where?
posterior
156
what imaging can get for larger osteolytic defects?
CT
157
Fat atrophy and skin depigmentation can happen if inject steroid where when giving a trigger finger injection?
subQ
158
Extraarticular fractures at the base of the proximal phalanx occur at the metaphyseal-diaphyseal junction. The fracture is usually comminuted dorsally, is impacted, and has apex *** angulation
volar
159
Malunion of base fractures of the proximal phalanx can lead to what?
pseudoclawing
160
What position should the MP joint be positioned for Base Fractures of the Proximal Phalanx?
flexion
161
Receptor activator of nuclear factor kappa binds its ligand and activates ***
osteoclasts
162
gait instability, clumsiness and loss of manual dexterity, and glove-like (rather than dermatomal) numbness of the hands symptoms of what?
cervical myelopathy
163
when do an ACDF as opposed to corpectomy for cervical myelopathy?
when compression just disc based not retrovertebral
164
The *** is the predominant blood supply to the spinal cord
anterior spinal artery
165
Treatment for pancarpal arthritis?
wrist fusion
166
What articulates with radius after scaphoid excision and 4 corner fusion?
lunate
167
what ligament incompetence contraindication to PRC?
radioscaphocapitate ligament
168
what tendon inserts on the navicular?
posterior tibialis
169
non-neural, fibrous extension of the conus medullaris that attaches to the coccyx
filum terminale
170
external sphincter of the bladder is controlled by the ***
pudendal nerve
171
bladder dysfunction involved in cauda equina syndrome involves what?
urinary retention and eventually to overflow incontinence
172
The one accepted indication for operative treatment of a displaced partial radial head fracture (Mason II) is a ***
block to motion
173
Kocher approach to the elbow bw what two muscles?
ECU
| anconeus
174
what marks the 90 degree safe zone of the radial head for implant placement?
bw radial styloid and lister tubercle
175
what is the cm cutoff for saying someone has sagittal plane imbalance of the spine?
5cm
176
what region of spine more often gets degenerative scoliosis?
lumbar
177
primary restraint to lateral patellar translation
MPFL
178
what inserts bw the adductor magnus and superficial medial collateral ligament?
MPFL
179
*** are expansile metaphyseal lesions that are never wider than the physis
Unicameral bone cysts
180
early infection, may be only evidence on the XR?
soft tissue sweling
181
*** are eccentric metaphyseal lesions with scalloped borders.
nonossifying fibroma
182
Surgical dissection of the posterior arch of C1 should be limited to *** lateral to the midline
1.5cm
183
spinal tumors usually emanate from the level of the ***, not the disk space.
vertebral body
184
alendronate, risedronate, pamidronate, ibadro- nate are examples of what type of diphosphonate?
nitrogen containing
185
what enzyme do nitrogen containing diphosphonate inhibit?
inhibit farnesyl pyrophosphate synthase
186
how do nonnitrogen containing bisphosphonate work?
form ATP analog that induces osteoclast apoptosis
187
what patient population not give teriparatide to due to risk of osteosarcoma?
paget
188
A 47-year-old man undergoes a posterior cervical procedure for a benign tumor. Postoperatively, severe dysfunction with decreased forward elevation and abduction develops and he has lateral winging of the scapula. What nerve is hit?
spinal accessory nerve
189
Split pectoralis major transfer is performed to restore ***function
serratus anterior
190
A 22-year-old college baseball pitcher reports the recent onset of anterior and posterosuperior shoulder pain in his throwing shoulder. Examination shows a 15-degree loss of internal rotation, tenderness over the coracoid, and a positive relocation test. Radiographs are normal, and an MRI scan without contrast shows no definitive lesions. A rehabilitation program is prescribed. Which of the following regimens should be initially employed?
stretch posterior capsule and pec minor
191
SICK scapula stands for what?
SICK (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement) scapula
192
In this procedure, the levator scapulae and rhomboid minor and major muscles are transferred laterally?
eden lange
193
Compression of the suprascapular nerve at the *** causes isolated infraspinatus weakness while compression at the suprascapular notch would affect both the supraspinatus and infraspinatus
spinoglenoid notch
194
Compression of the suprascapular nerve at the spinoglenoid causes isolated infraspinatus weakness while compression at the *** would affect both the supraspinatus and infraspinatus
suprascapular notch
