ortho_2_n Flashcards
(201 cards)
1
Q
what is the most severe consequence of amniotic band syndrome?
A
amputation
2
Q
How aspirate the elbow:palpate lateral epicondyle***palpate olecranonin the middle soft spot for injectiongo perpendicular to the skin when placing the needle
A
palpate radial head
3
Q
These are the uses for the anterior approach to the hip:***synovial biopsyfusionTHAhemiarthroplastyexcision of tumorupper pelvic osteotomy
A
ORIF hip dislocation with the head anterosuperior
4
Q
what is normal flexion/extension for the hip?
A
120-140 degrees
5
Q
what may be a potential option for younger patients with lateral compartment OA of the knee who are not good candidates for arthroplasty and have lateral condyle hypoplasia?
A
distal femoral osteotomy
6
Q
How aspirate the elbow:***palpate radial headpalpate olecranonin the middle soft spot for injectiongo perpendicular to the skin when placing the needle
A
palpate lateral epicondyle
7
Q
if someone has dorr c femur, old, osteoporotic and >75, what type of fixation can pursue?
A
cemented
8
Q
More than 90% of GCT and chondroblastoma a/w what genetic defect?
A
Histone H3.3 mutation
9
Q
MSIS criteria(need 4):1) elevated esr(30) or crp(10)2) elevated synovial wbc(1,1k knee/3k hip)3) elevated synovial pmn(64 knee/80%hip)4) purulence5) pathogen isolation 1 culture6) ***
A
> 5 PMN per hpf frozen section
10
Q
MSIS criteria(need 4):1) ***2) elevated synovial wbc(1,1k knee/3k hip)3) elevated synovial pmn(64 knee/80%hip)4) purulence5) pathogen isolation 1 culture6) >5 PMN per hpf frozen section
A
elevated esr(30) or crp(10)
11
Q
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperiorsynovial biopsyfusionTHAhemiarthroplasty***upper pelvic osteotomy
A
excision of tumor
12
Q
which metacarpal do the lunate and capitate line up with?
A
3rd
13
Q
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperior***fusionTHAhemiarthroplastyexcision of tumorupper pelvic osteotomy
A
synovial biopsy
14
Q
what femoral condyle does the PCL attach?
A
medial
15
Q
contracture of what tissue is the initial deformity at the anterior elbow in CP?
A
muscle
16
Q
Neuro ddx for hip pain:***spinal stenosisneuropathymeralgia parestheticaCRPS
A
lumbar radiculopathy
17
Q
how is the torso oriented in a trendelenburg gait?
A
leaned over the affected side
18
Q
Hip DJD ddx:OA***osteonecrosisdysplasiatraumasepsis
A
inflammatory arthritis
19
Q
what is thought to cause amniotic band syndrome?
A
amniotic disruption with release of bands
20
Q
how can release a proximal ring that is proximal and severe but which can lead to 6-10% chance of abortion?
A
fetoscopic release
21
Q
How treat zone 1 fifth MT fx(2)?
A
wbat in a hard soled shoe or boot
22
Q
MSIS criteria(need 4):1) elevated esr(30) or crp(10)2) elevated synovial wbc(1,1k knee/3k hip)3) ***4) purulence5) pathogen isolation 1 culture6) >5 PMN per hpf frozen section
A
elevated synovial pmn(64 knee/80%hip)
23
Q
why would you wait to do a THA after giving a CS injection?
A
decrease chance of infection
24
Q
6 yr old R thigh pain, limp, very active, smaller kid, + log roll, < IR and abduction, + ischial spine sign, what is the diagnosis?
A
legg calve perthes
25
what type of abnormal gait gets better when walking faster?
trendelenburg
26
what do you have to protect while placing guidewire for PCL tibial tunnel?
neurovascular structures
27
after elbow release in CP, what position splint extremity?
in extension
28
what imaging can you get beforehand when planning THA in someone with prior acetabular fx fixation?
CT
29
What rehabilitation strategy should you use following repair of tendon to bone?
protective immobilization of tendon to bone injury
30
The deep internervous plan for the anterior approach to the hip:rectus femoris(femoral n)***
gluteus medius (superior gluteal n)
31
The superifical internervous plane for the anterior approach to the hip:***tensor fascia latae(superior gluteal n)
sartorius(femoral n)
32
```
The deep internervous plan for the anterior approach to the hip:
***
gluteus medius (superior gluteal n)
```
rectus femoris(femoral n)
33
besides AL and medial portal, what else might need in PCL reconstruction?
posteromedial portal
34
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperiorsynovial biopsy***THAhemiarthroplastyexcision of tumorupper pelvic osteotomy
fusion
35
Neuro ddx for hip pain:lumbar radiculopathyspinal stenosis***meralgia parestheticaCRPS
neuropathy
36
what can trendelenburg gait indicate in terms of muscle deficiency?
abductor deficiency
37
besides latarjet and iliac crest grafting, what other bone can you use for allograft in addressing recurrent anterior shoulder instability with >20% glenoid bone loss?
tibia
38
MSIS criteria(need 4):
1) elevated esr(30) or crp(10)
2) ***
3) elevated synovial pmn(64 knee/80%hip)
4) purulence
5) pathogen isolation 1 culture
6) >5 PMN per hpf frozen section
elevated synovial wbc(1,1k knee/3k hip)
39
what is normal abduction of the hip?
60-80
40
older low demand patient who are thin and have unicompartmental dz candidates for what knee procedure?
uka
41
what condition is PAX3-MAML3 a/w?
sinonasal sarcoma
42
Neuro ddx for hip pain:lumbar radiculopathyspinal stenosisneuropathy***CRPS
meralgia paresthetica
43
How aspirate the elbow:palpate lateral epicondylepalpate radial headpalpate olecranon***go perpendicular to the skin when placing the needle
in the middle soft spot for injection
44
what area of femoral malunion has a greater magnitude on knee joint deformity?
more distal
45
does all the hardware have to come out when doing a THA in someone with a past procedure?
no, just take out what you need
46
What do the lunate and capitate line up on the AP of the hand?
3rd metacarpal
47
how treat nondisplaced both bone forearm fractures?
| how arm/elbow positioned?
well molded long arm cast in neutral rotation, elbow flexed to 90
48
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperiorsynovial biopsyfusionTHA***excision of tumorupper pelvic osteotomy
hemiarthroplasty
49
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperiorsynovial biopsyfusion***hemiarthroplastyexcision of tumorupper pelvic osteotomy
THA
50
patient with inflammatory arthritis, acl deficiency, varus/valgus deformity, decreased rom, and tricompartental arthritis shouldn't get what procedure for knee pain?
uka
51
what is the predominant deformity at the elbow in CP?
flexion contracture
52
how treat patient when can't abduct thumb after a carpal tunnel release?
urgent exploration and repair of median nerve
53
how far below the joint line does the PCL attach to the tibia?
1-1.5cm
54
how many legs do you need to see on xr to see the LLD?
both
55
How treat K line negative OPLL?
cervical corpectomy and anterior fusion
56
Steps for shoulder injection:1) mark PL corner of the acromion2) ***3) go inferior and medial to the PL corner about 2 finger breadth4) insert needle aiming for the coracoid
mark the coracoid
57
Nonunion and *** are complications of having a midfoot dislocation?
posttraumatic arthritis
58
what type of shoulder dx/glenoid not do latarjet for?
first time dislocator with minimal glenoid bone loss
59
what is the most common msk area to be injured with golf?
lower back
60
how much can biceps, brachialis, and BR lengthening increase elbow extension in CP kid?
40 degrees
61
kyphosis above what degree mark is a/w poor outcome in someone who undergoes cervical laminoplasty?
13 degrees
62
what type of bearing doesn't tolerate malposition well and can cause squeaking after THA?
ceramic on ceramic
63
what is meant by the MPFL being isometric?
doesn't change length
64
Hip DJD ddx:OAinflammatory arthritis***dysplasiatraumasepsis
osteonecrosis
65
how can a nerve be negatively affected by constriction ring?
peripheral nerve palsy
66
what degree of spastic deformity is musculocutaneous neurectomy used for in elbow contracture in CP?
<30 degrees
67
what side dips in trendelenburg gait?
contralateral hip dips
68
What bone can break if a golf club hits the ground when swinging?
hook of the hamate
69
what type of fracture can you see with hip resurfacing?
femoral neck
70
laminectomy, laminotomy, and foraminotomy are examples of what kind of spinal procedure?
decompression
71
If someone has ipsilateral hip and knee OA, what address first?
hip first then knee
72
rigid flatfoot can be causes by what problem in the adolescent?
coalition
73
what is the dorr classification useful for, or what attempt to do?
guide indications for cemented versus uncemented femoral component fixation
74
MSIS criteria(need 4):1) elevated esr(30) or crp(10)2) elevated synovial wbc(1,1k knee/3k hip)3) elevated synovial pmn(64 knee/80%hip)4) ***5) pathogen isolation 1 culture6) >5 PMN per hpf frozen section
purulence
75
In uncemented THA, how does acetabular component stay in?
press fit allowing bone ingrowth/ongrowth
76
what is the effect of distance of femoral malunion on joint deformity?
further deformity away is, less joint deformity
77
What is the standard of treatment for hip DJD refractory to nonop management?
THA
78
Coracoid transfer to the anteroinferior glenoid rim is what procedure?
latarjet
79
what postoperative complication are those who have THA for avn at risk for?
dislocation
80
in longstanding flexion contracture of the elbow in CP, what may you need to release in the elbow besides muscle?
joint capsule
81
what test can get to determine what tendons to lengthen in elbow contracture in CP?
dynamic EMG
82
These are the landmarks for the anterior approach to the hip?(2)
ASISiliac crest
83
where doe the meniscofemoral ligaments originate?
posterior horn of lateral meniscus
84
T/F: lower volume hospitals have higher rates of PJI?
false (Namba et al. JBJS 2013)
85
for both bone forearm fractures, in general what is the ratio of open injuries to closed compared to other anatomic areas?
higher open to closed ratio
86
what is the risk of a patella dx after the second dx?
>50%
87
What does desiccate mean?
remove moisture from something
88
Hip DJD ddx:OAinflammatory arthritisosteonecrosisdysplasiatrauma***
sepsis
89
condition caused by perinatal brain injury leading to irreversible, static injury?
cerebral palsy
90
13 y/o w/knee pain and limp, plays football, knee exam normal, hip extended, externally rotated, infantile genitalia what they got?
SCFE
91
The superifical internervous plane for the anterior approach to the hip:sartorius(femoral n)***
tensor fascia latae(superior gluteal n)
92
*** and postratumatic arthritis are complications of having a midfoot dislocation?
Nonunion
93
if someone has tinnitus, and possible new heart problem after a total hip, what type of toxicity may be going on?
cobalt toxicity
94
which facet of the patella is bigger?
lateral
95
posterolateral ankle pain with resisted eversion of the foot is what problem?
peroneal tendinopathy
96
how do you treat displaced both bone forearm fractures?
ORIF
97
what can you see sometimes on tibia in someone with pcl tear on XR?
avulsion fx
98
this disorder is a/w avn of the femoral head and involves bubbles forming in body when going from high to low pressure environment?
caisson disease
99
if treating both bone forearm fracture nonoperatively, what do you have to do after patient discharged?
frequent follow up
100
what does an ischial spine sign mean on AP pelvis in a kid?
hip stiff so the hemipelvis is rotating to try to compensate
101
why is stem polished in cemented tha?
prevent motion at the cement bone interface
102
what is normal IR/ER of the hip?
60-90
103
if someone has PCL tear with hyperextension, what other things look out for?
combined ligamentous injuries
104
if someone has previous fixation in the proximal femur, what should you do first before taking it out when converting to THA?
dislocate to prevent iatrogenic fracture if you take out implant first
105
MSIS major criteria for prosthetic joint infection(need 1):1) sinus tract to prosthesis2) ***
pathogen isolated by culture from 2 separate samples from joint
106
MSIS criteria(need 4):1) elevated esr(30) or crp(10)2) elevated synovial wbc(1,1k knee/3k hip)3) elevated synovial pmn(64 knee/80%hip)4) purulence5) ***6) >5 PMN per hpf frozen section
pathogen isolation 1 culture
107
what is a more important aspect of doing a THA related to the implants that prevents further risk of dislocation ahead of capsular repair?
component position
108
bmi over what increases risk of PJI in TKA/
>= 35
109
Other ddx of hip pain:vascular claudicationmetastatic disease***
infection
110
MSIS major criteria for prosthetic joint infection(need1):1) ***2) pathogen isolated by culture from 2 separate samples from joint
sinus tract to prosthesis
111
besides release what else can do to muscle contracture surgically causing hyperflexion in CP?
muscle denervation
112
if no subtalar arthritis, how treat a coalition?
resection
113
flicking nail of middle finger with ipsilateral thumb/index finger contraction is what test?
hoffman
114
How aspirate the elbow:palpate lateral epicondylepalpate radial head***in the middle soft spot for injectiongo perpendicular to the skin when placing the needle
palpate olecranon
115
Other ddx of hip pain:vascular claudication***infection
metastatic disease
116
which of the following chemo agents can be used for ewing sarcoma? doxorubicin, cyclophosphamide, methotrexate, etoposide?
everything except methotrexate
117
what is the prognosis for nerve injuries in the forearm?
rarely recover
118
most common presentation of nonaccidental trauma in kid?
skin lesions
119
What are the two goals for fixing a both bone forearm fracture?
restore length and alignment
120
Steps for shoulder injection:1) mark PL corner of the acromion2) mark the coracoid3) ***4) insert needle aiming for the coracoid
go inferior and medial to the PL corner about 2 finger breadth
121
what cell type makes up the initial response to an injury or infection?
neutrophil
122
this knee procedure is effective for offloading the medial compartment of the knee in younger patients as alternative to arthroplasty and also useful adjunct in those undergoing cartilage preservation procedures?
high tibial osteotomy
123
where doe the meniscofemoral ligaments insert?
posterolateral medial femoral condyle
124
Other ddx of hip pain:***metastatic diseaseinfection
vascular claudication
125
what force apply to the tibia when applying fixation to graft for PCL reconstruction?
anterior tibial force
126
what is acrosyndactyly?
fusion of the digits distally
127
what is critical to evaluate in both bone forearm injuries preoperatively, intraoperatively and postoperatively?(2)
radioulnar jointradiocapitellar joint
128
How is someone positioned for the anterior approach to the hip?
supine with a sandbag
129
lateral forefoot post should be combined with what whenn placing orthotic for cavovarus foot?
1st MT head recess
130
which pCL bundle taut in extension?
PM
131
what can happen to skin in the AC fossa during flexion contracture of the elbow in CP?
skin breakdown
132
why are people with avn at higher risk of dislocation if treated with THA?
capsule is looser since avn a more acute process than primary OA
133
how surgically treat constriction ring?
excision of the ring with a z plasty or w plasty
134
Anatomic ddx of hip pain:intrapelvicintrabdominal***SI joint pain
tumor
135
small epiphyseal lesion in a kid is most often what?
chondroblastoma
136
How can the hip be oriented in septic arthritis?
flexed, abducted, and externally rotated
137
what degree of contracture do a full elbow release in CP?(functional)
>40 degrees in functional extremtiy
138
T cells recognize _____
antigens
139
Steps for shoulder injection:1) mark PL corner of the acromion2) mark the coracoid3) go inferior and medial to the PL corner about 2 finger breadth4) ***
insert needle aiming for the coracoid
140
Neuro ddx for hip pain:lumbar radiculopathy***neuropathymeralgia parestheticaCRPS
spinal stenosis
141
This classification is based on the ratio of the inner canal diameter at midportion of lesser trochanter divided by diameter 10 cm distal?
dorr classification
142
what may elevated in the urine of those with osteoid osteoma?
prostaglandind/cyclin
143
C sign indicates coalition between what bones?
talus and calcaneus
144
How do you treat path fx with enchondroma of the hand?
let the fracture heal, then go back take sample send to path, curettage, and let know from hand and graft
145
what lab work up do you get in THA w/hx of acetabular fx?
ESR/CRP
146
where deos the AL bundle of the PCL attach relative to the PM bundle on the tibia (in the medial lateral direction)?
lateral
147
why use a constrained liner for a revision total hip arthroplasty in terms of muscle support?
abductor muscle deficiency
148
Anatomic ddx of hip pain:***intrabdominaltumorSI joint pain
intrapelvic
149
When does the patella engage with (how much flexion)?
20-30 degree
150
These are the uses for the anterior approach to the hip:ORIF hip dislocation with the head anterosuperiorsynovial biopsyfusionTHAhemiarthroplastyexcision of tumor***
upper pelvic osteotomy
151
what does ALVAL stand for?
aseptic lymphocyte-dominant vasculitis-associated lesion
152
partial removal of the lamina?
laminotomy
153
How aspirate the elbow: palpate lateral epicondyle palpate radial head palpate olecranon in the middle soft spot for injection ***
go perpendicular to the skin when placing the needle
154
What motion at the hip can you do to help find the sartorius in the anterior approach to the hip?
externally rotate the leg
155
T/F osteonecrosis decreases the chance of getting an infected total knee?
FALSE
156
how are proximal structures affected in constriction band syndrome?
they aren't
157
how treat chondroblastoma in a kid(2)?
curretage and grafting
158
Dendritic cells present antigens to T cells via ____
MHC class II receptors
159
what do you keep eye out for in both bone forearm fracture and swelling in the forearm?
compartment syndrome
160
Anatomic ddx of hip pain:intrapelvic***tumorSI joint pain
intrabdominal
161
what is a type 3 constriction ring classifed by?
tips of fingers joined
162
what part of the radius is important for supination and pronation?
radial bow
163
most important question to ask someone who suffered a patella dx?
is it the first time
164
complete removal of lamina?
laminectomy
165
how many hands needed to examine a hip?
2
166
what lab value normalizes first esr or crp?
crp
167
what can fracture and shortening of one forearm bone lead to in the other?
dislocation
168
Tenderness over the origin of the ECRB and pain with resisted middle finger extension are signs of what condition?
lateral epicondylitis
169
why is an MRI useful in assessing early AVN of the femoral head?
assess what % involved
170
when templating, what landmark does the acetabular cup sit next to medially?
the teardrop
171
how treat skin protuberance in amniotic band syndrome?
excision, resurfacing with full thickness skin graft
172
what issue with bone growth would argue for ulnar nerve release for surgery for elbow contracture?
heterotopic ossification
173
how treat a zone 3 fifth MT fx?
nwb 6-8 weeks in a cast
174
what about dial test would indicate combined PCL and PLC injury?
asymmetry in ER at 30 and 90 of flexion
175
Hip DJD ddx:***inflammatory arthritisosteonecrosisdysplasiatraumasepsis
OA
176
if can't reduce subtalar dislocation, what do?
urgent open reduction and possible subtalar pinning
177
what degree of contracture do a full elbow release in CP?(nonfunctional)
>100 degrees
178
culture every *** and biopsy every ***
tumor, infection
179
this treatment has been reserved for patients with spinal stenosis along with spondylolisthesis or scoliosis?
decompression and fusion
180
what is good way to test upper extremity nerves in a both bone forearm fracture?
two point discrimination
181
terminal abscence or amputation, localized swelling with digital edema distal to constriction a/w what condition?
amniotic band syndrome
182
how can the physis of the femoral head look like on xr of a SCFE?
widened
183
what nerve exits between the biceps and brachialis?
lateral antebrachial cutaneous nerve
184
```
Hip DJD ddx:
OA
***
trauma
sepsis
inflammatory arthritis
osteonecrosis
```
dysplasia
185
this is the primary dynamic restraint in the ankle?
peroneal tendon
186
what is a synchondrosis?
almost immovable joint bw two bones bound by layer of cartilage
187
what is the most common primary malignant tumor in the pediatric population?
osteosarcoma
188
What does fulgurate mean?
destroy by electricity
189
How many degrees is physiologic genu valgum? (range)
5-7 degrees
190
Where does current flow for unipolar cautery?
through the patient to the pad
191
Anatomic ddx of hip pain:intrapelvicintrabdominaltumor***
SI joint pain
192
positive tinel at posterolateral ankle is what nerve?
sural
193
what is usually in the hx of a PCL tear?
direct blow to the anterior lower leg
194
what cell type plays a role in integrating the innate and adaptive immune responses?
dendritic cells
195
what is a conservative amount of time to wait to do a THA after a CS injection?
6 months
196
Neuro ddx for hip pain:lumbar radiculopathyspinal stenosisneuropathymeralgia paresthetica***
CRPS
197
what should the radial head align with on views of the elbow?
capitellum
198
Hip DJD ddx:OAinflammatory arthritisosteonecrosisdysplasia***sepsis
trauma
199
for tendon to bone injuries, like rotator cuff tear, which is the primary healing response?
formation of a fibrovascular scar
200
7 y/o with fever and thigh pain, temp of 39 C and NWB, what have to have suspicion for?
septic arthritis
201
Steps for shoulder injection:1) ***2) mark the coracoid3) go inferior and medial to the PL corner about 2 finger breadth4) insert needle aiming for the coracoid
mark PL corner of acromion
