ortho_3_n Flashcards
(178 cards)
1
Q
reasons for fat suppressing: *** recognize where edema distinct from fat or prove something fatty
A
make tissue easier to appreciate
2
Q
what causes an AIIS avulsion?
A
eccentric contraction of the rectus femoris
3
Q
how do you measure a true limb length discrepancy?
A
ASIS t the medial malleolus
4
Q
which tendons get more irritated after a distal radius ORIF?
A
extensor tendon irritation
5
Q
why patients with osteopetrosis get vision issues?
A
encroachment on optic and oculomotor nerves
6
Q
what is the nerve innervationgo betweenfor extending approach to distal radius proximally?
A
median nradial nerve
7
Q
The dorsomedial cutaneous nerve of the hallux consists of branches ofWhich of the following nerves?
A
Saphenous and superficial peroneal
8
Q
Operative indications DR fx:* Secondary loss of reduction* Articular comminution, step-off, or gap* —* Loss of volar buttress with displacement* DRUJ incongruity* Open fractures* Associated carpal fractures* Associated neurovascular or tendon injury* An impaired contralateral extremity
A
metaphyseal comminution or bone loss
9
Q
what mm comes off of your ischial tuberosity?
A
hamstring
10
Q
Figures 1 and 2 are the anteroposterior and lateral plain radiographs of a 45-year-old woman who had severe bilateral leg pain for 6 months. Videos 1 and 2 are her sagittal and axial T2-weighted MRI scans. After attempting nonsurgical treatment including physical therapy and epidural injections, she continued to experience persistent pain. What is the most appropriate treatment?(2)
A
decompression and instrumented fusion
11
Q
what happens to IM canals in osteopetrosis?
A
filled with bone, no distinction bw cortical and cancellous bone
12
Q
What are the two surgical options for treating a lisfranc sprain?
A
ORIF or fusion of the 1st and 2nd TMTJ
13
Q
what type of symptoms operate on someone with a meniscus tear?(3)
A
catching, locking, or giving way
14
Q
Operative indications DR fx:* Secondary loss of reduction* Articular comminution, step-off, or gap* Metaphyseal comminution or bone loss* Loss of volar buttress with displacement* DRUJ incongruity* —* Associated carpal fractures* Associated neurovascular or tendon injury* An impaired contralateral extremity
A
open fractures
15
Q
patellar tilt >20 can be indication for what procedure?
A
lateralr retinacular release
16
Q
most sensitive imaging modality for patellar tendon rupture?
A
MRI
17
Q
Compared with placebo, how do CS injections compare with placebo for lateral epicondylitis at 6 months in terms of pain and function?
A
no difference in pain and function
18
Q
Indications for glenohumeral joint arthrodesis:Brachial plexus injury***Chronic infectionFailed GH joint arthroplastySevere refractory instabilityBony deficiency following tumor or bone resectionPainful flail shoulder
A
Paralysis or severe paresis of the RTC or deltoid
19
Q
How can post stroke shoulder pain be treated if nonop measures fail?
A
Glenohumeral arthrodesis
20
Q
What is an absolute contraindication to shoulder fusion?
A
Active infection
21
Q
Operative indications DR fx:* Secondary loss of reduction* Articular comminution, step-off, or gap* Metaphyseal comminution or bone loss— DRUJ incongruity* Open fractures* Associated carpal fractures* Associated neurovascular or tendon injury* An impaired contralateral extremity
A
loss of volar buttress with displacement
22
Q
how do grind test on the toe?
A
hold PP compressed against the met head and move it plantar and dorsal in mid arc of motion
23
Q
what deformity in carpal bone position (scaphoid and lunate) does scapholunate dissocation lead to? 2
A
scaphoid flex palmar
lunate to dorsiflex
24
Q
how many degrees of flexion keep elbow while reducing it for an elbow dislocation?
A
30 degrees
25
reasons for fat suppressing:make tissue easier to appreciate***or prove something fatty
recognize where edema distinct from fat
26
what does tgf-beta do in dupuytren dz?
transform normal fibroblasts into myofibroblasts
27
-3
scapular stabilizationproprioceptive re-educationrotator cuff co-contraction
28
what initial nonop management of tibial tubercle apophysitis before casting?(6)
NSAIDresticeactivity modificationstrapping/sleevequad stretching
29
how do ober test?
lateral, hip from flexion and abduction into extension and adduction
30
uses for posterior approach to elbow w/out olecranon osteotomy:ORIF distal humerusTJA***
excision of tumor
31
Causes of boutinerre:Traumatic lac of central slipDupeytrenAnterior dislocation of PIPJ***Burn
RA
32
what is the thomas test used to evaluate?
hip flexion contracture
33
is .5mm articular step an operative indication for a tibial plateau fracture?
no
34
what additional xr view want of knee for OCD lesion?
tunnel knotch view with knee bent 30-50 degree
35
contribution to the spiral cord:pretendinous bandspiral band***grayson ligament
lateral digital sheet
36
Causes of boutinerre:***DupeytrenAnterior dislocation of PIPJRABurn
Traumatic lac of central slip
37
How position shoulder if glenohumeral arthrodesis performed?
30 abduction, forward elevation and internal rotation
38
why sometimes hard to tell bw aseptic and septic prepatellar bursitis?
collection is extra-articular so the patient does not have the pain one has with septic arthritis
39
what is the mechanism of a turf toe injury?
hyperextension of the hallux MTPJ
40
what is the approach of henry?
anterior approach to radius
41
what first step in management?
eval using ATLS protocol
42
surgical indications for cervical disc herniation:
progressive pain unresponsive to***
severe radicular pain runs along matching distribution
myelopathy
(3)
meds, PT, epidural for 6 weeks
43
what structure at risk when exposing the proximal radius through anterior approach?
PIN
44
what is the difference between a high T and a low T distal humerus fracture?
high T transverse component proximal or at level of olecrnonlow T transverse just proximal to the trochlea
45
what gene messed up in osteopetrosis?
carbonic anhydrase II
46
what is osteitis pubis?
inflammation of the pubic symphysis caused by repetitive trauma
47
what collagen ratio is increased in dupuytren?
increase in ratio of type III to type I collagen
48
disruption of the alignment of the lateral base of the 3rd MT with the lateral aspect of the the lateral cuneiform on the oblique view of the foot?
Lisfranc injury
49
how does the thumb look like in holt oram?
stiff hypoplastic joined to index finger by complete simple syndactyly
50
what tendon envelopes hallux sesamoid?
FHB
51
this is association between congenital heart disease and radial longitudinal deficiency?
holt oram syndrome
52
in general how are tibial plateau fx with medial and lateral condyle involvement treated?
operatively
53
rugger jersey spine, marble bone, erlenmeyer flask deformity of proximal humerus and distal femur a/w what disease?
osteopetrosis
54
what anatomic structure might cause projections of the CMCJ to appear oblique when getting xr of the hand?
transverse metacarpal arch
55
what serum ion level is a poor prognostic factor for metal on metal total hip?
>7ppb
56
how are type I collagen levels affected by degeneration of intervertebral discs?
increase
57
besides thumb problem and radial deficiency how else arm affected in holt oram?
proximal radial synostosis
58
what are the three stages of dupuytren?
proliferative, involutional, residual
59
how operatively fix stable ocd lesion?
drilling
60
what is another word for "pins and needles" sensation?
paresthesias
61
Indications for glenohumeral joint arthrodesis:***Paralysis or severe paresis of the deltoid and rotator cuffChronic infectionFailed GH joint arthroplastySevere refractory instabilityBony deficiency following tumor or bone resectionPainful flail shoulder
Brachial plexus injury
62
Indications for glenohumeral joint arthrodesis:Brachial plexus injuryParalysis or severe paresis of the deltoid and rotator cuffChronic infection***Severe refractory instabilityBony deficiency following tumor or bone resectionPainful flail shoulder
Failed GH joint arthroplasty
63
Following signs/treatment/complication profile indicate infection in what space:dorsal hand is swollen, warm and erythematousfinger extension is painful and usually difficulttreated with one or two dorsal longitiduinal incision (first index MC, between 4th and 5thMC)patients can get an extensor lag, tendon necrosis, scar formation
subaponeurotic space deep to the extensor tendons
64
uses for posterior approach to elbow w/out olecranon osteotomy:ORIF distal humerus***excision tumor
TJA
65
what causes ASIS avulsion? (mm involved)
forceful contraction of the tensor fascia latae and the sartorius
66
what produces more shear, open or close chain exercise?
open
67
what can interpose in MCPJ dislcoation blocking closed reduction?(2)
volar platesesamoids
68
Causes of boutinerre:Traumatic lac of central slipDupeytren***RABurn
Anterior dislocation of PIPJ
69
Operative indications DR fx:* Secondary loss of reduction* Articular comminution, step-off, or gap* Metaphyseal comminution or bone loss* Loss of volar buttress with displacement* DRUJ incongruity* Open fractures* Associated carpal fractures* ---* An impaired contralateral extremity
associated nv or tendon injury
70
Compression from tight cast, wrist watch or bracelet can cause what compressive neuropathy?
wartenberg syndrome (superificial sensory br of the radial nerve)
71
tibial tubercle-trochlear groove (TT-TG) distance *** is highly associated with patellar instability secondary to rotational malalignmen
>20mm
72
how treat thumb ucl injury with MCPJ arthrosis?
arthrodesis
73
what step do first for cervical facet fx/dx in a obtunded patient?
MRI
74
what test is it and what indicate?
hawkin+impingement
75
what makes a positive thomas test?
contralateral hip lifting off the table when fully flex one hip with patient supine
76
How treat lisfranc sprains in general?
Surgery
77
what do you divide when trying to reduce MCPJ dislocation?
A1 pulley
78
flexing the knee to 90, stabilizing the leg and then externally rotating the foot tests what structure?
the syndesmosis
79
what test and what indicate?
speed testproblem w/biceps tendon
80
how is trochlear dysplasia of femur defined?
sulcus angle >145 degree
81
what makes a positive ober test?
pain, tightness, clicking over IT band
82
In an elderly woman, what factor is most associated with risk of future spinal fragility fracture?
prior thoracic insufficiency fracture
83
contribution to the spiral cord:pretendinous band***lateral digital sheetgrayson ligament
spiral band
84
```
Operative indications DR fx:
Open fractures
Articular comminution, step-off, or gap
Metaphyseal comminution or bone loss
Loss of volar buttress with displacement
---
Secondary loss of reduction
Associated carpal fractures
Associated neurovascular or tendon injury
An impaired contralateral extremity
```
DRUJ incongruity
85
most important factor for outcome after patellar tendon rupture?
timing of repair
86
surgical indications for cervical disc herniation:***pain unresponsive to meds, PT, epidural for 6 weekssevere radicular painruns along matching distributionmyelopathy
progressive
87
what type of ocd do you operate on?(2)
detached/unstable
88
what can you do to distinguish bw septic and aseptic prepatellar bursitis?
aspiration with gram stain/culture
89
Operative indications DR fx:* ---* Articular comminution, step-off, or gap* Metaphyseal comminution or bone loss* Loss of volar buttress with displacement* DRUJ incongruity* Open fractures* Associated carpal fractures* Associated neurovascular or tendon injury* An impaired contralateral extremity
secondary loss of reduction
90
Operative indications DR fx:* Secondary loss of reduction* Articular comminution, step-off, or gap* Metaphyseal comminution or bone loss* Loss of volar buttress with displacement* DRUJ incongruity* Open fractures* ---* Associated neurovascular or tendon injury* An impaired contralateral extremity
associated carpal fractures
91
Operative indications DR fx:
* Secondary loss of reduction
* Articular comminution, step-off, or gap
* Metaphyseal comminution or bone loss
* Loss of volar buttress with displacement
* DRUJ incongruity
* Open fractures
* Associated carpal fractures
* Associated neurovascular or tendon injury
* ---
impaired contralateral extremity
92
what vascular zone think of fixing a meniscus?
red-red
93
what mm attach to superior edge of pubic symphysis?(2)
pectineusrectus abdominis
94
Old pts with OCD knee how treat?
arthroplasty
95
which tendon crosses the front of the elbow just medial to the BR?
biceps
96
First dorsal interosseous contraction a/w what nerve in the hand?
deep motor br of the ulnar nerve
97
for boys what age group does osgood schallter show up?
15-Dec
98
what is at risk with volar approach to reduce MCPj dislocation?
nv structures
99
Classification useful for1) true fracture-dislocations 2) fracture patterns that do not fit into the Schatzker classification (10% of all tibial plateau fractures)3) fractures associated with knee instability
Hohl and Moore
100
what hip motion causes asis avulsion?
extension
101
reasons for fat suppressing:make tissue easier to appreciaterecognize where edema distinct from fat***
or prove something fatty
102
what is the difference in the insertion of the direct and indirect head of the rectus femoris?
direct - AIISindirect - superior acetabular ridge
103
what is the proximal muscle plane for anterior approach to the radius?
BR and pronator teres
104
Pelvic fractures in children differ from those in adults because children with pelvic fractures are more likely to be treated how?
nonsurgically
105
what imaging get first for OCD lesion?
XR
106
what symptom indicates instability of OCD lesion of the knee?
mechanical symptoms
107
Operative indications DR fx:* Secondary loss of reduction* ---* Metaphyseal comminution or bone loss* Loss of volar buttress with displacement* DRUJ incongruity* Open fractures* Associated carpal fractures* Associated neurovascular or tendon injury* An impaired contralateral extremity
articular comminution, step off or gap
108
why get MRI for cervical facet fx/dx?
look for disc herniation --> would do anterior approach
109
contribution to the spiral cord:pretendinous bandspiral bandlateral digital sheet***
grayson ligament
110
what's the name of this test: manual distraction of the hip prosthesis used to assess limb tension during THA?
shuck test
111
what age group think of operating on with a meniscus tear?
younger
112
what condition is AIN syndrome a/w?
parsonage turner syndrome
113
surgical indications for cervical disc herniation: progressive pain unresponsive to meds, PT, epidural for 6 weeks, severe radicular pain, ***, myelopathy
runs along matching distribution of abnormality
114
surgical indications for cervical disc herniation:progressivepain unresponsive to meds, PT, epidural for 6 weeks***runs along matching distributionmyelopathy
severe radicular pain
115
Causes of boutinerre:Traumatic lac of central slip***Anterior dislocation of PIPJRABurn
Dupeytren
116
how can the shoulder be affected in holt oram?
GH joint hypoplasia
117
what is a gantzer muscle?
accessory FPL head
118
how "malignant" osteopetrosis inherited?
AR
119
Indications for glenohumeral joint arthrodesis:Brachial plexus injuryParalysis or severe paresis of the deltoid and rotator cuff***Failed GH joint arthroplastySevere refractory instabilityBony deficiency following tumor or bone resectionPainful flail shoulder
Chronic infection
120
how treat 40 y/o male with recent onset great toe pain w/mild arthritic changes?
carbon fiber insert with morton extension
121
coleman blocks used to assess for what type of limb length discrepancy?
apparent limb length discrepancy
122
in what direction does the tibial tubercle move if doing osteotomy for patellar instability?(2)
anterior and medial
123
what operation can you do for refractory osgood schlatter dz?
ossicle excision
124
what is the goal of scoping an OCD that has failed nonop?
see if it moves w/probe
125
what does lack of limb flexion to 90 and recoil indicate in the drop kick test?
lengthening
126
what's here?
compression sided femoral neck stress fx
127
how treat 63 yF with arthritic changes to the big toe but pain with dorsiflexion only?
cheilectomy
128
what test do for IT band tightness?
ober test
129
what's the most common pattern for patellar tendon rupture in terms of location?
avulsion with or without bone from the proximal insertion/inferior pole of patella
130
A child of short stature with cauliflower ears, hitchhikers' thumb, and kyphoscoliosis typically has a defect in what gene?
DTDST
131
how does heart disease and radial longitudinal deficiency correlate in holt oram?
they dont
132
how do you measure an apparent limb length discrepancy?
umbilicus to the medial malleolus
133
Arthroscopic remplissage of the shoulder is most indicated for patients with what bony deficit and how much?
large >25% humeral head deficiency
134
how mild ostepetrosis inherited?
AD
135
surgical indications for cervical disc herniation:
progressivepain unresponsive to meds, PT, epidural for 6 weeks
severe radicular painruns along matching distribution
***
myelopathy
136
Indications for glenohumeral joint arthrodesis:
Brachial plexus injury
Paralysis or severe paresis of the deltoid and rotator cuff
Chronic infection
Failed GH joint arthroplasty
***
Bony deficiency following tumor or bone resection
Painful flail shoulder
Severe refractory instability
137
uses for posterior approach to elbow w/out olecranon osteotomy:***TJAexcision tumor
ORIF distal humerus
138
why patients with osteopetrosis get anemic?
bc IM canal fills with bone
139
What is the romberg test?
Ask the patient to stand with their feet together (touching each other). Then ask the patient to close their eyes.Remain close at hand in case the patient begins to sway or fall.
140
-3
painfluid fluid mass on MRIcobalt ion levels
141
what is it?
osteitis pubis
142
how treat 57year old female with positive grind test and pain in mid arc of motion of the great toe?
1st MTP fusion
143
Indications for glenohumeral joint arthrodesis:Brachial plexus injuryParalysis or severe paresis of the deltoid and rotator cuffChronic infectionFailed GH joint arthroplastySevere refractory instabilityBony deficiency following tumor or bone resection***
Painful flail shoulder
144
```
contribution to the spiral cord:
***
spiral band
lateral digital sheet
grayson ligament
```
pretendinous band
145
how effective is CS injection compared to placebo for lateral epicondylitis at 6 months?
no difference
146
Indications for glenohumeral joint arthrodesis:Brachial plexus injuryParalysis or severe paresis of the deltoid and rotator cuffChronic infectionFailed GH joint arthroplastySevere refractory instability***Painful flail shoulder
Bony deficiency following tumor or bone resection
147
A 16-year-old female swimmer had bilateral shoulder pain for 3 months that limited her ability to complete workouts. Her shoulder range of motion was symmetric. Rotator cuff and deltoid strength findings were normal. Her Hawkins impingement sign and speed test results were positive on both shoulders. Radiograph and MRI scan findings were normal. Which intervention is the next step in evaluation and treatment?
therapy
148
```
Causes of boutinerre:
Traumatic lac of central slip
Dupeytren
Anterior dislocation of PIPJ
RA
***
```
Burn
149
what physical exam maneuver do for piriformis muscle syndrome?
FADIR
OB
150
First line rx for piriformis muscle syndrome?(5)
rest, NSAIDS, muscle relaxants, PT, steroid injections
151
what is the most common variant for course of the sciatic n?
splitting proximal to the piriformis with one branch passing anterior to and one branch passing through the piriformis
152
what constitutes a + ober test?
limited hip adduction when the hip is held in extension
153
Decreased IR with flexion abduction and IR, sign of what type of impingement?
CAM
154
This XR view is used to assess anterior coverage of the acetabulum?
false profile view
155
what angle is the pelvis to the film for a false profile view?
65 degrees
156
what eponym for xr deformity you see w/cam impingement?
pistol grip
157
what does crossover sign for hip indicate?
acetabular retroversion seen in pincer type impingement
158
what is this measuring?
head neck offset ratio
159
this is the best imaging modality to evaluate articular cartilge, labral degeneration/tears?
MRI
160
when consider surgery for FAI?(2)
patient symptomatic w/mechanical symtpoms
161
how treat FAI w/age >60 and end stage hip degeneration?
total hip
162
in what patient do PAO for FAI? (ie what type of abnormality)
structural deformity of acetabulum w/poor coverage of femoral head
163
what is the primary viewing portal for a hip scope?
anterolateral
164
what do you do before pumping joint with saline in hip scope?
apply in-line traction
165
what is the distal anterolateral hip portal used for?
access peripheral compartment in region of femoral neck
166
what n at risk w/anterolateral portal in hip scope?
superior gluteal n
167
what motion helps place anterior hip portal?
flexion and internal rotation
168
what motion puts sciatic n at risk during PL hip portal placement?
ER
169
what n placed at risk w/anterior hip portal?
LFCN
170
where is the most common site of rupture along the muscle for a hamstring?
myotendinous structure
171
which hamstring mm is more lateral?
semimembranosus
172
what's usually the cause of quad contusion?
direct trauma
173
what motion is limited after a quad contusion?
active knee flexion
174
what can you see on xr for eval of chronic injury to the quad tendon?
myositis ossificans
175
After sustaining a muscle contusion injury, prolonged immobilization leads to what histologically?
more granulation tissue
176
A 14-year-old girl reports a 3-week history of anterior thigh pain and a palpable mass after sustaining a soccer-related injury. Examination reveals a tender, firm mass in the midportion of the rectus femoris. Besides pseudotumor what can it be?
partial rupture of the rectus femoris
177
what is exertional compartment syndrome?
condition where there is reversible ischemia within a muscular compartment
178
what is most common exercise induced leg syndrome?
medial tibial stress syndrome
