RACS True/False Quiz 2018 Flashcards by Ali Vakili

No difference in PROMs, complication or revision rates between mechanical and kinematic alignment TKR groups at 2 years.

True

But long-term data are still lacking

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Mechanical alignment in TKR is created by making a femoral cut perpendicular to the anatomical axis of the femur

False

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Increased failure rate in patients with femoral components in > 8º of anatomic valgus, in addition to tibial components positioned in > 3º of varus relative to the midline

True

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Femoral components in kinematic knee are aligned in 2 to 4º more valgus and tibial components that are positioned in 2 to 4º more varus, while maintaining similar hip-knee-ankle angles

True

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Studies show marked difference in Knee Society Scores at 3/12, 6/12, and 5 years postoperatively when compared CAS (computer assisted surgery i.e Navigation) to non-CAS TKA

False

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Young and Burgess lateral compression never causes bleeding requiring angioembolization

False

Patterns most commonly requiring angioembolization are the Young and Burgess LC and APC types and Tile type C

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Approximately 85% of bleeding associated with pelvic fractures is from veins or bones

True

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Ligation of the internal iliac artery during laparotomy is an effective way to control pelvic arterial haemorrhage

False

Due to rich collaterals

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Hemodynamic instability on presentation (defined as systolic arterial pressure ,90 mm Hg after an infusion of 2 L of lactated Ringer solution and the initiation of transfusion of packed red blood cells) as an indication to immediately perform angiography with embolization

True

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Fractures through the sciatic notch are thought to be associated with a high rate of arterial injury

True

Because of the proximity of the superior gluteal artery

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Patients who get embolization after pelvic injury have higher mortality rates

True

Because of substantial high-energy trauma with multiple injuries (Mortality of 16-50% reported)

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Survival substantially improves when embolization is performed within 6 hours of arrival

False

Within 3 hours

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Name the most commonly embolized arteries in pelvic fractures in decreasing order

Internal iliac & its branches, Sup Gluteal, Obturator, Internal pudendal

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Inadequate response to initial resuscitation is very sensitive but not specific to predict arterial bleeding in angiography

True

100% sensitive and 30% specific

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Pressures of only 10 mm Hg are require for tamponade of venous bleeding in the pelvis

True

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Harder bearings (e.g. cobalt-chromium and ceramics) have lower wear rates than soft bearings because of lower surface roughness and less vulnerability to deformational forces

True

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Ultra high–molecular weight polyethylene (UHMWPE) and XLP, have a lower Young modulus of elasticity and therefore exhibit higher deformation under force

False

Higher Young modulus of elasticity

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UHMWPE has the highest surface roughness factor resulting in higher frictional forces during articulation and the generation of more wear particles than other bearing surfaces

True

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Large cobalt-chromium femoral heads (>32 mm), when coupled with both UHMWPE and XLP, have demonstrated low volumetric wear rates because larger femoral heads have more surface area for articulation

False

Larger surface area= higher volumetric wear

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Ceramic on-ceramic implants, given the nature of their smoother surfaces, have the best lubrication performance and can establish fluid-film lubrication at various femoral head sizes

True

Ceramic and metal are hydrophilic which aids in forming fluid film and fluid film lubrication

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XLP is irradiated at 200 kGy to increase the cross-linking potential between free radicals

False

50-100. Higher doses will cause breakdown of the mechanical structure

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The threshold for osteolysis resulting from polyethylene debris has been considered 0.10 mm/y for linear wear and 80 mm3/y for volumetric wear

True

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Trunnion corrosion related to larger femoral head sizes, longer length of trunnion, smaller trunnion diameter, longer neck length, higher taper angle, lower flexural rigidity, and dissimilar alloy pairings

True

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The bare area of the glenoid is thought to converge with the center of the inferior glenoid circle

True

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Coracoid process transfer procedures act mainly as a bone block to prevent further dislocation

False Sling effect by the conjoined tendon contributed 76% of the restored stability in the end range of motion & 56% in the midrange of motion

Latarjet procedure proved to be superior to Bristow in the presence of a significant bone lesion

True

Classic Latarjet procedure restored a 30% defect to within 5% of the intact glenoid surface area, whereas the congruent arc modification allowed full restoration to the intact condition

True

Coracoid osteolysis is often observed after anterior glenoid grafting. Osteolysis is usually around the inferior screw & more obvious when the reconstructed glenoid defect is \> 15%.

False More around the superior screw and when the defect is \<15%

Bony Bankart lesion is seen in 20% of first time and 90% of recurrent dislocations

True

Hill-Sachs lesions, are found in 67% of first-time dislocations and up to 100% of recurrent dislocations

True

15% glenoid bone loss in a patient with off-track lesion is an indication for Latarjet procedure

True

In paediatric ACL injuries peripheral physeal drilling is associated with a lower risk of growth arrest compared with central drilling

False Central is associated with less risk

In paediatric ACL injury In all epiphyseal technique distal post fixation may distribute a tethering force across the physis

True

The risk of ACL rupture is approximately two to eight times higher in females than in males

True Due to endocrine, biomechanical factors such as increased Q-angle and genu valgum, a high body mass index, unbalanced quadriceps strength, GLL , patella alta, a high tibial slope, and a low notch width index

Non surgical treatment in patients \<14 years of age with ACL injury and normal physical exam is not effective

False Non op Tx: functional bracing, activity modification, and physical therapy

The ACJ is a true synovial joint with the articular cartilage, a capsule, and several stabilizing ligament

True

Patient should start full ROM exercises immediately after ACJ stabilization

False 6/52 in sling then gradually start ROM

The center of the trapezoid attachment is roughly 26 mm from the ACJ

True Conoid insertion is 46 mm from lateral end of the clavicle

Stryker notch view allows better visualisation of ACJ

False Zanca view

Patient with GIII ACJ separation who is still symptomatic after 4/52 of non operative treatment and has media-lateral instability and scapular dyskinesia should be offered surgery.

True

50% of patient post ACJ stabilisation demonstrate some degree of loss of reduction

True 53% to be exact, 20% clavicle or crocoid fracture, 6% infection

Meniscal homologue and any other interposed tissue should be excised after performing clavicle excision in Weaver Dunn procedure

True

Achilles tendon is the largest and strongest tendon in the human body

True

The aponeuroses from each of 2 heads of gastrocnemius muscles combine to form the Achilles tendon, approximately 5-6 cm proximal to the Achilles insertion

True

Achilles tendon fibers undergo a clockwise rotation, imparting maximal stress 2 to 5 cm proximal to the Achilles insertion (hypovascular zone).

False Counterclockwise

Gastrocnemius-soleus (GCS) provides 83% of the plantar flexion torque to the ankle

False 93%

In patients who have chronic Achilles tendon ruptures that have healed in continuity, a Z-shortening procedure has been described to restore normal tension to the GSC

True

Primary repair of a chronic Achilles tendon rupture with gap \<3cm should not be attempted

False

The axis of pull of the FHL tendon most closely replicates that of the Achilles tendon

True FHL tendon advantages: Stronger than PB or FDL, in phase, in anatomic proximity to TA, Muscle belly of FHL may provide vascularity

Transferring FHL in chronic TA rupture causes no disruption to inversion/eversion

True

Dual-mobility systems increase the jumping distance by decreasing the femoral head offset

True

Osteolysis is uncommon, with wear rates of \<0.1 mm/yr.

True

Constrained tripolar designs carry less risk of impingement compaired to non constrained tripolar

False More risk of impingement

When press-fit constrained acetabular components are used, the shell and the host bone contact area is accepted to be \<50%.

False Must be \> 50% in Tripolar otherwise high failure rate at the bone shell interface: type I failure

Retentive failure is a term used specifically for dual mobility cup failure associated with dislocation

True

Constrained liners cause increase wear, ROM and impingement

False Increase wear and impingement Decreased ROM

Greater trochanteric (GT) pelvic impingement is a GT impingement on the ischium during a combination of hip flexion, abduction, and external rotation

True

Pelvic inclination does not affect loads on the lumbar spine

False

Hip joint disorders that limit terminal hip extension can aggravate symptoms due to hyperlordosis, narrowing of the foramina, and consequent lumbar nerve root compression

True

Sciatic nerve has 28 mm of excursion during hip flexion

True

Hamstring syndrome is the experience sciatic nerve irritation and symptoms in the lower buttock in the presence of Hamstring tear

True Because of inflammation

The branches from the Sciatic nerve to the long head of the biceps femoris and semitendinosus muscle emerge in the mid thigh

False Near ischial tuberosity

Pudendal nerve entrapment and/or irritation can occur at different locations such as the intrapelvic region, piriformis muscle at the sciatic notch, sacrospinous ligament and sacrotuberous ligament

True

Deep gluteal syndrome describes the entrapment of the inferior gluteal nerve in the deep gluteal space

False Sciatic nerve Structures causing entrapment: Fibrous bands containing blood vessels, gluteal muscles, hamstring muscles, the gemelliobturator internus complex, bone structures, vascular abnormalities, and space-occupying lesions

Long-stride walking test is positive in cases of lesser trochanter impingment on ischium.

True Pain is produced posteriorly and lateral to ischium

Inbone ankle replacement is designed to be a primary ankle replacement

False A revision

Inbone ankle replacement has a low survival rate

True 77% survival @ 2years due to talus osteonecrosis secondary to talus reaming

The STAR (Scandinavian Total Ankle Replacement) ankle is the only three piece mobile-bearing design

True

4th generation STAR is showing survival of 70% at 10 years

False \>90%

Second generation total ankle replacement required syndesmosis fusion

True porous metal-backed surfaces to improve osseous integration; replacement of the tibiotalar, talofibular, and medial-malleolar talar articulations; and/or improved stability with the fusion of the syndesmosis

Minimal bone resection, superior bony ingrowth, retention of ligamentous support, and anatomic balancing are some of 3rd and 4th generation total ankle replacement improvments

True

The revisions for 3rd and 4th generation total ankle replacements were attributed to poly wear and infection.

False aseptic implant loosening, talar & tibial components subsidence and talar osteonecrosis

Zimmer biomet trabecular metal ankle replacement requires a lateral transfibular approach therefore minimizes wound healing complications

True It also mimics the natural curvature of the tibiotalar joint and results in less bone removal and more surface area contact.

The average age of patients with ipsilateral femoral neck & shaft fractures is 50 years, and 75% of patients are female

False The average age of patients is 35 years, and 75% of patients are male

In patients with ipsilateral femoral neck and shaft faractures, ipsilateral knee injury is rare

False 20% to 40% of patients have ipsilateral knee injuries, including ligamentous injury, tibial plateau fracture, patellar fracture, or knee dislocation

In patients with ipsilateral femoral neck and shaft faractures, femoral neck fractures will be always diagnosed on pelvis CT scan

False Can be missed in CT scan, so special CT scan with fine-cut (2-mm) CT scan through the femoral neck should be considered in addition to fluoroscopic AP in internal rotation after nailing

In patients with ipsilateral femoral neck and shaft faractures, Fixation with a single intramedullary device has a higher rate of malreduction in comparison to two devices

True

In patients with ipsilateral femoral neck and shaft faractures,The most significant factor to determine the femoral neck non union is the accuracy of reduction

True Varus malunion has a higher rate of non union (\>5 degrees of varus)

In patients with ipsilateral femoral neck and shaft faractures, Miss-a-nail technique is placing the cannulated screws posterior to the antegrade nail.

False Anterior

In patients with ipsilateral femoral neck and shaft faractures, The risk of malunion or nonunion are less than the risk malunion and non union in pts with isolated neck of femur fractures.

True 5% risk of each of malunion or nonunion in patients with femoral shaft & ipsilateral neck fracture

In patients with ipsilateral femoral neck and shaft faractures, Femoral shaft fracture in this combined injury has a higher rate of non union than isolated fracture

True 20% of non union due to high energy trauma with a higher incidence of compound fractures

15% of patient with femoral shaft fracture as a result of high energy trauma will have ipsilateral NOF #

False 9%

NOF # in ipsilateral neck and shaft fracture are usually a Pauwel type III

True

For NOF # compared to THA, hemiarthroplasty has reduced surgical time, less blood loss, decreased risk of instability, and fewer postoperative complications

True

THA has been shown to produce better pain relief than hemiarthroplasty and is associated with lower long-term reoperation rates

True

THA for hip fractures confers the same risk of complications than elective THA

False Higher risk

Elderly patients can yield up to 40% reduction in muscle Strength after 4 weeks bed rest

True

Decreased mortality after NOF # is demonstrated when surgery is performed within 48 hours of injury

True

Cemented stems in comparison to cementless show some improved postoperative pain and hip function with less implant-related complications but longer surgical times

True

No statistical differences in mortality, hospital stay, operation time, residual pain, or complications between cemented and noncemented prostheses

True Remember it is about failed hemiarthroplasty

Chronic institutionalized patients have higher risk of infection 67% caused by gram-positive bacteria

False Gr-ve

55% of dislocated hemiarthroplasties were observed to have inappropriate femoral offset

True

Posterior approach has been proven to have higher dislocation rates in hemiarthroplasty

False

Leucocyte Esterase (LE) strip test is more sensitive than alpha-defensin test

False Both are 100% specific

Mortality increases after complications of hemiarthroplasty as infection or dislocation

True

Oblique pulley in the thumb is most important for preventing bowstringing of the flexor pollicis longus

True

Core suture material is relatively unimportant compared with the suture technique

True The strength of the repair is proportional to the number of core sutures and the caliber of the sutures that cross the repair site

In hand flexor tendon repair Peripheral stitch increased repair strength by 10% to 50% and substantially reduced gap formation

True

In hand flexor tendon repair Adding an epitendinous suture decreased the rate of reoperation by 84%.

True

In hand flexor tendon repair Advancing the tendon 5 mm can cause a quadriga effect

false \>1cm

The midaxial incision in finger should lie parallel and volar to the midline of the finger

False Dorsal

25% of A2 and all of A4 may be incised with little functional deficit

True

In hand flexor tendon repair Gap formation of \>5 mm also decreased the strength of the repair site and led to ultimate failure

True but the figure is more than 3mm of gap

Spaghetti wrist is the term used to describe injury in zone IV or V involving multiple tendons and the median nerve

True

The Kleinert rehab protocol allows the patient actively flex the fingers

False The Kleinert protocol involves attaching rubber bands to the patient’s fingers. The patient actively extends the fingers within the confines of the orthosis. Elastic bands passively flex the fingers to the palm

The modified Duran protocol involves a dorsal protective splint with 40 to 50 degrees of flexion at the metacarpophalangeal joint

True

Early passive motion protocols, including the Duran and Kleinert protocols, have a decreased risk of rupture but decreased postoperative digit ROM compared with active motion protocols.

True

During the inflammatory phase of flexor tendon healing, the strength of the tendon is equivalent to the strength of the suture repair

True is also the period during which postoperative tendon repair rupture is most likely to occur

During the proliferative phase tenocytes lay down type I collagen

False type III collagen which has poor mechanical properties; however, the strength of the repair increases compared with that of the inflammatory phase

During the remodeling phase, type I collagen synthesis begins and the extracellular matrix aligns in response to mechanical stresses

True

Cell density and synthetic activity decrease during the remodeling phase

True

Dorsal placement of the suture in flexor tendon repair is biomechanically advantageous

True Also should be placed 7-10mm from the edge of the tendon

In repairing flexor tendons of hand, Knots are the weakest component of the construct, with ruptures occurring at knot locations

True

In hand flexor tendon repair internal knots have decreased strength compared with external knots at day zero of repair but similar strength at 6/52

True

Risk of flexor tendon rupture in hand post active and passive rehab protocol is the same

False Higher in active protocol

Phases of healing are three: inflammatory (2-3 days), proliferative (5 days to 4 weeks), and remodeling (up to 16 weeks).

True

Intrinsic tendon healing process is resposible for creating scar tissue and adhesions

False Extrinsic healing causes scarring and adhesions

Capsulorrhaphy arthropathy in shoulder refers to the rapid anterior chondral wear due to overtightening of the anterior capsule and resultant compressive joint forces and loss of external rotation

False Causes post chondral wear

Shoulder pain at the end ranges of the motion arc is typical of the inflammatory arthritis process

False Osteoarthritis

Capsular release for shoulder arthritis should be considered in young patients in whom there is a 20 degrees side-to-side difference, particularly in external or internal rotation

True

Inferior osteophytes may limit shoulder abduction

True By tensioning the axillary pouch and compressing the axillary nerve, which can contribute to posterior shoulder pain

Biological shoulder replacement is shown to have successful rate better than that of the knee

False Less success than the knee

Results after conversion from Hemiarthroplasty (HA) to TSA are inferior to results after primary TSA

True

Glenohumeral arthrodesis is still viable option for young patients with end-stage disease and strenuous physical demands

True

Post traumatic arthritis is the most common cause of degenerative shoulder in young pateint population

False Osteoarthritis is the most common cause

The most common complication after rTSA is infection

False Instability Most common causes for revision in AOANJR: instability, infection, loosening & fracture

Females are at higher risk of dislocation after rTSA.

False Fx associated with instability: BMI\>30, Male, SC deficiency, previous surgery, Surgical approach, bone deficiency, previous trauma

In the native shoulder, the anterior deltoid is primarily a flexor, the middle deltoid an abductor, and the posterior deltoid an extensor

True

After rTSA, all three regions of the Deltoid become primary abductors

True

In medialized (centre of rotation) COR systems, the main biomechanical advantages are a constrained prosthesis with a large ball and greater range of motion (ROM).

True

A larger glenosphere diameter has the most impact on stability

False Larger glenosphere has more impact on ROM before impingement

In rTSR Inferior aspect of the glenoid, creating an overhang, may reduce the incidence of adduction impingement

True

Superior tilt of 10 degrees is recommended in Glenosphere positioning

False Inferior tilt is recommended to increase stability & reduce inferior notching

Lateralizing the glenosphere resulted in a stepwise increase in forces required for anterior dislocation in 5-, 10-, and 15-mm lateral offsets rTSR (i.e. more stable joint)

True

Disadvantages of lateralized Glenoid are increased deltoid forces required for abduction, with a potential risk for acromial stress fractures, deltoid pain and increases the risk of glenosphere failure secondary to increased torque on the short neck

True

More constrained cups are associated with an increased likelihood of impingement & less ROM in rTSR

True

Decreasing neck-shaft angle to 135 degrees, potentially increases adduction deficit

False Decreases abduction deficit

Both glenosphere lateralization and humeral lengthening improve stability but at a cost of increased deltoid force requirement

True

Humeral lateralization was the only parameter that decreased deltoid forces

True

In rTSR Glenoid retroversion should be around 30 degrees for maximum stability while the Humerus version should be slightly anteverted

False Glenosphere shoulde be \<10 degrees retroverted

Humerus version does not have much impact on stability in rTSR

True Retroversion of the stem ranges 0-30 degrees

Humeral retroversion has been suggested to improve postoperative internal rotation

False ER

Excessive glenoid medialization, defined by Boileau as a humeral axis medialized \>15 mm relative to the lateral acromion

True

Increasing glenosphere size, distalizing the humerus or more constrained poly are different ways of increasing stability in revision rTSR

True

Patients with fracture or previous surgery may be at a higher risk of instability

True

Patients who have conversion from anatomical TSA to rTSA are the hardest to manage

True Due to bone loss on both glenoid and humerus and compromised soft tissues

Deltopectoral approach has been associated with higher rates of dislocation compared with the superolateral approach when it comes to rTSR

True 5% rate of instability due to SC compromise

Revision to hemiarhtoplasty with large head is an option for recurrent instability post rTSR

True

In the primary setting, the humeral neck osteotomy should be made at the level of the native supraspinatus insertion and can be made in varying degrees of retroversion

True

Aggressive reaming of the Glenoid is recommended to medialize the COR

False not recommended as it can cause instability. Reaming should be only to remove the articular cartilage & to remove only enough bone to correct inclination or version

Tractioning shoulder at 45 degree of abduction with postero supriorly directed force while counter traction in applied using a sheet in the axilla is the maneuver to reduce dislocated rTSR

False 45 degree abduction with posteroinferiorly directed force and counter traction

The use of thicker polyethylene is a good option in revision surgery for instability when \> 15 mm of humeral shortening is present

False In cases of humeral shortening \<15 mm and no excessive medialization, soft-tissue tension can be increased with a metallic spacer or thicker polyethylene; otherwise \>15 mm of humeral shortening requires humeral stem revision

No strong evidence (on RCT) to suggest that transtendinous approach for Tibial IM nailing is associated with more anterior knee pain in comparison to paratendinous approaches

True JAAOS Sep 2018

Weak evidence to support that suprapatellar approach has less anterior knee pain to infrapatellar approach

True JAAOS Sep 2018

Safe zone for nail entry is on average 9 mm lateral to the midline and 3 mm lateral to the tibial tubercle

True JAAOS Sep 2018

Infrapatellar branch of the saphenous (IPBS) nerve are not at risk of injury during infrapatellar nailing

False

The suprapatellar and lateral extraarticular parapatellar approaches may have potential benefits in terms of preventing anterior knee pain

True because of less injury to the fat pad & IPBS nerve + avoid the pressure are when kneeling JAAOS Sep 2018

Studies showed that Knee pain was correlated with fracture union

True This finding could explain improving pain during early and mid-term follow-up JAAOS Sep 2018

More than half of the patients have improved anterior knee pain after metal removal

True JAAOS Sep 2018

The MPFL arises on the medial femur approximately 4 mm distal and 2 mm anterior to the medial epicondyle

False Anterior and distal to adductor tubercle JAAOS June 2018

Almost 50% of pt post IMN tibia exprience some anterior knee pain within the first 12/12 post op

True JAAOS Sep 2018

MPFL is nearly isometric throughout knee ROM

True JAAOS June 2018

MPFL is particularly important to avoid lateral patellar translation during between 30-90 degrees of knee flexion

False During the first 30º of knee flexion. After 30 degrees the trochlear groove is the most important restrain

Greater tibial internal rotation increases the risk of lateral patellar subluxation

False ER

Moving patellar apprehension test is the most specific and sensitive sign for lateral instability

True JAAOS 2018

Types A and C are most likely to benefit from a trochleoplasty because of the presence of a supratrochlear spur, which can be removed to deepen the groove to the level of the anterior femoral cortex

False Type B & D

Caton-Deschamps ratio is preferred by many clinicians because the values do not vary with knee flexion

True JAAOS June 2018

On axial X ray sulcus angle \<145 degrees is one criterion for trochlear dysplasia

False \>145

(TT-TG) distance has largely replaced the Q, angle as a measure of malalignment and should be measured to guide decision making for tubercle osteotomies

True JAAOS June 2018

TT-TG measurement is affected by knee rotation and that the tibial tubercle‒ posterior cruciate ligament distance more accurately describes lateralization of the tibial tubercle because both measurements use tibial reference points

True JAAOS June 2018

TT-TG measurements on MRI are 4.1mm less on average compared to CT

True JAAOS June 2018

MPFL repair may be indicated for management of a rare peel off lesion of the patella

True But primary repair has fallen out of favor JAAOS June 2018

2 N (approximately 0.5 lb) of MPFL graft tension accurately restored contact pressure and patellar tracking.

True JAAOS June 2018

Fixation of MPFL to the femur is recommended in 90 degrees

False Recommended between 30-45 degrees, because the patella engages the trochlear groove at approximately 30 degrees of knee flexion JAAOS June 2018

When MPFL graft tension increases during knee flexion, the femoral tunnel is too proximal (ie, high and tight), and if tension decreases during flexion, then the tunnel is too distal (ie, low and loose).

True JAAOS June 2018

Rate of recurrent patellar instability after MPFL reconstruction is low but high complication rate

True 4.5% redislocation rate, but 25% complication rates of graft failure, graft overtightening, and patellar fracture JAAOS June 2018

Patients with spur sign measuring \> 5 mm are likely to have less satisfactory outcome after MPFL reconstruction alone

True JAAOS June 2018

The main published complication after a trochleoplasty is stiffness (46%) requiring a manipulation under anesthesia and/or lysis of adhesions

True Other but rare complication is catastrophic subchondral collapse JAAOS June 2018

In Tibial tuberosity osteotomy, A steeper angle allows for more anterior translation of the tubercle, which can be used when more chondral off-loading is needed; a flatter cut allows for more medialization and a more aggressive decrease in the TTTG

True JAAOS June 2018

Complete detachment of the tibial tubercle (compared with maintaining the distal periosteal hinge) may increase the risk of complications, including nonunion, stress fractures, and compartment syndrome

True JAAOS June 2018

Greater number of dislocations was associated with higher-grade lesions of the glenohumeral joint cartilage lesion

True JAAOS June 2018

Chondral lesions are common in patients with superior labrum anterior to posterior (SLAP) tears, with the most common location of the lesion being posterior Glenoid

False Most common place is underneath the biceps tendon on the humerus side or at the ant half of the glenoid JAAOS June 2018

Good results achieved after arthroscopic débridement and capsular release for the management of shoulder osteoarthritis (Outerbridge grade 2 to 4 cartilage lesions)

False 42% of pts required total shoulder arthroplasty in 12/12 JAAOS June 2018

There is fair evidence to support arthroscopic microfracture in GHJ articular lesion

True JAAOS June 2018

Osteochondral autograft transplantation (OAT) for the management of focal chondral defects in the glenohumeral joint warrants a grade C recommendation

True JAAOS June 2018 (supported by conflicting or poor quality evidence)

In management of GHJ articular cartilage defect Osteochondral plugs were harvested from the outer edge of the medial femoral condyle

False Lateral femoral condyle JAAOS June 2018

Articular geometry of the lateral tibial plateau closely resembles that of the glenoid & can be used as an allograft

False Medial tibial plateau (Femoral head is suitable for humeral head defects) JAAOS June 2018

Patients with a history of using an intra-articular pain pump experienced –with chondral reconstructive surgery- significantly inferior patient satisfaction compared with patients who had no history of pain pump use

True JAAOS June 2018

Particulated juvenile allograft cartilage implantation has the advantage of being a single-stage procedure

True JAAOS June 2018

The mean length of the LHBT from its origin to the musculotendinous junction is approximately 10 cm, whereas intra-articular LHBT length is approximately 3 cm

True JAAOS Feb 2018

Biceps brachii internally rotates 90 degrees before the long and short heads of the biceps tendon attach as a single tendinous insertion distally on the ulnar aspect of the bicipital tuberosity of the radius

False Externally rotates JAAOS Feb 2018

On the bicipital tuberosity of the radius, the LHBT inserts more proximally and mostly functions as a forearm supinator

True Short head attaches distally and acts as flexor.It is also more medial at the musculotendinous junction JAAOS Feb 2018

The lacertus fibrosus originates from the long head of the biceps tendon and traverses distally, inserting on the forearm fascia

False From short head JAAOS Feb 2018

LHBT inflammation, instability, and rupture are associated with glenohumeral arthritis, labral lesions, and rotator cuff tears

True JAAOS Feb 2018

Speed & Yergason tests are sensitive but have low specificity

True JAAOS Feb 2018

Interference screws are stronger with less failure rates than anchors in LHBT tenodesis

True no significant statistical difference with the use of different screw sizes, but less failure when the screw is set flush with the bone in comparison to sitting proud or recessed JAAOS Feb 2018

Increased risk of axillary nerve injury with the use of a bicortical button to perform LHBT tenodesis

True Nerve is within 3mm of the button JAAOS Feb 2018

Low rates of return to play and return to previous level of play after arthroscopic SLAP repair, particularly in overhead athletes

True tenodesis is a good alternative option with more patient satisfaction & earlier return to activities, this is in addition to persistant stiffness & pain after repair but repair still an acceptable option for type II SLAP in younger patients aged \< 40 years JAAOS Feb 2018

Distal biceps tendon tears are believed to result from excessive eccentric tension as the arm is brought from flexion into extension

True

Hook test is 100% sensitive and 100% specific for the diagnosis of distal biceps tendon rupture

True JAAOS Feb 2018

Patients in the single-incision group (of distal Biceps repair) had 10% better final isometric flexion strength and a higher rate of early transient lateral antebrachial cutaneous neurapraxia than the 2 incision

True JAAOS Feb 2018

LHBT is supported and stabilized by a pulley system that consists of the subscapularis tendon, the supraspinatus tendon, the coracohumeral ligament, the superior glenohumeral ligament, the pectoralis major tendon insertion, and the falciform ligament

True JAAOS Feb 2018

Intact rotator cuff, conjoint tendon or transverse humeral ligaments are amongst tenodesis options for LHBT

True Other options are proximal or within bicipital groove in a subpectoral fashion JAAOS Feb 2018

Distal subpectoral LHBT tenodesis offers better pain relief results compared with proximal subpectoral tenodesis

True Completely removal of the biceps tendon JAAOS Feb 2018

Displaced midshaft clavicle fracture has between 15% to 20% nonunion rate with nonsurgical management

True JAAOS Nov 2018

Fractures with greater than 1.5 to 2 cm of shortening or greater than 100% displacement leads to decreased shoulder function and worse clinical outcomes

True JAAOS Nov 2018

Scapular dyskinesia is more common in patients treated surgically after clavicle fracture than patient treated conservatively

False More common in non surgical treatment i.e. 67% due to clavicular shortening while 37% in surgically treated patients JAAOS Nov 2018

Figure-of eight bracing for clavicle # have more dysatisfaction rate among patients than sling but the same rate of union

True JAAOS Nov 2018

No difference was found between 2.7 & 3.5 plating systems in clavicle ORIF

True JAAOS Nov 2018

With appropriate surgical technique no differences in implant irritation & removal between the anterior & superior plating of clavicles

True JAAOS Nov 2018

Dual plating of clavicle fractures resists loads better than single plating & has lower risk of metal irritation with no statistically significant improvement in the union rate

True JAAOS Nov 2018

Superior plate was worse at resisting torsional and axial loads than the IMN with more metal irritation to the plate

False JAAOS Nov 2018

Compared to non operative management, clavicle ORIF group have better outcome and shorter time to union

True Average Time to union: 16.4 versus 28.4 weeks Non-union rate: 3%versus 14.2% JAAOS nov 2018

Risk factors for clavicle nonunion: lack of cortical apposition, female sex, comminution, smoking, and advanced age

True JAAOS Nov 2018

Compared to antero-inferior plating, screw lengths are longer in superior plating

False Longer screws in antero-inferior plating JAAOS Nov 2018

Capital femoral epiphysis from one or multiple ossific nuclei beginning at age 4 to 6 months and fuses through the proximal femoral physis at age 14

True JAAOS June 2018

Injury to the trochanteric apophysis or the abductor musculature may disturb growth and angulation of the femoral neck, producing coxa vara, whereas overgrowth may result in coxa valga.

False injury to trochanteric apophysis produces valgus deformity while overgrowth causes coxa vara JAAOS June 2018

Artery of ligamentous teres increases its blood supply to the femoral head from age 8 years to provide a peak of 20% in early adulthood before declining with age

True JAAOS June 2018

Long term outcomes of management of Delbet type I fractures are worse compared with management of other Delbet fracture types

True JAAOS June 2018

The rate of osteonecrosis in paediatric NOF # was 4.2 times higher in patients who had delayed treatment compared with those who underwent treatment within 24 hours of injury

True also with delayed treatment more than 24 hours, the rate of physeal arrest is 64% & osteonecrosis is 55%) Overall risk of AVN is 25% JAAOS 2018

Open reduction has been associated with lower rates of osteonecrosis in paediatric NOF #

False This might be due to selection bias as ORIF is used with displaced fractute JAAOS June 2018

Transphyseal screws in paediatric NOF # fixation are ideally placed no less than 5 mm from the subchondral bone of the femoral head

True Care must to taken to avoid posterior perforation or screw placement in the anterolateral quadrant of the epiphysis to reduce the risk of iatrogenic injury to the blood vessels. Physeal-sparing fixation methods include transphyseal fixation with smooth wires or placement of screws that do not cross the physis JAAOS June 2018

Pediatric femoral neck stress fractures commonly occur on the tension (superior) side of the femoral neck

False Compression side JAAOS June 2018

The median time to development of osteonecrosis post NOF # in paediatric population is more than 12 months from injury

False 7.8 months JAAOS June 2018

Nonunion and coxa vara deformity post paediatric NOF fracture occur in 10 and 18%, respectively.

Ture JAAOS June 2018

Type II and type III Delbert fractures are the most common type of pediatric femoral neck fracture and are often displaced.

True JAAOS June 2018

Acceptable reduction in Delbet type II fractures consists of \<5 degrees of angulation and \<2 mm of cortical translation

True JAAOS June 2018

Acceptable reduction in Delbet type III fractures consists of \<10 degrees of angulation, with valgus malalignment being most common

False Varus malalignment is most common JAAOS June 2018

Preferred method of fixation of paediatric NOF # is smooth Kirschner wires in patients aged \<4 years, physeal-sparing cannulated screws in those aged 4 to 9 years, or transphyseal cannulated screws in those aged 10 or more years.

True JAAOS June 2018

The association between surgeon caseload and risk of revision was stronger with UKA than with TKA, suggesting that UKA is a more technically demanding surgery

True Revision rate after UKA decreased steeply as the surgeon’s annual caseload increased from zero to 10 procedures, with the rate plateauing at 30 cases per year JAAOS Oct 2018

Physiologic tibial radiolucencies are well defined but nonprogressive

True Observed in \<62% of cases. In contrast, pathologic radiolucencies are poorly defined, wide, and progressive and are associated with loosening or infection JAAOS Oct 2018

In patients with a painful UKA and normal radiographs, the use of MRI has not been advocated.

False MRI can show evidence of progressive arthritis in all knees and synovitis, loosening, sinus tract, tibial fracture, and infection JAAOS Oct 2018

Aseptic loosening is more common in fixed bearing models than mobile-bearing designs

True 4.4% versus 1.2% JAAOS Oct 2018

Aseptic loosening is the most common cause of revision of UKA

True 63% of the revision is due to loosening & more commonly the revision is to TKA JAAOS Oct 2018

The most important predictor of progression of OA is the arthritic grade of the lateral compartment at the time of surgery

True JAAOS Oct 2018

UKA for partial-thickness cartilage defects have been associated with inconsistent pain relief after UKA and a 2.5 times higher revision rate

True JAAOS Oct 2018

Outcomes of revision of a UKA to a TKA can be better than those of a revision TKA, but may not be as good as those after a primary TKA

True JAAOS Oct 2018

In revision from UKA to TKA, it is advised to leave the components insitu as long as possible so distal femoral resection is performed with the UKA implant in place

True this helps to accurate approximation of the joint line and to enable the surgeon to better reference landmarks. The saw will often hit the peg of the implant, at which time the component can be removed and the remainder of the distal femoral cut can be made JAAOS Oct 2018

UKA should be avoided in patients with inflammatory arthropathy and previous high tibial osteotomy.

True JAAOS Oct 2018

in UKA tibial component should be in neutral to 3 degrees of varus alignment, with \<2 degrees change of posterior slope.

True JAAOS Oct 2018

Femoral component loosening in UKA is frequently attributed to component malalignment, whereas tibial loosening may be related to poor initial fixation

False The other way around. 2 peg femoral implants are better than 1 peg JAAOS Oct 2018

In UKA Intraoperative fractures are attributed to excessive impaction of the tibial tray, whereas postoperative fractures are associated with tibial cuts and component alignment

True JAAOS Oct 2018

In Pilon ORIF, surgical incisions placed in parallel between the angiosomes pose no threat to the resultant skin bridge

True JAAOS Sep 2018

Primary arthrodesis in non reconstructable Pilon fractures reduced rate of infection compared with infection rates associated with conventional fixation techniques

True JAAOS Sep 2018

Bifocal compression/ distraction osteogenesis addresses Pilon # bone loss peripherally (through shortening) and resolves limb length discrepancy by proximal distraction osteogenesis

True JAAOS Sep 2018

Early fixation, upgrading, primary arthrodesis, staged sequential posterior and anterior fixation, acute shortening, and transsyndesmotic fibular plating have resulted in lower risk of infection in tibial plafond surgery

True JAAOS Sep 2018

In closed high energy Pilon fracture, early ORIF has similar good outcome to stage ORIF (with the use of temporarly external fixation),it also has a similar risk of deep infection provided the surgery is done in the first 3 days

True However, patients with notable regional or systemic comorbidities (ie, alcohol abuse, schizophrenia, diabetes, peripheral neuropathy, hemorrhagic fracture blisters) had unacceptable higher complications with the use of early ORIF. JAAOS Sep 2018

Relative indications for surgery in Tibial plateaus # are an articular step-off of \>3 mm, condylar widening of \>5 mm, and \>5 degrees of coronal alignment disruption

True JAAOS June 2018

Very high rate of failure was noticed for ORIF tibial plateau in elderly

True 79% fixation failure rate in patients aged \>60 years and a 100% fixation failure rate in patients with marked osteoporosis, this is in addition to other medical complications e.g. DVT…etc JAAOS June 2018

Old patients sustain tibial plateau fractures are likely to markedly drop their preinjury level of function after TKA

False JAAOS June 2018

Resection & replacement of the proximal tibia is associated with less complications than distal femur resection & replacement

False major potential complications with proximal tibia replacement, specifically disruption of the tibial tubercle and the extensor mechanism, as well as potential soft tissue coverage issues JAAOS June 2018

Infection rate is the same in patients undergoing secondary TKA and in those undergoing standard TKA

False Higher in secondary JAAOS June 2018

In secondary TKA flexion can be markedly improved with the proper surgical techniques

False JAAOS June 2018

Primary TKA for tibial plateau fracture in elderly patients is associated with lower reoperation rate compared to ORIF

True JAAOS June 2018

Secondary TKA for posttraumatic osteoarthritis secondary to malunion is associated with a higher rate of complications and poorer functional results than TKA for primary osteoarthritis

True JAAOS June 2018

Minor differences are seen in wear rates between Metal-on-XLP, ceramic-on-XLP and ceramic-on-ceramic bearings.

True Metal-on-XLP has the longest clinical follow up

What are fresh frozen graft options to address glenoid bone defect in recurrent shoulder dislocation

Glenoid Tibial plafond

Failure types in tripolar constrained designs

Type 1: shell-bone interface Type 2: Shell-liner interface Type 3: At bipolar locking mechanism Type 4: Inner bearing of the bipolar components

No evidence that three component designs total ankle replacements are better than two component designs

True

Iatrogenic chondrolysis has been associated with postoperative intra-articular infusion of bupivacaine or lidocaine, the use of nonabsorbable suture anchors and the use of thermal devices

True

A major advantage to superior plating is that for most fracture patterns, the plate is on the tension side of the fracture.

True JAAOS Nov 2018

Malposition, loosening, impingement, instability & sizing are some of the causes of bearing dislocation in UKA

True JAAOS Oct 2018

RACS True/False Quiz 2018 Flashcards

(262 cards)