SAQ

Question 1

What are 7 neurological causes of pes cavus aside from?

Answer 1

CMT
CP
Diastematomyelia
Stroke or closed head injury
Freidreich’s ataxia
Huntington’s chorea
Arthrogryposis

Question 2

What are the 3 most common procedures performed after a terrible triad?

Answer 2

Column procedure
Radial head arthroplasty for failed ORIF
TEA

Question 3

6 design features to reduce IM pressure during reaming?

Answer 3

Deeper flutes
Larger diameter bulb tip
Slower speed of rotation
Sharp reamer
455 stainless steel
Titanium nitride coating

Question 4

8 risk factors for Pavlik harness failure?

Answer 4

Bilateral
Teratologic
Ortolani negative
Initiation of treatment after 7 weeks
Male
Inappropriate application
Femoral nerve palsy
Patient noncompliance

Question 5

5 infantile disorders with thickened cortices/periosteal calcifications?

Answer 5

Caffey’s disease
Scurvy
Rickets
Hypervitaminoses (A and D)
Congenital syphilis

Question 6

8 risk factors for Dupuytren’s disease?

Answer 6

Male
Advanced age
Manual laborer
Smoker
Alcohol
HIV
Diabetes
Anti-epileptics

Question 7

6 indications for surgery in a Rheumatoid C-spine?

Answer 7

Progressive myelopathy
ADI >10mm static
ADI >4mm dynamic (ie: 4mm more on flex vs. ex view)
SAC <14mm
Tip of the dens past McRae’s line
Tip of the dens >5mm above McGregor’s line
>20% C3-C7 subluxation with neuro symptoms/severe pain

Question 8

7 principles of tendon transfers?

Answer 8

Expendable donor tendon
Donor tendon has similar strength and excursion
Straight line of pull
Supple joint
One tendon performs one function
Synergistic function
Lose 1 point on power grade after transfer

Question 9

Name 3 local complications related to metal toxicity

Answer 9

Pseudotumour
Metallosis (aseptic local necrosis secondary to metallic corrosion)
ALVAL (aseptic lymphocitic vasculitis associated lesion - T-cell mediated type IV hypersensitivity reaction to Co and Cr ions)

Question 10

Name 4 principles for maintaining reduction in a length-stable pediatric femur fracture managed with Nancy nails

Answer 10

> 80% canal fill
More nails to increase rigidity
Pre-contour nails to achieve adequate spread at fracture site
Use end caps to improve axial stability

Question 11

What’s an indication to do a metabolic work-up in SCFE?

Answer 11

Patient <10 yo or <50%ile for body weight

Question 12

List 4 endocrine abnormalities associated with SCFE

Answer 12

Hypothyroidism
Panhypopitutiarism
Growth hormone deficiency
Renal osteodystrophy

Question 13

Name 5 methods to reconstruct a zone 2 (periacetabular) pelvic lesion

Answer 13

Curettage and cementplasty
Conventional THA
THA with reinforcement ring/reconstruction cage
Harrington procedure (primary THA reinforced by 3 steel pins/screws from the iliac crest down and cement)
Megaprosthesis

Question 14

List 6 complications of an HTO

Answer 14

Intra-articular fracture propagation
Recurrence of deformity (60% at 3 years)
Patella baja
Decreased posterior slope
Compartment syndrome (recurrent anterior tibial)
Malunion/non-union

Question 15

3 advantages of a distal femoral locking plate over a DCS

Answer 15

Better fixation in osteoporotic bone
Better control of coronal-plane fractures
More bone preserving (screw removes a lot of bone)

Question 16

6 radiographic features of FAI

Answer 16

Alpha angle >55
LCEA >39
Tonnis angle <0
Head-neck offset ratio <0.17
Crossover sign
Ischial spine sign

Question 17

List 8 risk factors for infection in THA

Answer 17

Active infection
IVDU
Revision surgery
Diabetes
Obesity
Rheumatoid arthritis
Immunosuppression (HIV)
Smoker

Question 18

List 8 radiographic features of aortic dissection on CXR

Answer 18

Widened mediastinum
Widened paraspinal stripe
Widened paratracheal stripe
Indistinct aortic contour
Right trachial deviation
Left depressed mainstem bronchus
Left apical pleural cap
Left large haemothorax

Question 19

List 4 major and 4 minor criteria for fat embolism

Answer 19

1 major and 4 minor criteria required to make Dx.

Major: hypoxia, pulmonary edema, petechiae, CNS depression
Minor: fat in urine or sputum, tachycardia, fever, sudden indexplicable drop in platelets

Question 20

List 6 orthopaedic features in the diagnostic criteria of Marfan’s

Answer 20

Pectus excavatum requiring surgery
Reduced elbow extension
Positive wrist and thumb signs
Scoliosis or spondylolisthesis
Protrusio
Medial displacement of medial malleolus (pes planus)

Question 21

List 5 non-orthopaedic features of Marfan’s

Answer 21

Lens dislocation
Aortic dilatation
Aortic dissection
Mitral valve prolapse
Spontaneous pneumothorax

Question 22

List 5 indications for immediate amputation in trauma

Answer 22

Medically unfit for surgery
Crush injury with warm ischemia time >6h
Crush injury with cool ischemia time >12h
Irreparable vascular injury
Complete laceration of sciatic or tibial nerve

Question 23

List 3 methods of determining if a femoral neck fracture is anatomically-reduced in a young patient

Answer 23

Direct inspection through Smith-Peterson approach
Lowell alignment theory (head-neck should form an “S” on both the AP and lateral views)
Garden compression trabecular index (160 deg on AP and 180 deg on lateral)

Question 24

List 8 surgical considerations in the management of severe hallux valgus

Answer 24

1st MTP OA?
1st TMT instability/OA?
Sesamoid OA?
Medial eminence prominence?
HVIA <9
DMAA <9
HVA <15
IMA <9

Question 25

What are 10 risk factors for vision loss in spine surgery?

Answer 25

Male Diabetes PVD Obesity Preoperative anemia Long procedure Perioperative blood loss >1L Hypotension Prone positioning No colloid used during resuscitation

Question 26

What are the 4 principles of causality?

Answer 26

Strength of the association Specificity of the association Temporality Reversibility

Question 27

Explain the difference between blinding and concealment of allocation

Answer 27

Blinding: patient, their family, treating team and anyone involved in outcomes assessment is unaware to the intervention performed. Concealment of allocation: individual who is enrolling participants does not know in advance which study arm each successive patient will be enrolled to.

Question 28

List 4 indications for hemiresection and interpositional arthroplasty of the DRUJ

Answer 28

Painful arthritis (OA, RA, PTA) Ulnocarpal impaction with radio-ulnar incongruity Absence of longitudinal forearm instability Absence of post-traumatic ulnar subluxation of the carpus

Question 29

List 6 indications for MRI in juvenile scoliosis

Answer 29

Any child <10 with >20 degree curve Short, sharp curve Rapidly progressing curve Asymmetric abdominal reflex Upper motor-neuron signs Associated cavus foot

Question 30

List 3 risk factors for the development of metastasis in an isolated soft tissue sarcoma

Answer 30

High-grade tumour Resection with positive margins Local recurrence

Question 31

Which 2 muscles are commonly transferred after a proximal humerus resection and endoprosthetic reconstruction?

Answer 31

Pectoralis major Latissimus dorsi

Question 32

Which 3 muscles require transfer after a proximal femoral resection and endoprosthetic reconstruction?

Answer 32

Iliopsoas Short external rotators Abductors

Question 33

What % of resected and reconstructed (a) distal femoral and (b) proximal tibial tumours require a medial gastrocs flap for coverage?

Answer 33

(a) 25% (b) 100%

Question 34

What's the overall survival of an endoprosthetic reconstruction at 10 years? Which location has the worst?

Answer 34

85% (worst for proximal tibia, best for proximal humerus)

Question 35

Which 4 factors facilitate local high-grade sarcoma spread in the shoulder as compared to other joints?

Answer 35

Direct capsular extension Spread along the LHBT Fracture hematoma from pathologic fracture Inappropriately-planned biopsy

Question 36

If a proximal humerus tumour involves the axillary/brachial artery, what's the implication?

Answer 36

Brachial plexus is also involved due to proximity to the artery (axillary vein, artery and brachial plexus are all within the axillary sheath), and so this is a contraindication to limb salvage

Question 37

What are the 2 contraindications to a forequarter amputation?

Answer 37

Chest wall extension Extension into the posterior triangle of the neck

Question 38

Optimal position for wrist fusion? What about if bilateral?

Answer 38

10-15 deg extension, slight ulnar deviation. If bilateral, other side in neutral.

Question 39

What are the only 2 proven benefits to repair vs. accelerated rehab for achilles ruptures?

Answer 39

Better plantarflexion strength Earlier return to work

Question 40

What are the 3 risk factors for wound complications after achilles repair?

Answer 40

Female Smoker Steroid use

Question 41

Rank CRPP, ORIF, RSA, HA for proximal humerus fractures in terms of highest (a) complications, and (b) revision rate

Answer 41

(a) CRPP, RSA, ORIF, HA (b) ORIF, RSA/HA, CRPP

Question 42

What are the 3 indications for ankle distraction arthroplasty?

Answer 42

Young patients with post-traumatic arthritis Congruent joint >20 degree arc of motion

Question 43

How much distraction is needed in an ankle distraction arthroplasty?

Answer 43

5mm

Question 44

What are the 2 predictors of failure in ankle distraction arthroplasty?

Answer 44

Female <20 degree arc of motion

Question 45

What's the diagnosis if you see an athlete with pubic pain and widening/lysis of the symphysis on XR?

Answer 45

Chronic osteitis pubis (due to repetitive pull of the adductors and rectus abdominis on the pubic symphysis)

Question 46

What's the diagnosis if a patient presents with abdominal pain that radiates to the groin which is exacerbated by sport and relieved by rest?

Answer 46

Athletic pubalgia ("sports hernia" -- tear in abdominal wall)

Question 47

Which nerve should be neurolysed when doing a repair for athletic pubalgia?

Answer 47

Genital branch of genitofemoral nerve

Question 48

What is the hip labrum innervated by?

Answer 48

Branches of obturator nerve and nerve to quadratus femoris

Question 49

By how much (%) does the labrum increase intra-articular contact surface and volume? Without it, how much do femoroacetabular contact pressures increase by?

Answer 49

Surface: 22% Volume: 33% Contact pressures: 92%

Question 50

Has there been any level I/II evidence of better outcomes for labral repair vs. debridement?

Answer 50

Yes, repair is better in females with FAI. However, a recent Philippon JBJS study showed no difference at 10 year follow-up

Question 51

When are C. diff infections considered community-acquired vs. hospital-acquired?

Answer 51

Community: <48h after admission or >12 weeks after discharge Hospital: >48h-4 weeks after admission

Question 52

List 6 risk factors for acquiring C. diff

Answer 52

Age >65 Diabetes Prolonged hospital admission Revision surgery Multiple antibiotic exposure (especially Clinda) Bowel surgery

Question 53

What's the treatment for C. diff collitis (mild, moderate, severe, severe with elevated lactate, recurrence)?

Answer 53

Mild: PO Flagyl Mod: PO Vanco Severe: PO Vanco + IV Flagyl Severe with lactate >5 or WBC >50: subtotal colectomy Recurrence: Vanco, not Flagyl

Question 54

What constitutes an acceptable reduction after ORIF of a distal radius?

Answer 54

Radial inclination >15 Volar tilt >15 Radial shortening <2mm Articular incongruity <2mm Sigmoid notch incongruity <2mm

Question 55

Which ACL test has the best sensitivity and specificity?

Answer 55

Sensitivity: Lachman Specificity: Pivot-shift under EUA

Question 56

What's the first pelvic apophysis to appear and when does it ossify? What's the last pelvic apophysis to appear and when does it ossify?

Answer 56

First: AIIS (4, 17) Last: ASIS (17, 25)

Question 57

What are 3 symptoms of lead toxicity after a retained bullet?

Answer 57

Cramping Constipation Seizures

Question 58

When should you treat lead toxicity with chelation therapy?

Answer 58

Blood levels >0.45 μmol/L

Question 59

List 6 general risk factors for HO

Answer 59

Male Previous HO Multiple surgeries Closed head injury Prolonged mechanical ventilation DISH

Question 60

In what situation is static progressive splinting used these days?

Answer 60

In patients with severe head injuries to prevent elbow and ankle equinus contractures (ICU)

Question 61

What's the average wear rate of HXL-UHMWPE? At what annual wear rate do you get concerned for osteolysis?

Answer 61

Average: 0.02mm/y Concern: 0.2mm/y

Question 62

List 4 ways to measure wear in a THA

Answer 62

Linear wear Volumetric wear Dual circle technique Radiostereometric analysis

Question 63

How do you determine if a THA is "stable" intraoperatively?

Answer 63

Flexion >90 IR >45 with hip flexed to 90 ER >15 with hip extended

Question 64

List 3 ways to test for malnourishment and their cutoffs

Answer 64

Albumin <35 WBC < 1.5 Transferrin <20

Question 65

List 3 intraoperative considerations for obese patients undergoing a TKA

Answer 65

Reverse Trendelenburg is best for ventilation Computer navigation Stemmed tibial baseplate

Question 66

Where is type I collagen found?

Answer 66

Bone, ligaments, sclerae, dentin

Question 67

What are the spinal manifestations of patients with OI?

Answer 67

Basilar invagination Scoliosis Kyphosis Spondylolisthesis

Question 68

What are the 4 types of OI, their features and inheritance pattern?

Answer 68

I: mild (blue sclerae, fractures after walking age, mild scoliosis) -- AD II: deadly intra-uterine -- AR/spontaneous III: severe (fractures before walking age, spinal manifestations, dentinogenesis imperfecta, joint instability) -- AR/spontaneous IV: intermediate (less severe form of type III) -- AD

Question 69

What non-operative modality has been shown to reduce fracture rate and prevent scoliosis progression in OI?

Answer 69

Bisphosphonates (if started before age 6)

Question 70

How do you treat scoliosis in OI?

Answer 70

Bracing doesn't work; fuse when >45 degrees and consider cement augmentation through fenestrated screws at the most proximal and distal levels

Question 71

How do you treat basilar invagination that doesn't reduce with intraoperative traction?

Answer 71

Staged approach (trans-oral decompression followed by occiput-C2 posterior fusion usually 1 week later)

Question 72

List 5 intraoperative considerations when managing any patient with OI

Answer 72

Difficult airway (large head, short neck) Gentle transfer to table (fracture risk) Avoid tourniquet use (fracture risk) Avoid succinylcholine (can cause fasciculations = fracture risk) Increased bleeding risk

Question 73

What are 4 complications of a vascularized fibular transfer in pediatric patients with open physes?

Answer 73

Peroneal nerve injury Claw toes (FHL) Syndesmotic instability (consider doing a synostosis for distal harvests) Ankle valgus deformity (from distal tibial growth arrest)

Question 74

List 6 complications of halo gravity traction

Answer 74

Pin infection Skull penetration (don't use in patients <18 mo) Cranial nerve VI palsy (lateral gaze) Brachial plexus palsy Odontoid AVN SMA syndrome

Question 75

Where is the humeral head center of rotation relative to the intramedullary canal?

Answer 75

5mm medial and posterior

Question 76

What are the 4 red flags for back pain?

Answer 76

Night pain Constant pain B symptoms Back pain in patients <10

Question 77

What's the Sorensen criteria for Scheueremann's kyphosis?

Answer 77

>5 degree anterior wedging at 3 adjacent levels >45 degree local kyphosis

Question 78

What's the typical fusion level in Scheuermann's kyphosis? When is surgery indicated (4)?

Answer 78

T2-include first lordotic disc Surgery when: 1. >75 degree kyphosis 2. Pain not managed adequately without surgery 3. Neurologic symptoms 4. Failed conservative treatment

Question 79

What proportion of vertebral osteomyelitis shows (a) leukocytosis, (b) positive blood cultures, (c) organism identified on biopsy?

Answer 79

(a) half (b) one third (c) most

Question 80

What are the surgical indications for FDP reconstruction?

Answer 80

1. failed zone II repair 2. supple joint 3. no neurovascular injury 4. disrupted FDS (can still do it if FDS is intact by releasing FDS insertion on the middle phalanx and repairing it end-to-end to the distal FDP stump, but some people recommend against it since an intact FDS still provides reasonable function).

Question 81

Describe the general principles of a 2-stage Hunter procedure for a flexor tendon reconstruction

Answer 81

First stage: insert silicon rod in the flexor tendon sheath and reconstruct the pulleys as needed (A2 and A4 most importantly). Second stage: 3 months later, remove silicon rod and insert tendon graft (palmaris, plantaris)

Question 82

Describe the Seddon and Sunderland classification of nerve injuries and expected prognosis for each

Answer 82

I: Neurapraxia (full recovery, up to 2 months) II: Axonotmesis with intact endoneurium (mostly full recovery, 2-4 months) III: Axonotmesis with disrupted endoneurium (partial recovery, 12 months) IV: Axonotmesis with disrupted endo- and perineurium and only epineurium intact (poor recovery) V: Neurotmesis (no recovery)

Question 83

What tendon transfer is used for a foot drop (peroneal palsy)?

Answer 83

PTT through IOM to the lateral cuneiform (4 incision technique)

Question 84

List 5 risk factors for failure of bracing in AIS

Answer 84

Male Suboptimal correction in-brace Non-compliance Obesity Hypokyphotic thoracic curve

Question 85

List 5 ways to determine appropriateness of humeral implant height

Answer 85

5.6 cm above upper border of pectoralis major 0.8 cm above GT 1 cm below lateral acromial edge Anatomic reduction of the tuberosities Measure resected head

Question 86

Which 3 structures can block reduction of a medial subtalar dislocation? What about lateral?

Answer 86

Medial: EDB, deep peroneal bundle, TN capsule Lateral: Tib post, but also FHL, FDL, posterior tibial bundle

Question 87

Where are pediatric trigger fingers most commonly located? What % spontaneously resolve? What's the treatment if conservative management fails?

Answer 87

Thumb. 50%. A1 pulley release (if digit other than thumb is involved, A1 pulley release is not adequate since disease involved A3 pulley as well and has multiple nodules in the tendon).

Question 88

What 5 endocrine abnormalities is polyostotic fibrous dysplasia associated with?

Answer 88

Hyperthyroidism Hyperprolactinemia Cushing's Hypophosphatemia Acromegaly

Question 89

List 5 extra-osseous manifestations of fibrous dysplasia (McCune-Albright and Mazabraud syndrome)

Answer 89

Hyperthyroidism, hyperparathyroidism, precocious puberty, cafe-au-lait spots (M-A syndrome) and intramuscular myxomas (Mazabraud)

Question 90

What's the difference between the cafe-au-lait sports in neurofibromatosis vs. McCune-Albright syndrome?

Answer 90

NF1: "coast of California" smooth appearance M-AS: "cost of Maine" roughened appearance

Question 91

What is the histological hallmark of fibrous dysplasia?

Answer 91

Inability to produce mature lamellar bone from immature woven bone with "alphabet soup" appearance

Question 92

What can exacerbate fibrous dysplasia?

Answer 92

Pregnancy (increased number of hormones, and osteoblasts in FD have more hormone receptors)

Question 93

When are bisphosphonates used in fibrous dysplasia

Answer 93

Polyostotic form

Question 94

Which bone graft should you use in fibrous dysplasia?

Answer 94

Cortical or cancellous allograft (never autograft)

Question 95

What are the zones of the physis?

Answer 95

1. Trabecular bone zone 2. Zone of provisional calcification 3. Zone of hypertrophy (weakest) 4. Zone of proliferation (entire growth depends on this) 5. Resting zone

Question 96

List 6 factors that can lead to reduced knee extension after ACLR

Answer 96

Cyclops lesion Arthrofibrosis Anterior tibial tunnel placement (notch impingement) Graft tensioning in 30 degrees of flexion Failed bucket handle meniscal repair Delayed physiotherapy

Question 97

List 4 structures that can contribute to a swan-neck deformity in patients with RA

Answer 97

1. FDS rupture 2. PIP volar plate rupture with dorsal subluxation of lateral bands 3. Collateral extensor band rupture (mallet finger) 4. Volar subluxation of MCP joint

Question 98

List 4 malignant transformations of fibrous dysplasia

Answer 98

Osteosarcoma Chondrosarcoma MFH Fibrosarcoma

Question 99

What are 5 methods to diminish blood loss during spine surgery?

Answer 99

Permissive hypotension (aim for MAP 80) Acute normovolemic hemodilution Epidural blockade (vasoconstricts proximally) TEXA Electrocautery use

Question 100

List 6 risk factors for non-therapeutic opioid use

Answer 100

Age <45 History of drug abuse Family history of drug abuse Smoker Pre-operative opioid use Mental illness

Question 101

List 4 features of infantile scoliosis that suggests the deformity will progress

Answer 101

Mehta predictors of progression: 1. Cobb angle >20 2. RVAD >20 3. Phase 2 rib 4. Progression >6 degrees/year

Question 102

What's the feared complication in an infant with granulomatous vertebral osteomyelitis? What are 6 risk factors?

Answer 102

Buckling collapse (>120 degree kyphosis) Risk factors: 1. Pre-treatment kyphosis >30 degrees 2. Junctional level 3. Gapping of facet joints 4. Retropulsion of infected vertebra 5. Lateral listhesis 6. Toppling

Question 103

List 4 radiographic risk factors for progression of infantile Blount's

Answer 103

Drennan angle >16 Epiphyseal distortion Langenskiold IV-VI Progressive varus

Question 104

List 5 radiographic findings of femoral head AVN in DDH

Answer 104

Delayed development of ossific nucleus Fragmentation of ossific nucleus Lateral physeal irregularity Metaphyseal widening Varus neck with GT overgrowth

Question 105

List 5 radiographic findings in pediatric rheumatoid spine

Answer 105

Apophyseal fusion (C2-3 usually) Dens waist erosion (apple core deformity) Atlantoaxial instability Hypoplastic vertebral bodies Loss of cervical lordosis

Question 106

List 6 risk factors for non-union in type II odontoid fractures

Answer 106

Age >40 Gapping >1mm Posterior displacement >5mm Posterior re-displacement >2mm after start of treatment Angulation >11 degrees Comminution

Question 107

List 4 seronegative spondyloarthropathies

Answer 107

Ankylosing spondylitis Psoriatic arthritis Reiter's sydnrome Inflammatory bowel disease-associated arthropathy

Question 108

List 3 reasons to prophylactically pin the contralateral hip in SCFE

Answer 108

SCFE associated with endocrinopathy Age <10 Obesity (>90%ile)

Question 109

List 5 pediatric manifestations of Peyronie's disease

Answer 109

Bent penile erections Painful erections Penile plaques Penile numbness Decreased penile rigidity

Question 110

List 5 causes of lower extremity Charcot arthropathy other than diabetes

Answer 110

ETOH Myelomeningocoele Syrinx Syphilis Spinal cord injury

Question 111

List 4 compliciations associated with BMP-2 use in spine surgery

Answer 111

Ectopic bone formation Seroma Post-operative radiculitis Carcinogenic

Question 112

List 3 strategies for safe tourniquet usage for surgeries that are expected to take longer than 2.5 hours

Answer 112

1. Use wider cuff 2. Let tourniquet down at 2h for 10 minutes, then 10 minute down-times at hourly intervals 3. Inflate 75 mmHg >limb occlusion pressure

Question 113

Does GA or spinal anesthetic have a higher complication rate in TKA, and list 4 complications?

Answer 113

GA (infection, pneumonia, AKI, mortality)

Question 114

What nerves are blocked by an adductor canal block?

Answer 114

Saphenous Obturator nerve branches Medial retinacular branches Nerve to vastus medialis (motor)

Question 115

List 4 indications for debridement in isolation for shoulder OA?

Answer 115

Young laborer Concentric joint Small osteophytes <2cm OCDs

Question 116

List 3 predictors for requiring a THA following a hip arthroscopy?

Answer 116

Older age <2mm joint space Microfracture required

Question 117

What's a normal talocrural angle?

Answer 117

8-15 degrees (angle between a line perpendicular to the tibial plafond articular surface and a line connecting the malleoli)

Question 118

What is PDGF approved for in Canada?

Answer 118

Hindfoot fusions

Question 119

What is the risk of PGDF use?

Answer 119

Carcinogenic with topical form (not with rhPDGF that is used in foot and ankle fusions)

Question 120

What is BMP approved for in Canada?

Answer 120

Lumbar fusions Open tibia fractures

Question 121

What do NSQIP databases measure? Is IRB required to analyse the data?

Answer 121

Pre-operative events Post-operative events Comborbidities 30-day morbidity and mortality IRB is not required since patients are de-identified

Question 122

What's the initial non-operative treatment of a UCL injury?

Answer 122

Throwing cessation for 3 months Elbow strengthening Mechanics re-structuring Graduated painless return-to-throwing program

Question 123

List 5 risk factors for a pediatric VTE

Answer 123

Infection surgery Hyponatremia Hematologic disorder Abnormal PTT Elevated AST

Question 124

List 4 downsides of minimalist running vs. shod running (heel-strike)

Answer 124

1. Increased gastrosoleus injuries (eccentric contraction as forefoot or midfoot strike the ground) 2. Increased base of metatarsal stress fractures 3. Higher risk of puncture wounds 4. Higher risk of plantar fasciitis

Question 125

List 2 benefits of minimalist running vs. shod running

Answer 125

1. Less patellofemoral pain 2. Less joint reactive forces on the hip (center of gravity shifts more centrally)

Question 126

List 6 negative prognostic factors in TTC nailing

Answer 126

Diabetes PVD Previous foot ulcerations Smoker Rheumatoid arthritis Chronic steroid use

Question 127

The _____ an extra-articular knee deformity is to the knee, the _____ the impact is on alignment

Answer 127

closer, greater

Question 128

When can you manage an extra articular (a) femoral and (b) tibial deformity simply with soft-tissue balancing and not an extra-articular osteotomy?

Answer 128

Far from the joint line <20 degree deformity in the femur <30 degree deformity in the tibia

Question 129

List 6 clinical features of ankylosing spondylitis

Answer 129

Bilateral sacroiliitis Inflammatory back pain (>3 months) Progressive kyphosis (chin-to-chest) Anterior uveitis Peripheral joint arthritis Enthesopathy

Question 130

How many levels above and below a fracture in ankylosing spondylitis should be included in the fusion?

Answer 130

3

Question 131

List 2 complications specific to spine surgery in ankylosing spondylitis

Answer 131

Epidural hematoma Aortic dissection

Question 132

Which PCL bundle is largest and strongest?

Answer 132

Anterolateral

Question 133

What's the position of fusion for D2-5 MCPs and PIPs?

Answer 133

MCPs: start at 25 degrees for D2, then increase by 5 PIPs: start at 40 degrees for D2, then increase by 5

Question 134

Describe the (a) incision and (b) fixation choice for MCP/PIP fusion

Answer 134

(a) curved incision (allows both MCPs and DIPs to be addressed if needed) (b) crossed K-wires have a proven track-record

Question 135

List 4 special considerations when nailing a femur fracture in a patient with OI

Answer 135

1. Increased fracture risk 2. Non-linear canal due to previous fracture healing 3. Atypical femoral bowing (may need to do multiple osteotomies to pass the nail) 4. Short limb (may need to use pediatric implants)

Question 136

List 2 special considerations when performing a THA in a patient with OI

Answer 136

1. Acetabular protrusio (may need to either bone graft and use screws vs. cup-cage) 2. Cement the femur always

Question 137

What's the risk of femoral head AVN in hip dislocation if it was reduced within 6 hours and >6 hours?

Answer 137

<6h: 5% >6h: 50%

Question 138

What's the definition of proximal junctional kyphosis?

Answer 138

>10 degree Cobb angle and >10 degree change from pre-operative films at the top level of the fusion

Question 139

List 6 risk factors for PJK

Answer 139

Combined approached Fusion to sacrum (more rigidity but also worse curve) Pedicle screws at all levels (increased rigidity) >5 degree kyphosis at UIV preoperatively High preoperative pelvic incidence (saggital imbalance) Osteopenia

Question 140

List 5 strategies to diminish the risk of PJK

Answer 140

Single approach without disruption of PLC at UIV Hooks at UIV rather than screws (soft landing) Strategic use of pedicle screws if all-screw construct Instrument one level above UIV if >5 degree kyphosis Osteotomies to correct saggital imbalance

Question 141

List 5 factors associated with trunnion wear

Answer 141

Larger head Increased offset Varus neck Dissimilar metals Smaller, more flexible necks

Question 142

What's the optimal fixation for C1-C7?

Answer 142

C1: lateral mass screws C2: pars or intra-laminar screws C1-2: trans-articular screws (if C1-2 is reduced) C3-6: lateral mass screws C7: lateral mass/pedicle screws

Question 143

List 3 risk factors for navicular stress fractures

Answer 143

Long 2nd metatarsal Metatarsus adductus Equinus contracture

Question 144

What % of patients with chronic (>2 weeks) elbow dislocations will have HO?

Answer 144

75%

Question 145

List 4 structures that are pathologic in a chronic elbow dislocation

Answer 145

Triceps contracture Collateral contracture Capsular contracture Arthrofibrosis

Question 146

What's the best approach for dealing with a chronic elbow dislocation and why?

Answer 146

Medial and lateral paratricipital (Kocher interval extension laterally) since you can transpose the ulnar nerve which is often needed as well as release the collaterals to achieve reduction then repair them

Question 147

List 3 indications for triceps lengthening in a chronic elbow dislocation

Answer 147

>3 months <100 degrees of flexion after other releases performed >5cm overlap between humerus and olecranon on AP

Question 148

List 3 ways to achieve lengthening of the triceps

Answer 148

Triceps mobilization from distal humerus Anconeus slide Triceps V-Y lengthening

Question 149

What are the 2 indications to perform a supramalleolar osteotomy?

Answer 149

1. Asymmetric varus/vaglus deformity with >50% tibiotalar articular surface preserved 2. To correct alignment for planned ankle arthrodesis/arthroplasty

Question 150

List 5 contraindications to a SMO

Answer 150

Hindfoot instability Age >70 Inflammatory arthritis Charcot foot Severe PVD

Question 151

How can you determine if an ankle asymmetric varus/valgus deformity is originating from within the joint or outside?

Answer 151

If the difference between the *distal tibial plafond angle and **talar articular angle is >4 degrees, it means there's an intra-articular deformity. If the total amount of varus/valgus deformity on the Saltzman hindfoot alignment view exceeds that value, then there's also an extra-articular deformity. *Distal tibial plafond angle is the angle between the anatomic axis of the tibia and the tibial plafond. **Talar articular angle is the angle between the anatomic axis of the tibia and the talar dome.

Question 152

Describe the principles behind a SMO for an extra-articular varus deformity (1. where it's done; 2. what correction you aim for; 3. how you deal with the fibula)

Answer 152

1. Medial opening wedge at the CORA for <15 degree correction; medial opening dome osteotomy at the CORA for >15 degree correction. 2. Aim for 4 degrees of valgus at the level of the ankle joint (anatomical axis of the tibia to pass just lateral to the center of the ankle joint) 3. Fibular osteotomy required if >10 degree correction.

Question 153

What may need to be done if you're doing an opening dome SMO for an extra-articular varus deformity?

Answer 153

Lengthening of posteromedial structures Tarsal tunnel release

Question 154

Describe the principles behind a SMO for an extra-articular valgus deformity (1. where it's done; 2. what correction you aim for; 3. how you deal with the fibula)

Answer 154

1. Medial closing wedge at the CORA for <15 degree correction; medial closing dome osteotomy at the CORA for >15 degree correction. 2. Aim for 4 degrees of varus at the level of the ankle joint. 3. Almost always requires a fibular osteotomy.

Question 155

Which approach is used for a medial wedge vs. dome (opening or closing) osteotomy?

Answer 155

Wedge: medial approach Dome: anterior approach

Question 156

List 3 treatment strategies for prevention of PJK

Answer 156

Teriparatide (better than bisphosphonates) Use hooks at UIV (soft landing) Cement augmentation at UIV

Question 157

List 8 risk factors for development of a pseudarthrosis after an attempted spine fusion

Answer 157

Uninstrumented fusion Multilevel fusion L5/S1 level Smoker Diabetes Steroid use NSAIDs Bisphosphonates

Question 158

Where's the location of the anatomic femoral ACL tunnel?

Answer 158

8mm anterior to posterior articular margin 1.7mm proximal to the bifurcate ridge (ridge that divides the AM and PL bundles)

Question 159

Describe the ossification of the clavicle

Answer 159

Lateral: intramembranous Medial: endochondral

Question 160

Is diaphyseal endosteal blood flow centripetal or centrifugal?

Answer 160

Centrifugal in adults (starts of centripetal in paeds)

Question 161

Describe the course of the MFCx artery

Answer 161

Branch of profunda femoris (75%) or femoral artery proper (25%), runs between psoas and pectineus, then between obturator externus and adductor brevis, then it gives off ascending branch (femoral head), acetabular branch, transverse branch and posteroinferior branch.

Question 162

What's a donor artery option for vascularized fibular grafts?

Answer 162

Ascending branch of the LFCx

Question 163

What two arteries are at risk in a Kocher-Langenbeck approach?

Answer 163

MFCx Inferior gluteal (supplies GMax; emerges from GSN between piriformis and superior gemellus)

Question 164

What's the blood supply to the acetabulum?

Answer 164

Acetabular artery (branch of obturator -- supplies the triradiate cartilage) SGA IGA Ischial artery (branch of internal pudendal)

Question 165

How much bone superior to the acetabulum should be left intact during a PAO to preserve the blood supply?

Answer 165

2-2.5cm

Question 166

List 1 high-profile medical device failure

Answer 166

DePuy ASR metal-on-metal hip (4 x std revision rate)

Question 167

List the 4 pertinent findings of the BRAIST trial (bracing vs. observation in AIS patients with 20-40 degree curves between Risser 0-2)

Answer 167

78% of braced didn't progress past 50 degrees vs. 48% NNT was 3 to avoid 1 surgery >13 hrs/d was the threshold for a >90% success No difference in QOL scores for bracing vs. observation

Question 168

When is the Providence brace indicated?

Answer 168

TLSO used mostly for lumbar curves (per Dr. Smit)

Question 169

When is the Rigo brace effective?

Answer 169

Most AIS curves (thee-dimensional curve correction) -- can be worn during the day and night

Question 170

What's the goal of curve correction when the brace is applied?

Answer 170

About 50%

Question 171

List 8 contra-indications to participation in strenuous physical activity after a C-spine fracture

Answer 171

Occipital-cervical fusion C1 ring non-union C1-2 residual instability Subaxial instability Loss of cervical lordosis Pavlov ratio <0.8 (narrow canal from retropulsed frag.) 3 or more level arthrodesis Neurological symptoms

Question 172

What's the most common site of metastasis in the hand?

Answer 172

Distal phalanges (thumb most commonly)

Question 173

Where are hand enchondromas usually found?

Answer 173

Proximal phalanges

Question 174

List 4 local treatment adjuncts after intralesional curettage in GCTs and enchondromas

Answer 174

Phenol Dehydrated alcohol PMMA Liquid nitrogen (can cause skin burns, neuropraxia)

Question 175

How does MSSA become MRSA?

Answer 175

It gains resistance to b-lactams via 4 types of staphylococcal cassette chromosomes, which allow for transfer of the mecA gene to S. aureus (types I-III cassette chromosomes are associated with hospital-acquired MRSA, while type IV is associated with community-acquired). The mecA gene encodes for a penicillin-binding protein that has a low affinity for b-lactams, hence resulting in resistance.

Question 176

What are the most common bacteria in septic arthritis in patients <1, 1-5 and >5?

Answer 176

<1: Staph species, GBS 1-5: S. aureus, S. pneumo, Kingella Kingae, H. flu >5: S aureus, N. ghonorrhea

Question 177

What's the Kocher criteria (including CRP)?

Answer 177

Fever WBC >12 CRP >20 ESR >40 Refusal to weightbear

Question 178

What's the diagnostic criteria for juvenile idiopathic arthritis?

Answer 178

Fever >2 weeks Effusion >6 weeks 25,000-100,000 cells on aspirate <75% PMNs on aspirate

Question 179

List 5 factors associated with successful closed reduction in DDH

Answer 179

Appropriate timing (<6 months) Pre-reduction traction Medial die pool <5mm Adductor tenotomy Maintenance of reduction on post-operative CT

Question 180

What's the safe zone for spica casting in DDH?

Answer 180

100 degrees flexion <55 degrees abduction

Question 181

How can you growth modulate a coxa valga?

Answer 181

Single screw inserted just below the GT aiming for the inferior 1/3 of the femoral head epiphysis

Question 182

Define toughness

Answer 182

Area under the stress-strain curve

Question 183

What's the optimal % screw density for a bridge plate?

Answer 183

50%

Question 184

Compared to patients <80 yo undergoing THA/TKA, what risks are patients >80 subject to?

Answer 184

3 x higher risk of MI, pneumonia and death. However, no correlation between ASA score and postoperative complications in this age group.

Question 185

What's the pedicle for a medial gastrocnemius flap?

Answer 185

Medial sural artery

Question 186

Describe the posterior approach to the knee

Answer 186

1. S-shaped incision over popliteal fossa (extend along LHBT proximally, and along semiT distally) 2. Find medial sural cutaneous nerve, then incise deep fascia and follow it to the tibial nerve 3. In the fossa, the tibial nerve is most superficial and the popliteal artery is the deepest 4. Retract the bundle laterally off the capsule (may need to ligate superior medial and middle geniculates) 5. Retract medial head of gastrocs medially (may need to release off the femur)

Question 187

What's the best flap? 1. small tibial tubercle/patellar tendon defect (anterior distal knee) 2. moderate patellar/suprapatellar defect (anterior proximal knee) 3. large suprapatellar defect 4. large, complex defect

Answer 187

1. Medial gastrocs flap (medial sural artery) 2. Vastus lateralis flap (descending branch of LFCx, lateral superior geniculate) 3. ALT (anterolateral thigh) fasciocutaneous flap, which can be combined with a cuff of vastus lateralis (descending branch of LFCx, lateral superior geniculate) 4. Latissimus dorsi free flap (donor = thoracodorsal; recipient = descending geniculate)

Question 188

What's the % risk of vascular compromise in a free flap?

Answer 188

20%

Question 189

What's an optimal cast index for distal radius fractures and how is it calculated?

Answer 189

<0.84 (internal width of the cast on the lateral XR/internal width of the cast on the AP at the level of the fracture)

Question 190

List 5 indications for surgery in radius fractures in kids

Answer 190

Failure to achieve acceptable closed reduction Loss of reduction at follow-up Open fracture Associated vascular injury or compartment syndrome Floating elbow

Question 191

Where is the entry point for a radius TEN?

Answer 191

Between 1st and 2nd extensor compartments proximal to the physis

Question 192

What's the difference in time to union, blood loss, time in hospital and early ROM in TENs vs. ORIF for BBFFs?

Answer 192

No difference in time to union, blood loss or admission time; ORIF however allows early ROM, no immobilization (TENs require 3-4 weeks in cast) and anatomic reduction.

Question 193

What's the most common site of facet joint cysts and what's the pathophysiology?

Answer 193

L4-5 (DDD results in loss of disc height, which increases the stresses on the facet joints and add on to that L4-5 degenerative spondylolisthesis due to facet joint orientation at this level results in a stretched out facet joint capsule and cyst formation)

Question 194

What's the recurrence rate after surgery for a lumbar facet cyst?

Answer 194

<2% for decompression alone and 0% for decompression with fusion

Question 195

What are the 3 patterns of congenital spinal stenosis?

Answer 195

1. Short pedicles (decreased AP space) 2. Flat laminae (decreases transverse spacpe) 3. Global (combined)

Question 196

What's the best clinical outcome measure for lumbar spinal stenosis?

Answer 196

Oswestry Disability Index

Question 197

What are the transfers for a wrist drop?

Answer 197

PL to EPL FCR to EDC Pronator teres to ECRB

Question 198

Describe where the thumb UCL originates and inserts

Answer 198

Proximal-dorsal metacarpal to distal-volar proximal phalanx

Question 199

What indicates a grade 3 UCL thumb tear?

Answer 199

Absolute laxity of >35 degrees or >15 degree laxity compared to the other side

Question 200

List 2 indications for surgery in a Stener lesion

Answer 200

1. Soft tissue Stener >3mm displaced 2. Bony avulsion Stener

Question 201

List 5 risk factors for patellar tendinosis

Answer 201

Fat Flat foot Frail quads inFlexible quads LLD

Question 202

When doing the distraction method for pelvic discontinuity, when do you know you've reamed enough? How much bigger should the acetabular component be than what you reamed?

Answer 202

Reamed enough when you have AS and PI contact. 6-8mm bigger.

Question 203

List 2 radiographic measurements for scapulothoracic dissociation

Answer 203

1. Scapular distance >1cm (medial border to spinous processes) 2. Scapular distance ratio >1.29 (injured:uninjured)

Question 204

What's the rate of limb-threatening ischemia in scapulothoracic dissociation? How about mortality?

Answer 204

10% 10%

Question 205

What are the principles behind the Zelle classification for scapulothoracic dissociation?

Answer 205

Injury progresses from pure MSK injury, to MSK and vascular injury, to those plus post-ganglionic nerve injury to those plus plexus avulsion and Horner's syndrome.

Question 206

What's the best imaging modality for a pre- and post-ganglionic injury?

Answer 206

Pre-ganglionic: CT myelogram Post-ganglionic: MRI

Question 207

List 5 ways to determine appropriate joint height in a revision TKA

Answer 207

15mm above fibular head 25mm below lateral epicondyle 30mm below medial epicondyle 40mm below adductor tubercle at the level of the inferior patellar pole with knee at 90

Question 208

What are the 8 main dorsal wrist arthroscopy portals? List 1 danger for each.

Answer 208

3,4 - EPL 4,5 - EDC Radial midcarpal (just distal to 3,4) - EDC Ulnar midcarpal (just distal to 4,5) - EDC 6R (radial side of 6th compartment) - DSBUN 6U (ulnar side of 6th compartment) - DSBUN 1,2 - Radial artery STT - Radial artery

Question 209

List 5 negative prognostic factors in a patient with DDH undergoing a PAO

Answer 209

Tonnis grade 3 LCEA <0 <10 degrees of acetabular anteversion Asymmetric femoral head Os acetabuli

Question 210

Which is worse, CA-MRSA or HA-MRSA? How can they be differentiated?

Answer 210

CA-MRSA is much worse. CA-MRSA can be differentiated by: 1. Genetic elements (type IV cassette chromosome) 2. Presence of virulent exotoxins (PVL) 3. Absence of multi-drug resistance

Question 211

List the 4 Boston criteria for predicting chance of MRSA infection in pediatrics

Answer 211

Fever WBC >12 CRP >13 Hct <34%

Question 212

How is conventional radiation therapy given?

Answer 212

3 Gy x 10 fractions

Question 213

What are the 3 terminal branches of the tibial nerve?

Answer 213

Medial plantar Lateral plantar Calcaneal

Question 214

Where does the medial plantar nerve run and what does it innervate?

Answer 214

Between abductor hallucis and FDB. Motor supply to abductor hallucis, FDB, FHB, and 1st lumbrical.

Question 215

Where does the lateral plantar nerve run and what does it innervate?

Answer 215

Between FDB and quadratus plantae. Motor to quadratus plantae, flexor digiti minimi, abductor digiti minimi, lateral 3 lumbricals, interossei and adductor hallucis

Question 216

What is Jogger's foot and what's the surgical treatment if non-surgical management fails?

Answer 216

Medial plantar nerve compression. Treatment is release of abductor hallucis fascia from its origin to the Knot of Henry.

Question 217

Describe 3 differences between Baxter neuropathy vs. plantar fasciitis

Answer 217

Radiation to medial ankle and across lateral foot Exacerbation with activity and improvement with rest Exacerbated with foot eversion and abduction

Question 218

What's the surgical treatment of Baxter neuropathy if non-surgical management fails?

Answer 218

Release of abductor hallucis fascia, then follow nerve distally and release FDB fascia if it's tethering it

Question 219

What's soleal sling syndrome?

Answer 219

Compression of tibial nerve proximally in the calf deep to the fascial sling of the soleus

Question 220

List 3 indications for delaying surgery in patients with ESRD on dialysis?

Answer 220

K >5.5 pH <7.25 Hypervolemia

Question 221

List the attachments of tibialis posterior

Answer 221

navicular, medial, middle, lateral cuneiforms, cuboid, metatarsals 2-4, sustentaculum

Question 222

List the (7) attachments of semimembranosus

Answer 222

posteromedial tibia, OPL, POL, popliteus fascia, medial head of gastrocs, posteromedial capsule, sMCL

Question 223

List 4 transfers to restore elbow flexion in a musculocutaneous nerve palsy

Answer 223

Clark's pec major to biceps tendon transfer Lat dorsi to biceps tendon transfer Triceps to biceps transfer Steindler flexorplasty

Question 224

List two transfers to restore elbow extension in a high radial nerve palsy

Answer 224

Deltoid or lat dorsi to triceps

Question 225

List the transfer indicated in a low median nerve palsy

Answer 225

Abductor pollicis brevis is affected (thumb opposition), so the transfer is D4 FDS to APB tendon

Question 226

List the two transfers indicated in a high median nerve palsy

Answer 226

BR to FPL D4/5 FDP side-to-side transfer to D2/3 FDP

Question 227

List the three transfers in an ulnar nerve palsy

Answer 227

D4 FDS to adductor pollicis (thumb adduction) APL to 1st dorsal interosseous (index abduction) D3 FDS to lateral bands of D4/5 (reverses clawing)

Question 228

What's the usual critical segmental bone defect?

Answer 228

>50% cortex width or >2cm loss

Question 229

What's the management of a bone defect of size: a) <2 cm b) 2-5 cm c) 5-10 cm d) >10 cm

Answer 229

a) Acute shortening with secondary lengthening if needed b) ICBG (20 cc/side) c) Masquelet with RIA (40cc/femur) and allograft vs. distraction osteogenesis (1 cm/month defect) d) Masquelet, vascularized fibula, amputation

Question 230

What's the optimal ratio of allograft:autograft for a Masquelet?

Answer 230

<3:1

Question 231

How proximal and how distal can you harvest a vascularized fibula?

Answer 231

4cm from fibular head to 6cm from ankle joint

Question 232

What (2) factors differentiate SED from MED?

Answer 232

Basically the same presentation, except: 1. scoliosis and vertebral body abnormalities 2. COL2A gene

Question 233

List 3 considerations when planning a THA in a patient with MED

Answer 233

1. Small, shallow acetabulum 2. Modular implants needed (meta-dia mismatch) 3. HO prophylaxis (larger exposure needed)

Question 234

What's the only spasmolytic agent used in conscious sedation? What's its mechanism?

Answer 234

Benzodiazepines (midazolam) GABA agonist

Question 235

What's ketamine's mechanism? When is ketamine contraindicated?

Answer 235

Mechanism: NMDA antagonist (threshold-dependent, not dose-dependent) Contraindicated in uncontrolled HTN or CAD

Question 236

What's propofol's mechanism?

Answer 236

GABA agonist

Question 237

Why is fractionation important in radiation therapy?

Answer 237

4 "R's": 1. Repair 2. Reoxygenation (radiation damage relies on free radical formation) 3. Redistribution (to G2 cell cycle when cells are most vulnerable) 4. Repopulation of tumor cells (with rapidly-dividing cells that are vulnerable)

Question 238

List 4 pros and 3 cons of neoadjuvant radiation vs. adjuvant

Answer 238

Pros: shrinks tumor (can make it operable), less risk of positive margins, less risk of tumor seeding during surgery, lower dose than adjuvant (50 Gy divided over 5 weeks vs. 60 Gy). Cons: delays wound healing, risk of wound complications, more difficult for pathologist to examine margins

Question 239

What's the usual radiation protocol following surgical stabilization in a metastasis?

Answer 239

Single 8 Gy dose

Question 240

List 5 indications for replantation

Answer 240

Thumb Single digit distal to FDS Multiple digits Proximal to mid-palm Any pediatric amputation

Question 241

List the order of soft tissue repair in a replant

Answer 241

1. extensor tendon 2. flexor tendon 3. arteries 4. veins 5. nerves

Question 242

What are the 3 intraoperative options for poor venous outflow in a replant?

Answer 242

Remove nailbed and perform heparin swabs hourly Leave lateral incisions to close by secondary intention Leeches (need to cover with TMP-SMX)

Question 243

List 5 important postoperative management principles following a replant

Answer 243

Keep limb elevated Keep limb warm for 24h (heat lamps, room temp) Keep patient NPO in case you need to return to OR Adequate analgesia to prevent vasoconstriction Maintain high rate of IV fluids

Question 244

Describe the rehabilitation protocol following a replant

Answer 244

5 days: ROM of adjacent digits, tenodesis effect 2 weeks: intrinsic plus (wrist extended, MCPs flexed, IPs extended) and minus (wrist neutral, MCPs extended, IPs flexed) exercises 4 weeks: ROM with wrist at neutral 6 weeks: gentle functional ROM 8 weeks: resistance exercises 12 weeks: job simulation exercises

Question 245

List 8 negative prognostic factors in ORIF of calcaneus fractures

Answer 245

Male >50 yo Manual laborer Worker's compensation Smoker Bilateral Obesity Sanders IV

Question 246

List 5 indications for surgery in calcaneus fractures

Answer 246

Large, displaced extra-articular fractures Tongue-type Calcaneal tuberosity avulsion Intra-articular displacement >2mm Sanders II-III with flat Bohler's angle (normally 20-40)

Question 247

List cobal-chrome, cancellous bone, cortical bone, PMMA, titanium, steel, cermaic and polyethylene in terms of Young's modulus (high to low)

Answer 247

Cermic, Co-Cr, steel, titanium, cortical bone, PMMA, poly, cancellous bone

Question 248

List the 7 poor prognostic signs for hip survival following acetabular fracture surgery

Answer 248

Age >40 Associated hip dislocation Initial displacement >2cm Posterior wall fracture Femoral head injury Marginal impaction Non-anatomic reduction

Question 249

When do the following bones ossify/fuse and where does the growth of that bone occur? a) clavicle b) proximal humerus

Answer 249

a) central clavicle ossifies at 5 weeks gestation, medial and lateral ossify at 18 and fuse at 25; 80% growth from medial epiphysis b) epiphysis ossifies at 6 mo, GT at 2 and LT at 4 yrs and fuse at skeletal maturity; 80% of growth of the humerus is from the proximal epiphysis

Question 250

What's the closed reduction maneuver for pediatric proximal humerus fractures?

Answer 250

Longitudinal traction Abduction to 90 deg ER

Question 251

What are the (5) static stabilizers of the SC joint?

Answer 251

Posterior SC ligament (strongest) Anterior SC ligament Costoclavicular ligament Interclavicular ligament Intra-articular disk ligament

Question 252

Which muscles attach to the clavicle (6)?

Answer 252

Sternocleidomastoid Sternohyoid Subclavius Pectoralis major Deltoid Trapezius

Question 253

Which muscles attach to the scapula (17)?

Answer 253

Supraspinatus Infraspinatus Subscapularis Teres minor Teres major Rhomboid major Rhomboid minor Triceps (long head) Deltoid Biceps Coracobrachialis Pectoralis minor Trapezius Levator scapulae Omohyoid Serratus anterior Serratus posterior

Question 254

What's the closest neurovascular structure to the SC joint?

Answer 254

Brachiocephalic vein

Question 255

How do you do a Rockwood (serendipity) view?

Answer 255

40 degrees angled up with both clavicles in view

Question 256

What's the expected grip strength compared to normal in a single ray resection of the hand?

Answer 256

80%

Question 257

When is radiation risk from routine diagnostic procedures no longer a concern during pregnancy?

Answer 257

After 17 weeks

Question 258

What imaging studies are absolutely contraindicated in pregnancy before 17 weeks?

Answer 258

Gadolinium studies (iodine is safe) CT pelvis *N.B. CXR, CT head and of the extremities is safe

Question 259

List (5) ways that fetal radiation can be decreased during CT use?

Answer 259

Uterine shielding Limit scanned areas Lower voltage Reduce magnification Wider beam collimation

Question 260

What is the sole predictor of pain at 24h postop from an ACLR?

Answer 260

Anxiety

Question 261

What are the 2 most important factors influencing adherence to rehabilitation following ACLR in a) kids, and b) adults?

Answer 261

a) strong athletic identity, desire to return to sport b) social support, self-motivation

Question 262

What's the most sensitive and specific test for syndesmotic injury?

Answer 262

Sensitive: ATFL tenderness Specific: squeeze test

Question 263

List 3 radiographic findings of syndesmotic injury

Answer 263

Tib-fib clear space >6mm at 1cm above the joint on AP/Lat Tib-fib overlap <6mm at 1cm above the joint on AP Medial clear space >5mm

Question 264

What perpetuates the DIP flexion deformity in a non-operatively managed Seymour fracture?

Answer 264

1. Differential insertion of extensors (epiphysis) and flexors (metaphysis) 2. Interposition of tissue at the fracture site (nail germinal matrix usually)

Question 265

What's a Kaplan lesion?

Answer 265

Irreducible dorsal MCP dislocation where the metacarpal head button-holes volarly and the volar plate is interposed between the proximal phalanx and the metacarpal head

Question 266

Which approach do you use for an irreducible MCP dislocation?

Answer 266

Dorsal dislocation: volar approach (release A1 pulley to expose volar plate) Volar dislocation: dorsal approach (split extensor tendon to expose joint, push/split volar plate to remove it from the joint

Question 267

What's the reduction maneuver for an MCP dislocation?

Answer 267

1. Flex wrist to de-tension flexors 2. Direct pressure to proximal phalanx base 3. Avoid longitudinal traction/extension (may displace volar plate into the joint and turn a simple dislocation into a complex one that need surgery)

Question 268

What's the interposed structure in an irreducible open vs. closed dorsal PIP dislocation? What approach do you use to get it reduced?

Answer 268

Closed: volar plate Open: dislocated FDP tendon Approach: dorsal, between central slip and lateral band

Question 269

What are the deforming forces acting on a base of thumb fracture?

Answer 269

APL EPL Adductor pollicis

Question 270

What's the reduction maneuver in a Bennett fracture?

Answer 270

Traction Extension Pronation Abduction

Question 271

Which 7 ligaments stabilize the 1st CMC joint?

Answer 271

superficial volar oblique deep volar oblique posterior oblique dorsoradial (primary restraint to dorsal subluxation; treatment of an unstable 1st CMC dislocation requires reconstruction of this ligament and pinning) ulnar collateral intermetacarpal dorsal intermetacarpal

Question 272

List the 3 indications required for limb lengthening with/without contralateral epiphysiodesis in PFFD

Answer 272

Aitken A/B >50% femur remaining <20cm predicted LLD at maturity

Question 273

When is a knee arthrodesis and foot ablation indicated in PFFD vs. Van Ness rotationplasty?

Answer 273

Van Ness: 1. ipsilateral foot at the level of contralateral knee 2. Aitken C/D 3. >60 degrees ankle ROM Knee fusion and foot ablation when ipsilateral foot is proximal to contralateral knee.

Question 274

What's the order of closure of the distal tibial physis?

Answer 274

Central, posterior, medial, anterior

Question 275

List 5 challenges when trying to brace a child for early onset scoliosis

Answer 275

Larger abdomen cylindrical body habitus more pliable ribs difficulty remaining still during molding non-compliance with brace wear

Question 276

List 3 factors associated with resolution of early-onset scoliosis following serial casting

Answer 276

1. Initiation of treatment <20 months 2. Curve <60 degrees 3. Treatment for >1 year

Question 277

What are 2 radiographic differences between granulomatous and pyogenic osteomyelitis?

Answer 277

1. Granulomatous spares the disks 2. Granulomatous can form thin-walled abscesses

Question 278

What's the order of surgical intervention in the lower extremity if the patient has multiple arthritic joints?

Answer 278

Forefoot Hip Knee Hindfoot Ankle *Deal with most symptomatic first in reality

Question 279

What are the only 3 medication/classes of medications that you need to hold for surgery in RA?

Answer 279

Sulfasalazine Leflunomide TNF-a inhibitors (Remicaide, Enbrel) *Hold for 4 half-lives pre-op and resume 3 weeks post-op

Question 280

List 5 factors associated with bisphosphonate-associated femur fractures

Answer 280

transverse fracture line laterally no comminution long medial spike lateral beaking increased femoral cortical thickness

Question 281

Where does the artery of Adamkiewicz run?

Answer 281

Left side between T9 and T12

Question 282

What's the cutoff for metal ion levels?

Answer 282

>7 ppb is abnormal

Question 283

What's TEXA's mechanism of action?

Answer 283

Reversibly binds plasminogen's binding site on fibrin, thereby inhibiting clot degradation by plasmin

Question 284

How much hotter is an early Charcot joint compared to the other uninvovled side?

Answer 284

3.3 degrees

Question 285

What do you need to do after reducing an inferior shoulder dislocation?

Answer 285

Brachial-brachial index (<0.95 is abnormal)

Question 286

List 8 risk factors for synostosis after ORIF of a radius/ulna fracture

Answer 286

head injury blast injury proximal fracture (close to PRUJ) both bones fractured at the same level fracture fragments in the IOM single incision failure to restore radial bow long screws that breach into IOM

Question 287

What's the normal radial bow and how do you measure it?

Answer 287

1. Draw a line from the radial tuberosity to the ulnar articular margin of the distal radius 2. Maximal radial bow is 60% of the distance of this line from proximal 3. Bow is 10% the length of this line as measured from this line (radial bow)

Question 288

List 4 blocks to radial head reduction in a Monteggia fracture

Answer 288

Annular ligament Biceps Capsule PIN

Question 289

How do you pin the radius/ulna if you need to, such as in an acute DRUJ instability or Essex-Lopresti injury?

Answer 289

neutral forearm rotation pin radial to ulnar (protect superficial radial nerve)

Question 290

What's the rate of associated femoral neck fracture in a femoral shaft fracture?

Answer 290

10%

Question 291

What's the rate of associated Hoffa fragment in a distal femur fracture?

Answer 291

40% (usually lateral condyle)

Question 292

What's the blood supply to the talus?

Answer 292

1. Posterior tibial artery -Tarsal canal branch = main supply to talar body -Deltoid branch = supplies medial talar body 2. Anterior tibial = talar head/neck 3. Artery of tarsal sinus = talar head/neck

Question 293

What 3 steps do you need to take when faced with a bisphosphonate fracture?

Answer 293

Endocrinology consult Image contralateral leg Consider starting Teraparatide

Question 294

When is retroperitoneal pelvic packing indicated? How is it done? What if the patient is still unstable after?

Answer 294

Indicated in a hemodynamically unstable pelvic fracture that remains unstable after a binder is applied as an alternative to angiography since most bleeding is from the presacral venous plexus anyway. Pfannenstiel incision, incise rectus longitudinally at the linea alba, bluntly dissect the plane between the peritoneum and the bony pelvis and insert 3 sponges/side towards the SI joints. Close. Remove sponges in 24-48h when patient stabilizes. If patient remains unstable after packing and external fixation, send for angiography.

Question 295

List 3 contraindications to inserting a foley in pelvic trauma

Answer 295

blood at the meatus perineal bruising high-riding prostate If present, do a retrograde cystourethrogram

Question 296

How do you do a retrograde cystourethrogram?

Answer 296

Insert a small foley into the meatus, inflate and inject 25 cc of dye. Then, take an AP pelvis and if no contrast extravasation, deflate the baloon and advance all the way. Final step is to obtain a cystogram with 400 cc of dye and shoot another AP to rule out a bladder rupture, then evacuate the bladder and take a final AP to rule out an occult extraperitoneal rupture.

Question 297

List 5 ways to differentiate a congenital radial head dislocation from a traumatic one?

Answer 297

bilateral convex radial head hypoplastic capitellum irreducible atraumatic history

Question 298

List 3 angles you look at in flat foot and what's normal for each?

Answer 298

Meary's angle (0-10 degrees) Calcaneal pitch (15-20 degrees) Talonavicular uncoverage (<40%)

Question 299

How much of the humerus can be plated through a lateral triceps slide approach (a) with, and (b) without mobilization of the radial nerve and reflecting the triceps medially?

Answer 299

(a) 55% (b) 94%

Question 300

What's a normal: a) SL angle b) Radiolunate angle c) Capitolunate angle

Answer 300

a) 40-60 (<40 = VISI; >60 = DISI) b) 0-15 c) 0-15

Question 301

Where is the PUDA located? What's the normal value? What's the effect of changing the PUDA on elbow ROM?

Answer 301

PUDA is 5.7 degrees, located 47mm distal to the olecranon tip. Increasing the PUDA results in decreased elbow extension. The PUDA however doesn't affect elbow flexion.

Question 302

List 5 factors associated with an unstable patient requiring a DCO approach

Answer 302

Lactate >2.5 SBP <90 Temp <33 Platelets <90 PaO2/FiO2 <300

Question 303

List 5 features in the paediatric C-spine that are different than in the adult

Answer 303

Pseudosubluxation (C2-3 usually) C1 can override C2 Hypolordosis Anterior angulation of odontoid Wedge-shaped vertebral bodies

Question 304

What is Swischuk's line?

Answer 304

Line drawn along the anterior border of the posterior arches from C1 to C3. The anterior border of the posterior arch of C2 should be within 1.5 mm of this for it to be pseudosubluxation.

Question 305

What's the procedure indicated for a flexible equinovarus foot in CP?

Answer 305

If driven by tibialis posterior, transfer plantar half of tendon around the fibula to peroneus brevis and lengthen Achilles (hoke vs. Strayer). If driven by tibialis anterior, treatment is Rancho procedure (tib post lengthening above MM, split tibialis anterior transfer to cuboid) and Achilles lengthening.

Question 306

What's the procedure indicated for a flexible equinovalgus foot in CP?

Answer 306

Evans, Achilles lengthening +/- plantar closing wedge osteotomy of medial cuneiform for residual forefoot supination.

Question 307

What special test is helpful to determine if the equinovarus is driven by tib ant in CP?

Answer 307

Confusion test (co-contraction of tib ant with resisted hip flexion)

Question 308

How do you lengthen the hamstrings if needed in CP?

Answer 308

Medial tendon Z-lengthening (ST, gracilis) Lateral intra-muscular fascial release, like a Strayer (biceps femoris long head, SM)

Question 309

List 5 anatomical causes of thoracic outlet syndrome

Answer 309

Cervical rib Scapular ptosis (from trapezius palsy) Obesity Large breasts Clavicle/first rib malunion

Question 310

Which bug do you need to cover against in fresh water open injuries and what do you use? Which antibiotic do you use for salt water?

Answer 310

Fresh: aeromonas hydrophilus; cover with cipro (fluoroquinolones) Salt: doxycyline and ceftazidime (or cipro)

Question 311

List 8 signs of denervation (ulnar neuropathy, CTS, etc.) on a NCS

Answer 311

Distal sensory c >3 ms Distal motor latency >4 ms Nerve conduction velocity <50 m/s Sharp waves Fibrillations (spontaneous discharge from single muscle fiber) Fasciculations (spontaneous discharge from multiple fibers) Complex repetitive discharges Myokimic disharges

Question 312

List 7 factors associated with early mortality after a hip fracture

Answer 312

Male Age >85 Dementia Reduced mobility prior to fracture ASA status 2 or more comorbidities (especially renal failure) Delay >48h

Question 313

List 5 factors associated with femoral neck fracture following a resurfacing arthroplasty

Answer 313

Female (small neck) Metaphyseal cysts Notching Varus positioning (<130 degrees) Improper prosthesis seating

Question 314

List 5 criteria for selective thoracic fusion in AIS

Answer 314

Lenke 1C, 2C curves Thoracic prominence > lumbar on Adams FBT Lifestyle factors (dancer, athlete requiring lumbar ROM) Skeletally mature Absence of hyperlaxity (if you selectively fuse in this case, can make the T/L-L curve worse due to the "adding on" effect)

Question 315

What infections are patients with ankylosing spondylitis more susceptible to?

Answer 315

Klebsiella pneumoniae synovitis

Question 316

List 5 factors during hallux valgus surgery that can result in hallux varus

Answer 316

excessive lateral release resection of the fibular sesamoid medial plication excessive medial eminence resection overcorrection of the IMA

Question 317

List 6 causes of acquired coxa vara

Answer 317

Fracture Malunion Infection Perthes SCFE Fibrous dysplasia or Paget's

Question 318

List 6 negative prognostic signs for septic arthritis

Answer 318

Paediatric (age <6 months) Delay in presentation >4 days Polyarticular Hip involvement Associated osteomyelitis High-virulence organism

Question 319

List 5 medications associated with osteoporosis

Answer 319

corticosteroids phenytoin SSRIs lasix antiretrovirals

Question 320

Where do you do a biopsy for the following locations? 1. wrist 2. distal humerus 3. proximal humerus 4. iliac crest 5. supraacetabular region 6. femoral neck/head 7. distal femur 8. tibia 9. internal pelvis

Answer 320

1. 2nd dorsal compartment 2. brachialis 3. anterior deltoid 4. superior abductors 5. TFL and rectus femoris 6. trans-trochanteric 7. posteromedial vastus medialis or posterolateral vastus lateralis 8. subcutaneous border 9. pfannensteil incision, work along the pubic brim either medial or lateral to external iliac vessels

Question 321

What approach has the highest risk of early aseptic femoral component loosening in THA?

Answer 321

DAA

Question 322

What were the findings of the Kreder RCT on early vs. delayed WB for unstable ankle fractures (no syndesmotic injury, <25% posterior malleolus)?

Answer 322

1. better early (<3 months) ROM and functional outcome scores, but this did not correlate to earlier RTW time 2 increased rate of hardware removal in delayed WB (perhaps early WB decreases scarring and sensitivity around the plate)

Question 323

Which 5 factors are associated with failure of initial I&D in a septic native knee?

Answer 323

Male Advanced age Multiple comorbidities Joint aspirate culture-positive Open I&D (instead of arthroscopic)

Question 324

In THA and TKA, is there a difference between IV and PO TEXA?

Answer 324

No, equivalent outcomes for 2g PO given 2 hrs prior to incision vs. 1g IV given immediately before incision.

Question 325

After what age does THA become more cost-effective than ORIF for femoral neck fractures?

Answer 325

54 for no comorbidities 47 with mild comorbidties 44 for severe comorbidities

Question 326

What percentage of fluid, soft-tissue and explant specimen cultures are positive in a revision TSA for an infection?

Answer 326

Soft-tissue: 66% Explant: 55% Fluid: 32% Men have higher p. acnes load.

Question 327

Which 5 factors are predictive of having a pseudotumor?

Answer 327

female vertical cup femoral osteolysis acetabular osteolysis acetabular loosening

Question 328

Which 2 factors are predictive of not having a pseudotumor?

Answer 328

acetabular anteversion >5 degrees heterotopic ossification

Question 329

How do you culture p. acnes?

Answer 329

Hold cultures for 3 weeks in blood/Brucella/chocolate agar and brain-heart infusion broth

Question 330

What did the 2017 RCT comparing TBW and plate ORIF for simple, displaced olecranon fractures show?

Answer 330

1. no difference in outcomes 2. equal cost despite higher initial cost in plate group 3. more complications overall in the TBW group, but if hardware removal was excluded, plates had more complications (from infection)

Question 331

What are 5 risk factors for malignant transformation of an osteochondroma?

Answer 331

pain surface irregularity continued growth after skeletal maturity cartilage cap thickness >2 cm osteochondroma size >5 cm

Question 332

When are UBCs considered active vs latent?

Answer 332

Active when within 1 cm of the physis, latent when they progress to a diaphyseal location

Question 333

Which 3 tumors often have secondary ABCs?

Answer 333

GCT chondroblastoma UBC

Question 334

Which 2 benign tumors can metastasize to the lungs?

Answer 334

GCT chondroblastoma

Question 335

List 5 poor prognostic factors applicable to both osteosarcoma and Ewing's

Answer 335

Metastases Large lesion Tumor necrosis <90% after neoadjuvant chemotherapy Elevated LDH Inadequate margins following resection

Question 336

What are 5 important findings in the recent JBJS study comparing bilateral THAs under a single anesthetic vs a staged approach?

Answer 336

1. shorter total length of stay and more cost-effective 2. shorter total surgical time 3. no difference in transfusion rate (intra-op recovery excluded) 4. no difference in the rate of DVT/PE or complications 5. ASA 1-3 not predictive of complications

Question 337

What has been shown to improve fusion rates in osteoporotic patients undergoing PSIF?

Answer 337

Weekly Teriparatide infusions for 6 months post-operatively

Question 338

What's the best imaging modality for pseudotumor?

Answer 338

MARS MRI (or ultrasound if contraindications)

Question 339

What serum values of vitamin D define insufficiency?

Answer 339

<20 ng/mL

Question 340

What's lab tests should you order for vitamin D deficiency?

Answer 340

25-hydroxyvitamin D (decreased) PTH (increased) Calcium

Question 341

Which 3 muscles deform a Bennett fracture?

Answer 341

EPL (extension) APL (abduction) Adductor pollicis longus (supination)

Question 342

List 3 strategies for preventing CRPS prior to surgery

Answer 342

Local anesthetic infiltration prior to incision Vitamin C 500mg daily for 50 days Gabapentin

Question 343

List 3 medications with good evidence in the treatment of CRPS

Answer 343

Bisphosphonates Gabapentin TCAs

Question 344

List 4 indications for ligament reconstruction instead of Brostrom repair

Answer 344

Attenuated ligaments Failed initial repair Obesity Generalized ligamentous laxity

Question 345

What did the HULC RCT on single- vs dual-incision DBTR show?

Answer 345

10% better flexion strength in dual-incision More early LABCN palsy in single-incision

Question 346

What are the 3 most common neuropraxias after an extension-type SCH #?

Answer 346

AIN Median Radial

Question 347

Does MED or SED have atlantoaxial instability? List 3 other syndromes with AA instability

Answer 347

SED Morquio's Pseudoachondroplasia Down's

Question 348

List 3 factors associated with favorable wound healing in diabetic foot

Answer 348

TcO2 >30 Toe pressure >40 Triphasic flow

Question 349

After how much of a platelet drop do you start a work-up for HIT?

Answer 349

>50%

Question 350

Where can you best appreciate atrophy from ulnar neuropathy?

Answer 350

1st dorsal interosseous

Question 351

List 3 special signs for ulnar neuropathy

Answer 351

Wartenberg sign: D5 abducts when patient is asked to keep fingers adducted due to unnoposed abduction of abductor digiti quinti (weak parlmar interossei). Froment's sign: thumb IP joint flexes on attempted key pinch due to FPL compensating for weak adductor pollicis. Jeanne sign: MCP hyperextends during attempted key pinch from EPL pull.

Question 352

List 6 negative prognosticators following calcaneus fractures

Answer 352

Male Smoker WSIB Heavy manual labourer Sanders IV Negative Bohler's angle

Question 353

What were the 2 pertinent findings of the RCT comparing ORIF to circular fixator for bicondylar tibial plateau fractures?

Answer 353

Shorter hospital stay in the fixator group Less complications in the fixator group

Question 354

What were the 2 pertinent findings of the interTAN vs DHS study in geriatric hip fractures?

Answer 354

No difference in outcomes Less femoral shortening in interTAN group

Question 355

What are 3 important findings of the RCT comparing wrist fusion to arthroplasty?

Answer 355

No difference in outcomes Less complications in fusion Fewer revisions in fusion

Question 356

Describe the general principles behind the accelerated rehab protocol for Achilles ruptures

Answer 356

0-2 weeks: NWB in plantarflexion slab 2-4 weeks: PWB with 2 cm heel lift in Aircast 4-6 weeks: WBAT with 2 cm heel lift in Aircast 6-8 weeks: WBAT without heel lift in Aircast, start PT 8-12 weeks: wean Aircast, progress PT >12 weeks: strengthening and endurance training

Question 357

What's the difference between a neurofibroma and schwannoma when it comes to surgical excision?

Answer 357

Neurofibroma requires excision of the nerve

Question 358

Which nerve fibers transmit proprioception?

Answer 358

Pacini corpuscles ("P" for proprioception)

Question 359

What is the hypervirulent strain of C. diff and what does it cause?

Answer 359

NAP1 (resistant to fluoroquinolones)

Question 360

What's the 6-month rate of mortality in patients who develop C. diff after a hip fracture vs those who do not?

Answer 360

35% (vs 9%)

Question 361

What's the most common complication following non-surgical management of a distal radius fracture in the elderly?

Answer 361

Median neuropathy

Question 362

List 3 risk factors for pelvic discontinuity after THA

Answer 362

female rheumatoid previous radiation

Question 363

List 6 risk factors for transfusion in spine surgery

Answer 363

longer surgery >6 levels Cobb >50 osteotomies lower body weight (smaller reserve) neuromuscular

Question 364

List 5 downsides of the gap balancing method in TKA

Answer 364

1. jointline elevation 2. excessive flexion gap with PCL recession 3. midflexion instability 4. altered center of rotation 5. altered patellar biomechanics (contact force increased by 60% for every 1 mm of jointline elevation)

Question 365

What's the best view to identify a post-partum symphyseal rupture?

Answer 365

Flamingo single-leg stance view (>5 mm vertical translation = instability)

Question 366

List 3 initial options for peristent wound drainage >72 hours following TKA

Answer 366

limit physiotherapy for 24 h NPWT for 24 h (good RCT evidence in trauma literature) hold anticoagulation for 24 h

Question 367

What does the gull sign predict?

Answer 367

inadequate reduction after ORIF early loss of reduction after ORIF progression to THA

Question 368

What are 5 special considerations when planning for surgery in a patient with Parkinson's disease?

Answer 368

1. avoid traditional inhalational anesthetics (interact with levodopa) 2. risk of hypotension (due to levodopa) 3. risk of delirium 4. risk of aspiration 5. risk of urinary retention

Question 369

What's the primary source of failure in TEAs?

Answer 369

Bushing wear (from the link)

Question 370

List 4 radiographic signs of crankshaft phenomenon

Answer 370

RVAD >20 Cobb angle change >10 degrees >5 degrees apical rotation Vertebral body penetration into the chest on axial CT

Question 371

What does the recurrent motor branch of the median nerve supply?

Answer 371

APB Opponens pollicis FPB

Question 372

What forms the superficial palmar arch?

Answer 372

Ulnar artery Superficial palmar branch of radial artery

Question 373

List 3 risk factors for displacement after a distal radius fracture

Answer 373

Age Metaphyseal comminution Radial shortening (ulnar variance)

Question 374

List 5 sugical risk factors for periprosthetic fracture in a TKA

Answer 374

anterior notching inadvertent perforation with the canal finder eccentric box cut malpositioned im plants aggressive impaction of trial components

Question 375

What's the most important predictor for interprosthetic fracture (between THA and TKA)?

Answer 375

decreased femoral cortical thickness

Question 376

When is open rotator interval plication beneficial over arthroscopic?

Answer 376

Arthroscopic: better for anterior instability Open: better for posterior and inferior instability

Question 377

List the 4 components of the WOMAC

Answer 377

pain stiffness function global score

Question 378

List 4 risk factors for SMA syndrome

Answer 378

2-stage procedure Lumbar modifier B or C Low BMI Stiff thoracic curve

Question 379

List 3 radiographic risk factors for SCFE

Answer 379

Coxa vara Posteror sloped physis >12 degrees (on FLL) Retroverted femoral head

Question 380

List 4 things that change in muscles undergoing endurance training

Answer 380

increased capillaries increased number of mitochondria increased mitochondrial size increased muscle glycogen content

Question 381

List 5 factors associated with a poor prognosis in pediatric radial neck fractures

Answer 381

angulation >30 degrees complete displacement older age delayed presentation ORIF

Question 382

List 7 ways to prevent overstuffing in a radial head arthroplasty

Answer 382

1. template off resected head 2. template off contralateral radial head 3. proximal aspect of implant is 1 mm proximal to lateral ulnohumeral articular margin 4. proximal aspect of implant is in line with the medial ulnohumeral articular margin 5. proximal aspect of implant is 2 mm distal to coronoid tip 6. intra-operative XR looking for ulnohumeral gapping 7. check ROM

Question 383

List 3 ways to more safely apply a Halo in a child

Answer 383

CT scan to identify suture lines and avoid them Use more pins (8) Use less torque (4 inch/lb vs. 8 inch/lb in adult)

Question 384

What 3 radiographic findings are associated with Scheuermann's kyphosis?

Answer 384

Schmorl's nodes AP elongation of vertebral bodies narrowing of intervertebral spaces

Question 385

List 8 risk factors for vertebral osteomyelitis in adults

Answer 385

immunocompromised malignancy IVDU HIV intravascular hardware spine surgery bacterial endocarditis speticemia

Question 386

List 4 medications that require renal dosing

Answer 386

morphine enoxaparin ancef vancomycin

Question 387

What are the ASA recommendations for initiating anticoagulation in the setting of an epidural catheter?

Answer 387

wait 2 hours after catheter removal

Question 388

Biomechanically, how does UCL reconstruction do relative to the native UCL wrt restoring valgus stability?

Answer 388

At flexion angles >90 degrees, both the modified Jobe and docking techniques are equivalent to the native UCL, but at <90 degrees the native UCL wins

Question 389

What are the anatomic sites of compression of the PIN and indicate which is most common?

Answer 389

"FREAS": fibrous bands of the radiocapitellar joint radial recurrent vessels (Leash of Henry) ECRB fascia Arcade of Frohse (proximal supinator - most common) Supinator distal edge

Question 390

Describe when the midfoot and hindfoot bones ossify

Answer 390

6 mo fetal: calcaneus 7 mo fetal: talus 9 mo fetal: cuboid 1 yo: lateral cuneiform 3 yo: medial cuneiform 4 yo: middle cuneiform, navicular

Question 391

Where do you plate the occiput in occipital plating in kids?

Answer 391

external occipital prominence (unicortical)

Question 392

Where's the start point for a C1 lateral mass screw? How do you angle it?

Answer 392

Just inferior to where the posterior C1 ring enters the lateral mass (need to retract C2 nerve root inferiorly and may even need to resect it to expose the start point). Screw is angled medial to the vertebral artery foramen without breaching into the spinal canal (need to dissect and see the medial edge of the lateral mass). Fluoroscopy is used for cranial-caudal angulation.

Question 393

List 6 differentials for shoulder pain in a swimmer

Answer 393

1. subacromial impingement 2. GIRD 3. scapular dyskinesis (from over-developed lat dorsi and pec major) 4. hyperlaxity 5. labral tear 6. suprascapular neuropathy (associated with scapular dyskinesia)

Question 394

List the components of a scoliosis brace

Answer 394

"BRACe MaP" Build (custom vs. pre-fabricated) Rigidity (soft, elastic, rigid) Anatomic level (C, T, L, S) Construction of the Envelope (symmetric vs. asymmetric) Mechanism of Action (3-point, elongation, etc.) Plane of action (2D vs 3D)

Question 395

List 4 complications of MRSA infection in kids

Answer 395

persistent bacteremia DVT septic emboli pathologic fracture

Question 396

What's the precursor to scoliosis in patients with Parkinson's disease?

Answer 396

Pisa syndrome (lateral thoracic bend >10 degrees)

Question 397

What are 4 spine abnormalities in Parkinson's disease?

Answer 397

1. Pisa syndrome 2. Anterocollis (>45 degree cervical flexion; passively correctable) 3. Camptocormia (>45 degree T-L flexion; passively correctable) 4. Scoliosis

Question 398

List 4 non-surgical options for spine issues in patients with Parkinson's disease

Answer 398

Bracing with anterior distraction Botox injection of iliopsoas (improves camptocormia) Lidocaine injection of external obliques (improves pisa) Deep brain stimulation (improves camptocormia)

Question 399

Which vessels make up the anastomotic ring around the knee?

Answer 399

medial superior geniculate (dominant) medial inferior geniculate (dominant) lateral superior geniculate lateral inferior geniculate descending geniculate anterior tibial recurrent

Question 400

When repairing a jersey finger (FDP avulsion), what's the best fixation method biomechanically?

Answer 400

suture-anchor

Question 401

Which type of jersey finger should be repaired acutely (within 10 days) and why?

Answer 401

type I (soft-tissue FDP avulsion, no bony component) since these retract all the way into the palm and disrupt the vinculae (brevis and longus profundus)

Question 402

List 2 indications for flexor pulley reconstruction

Answer 402

multiple pulley rupture (A2 and A4) bowstringing

Question 403

What's the best type of muscle strengthening for patellar tendinosis?

Answer 403

eccentric

Question 404

How can you distinguish a weak tib ant from a common peroneal nerve palsy or L4/5 radiculopathy?

Answer 404

Test resisted hip abduction (also L5) and if this is weak as well, then it's due to radiculopathy

Question 405

List 5 advantages for the lateral decubitus position over the beach chair

Answer 405

better cerebral perfusion less risk of hypotensive bradycardia lateral force distracting and opening up the GHJ better access to posterior/postero-inferior labrum bubbles move up/out of the way when using cautery

Question 406

What are 5 disadvantages of the lateral decubitus position

Answer 406

disorienting anatomy have to reach around arm to establish anterior portal risk of traction injury to brachial plexus increased DVT risk vs. beach chair difficulty accessing the airway

Question 407

What are 3 risk factors for development of DVT in paediatric MRSA infections?

Answer 407

MRSA osteomyelitis Age >8 CRP >6 *Should provide DVT prophylaxis in all kids with MRSA

Question 408

Where does calcific tendinitis most commonly occur in the hand and wrist and what's the most common site of recurrence?

Answer 408

FCU insertion (most common site of recurrence) MCPs IPs

Question 409

What 3 conditions are associated with calcific tendinitis?

Answer 409

Scleroderma Dialysis Hypophosphatemia

Question 410

What's the best way to screen for structure allograft bone quality?

Answer 410

cortical thickness (age and BMD don't correlate well)

Question 411

What are 4 surgical steps to do when operating on a patient with ESRD?

Answer 411

cement femur in arthroplasty use locking plates fill any metaphyseal bone voids delayed weight-bearing

Question 412

List 5 ways of increasing the stiffness of a circular frame

Answer 412

smallest rings possible largest wires possible inter-wire angle >60 degrees use a drop wire use 2-level frames

Question 413

List 5 risk factors for extensor mechanism disruption following TKA

Answer 413

previous surgery diabetes ESRD rheumatoid arthritis obesity

Question 414

What are the 3 diagnostic criteria for chronic exertional compartment syndrome?

Answer 414

Pre-exercise pressure >15 mm Hg Pressure >30 mm Hg 1 min after exercise Pressure >20 mm Hg 5 min after exercise

Question 415

List 5 sequelae of untreated foot compartment syndrome

Answer 415

claw toes cavus foot chronic pain neuropathy neuropathic ulcerations

Question 416

How do you surgically treat a flexible claw toe deformity following missed foot compartment syndrome?

Answer 416

flexor tenotomy extensor tendon lengthening

Question 417

How do you surgically treat a rigid claw toe deformity following missed foot compartment syndrome?

Answer 417

IP fusion MCP capsulotomy flexor tenotomy extensor tendon lengthening

Question 418

List the 6 risk factors for LCP

Answer 418

male hyperactivity Low body weight family history history of Perthes in the other hip Inuit population

Question 419

List 8 anatomic/physiologic differences in paeds that can affect how you manage them in a polytrauma setting

Answer 419

1. large head to body ratio 2. higher incidence of C-spine injury due to the above 3. SCIWORA 4. pseudosubluxation 5. anterior airway 6. large tongue 7. require 30% blood volume loss to show tachycardia (vs. 15% in adults) 8. rapid hemodynamic crash after critical threshold

Question 420

What are the components of the Pirani severity score in clubfoot?

Answer 420

Hindfoot contracture score: 1. posterior crease 2. empty heel 3. rigid equinus Midfoot contracture score: 1. medial crease 2. curvature of lateral border of the foot 3. position of the head of the talus

Question 421

How much correction can you obtain with a Pemberton or innominate (Salter) osteotomy?

Answer 421

10-20 degrees (more with Pemberton)

Question 422

Describe the steps for a repair of a dural tear

Answer 422

Trendelenberg position Microscope Use paddys instead of suction to not injure roots 6-0 non-absorbable suture repair Watertight closure Valsalva to check repair +/- paraspinal fascial patch and fibrin sealant if needed

Question 423

What's the major type of radiation used for metastatic bone lesions (of the spine, pelvis, etc.)?

Answer 423

focused external beam radiation

Question 424

When applying sequential traction during a closed reduction of a jumped facet, how do you know radiographically that you're over-distracted and should abandon?

Answer 424

if the involved disc space is >1.5 times the width of adjanced disc spaces

Question 425

What's the algorithm for surgical management of a chronic Achilles tendon rupture?

Answer 425

<2 cm: primary repair 2-5 cm: V-Y lengthening +/- FHL transfer >5 cm: FHL transfer and pulvertaft weave of either auto/allograft (semiT)

Question 426

What are patients with Achilles ruptures at higher risk for (aside from wound complications)?

Answer 426

DVT

Question 427

What is rheumatoid factor?

Answer 427

IgM against native IgG

Question 428

List 5 conditions associated with rheumatoid arthritis

Answer 428

1. vasculitis 2. pericarditis 3. pulmonary fibrosis 4. Still's disease (acute onset of RA with fever, rash and splenomegaly) 5. Sjogren's disease (autoimmune exocrine gland disease)

Question 429

What are the 7 diagnostic criteria for rheumatoid arthritis?

Answer 429

Must have 4 or more: morning stiffness swelling in 3 joints rheumatoid nodules symmetric arthritis arthritis of the hand and wrist bony erosions positive rheumatoid factor

Question 430

What's the general surgical treatment of a cavovarus foot?

Answer 430

LCO, dorsiflexion medial cuneiform osteotomy, tibialis posterior to anterior transfer, peroneus longus to brevis transfer

Question 431

What's the total safe traction time for hip arthroscopy?

Answer 431

2 hours

Question 432

How do you decrease the risk of femoral and sciatic nerve injury during portal placement for hip arthroscopy?

Answer 432

Femoral: stay lateral to a vertical line down from the ASIS. Sciatic: internally rotate the leg.

Question 433

List 3 flap options for a full-thickness defect over the heel

Answer 433

Free flap Reverse sural flap Propeller flap

Question 434

What's the metal ion ratio suggestive of trunnionosis?

Answer 434

Co:Cr ratio >2:1

Question 435

List 4 indications for a static spacer vs. an articulating one

Answer 435

wound concerns stability concerns extensor mechanism disruption massive bone loss

Question 436

List 8 risk factors for scaphoid non-union

Answer 436

smoker delayed presentation proximal pole fracture displaced >1 mm intrascaphoid angle >35 scapholunate angle >60 radiolunate angle >15 previous surgery

Question 437

List the congenital scoliosis causes in order of likelihood to progress

Answer 437

unilateral hemivertebra with contralateral bar unilateral bar fully-segmented hemivertebra unincarcerated hemivertebra incarcerated hemivertebra unsegmented hemivertebra block vertebra

Question 438

What two types of steroid injections are used in lumbar spinal stenosis?

Answer 438

Epidural Transforaminal

Question 439

For a medical practice to be considered "ethical", it must respect all four of these principles

Answer 439

Justice Beneficence (patient's well-being is the goal) Non-maleficence Autonomy

Question 440

What are McQueen's modifications of LaFontaine's criteria of displacement in non-operatively managed distal radius fractures?

Answer 440

Age >60 Metaphyseal dorsal comminution Radial shortening (LaFontaine's initial criteria also had dorsal angulation >20 degrees, but this was disproved in McQueen's paper)

Question 441

List 4 causes of dural ectasia

Answer 441

"MEAN" Marfan's Ehlers-Danlos Ankylosing spndylitis Neurofibromatosis

Question 442

What's the return to play, return to previous level and return to competitive level sport following ACLR?

Answer 442

Return to play: 80% Previous level: 60% Competitive: 40%

Question 443

List 5 factors affecting RTP following ACLR

Answer 443

Age (younger is better) Pre-operative ROM Knee extension Proprioception Fear of reinjury (#1 reason)

Question 444

What's the risk of re-rupture after ACLR and of contralateral ACL tear?

Answer 444

5-10% re-rupture 10% contralateral ACL tear

Question 445

List 5 risk factors for SCC of the hand

Answer 445

UV exposure Chronic inflammation/nonhealing wound HPV Arsenic exposure Polyaromatic hydrocarbon exposure

Question 446

List 5 negative prognostic signs in SCC of the hand

Answer 446

>2 cm Deep to reticular dermis Perineural invasion Poorly-differentiated Arising in areas of chronic inflammation

Question 447

What are the 5 signs of a cutaneous melanoma?

Answer 447

ABCDE Asymmetry Border irregularity Color variation Diameter >5 cm Evolution

Question 448

1. What's the most important prognostic factor for a skin melanoma? 2. What's the treatment for a subungal melanoma?

Answer 448

1. Breslow thickness 2. Amputation through IP joint and sentinel node biopsy (node biopsy is true for any melanoma)

Question 449

List 5 contraindications to surgery for elbow contractures

Answer 449

Continued gains with static progressive splinting Mid-arc ROM pain (suggests OA) Head injury Non-compliance Poor soft-tissue envelope

Question 450

What's the algorithm for pediatric chronic (>2 weeks) torticollis secondary to AARI?

Answer 450

1. Halter traction (NSAIDs, Benzos) -if successful, C-collar x 3 months -if fails after 2 weeks, progress to next step 2. Skull traction (NSAIDs, Benzos) -if successful, Halo x 3 months -if fails after 2 weeks, progress to C1/2 fusion

Question 451

Which meds treat Tb?

Answer 451

RIPE Rifampin INH Pyrazinamide Ethambutol (can be DC'd if bug is sensitive to RIP)

Question 452

What's the union rate in an atypical femoral fracture?

Answer 452

50-70%

Question 453

List 4 conditions associated with CVT

Answer 453

distal arthrogryposis myelomeningocoele Costello syndrome Rasmussen syndrome

Question 454

Quartet of nail-patella syndrome?

Answer 454

1. Nail dysplasia 2. Patellar hypoplasia (and often hypoplastic lateral femoral condyle) 3. Capitellar hypoplasia (with associated radial head dislocation) 4. Iliac horns (ram's horn exostoses from the ilium)

Question 455

What's the most important non-orthopaedic manifestation of nail-patella syndrome?

Answer 455

Renal failure

Question 456

Which 2 syndromes are associated with Madelung's?

Answer 456

Nail-patella Leri-Weill

Question 457

List 7 non-orthopaedic manifestations of Down's syndrome

Answer 457

1. Developmental delay 2. Cardiac disease (ASD, VSD) 3. Duodenal atresia 4. Risk of leukemia 5. Hypothyroidism 6. Risk of infections 7. Premature aging

Question 458

List 10 orthopaedic manifestations of Down's syndrome

Answer 458

1. Occiput-C1 instability 2. C1/2 instability 3. Odontoid hypoplasia 4. Cervical spinal stenosis 5. Scoliosis 6. Spondylolisthesis 7. General hyperlaxity 8. Hip dysplasia 9. Patellar dislocation 10. Pes planovalgus

Question 459

What are 6 indications for hemiepiphysiodesis in congenital scoliosis?

Answer 459

1. Age <5 2. Curve <70 deg 3. <5 segments involved 4. Lumbar curve 5. No kyphosis 6. Hemivertebrae instead of bars

Question 460

Which 5 conditions affect the zone of hypertrophy of the physis?

Answer 460

1. SCFE/fractures 2. Rickets 3. Mucopolysaccharidoses (Hunter's, Hurler's, Morquio's) 4. MED 5. SED

Question 461

Which 3 conditions affect the zone of resting cartilage (reserve zone) of the physis?

Answer 461

1. Diastrophic dysplasia 2. Pseudoachondroplasia 3. Gaucher's disease

Question 462

Which 4 X-Rays are standard in assessing CVT?

Answer 462

AP, lateral in neutral/maximal dorsiflexion/plantarflexion

Question 463

Which 2 angles are used to diagnose CVT and what's abnormal for each? What's the angle used for clubfoot?

Answer 463

CVT: Talo-calcaneal angle (Kite) >40 (normal is 20-40) Talar axis-1st metatarsal base angle (TAMBA) >35 Clubfoot: Kite <20 TAMBA <35

Question 464

Describe the principles for treatment of CVT

Answer 464

1. Serial reverse-Ponsetti weekly casting (5 usually) 2. Foreoot dorsiflexion and abduction are simultaneously corrected with the fulcrum being the head of the talus 3. Foot is progressively brought into equinovarus to stretch out the posterolateral capsule (at the end of 5 weeks it looks like a clubfoot) 4. Once most of the correction is achieved, patient undergoes TN open reduction and pinning and percutaneous Achilles tenotomy 5. Pin removal at 6 weeks 6. Boots-and-bars in neutral DF and 0 degrees of abduction full-time for 2 months then night-time use for 2 years

Question 465

What's the most important part of the S-L ligament?

Answer 465

Dorsal

Question 466

List 8 steps when faced with neuromonitoring loss intra-operatively

Answer 466

Alert anesthesia Anesthesia to check Hgb, temperature, MAP Check patient positioning Check leads Reverse correction Check screws and remove if concerned Wake-up test

Question 467

When doing an L5-S1 decompression and fusion for a spondylolisthesis, what do you decompress?

Answer 467

1. L5 lamina (usually just comes off easily due to the listhesis) 2. S1 upper half laminectomy and resect part of the posterior S1 body (this is where the S1 nerve roots drape over)

Question 468

List 4 MRI and 4 X-Ray findings of dystrophic curves in neurofibromatosis

Answer 468

MRI: Dural ectasia Dumbbell lesions in neuroforamina Dislocation of rib heads into the canal Intraspinal neuroforamina X-Ray: Rib penciling Vertebral scalloping Vertebral body wedging Foraminal widening

Question 469

What's the acronym for coxa vara etiologies?

Answer 469

"PORT IS SOFT" Perthes OI Rickets Trauma Infection SCFE SED/MED Osteopetrosis Fibrous dysplasia Tumour

Question 470

List 8 indications for DCO

Answer 470

Lactate >2.5 Base deficit/excess outside -2 to +2 range Platelets <90 ISS > 40 ISS > 20 with lung injury Hypothermia Hemodynamic instability Severe head injury (relative, since can get neurosurg to do intra-cranial pressure monitoring)

Question 471

List 5 contraindications for inserting an odontoid screw

Answer 471

Reverse-obliquity fracture pattern Displaced fracture Barrel chest Obesity Kyphotic deformity

Question 472

What are the 2 mechanisms of action of BMP?

Answer 472

1. promote MSC differentiation into osteoblasts 2. upregulate growth factors involved in various functions such as angiogenesis

Question 473

List 5 conditions associated with clubfoot

Answer 473

tibial hemimelia arthrogryposis Larsen syndrome diastrophic dysplasia myelodysplasia

Question 474

List 2 indications for limited open fasciectomy in Dupuytren's disease

Answer 474

MCP contracture >30 PIP contracture >15

Question 475

List 3 contra-indications to teraparatide (Forteo)

Answer 475

Paget's Prior radiation Open physes

Question 476

List 5 conditions that present in the newborn with thickened cortices

Answer 476

"CCOMP" Caffey's disease Camurati-Engelmann disease Osteopetrosis Melorheostosis Pyknodysostosis

Question 477

Describe the Leadbetter maneuver

Answer 477

FATI CAR Flexion (to 90), Adduction, Traction, IR, Circumduction, Abduction and Reduction check in extension

Question 478

List 6 indications for bisphosphonates other than osteoporosis

Answer 478

OI (ideally before age 6) Polyostotic fibrous dysplasia Paget's disease AVN (pre-collapse) Hypercalcemia Mets/myeloma

Question 479

Where does the common iliac bifurcate? What are the branches of the internal iliac artery?

Answer 479

Bifurcates at L4 "I Love Going Places In My Very Own Underwear" Iliolumbar Lateral sacral superior/inferior Gluteal internal Pudendal Inferior vesicle Middle rectal Vaginal Obturator Umbilical

Question 480

How much combined overhang of C1 on C2 following a Jefferson fracture is indicative of rupture of the transverse ligament?

Answer 480

6.9 mm

Question 481

What are 3 potential spaces in the hand?

Answer 481

Midpalmar Thenar Hypothenar

Question 482

Which nerves emerge lateral to psoas?

Answer 482

iLioinguinal iLiohypogastric LFCN

Question 483

Which nerves emerge medial to psoas?

Answer 483

Obturator Lumbosacral trunk

Question 484

What are the indications for initiation of bisphosphonates in osteoporosis?

Answer 484

Age >50 with either: 1. T-score < -2.5 2. T-score -1 to -2.5 with >3% 10-year hip # risk or >20% risk of major osteoporosis-related fracture

Question 485

List 5 side-effects of bisphosphonates in adults

Answer 485

Osteonecrosis of the jaw Esophagitis Dysphagia Gastric ulcers Atypical femoral fractures

Question 486

List 5 side-effects of teriparatide

Answer 486

Transient hypercalcemia Dizziness Nausea Headache Malignancy (especially in Paget's)

Question 487

Which conditions cause ligamentous laxity?

Answer 487

Marfan's Ehlers-Danlos OI Achondroplasia Pseudoachondroplasia Mucopolysaccharidoses

Question 488

Which conditions don't have C1-2 instability?

Answer 488

Achondroplasia Diastrophic dysplasia

Question 489

What is congenital radioulnar synostosis associated with?

Answer 489

MACKA Mandibulfacial dysostosis Apert syndrome Carpenter's syndrome Klinefelter's syndrome Arthrogryposis

Question 490

What is syndactyly associated with?

Answer 490

PACA Poland syndrome Apert syndrome Carpenter's syndrome Acrosyndactyly

Question 491

What are the features of Poland syndrome?

Answer 491

1. Unilateral chest wall hypoplasia (absent sternal head of pec major) 2. Hand/forearm hypoplasia 3. Symbrachydactyly 4. Sprengel's deformity 5. Scoliosis

Question 492

When do you transfuse postoperatively in a pediatric spine?

Answer 492

Tachycardia Hypotension Urine output <0.5 cc/kg/hr Acidosis

Question 493

List 4 risk factors for lumbar DDD

Answer 493

Age Genetic predisposition Occupation Smoker

Question 494

What are the indications for surgery in lumbar DDD?

Answer 494

Symptoms >6 months Single level disease Midline tenderness at that level

Question 495

What's the treatment for puerpal symphyseal rupture?

Answer 495

<2 weeks: ORIF >2 weeks: arthrodesis

Question 496

Which surgical factors are associated with successful ORIF of puerpal symphyseal ruptures?

Answer 496

Longer plate (>2 screws per side) Precontoured plate (better contact) Locking plate

Question 497

What's the main advantage of a press-fit humeral component vs. cemented in TSA?

Answer 497

Press-fit has better rotational stability (axial is the same)

Question 498

List 5 ways of ensuring proper femoral and tibial tunnel placement in anatomic ACLR (not including fluoroscopy, which is an option)

Answer 498

Femoral: 1. 8-mm anterior to posterior margin, 1.7-mm proximal to bifurcate ridge 2. 45% of the proximal-to-distal length of the condyle along the posterior 1/3 of the condyle Tibial: 3. In line with the posterior border of the anterior horn of the lateral meniscus 4. 9-mm behind the posterior border of the intermeniscal ligament 5. 5-mm anterior to the peak of the medial eminence

Question 499

Where does the common iliac bifurcate? What are the branches of the internal iliac artery?

Answer 499

Bifurcates at L4 "I Love Going Places In My Very Own Underwear" Iliolumbar Lateral sacral superior/inferior Gluteal internal Pudendal Inferior vesicle Middle rectal Vaginal Obturator Umbilical

Question 500

List 5 side-effects of bisphosphonates in adults

Answer 500

Osteonecrosis of the jaw Esophagitis Dysphagia Gastric ulcers Atypical femoral fractures

Question 501

List 5 side-effects of teriparatide

Answer 501

Transient hypercalcemia Dizziness Nausea Headache Malignancy (especially in Paget's)

Question 502

List 4 risk factors associated with recurrence of clubfoot

Answer 502

1. Drop toe sign 2. Flexion contractures of wrists and fingers (distal arthrogryposis) 3. Spinal dysraphism 4. Noncompliance with FAOs

Question 503

What are 4 risk factors for poor outcomes in growth modulation for adolescent Blount's?

Answer 503

Age >14 BMI >45 Severe deformity Titanium implants (high risk of hardware failure)

Question 504

List 5 ways to gauge accuracy of femoral/tibial tunnel placement in an anatomic ACLR

Answer 504

Femoral: 1. 8-mm anterior to posterior margin, 1.7-mm proximal to bifurcate ridge 2. 45% of the proximal-to-distal length of the condyle along the posterior 1/3 of the condyle Tibial: 3. In line with the posterior border of the anterior horn of the lateral meniscus 4. 9-mm behind the posterior border of the intermeniscal ligament 5. 5-mm anterior to the peak of the medial eminence

Question 505

List 5 factors that predict success of single-stage revision arthroplasty

Answer 505

THA Monomicrobial culture-positive organism Gram + Optimal host factors Sensitivity-tailored antibiotic therapy for 3 months

Question 506

List 5 methods of assessing for patella alta and indicate normal values for each

Answer 506

1. Caton-Deschamps (0.6-1.3) 2. Insall-Salvati (0.8-1.2) 3. Blackburne-Peel (0.5-1) 4. Plateau-patella angle (normal 20 degrees) 5. Blumenstaat's line should touch the inferior patellar pole at 30 degrees of knee flexion

Question 507

List 5 poor prognostic factors in pilon fractures

Answer 507

Male Multiple comorbidities Lower SES Lower education level WSIB