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techniques to prevent malalignment in tibial nail


  • lateral blocking screw, posterior blocking screw
    • in distal fragment 
    • blocking screws increase construct stiffness 
  • lateral start point to prevent valgus
  • insertion technique critically important must be parallel to both lateral and anterior cortex
  • semi-extended knee position prevents apex anterior or procurvatum deformity 
  • application of a provisional anterior unicortical plate
    • useful to prevent procurvatum and anterior translation of the proximal fragment



*Endocrine problems associated with SCFE

GH deficiency
Renal osteodystrophy


Stabilizers of the DRUJ

  • dorsal RU ligament
  • volar RU ligament
  • IOM
  • radial syloid
  • ulnar head
  • ECU sheath
  • pronator quadratus


4 risk factors of DVT associated with MRSA ostoemyelitis

From yellow article:

CRP > 6 at admission
Age > 8

from journal of infectious disease 2012



Release of a Varus knee

  • osteophytes
  • deep MCL
  • SemiM, capsule
  • superficial MCL
  • PCL
  • pes anserinus
  • pop oblique ligamnet


What are the components of the lenke classification

Curve Type       
Lumbar modifier
Sagittal thoracic modifier


3 predictors of successful treatment of UBC with methylprednisone

- Large size

- Multi-loculated

- Active lesion


Anatomical anomalies in other organ systems that are associated with congential scoliosis

    • Vertebral anomalies
    • Anorectal Atresia
    • Cardiac abnormalities
    • TracheoEsophageal fistula
    • Renal Abnormalities
    • Limb Deformities
  • Absent kidney, obstructive uropathy
  • Atrial septal defect, patent ductus arteriosus, tetraology of fallot
  • Clubfoot, DDH, Spregnels


Structures of the shoulder suspensory complex



acromioclavicular ligaments

coracoclavicular ligaments



Motion preserving procedures for SLAC

4 corner fusion

Proximal row carpectomy


+Changes associated with strength training

  • results in increased cross-sectional area of muscle due to muscle hypertrophy
  • results in increased motor unit recruitment +/- improved synchronization of muscule activity
  • maximal force production is proportional to muscle physiologic cross-sectional area


What are features suggestive of a structural curve

  • rotational component
  • corrects to >25 deg on lateral bend
  • >20 deg kyphosis (T10-L2) 
  • if no other curve fits this definition the curve with the largest cobb angle is considered structural


3 ways to prevent AVN in pediatric nail

Trochanteric start point
Lots of fluoro to prevent slipping to fossa
Sharp reamers to prevent reaming out into fossa


Important factors for placing trans-articular screws

  • is the most stable form of fixation and obviates need for postoperative halo immobilization
  • Contraindicaitons
    • large/medial VA (CT angio)
    • nonanatomic reduction C1/C2
    • hypoplastic C2 pars
    • substatial thoracic kyphosis
  • Optimal screw length is 34mm


3 Way to fuse C1/2

  • C1 lateral mass screws / C2 pedicle screw construct - Harms
    • C1 lateral mass screws
    • C2 pedicle screws - still VA s at risk
  • C1-2 transarticular screw placement - Magerl
    • is the most stable form of fixation and obviates need for postoperative halo immobilization
    • Need to get a CT to check for high riding vertebral artery
  • C1-2 wiring techniques
    • also used but are considered less stable and are usually treated with postoperative halo immobilization. Wiring techniques include
    • Brooke's technique 
    • Gallie's technique 


Considerations for DDH THA

  • Acetabulum
    • smaller cup
      • smaller cup means smaller head
    • superior migration, false acetabulum
    • loss of anterior/superior and lateral coverage
      • Augment with screw fixation
      • Augment with implant augments
    • Offset-bore components are available that change the position of the head in the poly to reduce risk of instability
  • Femur
    • Previous surgeries
    • Loss of canal
    • Anteversion of neck
    • May need to shorten
  • Soft tissue changes associated with superior migration
    • Abductors become transverse
    • Psoas and capsule hypertrophy
    • Adductor, rectus and hamstring shortening


3 anatomical landmarks for the femoral component of TKA

  • Whitesides (90 to)
  • Epicondylar axis
  • Posterior condylar axias (ER 3 degrees)


How does a pediatric patient differ regarding trauma ressuciation 

  • large head - spine board cutout
  • higher cervical injury with neuro damage
  • higher C1-3 injury
  • spleen and liver outside rib cage
  • lower blood volume - high HR, low BP
  • higher porportional surface area - hypothermia
  • elastic rib cage - more thoracic trauma
  • strong ligaments; weak bones - low chance of pelvic ring injury
  • anterior trachea - no need for cuff in ETT


Three biomechanical effects of the Latarjet (3)

1. Sling concept from conjoint tendon

2. De-function pec minor

3. Bony block increases articular arc

4. Capsular reinforcement

5. Bony autograft for defect


4 components of the syndesmosis

Anterior-inferior tib-fib ligament
Posterior-inferior tib-fib ligament
Intraosseous membrane
Intraosseous ligament
Inferior Transverse ligament (with PITFL)


Differential diagnosis for lytic lesion in the proximal phalanx

  • enchondroma
  • ABC
  • GCT
  • UBC
  • brown's tumor
  • EG
  • infection
  • NOF


3 ways to avoid varus in a subtroch femur fracture

Medial start point: Nail will not reduce your fracture

  • Piriformis entry nail
  • Lateral nailing
  • Abduct the body

Clamp or k-wire the reduction
Fixed angle plate (95 blade or PFLP)


Long term complications of radiation for sarcoma treatment

Pathological fracture
Joint contracture
Muscle atrophy
Limb length discrepancy


Prognosis of poor predictors of Type II Odontoid

> 5 mm displacement (>50% nonunion rate)
fx comminution
angulations > 10 degrees
age > 50 years
delay in treatment


Risk factors for neurological deterioration of vertebral OM

  • elderly
  • diabetes
  • MRSA (aggressive pathogen)
  • associated abcess
  • cervical level
  • late diagnosis


Changes that muscles undergo during endurance training


  • contractile muscle adapts by increasing energy efficiency
  • increases in mitochondrial size, number, and density
  • increases in enzymes involved in Krebs cycle, fatty acid processing, and respiratory chain
  • over time, increased use of fatty acids > glycogen
  • over time, oxidative capacity of Type I, IIA, and IIB fibers increase 
  • percentage of more highly oxygenated IIA fibers increases
  • Aerobic Threshold: level of effort at which anaerobic energy pathways become significant energy producer
  • Anaerobic (lactate) Threshold: level of effort at which lactate production > lactate removal


*False positive for Thesaly test

Multiple knee injuries
Hx of  knee surgery
Articular cartilage injuries
Neurodegenerative disorders


*Stages of perilunate dislocation

SL disruption (ligament vs. transscaphoid)
Lunocapitate disruption
Lunotriquetrial disruption
Lunate dislocation 


What are you blocks to reduction in DDH (7)


adductor tendon



hypertrophied teres 


transverse acetabular ligament


What are the 4 types of neural tube defects

  • spinal bifida oculta 
    • defect in vertebral arch with confined cord and meninges
  • meningocele 
    • protruding sac without neural elements
  • myelomeningocele 
    • protruding sac with neural elements
  • rachischisis 
    • neural elements exposed with no covering