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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


Describe requirements of informed consent?

1. Competent patient

2. Disclosure of all relevant risks and alternative

3. Free or coercion/voluntary


Abnormalities associated with the spinal anatomy in dysplastic spondylolisthesis

hypoplastic facets

maloriented facets

sacral beaking

abnormal pars development (leads to elongation and slippage)


Name five modifiable risk factors (non-medication) for osteoporosis

1. Smoking

2. Impact exercise

3. Diet high in calcium 1-1.2g/day and vitamin d/sunlight exposure

4. EtOH - > 2 units/day

5. Low BMI

6. Estrogen deficiency


Etiology of groin pain after THA

  • infection
  • psoas impingement
  • aseptic loosening
  • stress fracture
  • pseudotumor
  • GT impingement


*Risk factors for femoral neck fracture in hip resurfacing?


notching of the femoral neck
osteoporotic bone
large areas of pre-existing osteonecrosis
femoral neck impingement (from malaligned acetabular component)
female sex
varus positioning of femoral component



*Complications associated with tibial tuberosity fixation?

  • Recurvatum deformity
    • more common than leg length discrecancy
    • growth arrest anteriorly as posterior growth continues leading to decrease in tibial slope
  • Compartment syndrome
    • related to injury of anterior tibial recurrent artery 
  • Loss of range of motion
  • Bursitis
    • due to prominence of screws and hardware about the knee
  • Skin Necrosis


Radiologic assessment of femoral shaft fracture reduction (3)

1. LT contour compared to uninjured side

2. Cortical width/diameter

3. Cortical thickness

4. C- arm true lateral of femoral neck and other with posterior condyles aligned (differences in inclination of the position of the C-Arm reflects angle of anteversion of femoral neck)

5. Post op CT scan - femoral malrotation using limited cuts through proximal and distal femurs (femoral neck and posterior condyles)

6. Compare lines tangential to these to assess rotation


Risk factors for SMA syndrome following scoliosis

  • Smaller (shorter, weight less)
  • Rigid curve on lateral bend
  • Lenke lumbar modifier B, C
  • Staged procedure
  • Low BMI


*Classes of Shock (Usually specifically about class IV)

  • I  < 15% 
    • <750ml blood loss
    • BP normal
    • > 30 mL/hr 
    • HR normal
    • Anxious
  • II 15% to 30% 
    • (750-1500ml)  
    • > 100 bpm
    • BP normal
    • 20-30 mL/hr 
    • pH normal
    • confused, irritable, combative 
  • III 30% to 40%
    • (1500-2000ml)
    • > 120 bpm
    • decreased BP
    • 5-15 mL/hr  urine
    • acidoditc
    • lethargic
  • IV > 40% (life threatening) 
    • (>2000ml)
    • > 140 bpm
    • decreased
    • negligible uring
    • acidotic
    • coma


Conditions associated with dural ectasia

  • Marfans
  • Neurofibromatosis
  • Ehuler Danlos
  • Osteogenesis Imperfecta
  • Ankylosing Spondylitis


Relative contraindications to total joint arthroplasty?

Neurologic disorder
Previous infection (osteo)
Poor medical status


Complications of OM in a pediatric patient

  • DVT
    • is an infrequent complication  
    • risk factors
      • CRP > 6
      • surgical treatment
      • age > 8-years-old
      • MRSA
      • Meningitis
  • Chronic osteomyelitis
  • Septic arthritis
  • Growth disturbances
  • Limb-length discrepancies
    • may result in gait abnormalities
  • Pathologic fractures


*Determinants of skeletal growth remaining

  • < 12 y
  • Tanner stage (< 3 for females)
  • Risser Stage (0-1) 
    • Risser 0 covers the first 2/3rd of the pubertal growth spurt
    • correlates with the greatest velocity of skeletal linear growth
  • open triradiate cartilage 
  • open olecranon physis
  • timing of menarche
  • hand XR 


Varus malunion in femoral neck fracture, clinical findings?

  • Decreased ROM
  • LLD
  • Abductor lurch
  • Trendelenburg sign
  • Prominent GT


What are radiological risk factors for development of SCFE

  • Posterior slope angle >14
  • vertical physis
  • retroverted head
  • protrusio


*4 things that lead to bad prognosis in pediatric radial head fracture

  • Open management
    • Internal fixation
    • AVN
    • Synostosis
  • > 3 mm translation
  • >45 angulation
  • Malunion 
  • <60 deg of motion following reduction


Risk factors for radioulnar synostosis

Proximal third of both bones
Same level fractures
IOM injury
Severe soft tissue disruption
Head injury
Boyd approach
Delayed management
Bone in IO space
Onlay graft
Hardware in IO space


*Measures of adequate resusitation

  • MAP > 60
  • HR < 100
  • urine output 0.5-1.0 ml/kg/hr (30 cc/hr)
  • serum lactate levels
    • most sensitive indicator as to whether some circulatory beds remain inadequately perfused (normal < 2 mmol/L) 
  • gastric mucosal ph
  • base deficit
    • normal -2 to +2 
  • pH < 7.24


What are the components of the DRUJ?

  • TFCC made up of 
    • dorsal and volar radioulnar ligaments
      • deep ligaments known as ligamentum subcruatum
    • central articular disc
    • meniscus homolog
    • ulnar collateral ligament
    • ECU subsheath 
    • origin of ulnolunate and ulnotriquetral ligaments
  • DRUJ Stability - TFCC has elements that converge to this, so you need to repair it first when you have instability
    • Primary - moves in the direction of the palm
      • One will act as a buttress, one will act as a check rein, so we don't really know which one is more important
      • volar radioulnar ligaments
        • volar translation
        • supination
      • dorsal radioulnar ligaments
        • dorsal translation
        • pronation
      • trigangular fibrocartilage
    • Secondary
      • ulnar head
      • sigmoid notch
      • interosseous membrane
      • pronator quadratus


Radiographic evidence of syndesmotic injury

medial clear space > 4mm

tib-fib clear space > 6mm

tib-fib overlap < 1mm on mortise


Spinal findings in achondroplasia

  • lumbar spinal stenosis
    • caused by short pedicles
    • most likely to cause disability
  • thoracolumbar kyphosis
    • may cause neurologic symptoms
  • foramen magnum and upper cervical stenosis
    • may cause periods of apnea


Three ways to avoid patellar maltracking

  • Avoid internal rotation of the femoral prosthesis
    • use the transepicondylar axis
    • use the posterior condyles with 3 deg ER
  • lateralization of the femoral component
  • internal rotation of the tibial prosthesis
    • medial 1/3 of the tibial tubercule is your landmark
  • placing the patellar prosthesis lateral on the patella


anatomic reasons for pseudosubluxation

  • horizontal facets
  • hyperlaxity
  • poor motor control


4 non-skeletal features of fibrous dysplasia

  • Commonwith polyostotic
    • Hyperthyroidism
    • Hypophosphatemia
    • Acromegaly
    • hyperprolactinemia
  • Café au lait spots (McCune Albright - coast of maine)
  • Precocious puberty (McCune  Albright)
  • Eye deviation and blindness (Chereubism)
  • Cranial abnormalities (Chereubism)           


4 types of SLAP tears

  • I - Labral and biceps fraying, anchor intact
  • II - Labral fraying with detached biceps tendon anchor
  • III - Bucket handle tear, intact biceps tendon anchor (biceps separates from bucket handle tear)
  • IV- Bucket handle tear with detached biceps tendon anchor (remains attached to bucket handle tear)
  • V - SLAP lesion and anterior labral tear (Bankart lesion)
  • VI- Superior flap tear
  • VII- SLAP lesion with capsular injury


*3 causes for RA patient not to extend 4/5th digits

  • Caput Ulnae Syndrome
    • Vaughn- Jackson Syndrome (attritional rupture of EDQ only)
  • MCP dislocation
  • Sagital band attenuation
  • PIN palsy


Describe the leadbetter maneauver

  • Flex the hip to 90, pull axial traction
    • relaxes hip musculature
  • IR to 45 degrees
    • relaxes Y ligament
  • Extend and slightly abduct the hip maintaining IR and traction


Principles of medical ethics

  • Respect for autonomy - the patient has the right to refuse or choose their treatment
  • Beneficence - a practitioner should act in the best interest of the patient
  • Non-maleficence - "first, do no harm" 
  • Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality)
  • Respect for persons - the patient (and the person treating the patient) have the right to be treated with dignity.
  • Truthfulness and honesty - the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee syphilis experiment.


*4 long term complications of radial head fracture in adults

  • Elbow stiffness
  • Heterotopic Ossification
    • Concurrent injury
    • Recurrent surgery
    • Delay to surgery
    • Prolonged immobilization
  • PIN Palsy
  • Ulnar nerve injury
  • Infection
  • Instability
  • Elbow OA
  • Fracture displacement


Borders of the triangular space

long head triceps

teres major

teres minor


This healthy patient had a fall from height onto a plantar-flexed foot.  What are the key things you need to look for on XR?

five critical radiographic signs that indicate presence of midfoot instability

  1. disruption of the continuity of a line drawn from the medial base of the second metatarsal to the medial side of the middle cuneiform (diagnostic of lisfranc)
  2. widening of the interval between the first and second ray (may see a fleck sign diagnosic of lisfranc)
  3. medial side of the base of the fourth metatarsal does not line up with medial side of cuboid on oblique view
  4. metatarsal base dorsal subluxation on lateral view
  5. disruption of the medial column line (line tangential to the medial aspect of the navicular and the medial cuneiform)

Don't forget WB or stress veiws if you have concerns and there is nothing obvious on XR


Structures of the PLC

  • Static structure - is what you will reconstruct during injury
    • LCL
      • Attaches 8mm behind the most anterior fibula
    • Politeus tendon with popliteofigular ligament
      • Inserts 18.5mm distal, anterior and underneath LCL on the tibia
    • Popliteofibular ligament
    • Lateral capsule
    • Arcuate ligament
    • Fabellofibular ligament
  • Dynamic
    • Biceps femoris (inserts posterior to LCL on fibula)
    • Popliteus
    • Iliotibial tract


3 ways to assess adequate femoral neck reduction

  • Restoration of Shenton’s line
  • S- curve on all views (head-neck jxn)  – never a c-curve  (Rockwood and Green’s)
  • Garden Alignment Index (Rockwood and Green’s)
    • AP: medial trabeculae:medial femoral cortex 155-180 degrees
    • Lateral: central trabeculae in head:neck 155-180 degrees


+Deformities associated with CAM (radiographic)

decreased head-to-neck ratio
aspherical femoral head
decreased femoral offset
femoral neck retroversion 


Indications for scaphoid ORIF

  • Proximal pole fracture
  • Displaced scaphoid fractures
    • 1 mm displacement
    • SL angle > 60
    • RL angle > 15
    • Intrascaphoid angle > 35  
  • Associated perilunate
  • Multipy injured patient
  • Comminution
  • DISI > 15 degrees


Describe mechanism of proximal tib-fib dislocation.  Features on exam, reduction mechanism and treatment?

  • Mechanism: Twisting of flexed knee (athletic injury)
  • Physical Exam:
    • Prominent lateral mass
    • Pain worse with ankle DF (proximal fibular migration)
    • Pain worse with knee extension
    • Examine stability at 90 degrees (relaxes LCL)
    • Translation of prox fibula
    • Peroneal nerve
    • Ankle exam
    • LCL and PLC instability to rule out other injuries
  • Closed Reduction:
    • Flex btw 80-110 to relax LCL
    • Reduce opposite direction of dislocation
    • immobilize for 3 weeks (controversial)
  • Open Reduction:
    • Screw with repair of joint capsule
    • immobilize for 6 weeks
    • ​remove in 12 weeks
  • Chronic Dislocation
    • ​usually non-op with activity modificaiton and strap
    • arthrodesis with mid-fibular resection is an option in older patients
    • attempts have been made to use the IT or biceps to create a sling for the head of the fibula
  • Results are improved with LCL/PLC pathology and repair

Note that actue and chronic entities are two seperate issues and should be treated differented.  The IT band can be use 


Anatomy of the DRUJ with scope

  • Fibrocartilage
    • can debride 80% without causing instability
  • Radial and ulnar insertions of the radioulnar ligaments
    • can stress them and assess for instability
  • ECU sheath?
    • sometimes used to teather a TFCC repair to


Deformities associated with Pincer - descriptive, not measurements

anterosuperior acetabular rim overhang
acetabular retroversion
acetabular protrusio
coxa profunda (deep socket)


Reasons for lack of extension post-op ACL

  • lack of extension pre-op
  • post-op arthrofibrosis
  • cyclops lesion
  • anterior tibial tunnel placement
  • tighten in flexion


Measurements indicating normal c-spine alignment

  • Lateral view
    • Basion Dens Interval (BDI)
    • Anterior spinolaminar line < 1mm
    • Drawn from opisthion to C1 arch, should pass C1/C2
    • ADI < 3mm
    • Posterior cortex of atlas should be parallel to anterior cortex of axis
    • SAC > 13mm
  • Open mouth
    • Joint articulations should be
    • Combine overhang < 7mm


What are 4 major and 4 minor criteria for fat emboli syndrome

  • Major (1) 
    • hypoxemia (PaO2 < 60)
    • CNS depression (changes in mental status)
    • petechial rash
    • pulmonary edema
  • Minor (4) 
    • tachycardia
    • pyrexia
    • retinal emboli
    • fat in urine or sputum
    • thrombocytopenia
    • decreased HCT
  • Additional 
    • PCO2 > 55
    • pH < 7.3
    • RR > 35
    • dyspnea
    • anxiety


*4 ways to tell the difference bettween transient synovitis and septic OA

Temp > 38.5
WBC > 12
CRP > 20
ESR > 40
Refusal to WB
5 predictors à 98% septic
4 predictors à 93% septic
3 predictors à83% septic


Indications for fixation of the proxiaml humerus

  • Acceptable Alignment
    • < 20° anterior angulation
    • < 30° varus/valgus angulation
    • < 3 cm shortening
  • absolute indications
    • floating elbow
    • open fx
    • vascular injury
    • intraarticular fractures
  • relative indications
    • bilateral humerus fx and other polytrauma (allows full weight bearing on humerus)
    • failure of closed treatment
    • segmental fractures
    • polytrauma
    • brachial plexus injury (allows earlier rehabilitation)
    • post-reduction new-onset radial nerve palsy
    • pathologic fractures
    • neuromuscular conditions


Indications for hemiepiphyseodesis in congential scoliosis

  • intact growth plates on the concave side 
  • patients less than 5 yrs
  • < 40-50 degree curve


Important factors regarding periprothetic # of the hip

  • fracture location
  • stability of prosthesis
  • bone loss
  • rule out infection


4 risk factors of progression of degenerative spondylolisthesis

african americans


woman over 40 years of age

transitional L5 with saggital facets


4 stabilizers of the AC joint

1. AC ligament

2. CC ligament

3. Capsule

4. Deltoid and Trapezius


Complications of doing an ankle ORIF in diabetic

  • Loss of fixation
  • Wound infection
  • Non-union
  • Amputation
  • delay to union


Non-operative treatment of carpal tunnel syndrome


Nighttime bracing

activity modification

Cortisone injections



**Name 8 steps in the WHO pre-operative checklist

5 most important

  • procedure
  • limb
  • allergies
  • antibiotics
  • critical events


*What are the ASIA dermatomes and myotomes


Classificaiton of congential kyphosis?

I - Failure of formation

II - Failure of segmentation

III - Mixed

types I and III are at higher risk of neurological invovlement and progression


*What is important for staging Ewings?

  • plain radiographs and MRI of the primary site
  • CT chest - pulmonary mets
  • Bone Scan - skip lesions, boney mets
  • Bone marrow biopsy


4 components of the WOMAC




Global Scale


What are complications assoicated with hemophilia

  • infection
  • post-op hemarthrosis


knee ligaments, weakest to strongest

LCL (700 N)
ACL (2200 N)
PCL (2500 N)
MCL (4000 N)


Four benefits of high offset of THA

  • Tensions abductors (decrease trendelenburg)
  • Increased stability
  • Decreased impingement
  • decreased joint reaction force
  • moves abductor moment away from center of rotation
  • increase abductor moment arm
  • reduces abductor force required for normal gait


Causes for lack of flexion post-op TKA

  • number one predictor of post-op motion is pre-op motion
  • no tibial slope to tibial component
  • oversized femoral component
  • patella baja/raised joint line
  • tight flexion gap
  • arthrofibrosis
  • lack of compliance with PT
  • post-op complication (DVT, infection)


*4 techniques to fix and ACL in 11yo female


  • IT Band Reconstuction (extra-articular)
    • over the top
  • Complete transphyseal
    • small tunnels, verticle tunnels
    • sharp drills, don't burn the bone
    • one pass
  • Transphyseal (Tanner 1-4)
    • Partial
  • All Epiphyseal (Tanner 1-3)
    • Anderson
    • All-inside


*List complications of malpositioning of the acetabular cup

Poly wear
Cup spin out (loosening)


Formula for pelvic incidence

PI = PT + SS


6 biological capabilites for a tumor to metastasize

1. Evading apoptosis

2. Self-sufficiency in growth signals

3. Insensitivity to anti-growth signals

4. Tissue invasion and metastasis inactivation

5. Limitless replicative potential

6. Sustained angiogenesis


sites of radial nerve compression after is passes threw the septum

fibrous bands

leash of henry


arcade of froshe

distal supnator


*C-Spine Pathology in downs

Higher than sex match, healthy children

  • C1-2 Pathology (assessed with observed flex-ex and ADI measurement)
    • Atlantoaxial instability
    • Os odontoideum
    • persistent dentocentral synchondrosis of C2
    • spina bifida occulta of C1
    • ossiculum terminale 
  • Atlano-occipitial instability (assessed with powers ratio)


What are normal findings in pediatric C-spine imaging?

  • prevertebral swelling < 2/3 of adjacent vertabral width
  • smooth contour lines of
    • anterior vertebral bodies
    • posterior vertebral bodies
    • spinolaminar line (inside lamina)
    • tips of spinous process
  • parallel facet joints
  • normal retropharyngeal space
    • < 6 mm at C2
    • < 22 mm at C6
    • retrotracheal space < 14 mm
  • atlanto-dens interval < 5 mm in children and < 3 mm adolescents
  • absent vertebral body wedging
    • 7% of normal children have a wedge shaped C3 vertebral body
  • absence of of cervical lordosis
    • loss of cervical lordosis may be found in 14% of normal children
  • C2-3 or C3-4 pseudosubluxation < 4mm
    • considered normal as long as the posterior laminar line is contiguous


Risk factors for progression of congential kyphosis

Lovell and WInter - Congenital Kyphosis

  • Rapid growth periods
    • 0-3 yo
    • adolesence
  • Type 1 - Failure of formation
  • Type 2 - Mixed 


  • No role for bracing
  • < 50 deg, <5yo
    • posterior fusion alone
    • allows some correction with growth
  • >60 deg
    • anterior and posterior fusion
    • be careful with pre-op halo or attempts at correction because there is a high risk of neurological complication


Describe push up test for PLRI (2)?

Patient prone on floor in push up position, elbow flexed to 90 degree, forearms supinated and shoulder abducted slightly wider than push up position Patient attempts to push up using arms, patient will experience apprehension with terminal extension, guarding or dislocation are considered positive Similar idea to lateral pivot shift test --> Supine with affected arm overhead - forearm supination and the arm is taken from extension to flexion - radial head reduces with flexion


List evidence for pseudosubluxation

  • C2 with-in 1.5mm of Swischuk's line
  • corrects with extension
  • no anterior swelling
  • no initiating trauma


3 ways to identify spinal cord injury in deformity correction



- Wake up test

- Clonus


Clinical and radiographic features that suggest C-spine instability?

  • Clinical
    • neck pain 
    • midline tenderness
    • pain with rotation/flexion
    • neurological findings
  • Subtle changes on XR
    • soft-tissue swelling
    • hypolordosis
    • disk-space narrowing or widening
    • widening of the interspinous distances


Aspects of informed consent

• Nature of the procedure
• Reasonable alternatives to the proposed intervention
• Relevant risk/benefits, uncertainties related to each alternative

• Assessment of patient understanding
• Acceptance of the intervention by the patient 


*3 things that enhance in the spine with gad

Scar tissue
Tumors (most)


*Pathology of cavus foot in adults

  • Neurologic
    • Hereditary motor and sensory (CMT)
    • Cerebral palsy
    • After effects of cerebral injury (stroke)
    • Anterior horn cell disease (spinal root injury)
    • Spinal cord lesions
  • Traumatic
    • Compartment syndrome
    • Talar neck malunion
    • Peroneal nerve injury
    • Knee dislocation (neurovascular injury)
  • Residual clubfoot
  • Idiopathic 


What is the criteria for causation

  • Analogy: The effect of similar factors may be considered.
  • Consistency: Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
  • Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that "... lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations"
  • Experiment: "Occasionally it is possible to appeal to experimental evidence"
  • Strength: A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal
  • Specificity: Causation is likely if a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship
  • Plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge)
  • Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
  • Biological gradient: Greater exposure should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence


Negative prognostic factors in osteosarcoma

High LDH
High ALP
< 90% tumor necrosis post chemo
Mets at presentation
Axial skeleton location
Lymph node involvement
Vascular involvement
Positive margins


Imaging required for FAI and associated radiological signs

  • Imaging
    • ​AP pelvis
      • centered between pubis and ASIS, hips in 15 IR
      • ​make sure to rule out OA
      • Adequate
        • equal obturator, iliac wing
        • coccyx 2cm above symphisis
    • 45deg Dunn lateral
      • ​best to look at alpha angle
    • Cross table lateral, frog-leg
      • ​assess anterior head-neck junction
  • ​Cam deformity (pistol grip)
    • Alpha angle >55 on dunn
    • Head-neck offset > 8mm on Dunn
  • Pincer deformity
    • Protrusio - femoral head projects medial to ischioilial line
    • Retroversion
      • cross over sign
      • ​​posterior wall sign 
      • ischial spine sign
    • Overcoverage
      • tonnis angle < 0
      • CEA > 40


Indications and Contraindications to HTO

  • Indications
    • medial compartment arthrosis
    • knee instability
    • medial compartment overload following meniscectomy
    • osteochondral lesions requiring resurfacing procedures. 
  • General contraindications
    • inflammatory arthritis
    • obese patient BMI>35
    • flexion contracture >15 degrees
    • knee flexion <90 degrees
    • procedure will need >20 degrees of correction
    • patellofemoral arthritis
    • ligament instability
    • varus thrust during gait


Three clinical findings in diagnosis of ankylosing spondylitis.

1) Decreased chest expansion less than 1 cm

2) Sacroiliitis (FABER test)

3) Uveitis (Anterior iritis/Uveitis)

4) Progressive kyphotic deformity (Chin brow vertical angle 30 degrees)

5) Decreased spine motion (Schober test)

6) Large joint OA

7) Enthesitis

8) Renal amyloidoss

9) HLA B27 (Diagnostic criteria with SI inflammation/Uveitis


Orthopedic and non-orthopedic association with marfans

  • orthopaedic conditions
    • Arachnodactyly
    • scoliosis (50%)
    • protrusio acetabuli (15-25%)
    • ligamentous laxity
    • recurrent dislocations (patella, shoulder, fingers)
    • pes planovalgus
  • nonorthopaedic conditions
    • cardiac abnormalities
      • aortic root dilatation
      • possible aortic dissection in future
        • Most lethal consequence
        • May require prophylatic surgery to repair if > 5cm
      • mitral valve prolapse
        • requires pre-op echo
    • superior lens dislocations (60%) (ectopia lensitis)
      • diagnose with slit lamp
    • Mypoia
    • Glaucoma
    • cataracts
    • pectus excavatum
    • spontaneous pneumonthoraces
    • dural ectasia (>60%)
    • Meningocele


*Indications for CRPP of a pediatric distal radius fracture

  • SH3 and 4
  • BBFF > 10 yrs
  • Failure to maintain reduction closed 
    • <9yo and >30deg
    • >9yo and >20deg
  • floating elbow
  • compartment syndrome or excessive soft tissue damage
  • <50% apposition


Differential Diagnosis for DRUJ pain

DRUJ instability or arthritis
TFCC tear
LT ligament tear
pisotriquetral arthritis
ECU tendonitis or instability


Indications for a hemiresection arthroplasty of the DRUJ


- DR Malunion

- unconstructable ulnar head fracture



Mirel's criteria


4 symptoms of post-tourniquette syndrome



Advantages of uses locking plate over DCS compression plate in a distal femur fracture

  • Locks to plate - better varus control
  • Better control of comminution with multiple points of fixation
  • Lock or compress as needed
  • Less invasive insertion, less tissue disruption
  • Has the versatility to use around  TKA


Aside: 38% coronal plane fractures in all supracondylar femur fractures (L>M)


*Risk factors associated with short term mortality after hip fracture?

  •  male gender
  •  partially dependent functional status
  • totally dependent
  •  dyspnea
  •  congestive heart failure
  •  serum sodium >145
  • WBC >11
  • INR >1.3
  • resident involvement
  •  dirty wound
  • ASA class 3
  • ASA class 4 


5 concerning conditions for fixing achilles



Deformity associated with madelung's

  • Pathology
    • volar-ulnar tethering of radio-lunate ligament = vicker's ligament
  • Clinical
    • bilateral
    • volar hand
    • ulnar hand
    • dorsal prominence ulnar wrist
  • Radiological
    • pyramidalizaiton of carpus
    • narrowing of ulnar distal radius physis
    • anterior bowing of the radial shaft
    • dorsal subluxation of ulnar head
  • Radiological diagnosis
    • volar tilt
    • lunate subsidence
    • lunate fossa angle
    • palmar carpal displacement


In a patient with trendelenberg gait what will you find on physical exam?

1. Non affected (contralateral) pelvis will sag inferiorly on single leg stance of affected limb

2. Weak abduction of hip to resistence

Possible weak dorsiflexion/ehl due to L4/L5 nerve injury Body may leave to weak side to help COG


List the 7 components of canmeds

“Please Help Me Memorize Stupid Canmeds Crap”

Health advocate
Medical expert


Swan neck deformity in RA patient

  • Volar plate rupture
  • MCP joint volar subluxation (rheumatoid arthritis)
  • mallet finger
  • FDS laceration
  • intrinsic contracture


Mechanisms of action of BMP

  • Induce mesenchymal differenction to osteoblasts
  • Active osteoblasts to lay down bone
  • Mechanism 
    • leads to bone formation
    • activates mesenchymal cells to transform into osteoblasts and produce bone
  • Signaling Pathways and Cellular Targets 
    • BMP targets undifferentiated perivascular mesenchymal cells 
    • activates a transmembrane serine/threonine kinase receptor that leads to the activation of intracellular signaling molecules called SMADs. 
      • SMADS are primary intracellular signaling mediators
      • currently eight known SMADs, and the activation of different SMADs within a cell leads to different cellular responses.


What are complications of IM nail in hemi-lithotomy position?

  • Well leg compartment syndrome
  • Nerve injury (Pudendal 2-27% - this is a problem - ED)
  • Fracture malalignment (3.5x risk of being IR)
  • Skin and soft tissue injury (peroneal area)
  • Crush syndrome (lateral position with thigh crushed against bed by the post)


Landmarks for wrist scope portals

  • Radiocarpar Portals
    • 3-4
      • Located just distal to Lister tubercle, between EPL and EDC
      • Established first, primary viewing portal
    • 4-5
      • Located in line with ring finger metacarpal, between EDC and EDM;
      • Portal for instrumentation, visualization of TFCC
    • 6R
      • Located just radial to ECU tendon;
      • Primary adjunct for visualization and instrumentation, ulnar-sided TFCC repairs
      • Dorsal sensory branch of ulnar nerve
    • 6U
      • Located just ulnar to ECU tendon;
      • Primary adjuct for visualization and instrumentation, ulnar-sided TFCC repairs
      • Dorsal sensory branch of ulnar nerve
    • 1-2 
      • Located between APL and ECRB, along dorsal aspect of snuffbox; 
      • Not often utilized, provides access to radial styloid and radial aspect of joint, sometimes used for inflow
      • Superficial branch of radial nerve; Radial artery
  • Midcarpal Portals
    • MCR
      • Located 1 cm distal to 3-4 portal along axis of radial border of middle finger metacarpal, between ECRB and EDC.
      • Allows visualization of scapholunate, scaphocapitate, and scaphotrapezoid joints.
    • MCU
      • Located 1 cm distal to 4-5 portal along axis of ring finger metacarpal, between
      • Allows visualization of lunocapitate, lunotriquetral, and triquetrohamate joints.
    • STT
      • Located along axis of index finger metacarpal just ulnar to EPL at level of STT joint
      • Allows visualization of scaphotrapezial and scaphotrapezoid joints.
  • First CMC Joint
    • 1U
      • Located on ulnar aspect of EPL at level of first CMC joint (basal joint)
      • Allows diagnosis of DJD of first CMC joint and arthroscopic debridement.
      • Superficial sensory branch of radial nerve
    • 1R
      • Located on radial aspect of EPL at level of thumb CMC joint, just volar to APL tendon
      • Allows diagnosis of DJD of first CMC joint and arthroscopic debridement.
      • Superficial sensory branch of radial nerve


 6 Reasons for revision of TKA

  • Infection
  • Instability
  • Patellofemoral malalignment
  • Stiffness
  • Extensor mechanism failure
  • Poly Wear/Osteolysis/Aspetic loosening
  • Fracture
  • PCL Failure


Poor prognostic factors associated with septic OA

  • age < 6 months
  • associated osteomyelitis
  • hip joint (versus knee)
  • delay >4 days until presentation
  • MRSA


*Features of central cord syndrome

Most common incomplete cord injury, usually in elderly with hyperextension injury and pre-existing pathology

Painful dysthesias


distal > proxiaml

Sacral sparing


Complications of performing an open repair of achilles tendon rupture

  • Wound dehisence
  • Deep Infection (smoking)
  • Sural nerve


4 patient factors associated with cuff re-tear

> 65
Non-compliance with PT


*3 advantages of coning down an XR

  • Coning
    • 'Cone' that removes the periphery from the feild
    • helps to reduce the scatter and the effective penumbra
  • Advantages
    • Decreased rads to patient
      • reduces volume of tissue irradiated
    • Decreased rads to staff
    • Improved focus



Stages of muscle repair

  • Hematoma
  • Regeneration
  • Fibrosis/tissue remodelling


*3 ways to treat CVT minimally invasive

Serial casting
Perc pin fixation
Perc Achilles tenotomy


Prognosis of sarcoma other than metastasis

1) mets (distant mets the most important factor for any staging system)

2) tumour grade (represents a tumours ability to metastasize)

3) size

4) compartmentalization

5) tumour depth- controversial as a prognosticator


*5 concerning signs of head at risk in LCP (Caterall criteria)

Gage sign
Lateral subluxation
Lateral Ossification
Horizontal growth plate
Metaphyseal cyts


What are risk factors for patellar instability?

  • ligamentous laxity (Ehlers-Danlos syndrome)
  • dysplastic vastus medialis oblique (VMO) muscle
  • lateral displacement of patella
  • patella alta
    • causes patella to not articulate with sulcus, losing its constraint effects
  • trochlear dysplasia
  • excessive lateral patellar tilt (measured in extension)
  • lateral femoral condyle hypoplasia
  • increased quadriceps angle (Q angle)
    • average for women 15 degrees
    • average for men 10 degrees
  • previous patellar instability event 
  • "miserable malalignment syndrome" 
    • femoral anteversion
    • genu valgum
    • external tibial torsion / pronated feet


Radiographic indicators for progression of blounts

MDA >16

MEA >20

medial physeal bar

metaphyseal beaking


*What are the considerations for a pediatric halo?

  • More pins (6-8)
  • Less torque (4 lbs/finger tight)
  • < 2 use a minerva vest
  • >2 use a custom vest
  • Thin cortices - need a pre-op CT
  • Avoid pins in sutures
  • Avoid temporalis muscle


Pros and Cons to steroids in Duschennes

  • Benefits
    • Walk for longer
    • Improved pulmonary function
    • Decreased progression of scoliosis
  • Downsides
    • Weight gain
    • Short stature
    • Osteopenia
    • Cataracts


*3 ways to size the radial head

  • Size the contralateral joint
  • Size to original radial head - thickness and cup
  • Trial reduction
    • Proximally should line up with lesser sigmoid notch
    • Lateral UH joint are opposed
  • Flouro
    • Medial and lateral UH joint lines (can't see this until >6mm)
    • Look for congruency of the medial UH joint


*Parameters that suggest the patient is unstable

  • BP <90 (class 4 shock)
  • Lactate > 2.5
  • Blood transfusion >  5 units
  • Base deficiet > 8
  • Platlets < 70 000
  • Fibrinogen < 1
  • Tempature < 35 (hypothermia)
  • ISS > 40
  • ISS > 20 with thoracic trauma; AIS >2
  • Clinical parameters
    • bilateral femur fractures
    • pulmonary contusions
    • severe head injury


Three causes of a SLAP lesion

repetitive overhead activities (often seen in throwing athletes)
fall on outstretched arm with tensed biceps
traction on the arm


5 Ways to use a plate

  • antiglide/buttress
  • tension band
  • bridge
  • compression
  • neutrilization


2 advantages of a piriformis start site

  • Piriformis
    • less risk of varus
    • colinear with shaft
    • less risk of eccentric reaming
    • disadvantage
      • medial can cause neck fracture
      • lateral will increase varus
      • risk of AVN
  • Lateral entry
    • easier to perform
    • less risk AVN
    • disadvantage
      • risk of lateral GT #
      • risk of femoral neck fracture
      • eccentric reaming 
      • increased risk of varus


*8 features of aortic arch rupture on CXR

Widened mediastinum (>8cm)
Indistinct aortic arch contour
Deviated trachea
Depressed left bronchus
NG tube deviation to right
Apical pleural hematoma (left apical cap)
Fracture of rib 1 or 2
Disruption of of calcium ring of aortic knob (broken halo sign)
Enlarged aortic contour


+Contraindications for function bracing in humeral shaft fracture

  • severe soft tissue injury or bone loss
  • unreliable patient
  • polytrauma
  • brachial plexus injury
  • proximal one-third humeral fracture
  • inability to maintain reduction (segmental fracture)
  • radial nerve palsy is NOT a contraindication to functional bracing 


Sites of compression of the AIN

  • Ligament of struthers
  • heads of pronator
  • biceps aponeurosis
  • FDS (subliminis)


Three features of sacral sparing

Voluntary anal contraction
Intact perianal sensation
Great toe flexion (FHL is S2)


What are the stabilizers to posterolateral elbow instability

  • LCL
  • coronoid
  • radial head


Causes of charcot joint

  • Diabetes 
  • Alcoholism
  • Leprosy
  • Syphillis
  • Syrinx/syringomyelia
  • Spinal cord tumor



*Requirements to perform a PAO?

  • Indicated in young patients with pain or progressive limp
  • No OA - tonnis grade < 2
  • Painless passive ROM
    • Flexion > 90 deg
    • Abduction > 30 deg
  • congruent joint


List four signs of posterior should dislocation in BPP

1. Internal rotation contracture of shoulder

2. Decreased ROM

3. Asymmetry of skin folds of the axilla and proximal arm

4. Apparent shortening of humeral segment

5. Palpable asymmetric fullness in posterior shoulder

6. Progressive loss of ER between monthly exams

7. Glenohumeral deformation secondary to muscular imbalance/physeal trauma

8. Leads to glenoid dysplasia and posterior should subluxation occur as a result around 6/12 Investigate with US!


What should the factor levels be pre-op and how long do you maintain them

  • 100%
    • factor VIII (hemophilia A)
    • factor XI (hemophilia B)
  • 2 hrs preop - infuse to attain 100% activity of normal
  • intra-op - continuous infusion of factor to maintain levels >60%
  • immediate post-op - continuous infusion to maintain >60% level until d/c
  • 2 weeks post op - infusion of bolus doses to maintain levels 30-60%
  • vigorous physio - infused to a 30% level just before therapy


Criteria for selective thoracic fusion in AIS (4)

  • Lumbar modifier
  • saggital modifier
  • flexibity 
    • lumbar curve is more flexible than thoracic
      • thoracic > 20% AVT
      • more apical rotation
  • magnitude/type
    • include all structural curves
    • no need to fuse non-structure
    • only need to fuse one that crosses central line
  • maturity



Principles of treating a pilon

  1. Restore length
  2. anatomic articular reduction
  3. bridge metaphysis and diaphysis
  4. address bone loss


MRI findings with neurofibromatosis and scoliosis

Paraspinal mass (helps to distinguish from AIS)
Dumbell lesions
Dural ectasia
Vertebral body scalloping


Component of brown-segard syndrome

  • ipsilateral motor loss (corticospinal)
  • ipsilateral vibration/touch (dorsal column)
  • contralateral pain/temp (spinothalamic)
  • good prognosis
  • usually direct trauma (stabbing)


Sites of compression of the radial nerve

  • fibrous bands
  • recurrent radial nerve (leash of henry)
  • ECRB
  • proximal supnator (arcade of froshe)
  • distal supnator


Clinical (not radiographic) findings in FAI

  • groin pain with activity
  • mechanical symptoms
  • difficulty sitting
  • trauma as child
  • trendeleberg
  • <90 deg of flexion, IR < 5 deg
  • anterior impingment
  • ER extremity
    • increased anteversion
    • old SCFE


4 changes in and around muscles with endurance training


4 risks for SCFE (radiographic risks)

Posterior slope angle >14

Vertical physis

Retroverted femoral head



X-ray findings of AVN of femoral head post DDH treatment

1) Failure of appearance or growth of ossific nucleus at 1 year after reduction

2) Broadening of femoral neck

3) Increased density and fragmentation of ossified femoral head

4) Residual deformity of proximal femur after reduction

5) Shortening of the femoral neck

6) Greater trochanter overgrowth

7) Premature physeal closure


Radiogrpahic Findings after persisent ankle pain after "ankle sprain"

1) Anterior process of calcaneus fracture

2) Lateral process of talus fracture

3) Base of 5th metatarsal fracture

4) OCD

5) Peroneal tendon injury

6) Tarsal coalition

7) Syndesmosis injury


Posterior shoulder dislocation with hill sachs

3 treatment options

1)    McLaughlin Procedure (subscap transfer)

2)    Modified McLaughlin Procedure (LT transfer)

3)    Anterior approach, disimpaction and bone grafting (autograft or allograft)

4) hemiarthroplasty (>40%)


Marfans: name orthopaedic associations

○      arachnodactyly

○      scoliosis (50%)

○      protrusio acetabuli (15-25%)

○      ligamentous laxity

○      recurrent dislocations (patella, shoulder, fingers)

○      pes planovalgus

○      dural ectasia (>60%)

○      meningocele

○      pectus excavatum


5 factors associated with poor prognosis for patient undergoing PAO

1.     Tonnis Grade 3 osteoarthrosis

2.     aspheric femoral head

3.     preop center edge angle < 0 degrees

4.     preop os acetabuli

5.     acetabular anteversion < 10 degrees on preop CT


Describe the Leadbetter maneuver

-       Flex hip to 90deg

-       Adduct hip

-       Apply traction

-       Internally rotate 45deg

-       Slowly extend and abduct while maintaining traction/IR


Tibial eminene fracture

Block to reduction

Consequences of failed reduction

Blocks to reduction

  • entrapped meniscus
  • intermeniscal ligament

Consequences of failed reduction

  • ACL laxity
  • Loss of full extension from impingement of the displaced fracture in the notch


Orthotic for a 16yo M with subtle cavovarus foot

custom full-length semi-rigid with “recessed first ray, a lateral wedge, and a lowered medial longitudinal arch,”


Types of spondy

Wiltse-Newman Classification


6 modifiable risk factors for fracture non-union



Alcohol Abuse

Low Vitamin D levels

Poor nutrition

Poorly controlled diabetes




5 components of capacity to provide informed consent

Does the person understand the condition for which the specific treatment is being proposed?

                        Is the person able to explain the nature of the treatment and understand relevant information?

            Is the person aware of the possible outcomes of treatment, alternatives or lack of treatment?

            Are the person’s expectations realistic?

            Is the person able to make a decision and communicate a choice?

            Is the person able to manipulate the information rationally?


5 steps in management of a medical error


Notify agency (CMPA)





5 ways to elimate bias in RCT


Allocation concealment


Intention to treat analysis

Adequate washout period


List 4 ways in which radiographs of the cervical spine in children differ from those of skeletally mature patients?

1.     C2/3 and C3/4 pseudosubluxation up to 4mm, age 1-7

2.     absence of cervical lordosis - reduces with extension

3.     anterior wedging of vertebral bodies

4.     ADI up to 5mm (2.5 mm in adults)

5.     facets are more horizontal in c-spine


List 4 indications for surgery in rheumatoid c-spine.

ADI > 10 mm

-PADI < 14mm

-Basilar invagination (cervicomedullary angle < 135 degrees, or odontoid 5mm above McGregor’s line)

-Subaxial subluxation > 4mm (or body height/width ratio < 2.0)

-Brain stem compromise

-Progressive neuro deficit


INdications for bracing congenital scoliosis

  • Age <5 years
  • Site of anomaly in lumbar as opposed to thoracic spine
  • A curve of five segments or less
  • A progressive curve <70°
  • Anomalies consisting of
  • Absence of excessive kyphosis
  • Absence of neurological deficits, including syrinx, di
astomatomyelia and tethered spinal cord


4 traditional pillars of medical ethics






Complications of Darrach procedure

  • instability of the distal ulnar shaft
  • painful subluxation of the ECU over the transected end of the ulna
  • palmar subluxation or ulnar translation of the carpi
  • radio-ulnar impingement