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1

LIST THE THREE MOST COMMON PEDIATRIC AVULSION FRACTURES IN THE PELVIS/FEMUR

•    Sartorius from ASIS
•    Iliopsoas from LT
•    Hamstrings from ischium (only one that may cause symptoms after healing)

 

 

 

Skaggs - Staying out of trouble

2

METHODS TO MEASURE PATELLA HEIGHT

    Insall-Salvati         0.8-1.2
    Blackbourne-Peel Ratio     0.5-1.0
    Canton-Deschamps    0.6-1.3
    Plateau-Patella angle    20-30 degrees is normal
    Blumensaats line should intersect inferior pole of patella at      30 degrees of flexion

 

3

BONY BANKART - HOW ARE YOU GOING TO TREAT THE FOLLOWING LESIONS IN A 25 YR OLD (FOLLOWING THE BOORMAN DOGMA OF SOFT TISSUE FOR SOFT TISSUE AND BONE FOR BONE)?

•    Attempt at ORIF 
•    then I would do a Latarjet

 

4

DESCRIBE ANATOMICALLY HOW YOU WILL PLACE YOU TUNNELS FOR ACL RECONSTRUCTION

•    For a single bundle ACL recon, going from center of origin to center of insertion (anatomic)
•    Femoral: 
-    center of femoral ACL origin is 1.7mm proximal (posterior on scope) to bifurcate ridge and 6.1mm posterior to intercondylar ridge (inferior on scope)
-    to confirm this position, also ensure its ~8.5mm anterior to the posterior cartilage and between 11-8 o' clock 

•    Tibia:
-    center of tibial insertion is 7.5mm medial to anterior horn of lateral meniscus, 7.9mm lateral to medial plateau cartilage, and 13mm anterior to the retroeminence ridge
-    radiographically tunnel centered in AP direction at 41% from anterior and 47% from medial

5

What are 7 ways to optimize conditions in distraction Osteogenensis?

  • Low energy osteotomy
  • Minimal soft tissue stripping at corticotomy
  • Stable external fixation
  • Latency period 5-7 days
  • Distraction at 1 mm/day divided into 4
  • Neutral fixation interval - consolidation
  • Normal physiologic use of the extremity during the process

Miller's page 17

6

List 4 Risk Factors for Mortality after Hip Fracture

  • Advanced age
  • Male
  • Poor cognitive function
  • > 3 medical comorbidities (when not actively medically optimizing)
  • > 48 hrs until treatment

Miller's

7

WHAT ARE THE 17 MUSCLES ATTACHED TO THE SCAPULA?

Serratus Anterior

Supraspinatus

Subscapularis

Trapezius

Teres Major

Teres Minor

Triceps Brachii long head

Biceps Brachii

Rhomboid Major

Rhomboid Minor

Coracobrachialis

Omohyoid inferior belly

Lattisimus Dorsi

Deltoid

Levator Scapula

Infraspinatus

Pectoralis Minor

 

8

What is the. Safe zone for acetabular screw placement and what structures are at risk in each zone?

Postero superior (safe)

Sciatic nerve

superior gluteal vessels

 

posteroinferior

sciatic nerve

inferior gluteal  artery and nerve

internal pudendal nerve and vessel

use screw <20mm, then safe

 

antero-inferior (Unsafe - danger zone)

obturator nerve, artery and vein (artery most at risk)

 

anteo-superior (Unsafe - death zone)

external iliac vessels ( vein most at risk)

 

9

WHAT ARE 3 CRITERIA TO DIAGNOSE POST RADIATION SARCOMA?

-    The histological features of the original lesion and PRS are completely different.
-    PRS is located within the field of irradiation.

-    Patients with cancer syndromes such as Li-Fraumeni and Rothmund-Thomson are excluded.
-    The latent period (period between initiation of radiotherapy and histologic diagnosis of second neoplasm) is more than 5 years. 


Manny's notes

 

 

10

Regarding Patellar Clunk Syndrome

  • What type of TKR'S are affected?
  • What causes it?
  • In what degree of flexion does it occur?
  • What is the treatment?

  • PS
  • Fibrous tissue posterior to the quads above the superior pole of the patella catches in the box when the knee flexes/extends.
  • 30-45 degrees
  • arthroscopic or open debridement

11

LIST 6 SARCOMAS THAT METASTASIZE TO LYMPH NODES

SCREAM
•    Synovial cell
•    Clear Cell Sarcoma
•    Rhabdomyosarcoma
•    Epitheloid
•    Angiosarcoma
•    Myxoid liposacoma


From Mike's notes

12

MDI - HOW ARE YOU GOING TO TREAT THE FOLLOWING LESIONS IN A 25 YR OLD (FOLLOWING THE BOORMAN DOGMA OF SOFT TISSUE FOR SOFT TISSUE AND BONE FOR BONE)?

•    Non-op x 1 
•    then arthroscopic bankart repair using suture anchor construct

 

13

What 5 Factors can Contribute to Catastrophic Wear in TKA?

  • PE thickness (>=8mm is better)
  • Articular geometry (flatter = worse)
  • PE sterilization (oxygen environment = worse)
  • PE machining (compression molding = better)
  • Sagittal plane kinematics (sliding = worse)

14

COMPLICATIONS OF MENISCAL REPAIR

    Saphenous neuropathy (7%)
    Arthrofibrosis (6%)
    Effusion (2%)
    Peroneal neuropathy (1%)
    Infection (1%)

 

15

WHAT IS THE BEST LABORATORY TEST TO "RULE IN" INFECTION AND WHAT IS THE BEST TEST TO "RULE OUT" INFECTION?

•    Neutropenia (WBC < 5000) in a newborn is best to rule infection
•    CRP is best to rule out infection

 

16

LIST SIX SIGNS/SYMPTOMS OF HYPERCALCEMIA


•    Polyuria
•    Polydypsia
•    Renal stones/flank pain
•    Osteitis fibrous cystica
•    Altered CNS function (marty does not like points)
•    Anorexia
•    Nausea
•    Vomitting
•    Constipation
•    Weakness

 

17

LIST THREE BLOCKS TO REDUCTION OF A PEDIATRIC PROXIMAL HUMERUS FRACTURE


•    Periosteum
•    joint capsule
•    Long head of biceps tendon

 


Rockwood and Wilkins 7th ed p650

 

18

LIST 6 MINIMALLY INVASIVE TECHNIQUES TO REDUCE A PEDIATRIC RADIAL NECK FRACTURE

Closed reduction Techniques
o    Patterson’s Technique: traction with forearm in supination and apply a varus force and manipulate the fragment with a thumb.
o    Israeli technique:  Flex the arm to 90 degrees in supination and put a thumb on the radial head. Pronate the arm and push the RH back in. If the patient can achieve 60 pro and 60 sup, it is a success.
o    Esmarch Bandage (Chambers technique):  wrap the extremity tightly from distal to proximal.
Percutaneous Reductions
o    Perc pin:  Single perc Steinmann pin as close to the lateral border of the olecranon as possible.
o    Wallace Method: Periosteal elevator plated perc down the lateral border of the olecranon. Lever the distal fragment laterally and the proximal fragment medially with a thumb. Can hold the reduction if unstable with a perc K wire.
o    Metaizeau: Percutaneous bent intramedullary rod from radial styloid proximally. Hook the displaced radial head and rotate it into position.

 

19

List 10 Radiographic Findings with Achondroplasia

  • Foramen magnum stenosis
  • TI kyphosis
  • Lumbar stenosis
  • Short pedicles
  • Decreased intra-pedicular distance
  • Genu varum
  • Coxa vara
  • Champagne pelvis
  • Trident hands
  • Frontal bossing
  • Button nose
  • Normal intelligence
  • Hypotonia

20

  1. HOW LONG DO YOU BRACE POST PONSETTI TREATMENT?
  2. WHAT IS THE SUCCESS RATE WITH VIGILANT FOLLOW-UP AND BRACING?
  3. WHAT IS THE RECURRENCE RATE IF NOT VIGILANT?
  4. PIRANI SCORE?

  1. •    continuous for 3 mos, •    Then 14-16 hours per day until 3-4 yrs
  2. >    90 %
  3. 80%

  4. -    Midfoot
    o    Curved lateral border
    o    Lateral head of talus
    o    Medial crease
    -    Hindfoot

    o    Empty heel
    o    Posterior heel crease
    o    Rigid equinus

 

21

LIST 5 PREDICTORS OF HUMERAL HEAD ISCHEMIA FOLLOWING FRACTURE

•    Less than 8 mm metaphyseal extension attached to humeral head
•    Anatomic neck fracture
•    Medial hinge disruption > 2mm
•    4 pt fracture
•    More than 45 deg angular displacment of humeral head
    10 mm displacement of a tuberosity
•    Glenohumeral fracture dislocation
•    3 pt fracture
•    Head splitting fracture


Mo's book p361

 

22

List 4 Techniques to Dislocate the Hip in a THA Patient with Protrusio

  • Liberal capsular release
  • In-situ neck cut
  • Extended trochanteric osteotomy/gt osteotomy
  • Resect a small portion of the medial wall

 

 

ref: I think I got if from Campbell's

23

FACTORS ASSOCIATED WITH POSITIVE OUTCOMES WITH PHYSEAL BAR RESECTION

-    Younger presentation
-    Smaller the bridge
-    Smaller the deformity
-    Central bridge
-    Shorter the time interval between injury and surgery

 

Meningococcal septicemia do worse

 

24

WHAT ARE THE HONEY BADGERS 4 SOFT TISSUE MASSES THAT REQUIRE CHEMOTHERAPY

 

RSSD
-    Rhabdomyosarcoma
-    Synovial Cell Sarcoma
-    Soft tissue Osteosarcoma (MFH), Soft tissue Ewings
-    De-differentiated or Mesenchymal Chondrosarcoma

 

25

LIST 5 SIGNS OF IATROGENIC AVN IN DDH TREATMENT

Salter classification of AVN (5 signs)

•    Failure of appearance of ossific nucleus of femoral head during one yr or longer after reduction
•    Failure of growth of an existing ossific nucleus during one year or longer after reduction
•    Broadening of the femoral neck within one year after reduction
•    Increased radiographic bone density followed by fragmentation of the femoral head
•    Residual deformity of the femoral head and neck when reossification (resolution) is complete
o    These deformities include coxa plana, coxa magna, coxa vara, short broad femoral neck


•    Chief notes

26

WHAT ARE THE DIAGNOSTIC CRITERIA FOR FAT EMBOLISM SYNDROME?

Gurd and Wilson Criteria: Needs at least one major and 4 minor criteria
•    Major
  o    Petechiae in a vest distribution
  o    Hypoxemia with PaO2<60 mmhg and FiO2<0.4
  o    CNS depression disproportionate to hypoxemia
  o    Pulmonary edema
•    Minor
  o    Tachycardia (>110 bpm)
  o    Pyrexia (>38.5)
  o    Fat emboli visible in retina
  o    Fat in urine
  o    Fat in sputum
  o    Unexplained drop in HCT or PLT count
  o    Increasing ESR
Ref: Gurd and Wilson

27

POSTERIOR TIBIAL TENDON DYSFUNCTION CLASSIFICATION


-    Stage 1: 
o    able to perform straight toe raise 
o    tenosynovitis without deformity
o    No x-ray changes
-    Stage 2:
o    A: 
    unable to perform single leg heel rise. 
    Flexible Hindfoot
    <30% TN uncoverage on X-ray
o    B:
    unable to perform single leg heel rise. 
    Flexible Hindfoot
    Too many toes sign clinically
    >30% TN uncoverage 
-    Stage 3:
o    unable to perform single leg heel rise
o    Rigid hind and forefoot deformity
o    Degenerative changes subtalar joint
-    Stage 4:
o    3 + deltoid compromise (lateral tilt ankle)

 

28

LIST 5 INDICATIONS TO OPERATE ON A SCAPULA FRACTURE

•    Open fracture
•    25% glenoid involvement with humeral instability
•    5 mm glenoid articular surface step-off or major gap
•    Extensive medialization of glenoid
•    Displaced scapular neck fracture > 40 deg of angulation or 1 cm translation
•    Glenopolar angle <20
•    Coracoid displace > 1cm7

(Chart here I could not copy)

GPA = Angle measured between a line connecting the most cranial with the most caudal point of the glenoid cavity (white line)and a line connecting the most cranial point of the glenoid cavity with the most caudal point of the scapular body (black line).
The GPA measures the obliquity of the glenoid articular surface in relation to the scapular body.
Normal is 30° to 45°

 

 

 

29

Name 3 Indications for Revision for Metal on Metal Hips (COA 2011)

  • Painful hips with MRI showing a soft tissue mass and high blood cobalt (>7ppb)
  • Painful hips with +MRI and normal Cobalt levels
  • Soft tissue mass increasing in size with or without high blood levels

 

Rising levels on their own are an indication for follow-up, not revision.

Jer's notes ...(and COA update)

 

30

REVERSE BANKART IN POSTERIOR INSTABILITY - HOW ARE YOU GOING TO TREAT THE FOLLOWING LESIONS IN A 25 YR OLD (FOLLOWING THE BOORMAN DOGMA OF SOFT TISSUE FOR SOFT TISSUE AND BONE FOR BONE)?

•    reverse Bankart repair