[PDF 1] Miller's Review Testable Concepts
[PDF 1] Miller's Review - Anki Q&A Cards
Anki-style cards generated from [PDF 1], Miller's Review of Orthopaedics Testable Concepts. Click Show answer on each card. Source page numbers refer to the supplied PDF.
Cards are organised by Miller's original section and subsection headings. Verify clinical decisions against current guidelines and local protocols.
source p. 1
I. Bone#
QuestionWhat does Haversian canals carry?
AnswerHaversian canals carry nerves and blood vessels longitudinally in bone, and Volkmann canals connect different Haversian canals.
Source: PDF 1, p. 1
Cellular biology#
QuestionWhat are Osteoblasts?
AnswerOsteoblasts are derived from undifferentiated MSCs
Source: PDF 1, p. 1
QuestionWhat is Core binding factor alpha-1/RUNX2?
AnswerCore binding factor alpha-1/RUNX2 is the multifunctional transcription factor that directs this process.
Source: PDF 1, p. 1
QuestionWhat are Wnt/Beta-catenin (B-catenin) pathways?
AnswerWnt/Beta-catenin (B-catenin) pathways are involved in osteoblast differentiation.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Stable B-catenin major role in inducing cells to?
AnswerStable B-catenin major role in inducing cells to form osteoblasts
Source: PDF 1, p. 1
QuestionWhat does Sclerostin and Dkk-1 inhibit?
AnswerSclerostin and Dkk-1 inhibit binding of the Wnt molecule to LRP5/6.
Source: PDF 1, p. 1
QuestionWhat do Inhibition of sclerostin or Dkk-1 will lead to?
AnswerInhibition of sclerostin or Dkk-1 will lead to increased bone mass.
Source: PDF 1, p. 1
QuestionWhat does BMPs work through SMAD to cause?
AnswerBMPs work through SMAD to cause osteoblastic differentiation.
Source: PDF 1, p. 1
QuestionWhat does Osteoblasts produce?
AnswerOsteoblasts produce type I collagen (i.e., bone), alkaline phosphatase, osteocalcin, osteonectin, osteoprotegerin (OPG), bone sialoprotein, and RANKL.
Source: PDF 1, p. 1
QuestionWhat are Osteocytes?
AnswerOsteocytes are former osteoblasts surrounded by newly formed matrix. They are important for control of extracellular calcium and phosphorous concentration and are less active in matrix production than osteoblasts.
Source: PDF 1, p. 1
QuestionWhat are Osteoclasts?
AnswerOsteoclasts are derived from myeloid hematopoietic cells in the monocyte/macrophage lineage. RANKL is produced by osteoblasts, binds to immature osteoclasts, and stimulates differentiation into active, mature osteoclasts that increase bone resorption. OPG inhibits bone resorption by binding and inactivating RANKL.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Calcitonin, estrogen, transforming growth factor beta (TGF beta)?
AnswerCalcitonin, estrogen, transforming growth factor beta (TGF beta), and interleukin also inhibit osteoclast production.
Source: PDF 1, p. 1
QuestionWhat is Denosumab?
AnswerDenosumab is a monoclonal antibody that targets and inhibits binding of RANKL to the RANK receptor found on osteoclasts.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Osteoclasts bind to bone surfaces utilizing integrins (vitronectin?
AnswerOsteoclasts bind to bone surfaces utilizing integrins (vitronectin receptor), effectively sealing the space below and creating a ruffled border (Howship lacunae).
Source: PDF 1, p. 1
QuestionWhat is Bone matrix?
AnswerBone matrix is removed by proteolytic digestion through the lysosomal enzyme cathepsin K.
Source: PDF 1, p. 1
QuestionWhat are Bisphosphonates directly inhibit osteoclastic bone resorption. Nitrogen-containing bisphosphonates?
AnswerBisphosphonates directly inhibit osteoclastic bone resorption. Nitrogen-containing bisphosphonates are up to 1000-fold more potent than nonenitrogen-containing bisphosphonates. Bisphosphonates function by inhibiting farnesyl pyrophosphate synthase in the mevalonate pathway. They are associated with osteonecrosis of the jaw, and in animal models, they have reduced the rate of spinal fusion.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Bone matrix comprises 60% inorganic (mineral) and 40%?
AnswerBone matrix comprises 60% inorganic (mineral) and 40% organic components. Calcium hydroxyapatite Ca10(PO4)6(OH)2 constitutes the majority of the inorganic matrix. Type I collagen is 90% of the organic component, and osteocalcin is the most abundant noncollagenous protein in bone.
Source: PDF 1, p. 1
QuestionWhat is Wolff’s law?
AnswerWolff’s law: Remodeling occurs in response to mechanical stress. Hueter-Volkmann law: Compressive forces inhibit growth, whereas tension stimulates it.
Source: PDF 1, p. 1
QuestionWhat are three major types of bone formation.?
AnswerThere are three major types of bone formation.
Source: PDF 1, p. 1
QuestionWhat does Endochondral formation occur?
AnswerEndochondral formation occurs with a cartilage model. Bone replaces cartilage.
Source: PDF 1, p. 1
QuestionWhat does Iiiintramembranous formation occur?
AnswerIiintramembranous formation occurs without a cartilage model. Aggregates of undifferentiated mesenchymal differentiate into osteoblasts, which form bone.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Appositional formation increases bone diameter when osteoblasts lay?
AnswerAppositional formation increases bone diameter when osteoblasts lay down new bone on existing bone. The groove of Ranvier supplies the chondrocytes.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Fracture stability and degree of strain determine the?
AnswerFracture stability and degree of strain determine the type of healing. Fracture healing type varies with treatment method.
Source: PDF 1, p. 1
QuestionWhat does Primary bone healing occur?
AnswerPrimary bone healing occurs via Haversian remodeling.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Absolute stability compression plate?
AnswerAbsolute stability compression plate
Source: PDF 1, p. 1
QuestionWhat is Ssssecondary bone healing occurs in three stages?
AnswerSssecondary bone healing occurs in three stages: inflammation, repair, and remodeling.
Source: PDF 1, p. 1
QuestionWhat do In closed treatment, healing occur?
AnswerIn closed treatment, healing occurs through periosteal bridging callus and interfragmentary endochondral ossification.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Nonrigid fixation casting, external fixation, intramedullary (IM) nailing?
AnswerNonrigid fixation casting, external fixation, intramedullary (IM) nailing
Source: PDF 1, p. 1
QuestionWhat is BMP-2?
AnswerBMP-2 is used for acute open tibia fractures; BMP-7 is used for tibial nonunions. BMP-3 has no ooosteogenic activity.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: NSAIDs adversely affect healing of fractures as well?
AnswerNSAIDs adversely affect healing of fractures as well as of lumbar spinal fusions. Cyclooxygenase-2 (COX-2) activity is required for normal endochondral ossification during fracture healing.
Source: PDF 1, p. 1
Bone grafts have three properties#
QuestionIn I. Bone, what should you remember about: Osteoconductivedacts as a scaffold for bone growth; demineralized?
AnswerOsteoconductivedacts as a scaffold for bone growth; demineralized bone matrices (DBMs)
Source: PDF 1, p. 1
QuestionWhat do Oosteoinstructive growth factors that stimulate?
AnswerOosteoinstructive growth factors that stimulate bone formation; BMP
Source: PDF 1, p. 1
QuestionWhat do Oooosteogenic cells that will produce?
AnswerOoosteogenic cells that will produce bone; primitive mesenchymal cells, osteoblasts, and osteocytes
Source: PDF 1, p. 1
QuestionWhat are Calcium phosphate-based grafts?
AnswerCalcium phosphate-based grafts are capable of osteoconduction and osteointegration. They have the highest compressive strength of any graft material. Calcium sulfate is osteoconductive but rapidly resorbed.
Source: PDF 1, p. 1
QuestionWhat is Resorption rates?
AnswerResorption rates: calcium sulfate > tricalcium phosphate > hydroxyapatite
Source: PDF 1, p. 1
QuestionWhat are primary homeostatic regulators of serum calcium?
AnswerThe primary homeostatic regulators of serum calcium are PTH and
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Bone mass peaks between 16 and 25 years?
AnswerBone mass peaks between 16 and 25 years of age. Physiologic bone loss affects trabecular bone more than cortical bone.
Source: PDF 1, p. 1
QuestionWhat is Both urinary hydroxyproline and pyridinoline cross-links are elevated when there?
AnswerBoth urinary hydroxyproline and pyridinoline cross-links are elevated when there is bone resorption.
Source: PDF 1, p. 1
QuestionIn I. Bone, what should you remember about: Serum alkaline phosphatase increases when bone formation increases.?
AnswerSerum alkaline phosphatase increases when bone formation increases.
Source: PDF 1, p. 1
QuestionWhat is most common cause of hypercalcemia?
AnswerThe most common cause of hypercalcemia is malignancy. Initial treatment is hydration, which causes saline diuresis, along with loop diuretics.
Source: PDF 1, p. 1
QuestionWhat is Renal osteodystrophy?
AnswerRenal osteodystrophy is a spectrum of disorders observed in chronic renal disease. The majority of cases are caused by phosphorous retention and sssecondary hyperparathyroidism.
Source: PDF 1, p. 1
QuestionWhat are Rickets (in children) and osteomalacia (in adults)?
AnswerRickets (in children) and osteomalacia (in adults) are caused by a failure of mineralization. In rickets, the width of the zone of provisional calcification is increased, which causes physeal widening and cupping.
Source: PDF 1, p. 1
QuestionWhat is Premature arrest following growth plate injury?
AnswerPremature arrest following growth plate injury is attributed to vascular invasion across the physis.
Source: PDF 1, p. 1
QuestionWhat is Osteoporosis?
AnswerOsteoporosis is a quantitative defect in bone. It is defined as a lumbar bone density of 2.5 or more standard deviations less than the peak bone mass of a healthy 25-year-old (T-score).
Source: PDF 1, p. 1
QuestionWhat do Loss of function of the OPG gene results in?
AnswerLoss of function of the OPG gene results in osteoporosis.
Source: PDF 1, p. 1
QuestionWhat does Treatment of osteoporosis include?
AnswerTreatment of osteoporosis includes calcium supplements of
Source: PDF 1, p. 1
QuestionWhat does Scurvy results from ascorbic acid deficiency, which cause?
AnswerScurvy results from ascorbic acid deficiency, which causes a decrease in chondroitin sulfate synthesis and, ultimately, defective collagen growth and repair. Widening in the zone of provisional calcification is observed. Basic Sciences 93
Source: PDF 1, p. 1
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QuestionWhat is Oooosteogenesis imperfecta?
AnswerOoosteogenesis imperfecta is caused primarily by a mutation in genes responsible for metabolism and synthesis of collagen type I. II Cartilage and Joint
Source: PDF 1, p. 2
QuestionWhat is Cartilage?
AnswerCartilage is viscoelastic (properties vary depending on rate of force application).
Source: PDF 1, p. 2
QuestionWhat is Composed of water (75%) > collagen (25% wet weight, 90%e95%?
AnswerComposed of water (75%) > collagen (25% wet weight, 90%e95% is type II) > proteoglycans (10% wet weight) > noncollagenous protein > cells
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Collagen contributes to viscoelastic behavior by restraining?
AnswerCollagen contributes to viscoelastic behavior by restraining
Source: PDF 1, p. 2
QuestionWhat is Aggrecan?
AnswerAggrecan is the most common proteoglycan.
Source: PDF 1, p. 2
QuestionWhat is Increases osmotic pressure and?
AnswerIncreases osmotic pressure and is responsible for ECM’s hydrophilic behavior
Source: PDF 1, p. 2
QuestionWhat are Chondrocytes?
AnswerChondrocytes are the only cell in cartilage.
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: BMP-2 and the transcriptional factor SOX-9 important in?
AnswerBMP-2 and the transcriptional factor SOX-9 important in regulating differentiation and formation.
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Have cilia that serve as mechanosensory organs or?
AnswerHave cilia that serve as mechanosensory organs or “antennae.”
Source: PDF 1, p. 2
Articular (hyaline) cartilage layers#
QuestionWhat does Zone 1 (superficial) has?
AnswerZone 1 (superficial) has highest concentration of collagen and lowest of PG.
Source: PDF 1, p. 2
QuestionWhat does Zone 2 (middle or transition) has?
AnswerZone 2 (middle or transition) has high levels of PG and water
Source: PDF 1, p. 2
QuestionWhat does Zone 3 (deep) has?
AnswerZone 3 (deep) has highest concentration of PG
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Zone 4 (calcified cartilage) contains type X collagen?
AnswerZone 4 (calcified cartilage) contains type X collagen
Source: PDF 1, p. 2
Growth factors#
QuestionWhat does IL-1 stimulate?
AnswerIL-1 stimulates MMP, COX-2, and nitric oxide synthetase, which degrades cartilage
Source: PDF 1, p. 2
QuestionWhat does TGF-b stimulate?
AnswerTGF-b stimulates synthesis of ECM and decreased activity of IL-
Source: PDF 1, p. 2
Mechanical Stress Response#
QuestionWhat is Physiologic loading?
AnswerPhysiologic loading is chondroprotective
Source: PDF 1, p. 2
QuestionWhat does Physiologic stress stimulate?
AnswerPhysiologic stress stimulates matrix synthesis
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Excess stress promotes chondrolysis?
AnswerExcess stress promotes chondrolysis
Source: PDF 1, p. 2
QuestionWhat do Both strenuous loading and underloading lead to?
AnswerBoth strenuous loading and underloading lead to cartilage thinning and proteoglycan loss
Source: PDF 1, p. 2
Changes with aging#
QuestionIn Testable concepts, what should you remember about: Fewer chondrocytes but larger?
AnswerFewer chondrocytes but larger
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Decreased chondroitin but increased keratin?
AnswerDecreased chondroitin but increased keratin
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Smaller PG molecules (less able to hold water?
AnswerSmaller PG molecules (less able to hold water / decreased compressive strength)
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Increased advanced glycosylation end products?
AnswerIncreased advanced glycosylation end products
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Increased stiffness (modulus of elasticity)?
AnswerIncreased stiffness (modulus of elasticity)
Source: PDF 1, p. 2
Changes with arthritis#
QuestionIn Testable concepts, what should you remember about: Decreased keratin but increased chondroitin/keratan ratio?
AnswerDecreased keratin but increased chondroitin/keratan ratio
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Increased water content and permeability initially followed by?
AnswerIncreased water content and permeability initially followed by decreased water content in later stages
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Decreased stiffness (modulus of elasticity)?
AnswerDecreased stiffness (modulus of elasticity)
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Osteophyte formation due to pathologic activation of endochondral?
AnswerOsteophyte formation due to pathologic activation of endochondral ossification by periarticular chondrocytes through Indian hedgehog (Ihh) mechanism
Source: PDF 1, p. 2
QuestionWhat is Lubricin?
AnswerLubricin is a mucinous glycoprotein that binds to hyaluronic acid and contributes to boundary lubrication.
Source: PDF 1, p. 2
QuestionWhat is Major mode of lubrication in joints?
AnswerMajor mode of lubrication in joints is elastohydrodynamic (lubricant pressure causes elastic deformation of the opposing surfaces, which increases conformity).
Source: PDF 1, p. 2
Rheumatoid arthritis#
QuestionWhat is Rheumatoid factor?
AnswerRheumatoid factor is antibody (IgM) against the Fc portion of IgG
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Anti-CCP test more sensitive and specific, and presence?
AnswerAnti-CCP test more sensitive and specific, and presence of antibodies linked to aggressive disease
Source: PDF 1, p. 2
DMARDs#
QuestionWhat is Target TNF-a?
AnswerTarget TNF-a: etanercept, infliximab, adalimumab
Source: PDF 1, p. 2
QuestionWhat is Target IL-1?
AnswerTarget IL-1: anakinra
Source: PDF 1, p. 2
QuestionWhat is Target CD20?
AnswerTarget CD20: rituximab
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Risks of opportunistic infection and lymphoma?
AnswerRisks of opportunistic infection and lymphoma
Source: PDF 1, p. 2
Crystalline arthropathies#
QuestionWhat is Gout?
AnswerGout: monosodium urate (strongly negatively birefringent, needle-shaped crystals)
Source: PDF 1, p. 2
QuestionWhat is Pseudogout?
AnswerPseudogout: calcium pyrophosphate dehydrate (CPP) (weakly positive birefringent, rhomboid-shaped crystals) III Muscle
Source: PDF 1, p. 2
QuestionWhat does A-band represent?
AnswerA-band represents thick filaments composed of myosin.
Source: PDF 1, p. 2
QuestionWhat does I-band represent?
AnswerI-band represents thin filaments composed of actin.
Source: PDF 1, p. 2
QuestionWhat does Z-disk represent?
AnswerZ-disk represents the terminus of sarcomere.
Source: PDF 1, p. 2
QuestionWhat is Motor unit?
AnswerMotor unit is composed of the a-motoneuron and the myofibers it innervates.
Source: PDF 1, p. 2
Contraction#
QuestionIn Testable concepts, what should you remember about: ACh diffuses across the synaptic cleft and binds?
AnswerACh diffuses across the synaptic cleft and binds to postsynaptic receptors on sarcolemma, which begin depolarization.
Source: PDF 1, p. 2
QuestionWhat is Masthenia gravis?
AnswerMasthenia gravis is due to IgG antibodies to the ACh receptor. Manifests initially as ptosis and diplopia. Weakness worse with use.
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Botulinum A reduces spasticity by blocking presynaptic acetylcholine?
AnswerBotulinum A reduces spasticity by blocking presynaptic acetylcholine release.
Source: PDF 1, p. 2
QuestionWhat do Following muscle injury, TGF-b stimulate?
AnswerFollowing muscle injury, TGF-b stimulates proliferation of myofibroblasts and increases fibrosis.
Source: PDF 1, p. 2
QuestionWhat is Delayed-onset muscle soreness?
AnswerDelayed-onset muscle soreness is more common after eccentric exercises and may be associated with changes in I-band. IV Tendon
Source: PDF 1, p. 2
QuestionWhat is Composed of water (50%e60%), collagen (75% dry weight, 95%?
AnswerComposed of water (50%e60%), collagen (75% dry weight, 95% is type I), PG, and elastin.
Source: PDF 1, p. 2
QuestionWhat is Elastin?
AnswerElastin is a highly elastic protein responsible for the “toe region” of stress-strain curve.
Source: PDF 1, p. 2
QuestionWhat is Decorin?
AnswerDecorin is the most predominant PG, regulates fibril diameter, and inhibits TGF-b1.
Source: PDF 1, p. 2
QuestionWhat does Sheathed tendons have?
AnswerSheathed tendons have vincula (extensions of synovium), which carry blood supply.
Source: PDF 1, p. 2
QuestionWhat is Note?
AnswerNote: Both the FDS and FDP tendons have 2 vincula
Source: PDF 1, p. 2
QuestionWhat is Following injury, the inflammatory stage?
AnswerFollowing injury, the inflammatory stage is the weakest stage of repair and is characterized by production of collagen type III.
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Tendon enthesis responsible for nociception.?
AnswerTendon enthesis responsible for nociception.
Source: PDF 1, p. 2
QuestionIn Testable concepts, what should you remember about: Strong in tension, less viscoelastic than ligaments.?
AnswerStrong in tension, less viscoelastic than ligaments.
Source: PDF 1, p. 2
V. Ligament#
QuestionIn V. Ligament, what should you remember about: Similar in composition to tendon but (1) more?
AnswerSimilar in composition to tendon but (1) more water, (2) less total collagen but more type III, and (3) higher PG content.
Source: PDF 1, p. 2
QuestionWhat do Following injury, healing ligament demonstrate?
AnswerFollowing injury, healing ligament demonstrates increased collagen fibers but fewer mature cross-links at 1 year.
Source: PDF 1, p. 2
QuestionWhat does Like tendons, ligaments have?
AnswerLike tendons, ligaments have direct or indirect (Sharpey fibers) insertions. VI Neural Tissue and Iiintervertebral Disc
Source: PDF 1, p. 2
QuestionWhat is Myelin sheath?
AnswerMyelin sheath is composed of galactocerebroside and speeds wave propagation (thicker sheath increases speed).
Source: PDF 1, p. 2
QuestionIn V. Ligament, what should you remember about: Action potential created when neurotransmitters cross synapse and?
AnswerAction potential created when neurotransmitters cross synapse and trigger voltage-gated Naþ channels.
Source: PDF 1, p. 2
Iintervertebral disc#
QuestionWhat does Nucleus pulposus derived from notochord and has?
AnswerNucleus pulposus derived from notochord and has a high concentration of proteoglycan
Source: PDF 1, p. 2
QuestionIn V. Ligament, what should you remember about: Annulus fibrosis derived from mesoderm?
AnswerAnnulus fibrosis derived from mesoderm
Source: PDF 1, p. 2
QuestionIn V. Ligament, what should you remember about: Avascular; nutrients and fluid diffuse from vertebral end?
AnswerAvascular; nutrients and fluid diffuse from vertebral end plates
Source: PDF 1, p. 2
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QuestionWhat is Early degenerative disc disease?
AnswerEarly degenerative disc disease is an irreversible process, with IL-
Source: PDF 1, p. 3
QuestionWhat does Aging disc has?
AnswerAging disc has decreased water content because of fewer large PGs.
Source: PDF 1, p. 3
QuestionIn Testable concepts, what should you remember about: Fibronectin cleavage and fragmentation associated with degeneration?
AnswerFibronectin cleavage and fragmentation associated with degeneration
Source: PDF 1, p. 3
I. Cellular and Molecular Biology#
QuestionWhat are Antibodies against nuclear content (ANAs)?
AnswerAntibodies against nuclear content (ANAs) are implicated in several conditions, including scleroderma (scl-70) and CREST syndrome.
Source: PDF 1, p. 3
QuestionWhat does Alterations in ploidy occur?
AnswerAlterations in ploidy occur during mitosis and gametogenesis, resulting in conditions such as trisomy-21.
Source: PDF 1, p. 3
QuestionWhat are Marfan syndrome and malignant hyperthermia?
AnswerMarfan syndrome and malignant hyperthermia are examples of disorders with autosomal dominant inheritance.
Source: PDF 1, p. 3
QuestionWhat is DDDDuchenne muscular dystrophy?
AnswerDDDuchenne muscular dystrophy is an example of a disorder with Xlinked recessive inheritance.
Source: PDF 1, p. 3
QuestionWhat is Fluorescent in situ hybridization?
AnswerFluorescent in situ hybridization is used to examine chromosomes for translocations predictable of diseases, including:
Source: PDF 1, p. 3
QuestionWhat is t(X;18)?
Answert(X;18): synovial sarcoma
Source: PDF 1, p. 3
QuestionWhat is t(11;22)?
Answert(11;22): in Ewing sarcoma
Source: PDF 1, p. 3
QuestionWhat is t(12;22)?
Answert(12;22): in clear cell sarcoma
Source: PDF 1, p. 3
QuestionWhat is Bacterial lipopolysaccharide?
AnswerBacterial lipopolysaccharide is recognized by TLRs on innate immune system cells.
Source: PDF 1, p. 3
QuestionWhat is Adaptive immunity?
AnswerAdaptive immunity is conferred with the production of antibodies.
Source: PDF 1, p. 3
QuestionWhat do Cell-mediated hypersensitivity (type IV) cause?
AnswerCell-mediated hypersensitivity (type IV) causes reaction to ooorthopaedic implants. II Infection and Microbiology
Source: PDF 1, p. 3
QuestionWhat are Roughly 80% of oooorthopaedic infections?
AnswerRoughly 80% of ooorthopaedic infections are due to Staphylococcus.
Source: PDF 1, p. 3
QuestionWhat is CA-MRSA at-risk groups?
AnswerCA-MRSA at-risk groups: athletes, persons who inject drugs, people experiencing homelessness, military recruits, incarcerated people.
Source: PDF 1, p. 3
QuestionWhat is C-reactive protein?
AnswerC-reactive protein is the most sensitive monitor of the course of infection; it has a short half-life and dissipates about 1 week after effective treatment.
Source: PDF 1, p. 3
QuestionWhat is Necrotizing fasciitis?
AnswerNecrotizing fasciitis is most commonly polymicrobial and associated with diabetes.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Requires early debridement/amputation above level of infection.?
AnswerRequires early debridement/amputation above level of infection.
Source: PDF 1, p. 3
QuestionWhat are Only 100 bacteria?
AnswerOnly 100 bacteria are required to cause infection in the presence of a foreign object; fibronectin increases adhesion, and glycocalyxbiofilm-slime-polysaccharide capsule inhibits phagocytosis.
Source: PDF 1, p. 3
QuestionWhat is Three basic mechanisms of antibiotic resistance have been identified?
AnswerThree basic mechanisms of antibiotic resistance have been identified: avoidance, decreased susceptibility, and inactivation. Biofilm formation is an example of avoidance; the biofilm creates a physical barrier.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Ssssuperantigens like TSS toxin-1 trigger cytokine release from?
AnswerSssuperantigens like TSS toxin-1 trigger cytokine release from T cells.
Source: PDF 1, p. 3
QuestionWhat does Smoking leads to?
AnswerSmoking leads to two to four times more infections/ooosteomyelitis.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Hyperglycemia impairs wound healing and decreases ability to?
AnswerHyperglycemia impairs wound healing and decreases ability to fight infection.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Lyme arthritis can be treated effectively with oral?
AnswerLyme arthritis can be treated effectively with oral antibiotics. Adults can be given amoxicillin, doxycycline, or cefuroxime for 4 weeks.
Source: PDF 1, p. 3
QuestionWhat is Clostridium tetani produces an exotoxin leading to tetanospasm. Td vaccine?
AnswerClostridium tetani produces an exotoxin leading to tetanospasm. Td vaccine is recommended every 10 years.
Source: PDF 1, p. 3
QuestionWhat is Sequestrum?
AnswerSequestrum is the dead bone nidus with surrounding granulation tissue. Involucrum is periosteal new bone formation.
Source: PDF 1, p. 3
QuestionWhat is MRI?
AnswerMRI is the best method to show early ooosteomyelitis but may overestimate the extent of disease.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Kingella kingae can be difficult to culture; PCR?
AnswerKingella kingae can be difficult to culture; PCR should be considered in a toddler with a septic knee.
Source: PDF 1, p. 3
QuestionWhat is Staphylococcus epidermidis?
AnswerStaphylococcus epidermidis is the most common organism in implant-associated infections.
Source: PDF 1, p. 3
QuestionWhat is Antibiotic therapy according to the Gustilo classification of open fractures?
AnswerAntibiotic therapy according to the Gustilo classification of open fractures:
Source: PDF 1, p. 3
QuestionWhat is Gustilo I and II?
AnswerGustilo I and II: first-generation cephalosporins
Source: PDF 1, p. 3
QuestionWhat is Gustilo IIIA?
AnswerGustilo IIIA: first-generation cephalosporin plus an aminoglycoside
Source: PDF 1, p. 3
QuestionWhat is Gustilo IIIB (grossly contaminated)?
AnswerGustilo IIIB (grossly contaminated): first-generation cephalosporin plus aminoglycoside plus penicillin
Source: PDF 1, p. 3
Antibiotics#
QuestionWhat does Aminoglycosides inhibit?
AnswerAminoglycosides inhibit translation through irreversible binding of the 30S ribosomal subunit, inhibiting translation of proteins.
Source: PDF 1, p. 3
QuestionWhat does Cephalosporins inhibit?
AnswerCephalosporins inhibit cell wall production by preventing peptidoglycan cross-linkage.
Source: PDF 1, p. 3
QuestionWhat do Glycopeptides, such as vancomycin, inhibit?
AnswerGlycopeptides, such as vancomycin, inhibit cell wall production by interfering with the addition of cell wall subunits.
Source: PDF 1, p. 3
QuestionWhat does Rifamycin inhibit?
AnswerRifamycin inhibits DNA-dependent RNA polymerase F and displays excellent biofilm penetration. Bacteria develop rapid resistance to rifampin used as monotherapy.
Source: PDF 1, p. 3
QuestionIn I. Cellular and Molecular Biology, what should you remember about: Macrolides, like erythromycin, bind the 50S ribosomal subunits.?
AnswerMacrolides, like erythromycin, bind the 50S ribosomal subunits.
Source: PDF 1, p. 3
QuestionWhat do Fluoroquinolones, such as ciprofloxacin, inhibit?
AnswerFluoroquinolones, such as ciprofloxacin, inhibit DNA gyrase.
Source: PDF 1, p. 3
QuestionWhat do Beta-lactam antibiotics, like penicillin, inhibit?
AnswerBeta-lactam antibiotics, like penicillin, inhibit peptidoglycan synthesis by binding to the bacterial cell membrane surface penicillin-binding proteins.
Source: PDF 1, p. 3
I. Thromboprophylaxis#
QuestionWhat is Virchow triad?
AnswerVirchow triad: endothelial damage, stasis or decreased blood flow, and hypercoagulability.
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Aspirin irreversibly binds and inactivates COX enzyme in?
AnswerAspirin irreversibly binds and inactivates COX enzyme in platelets, reducing thromboxane A2.
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Warfarin can be reversed with fresh frozen plasma?
AnswerWarfarin can be reversed with fresh frozen plasma and vitamin K.
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Heparin and low-molecular-weight heparin act through ATIII and?
AnswerHeparin and low-molecular-weight heparin act through ATIII and can be reversed by protamine sulfate.
Source: PDF 1, p. 3
QuestionWhat is Rivaroxaban?
AnswerRivaroxaban is a direct factor Xa inhibitor.
Source: PDF 1, p. 3
QuestionWhat is Lactate?
AnswerLactate is an indirect marker of tissue hyperperfusion and is the best measure of resuscitation. II Perioperative Disease and Comorbidities
Source: PDF 1, p. 3
QuestionWhat is Ratio of 1?
AnswerRatio of 1:1:1 blood product resuscitation is superior to saline fluid.
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Fat embolism syndrome classical triad 1⁄4 petechial rash?
AnswerFat embolism syndrome classical triad 1⁄4 petechial rash, neurologic symptoms, respiratory decline.
Source: PDF 1, p. 3
QuestionWhat is Malignant hyperthermia?
AnswerMalignant hyperthermia is autosomal dominantly inherited defect in ryanodine receptor.
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Caused by an uncontrolled release of calcium?
AnswerCaused by an uncontrolled release of calcium
Source: PDF 1, p. 3
QuestionIn I. Thromboprophylaxis, what should you remember about: Triggered by volatile anesthetics (and succinylcholine)?
AnswerTriggered by volatile anesthetics (and succinylcholine)
Source: PDF 1, p. 3
QuestionWhat is Early sign?
AnswerEarly sign is increasing end-tidal CO2
Source: PDF 1, p. 3
QuestionWhat is the treatment for Treatment?
AnswerTreatment is 100% O2 and dantrolene (stabilizes sarcoplasmic reticulum)
Source: PDF 1, p. 3
I. Imaging and Special Studies#
Increased radiation exposure associated with#
QuestionIn I. Imaging and Special Studies, what should you remember about: Imaging of larger body parts?
AnswerImaging of larger body parts
Source: PDF 1, p. 3
QuestionIn I. Imaging and Special Studies, what should you remember about: Positioning the eeeextremity closer to the x-source?
AnswerPositioning the eeextremity closer to the x-source
Source: PDF 1, p. 3
QuestionIn I. Imaging and Special Studies, what should you remember about: Use of large C-arm rather than mini C-arm?
AnswerUse of large C-arm rather than mini C-arm
Source: PDF 1, p. 3
QuestionWhat does 3.0 T MRI has?
Answer3.0 T MRI has 9x greater proton energy than 1.5T. Basic Sciences 95
Source: PDF 1, p. 3
source p. 4
QuestionWhat is Work?
AnswerWork is the product of force and the displacement it causes (Joule).
Source: PDF 1, p. 4
QuestionWhat is Energy?
AnswerEnergy is the ability to perform work.
Source: PDF 1, p. 4
QuestionWhat is Potential energy?
AnswerPotential energy is stored
Source: PDF 1, p. 4
QuestionWhat is Kinetic energy is energy caused by motion?
AnswerKinetic energy is energy caused by motion: 1/2 mv2
Source: PDF 1, p. 4
QuestionWhat is Stress?
AnswerStress is the internal resistance of body to a load (force/area).
Source: PDF 1, p. 4
QuestionWhat is Strain?
AnswerStrain is relative measure of deformation 1⁄4 change in length/ original length (no units).
Source: PDF 1, p. 4
QuestionIn Testable concepts, what should you remember about: Young’s modulus of elasticity (E) 1⁄4 stress/strain.?
AnswerYoung’s modulus of elasticity (E) 1⁄4 stress/strain.
Source: PDF 1, p. 4
QuestionIn Testable concepts, what should you remember about: Unique for every material?
AnswerUnique for every material
Source: PDF 1, p. 4
QuestionWhat is High E to low E?
AnswerHigh E to low E: ceramic, cobalt chrome, stainless steel, titanium, cortical bone, PMMA, polyethylene, cancellous bone, tendon/ligament, cartilage
Source: PDF 1, p. 4
QuestionWhat is Viscoelastic materials have a stress-strain behavior that?
AnswerViscoelastic materials have a stress-strain behavior that is time/rate dependent.
Source: PDF 1, p. 4
QuestionWhat are Isotropic materials have mechanical properties that?
AnswerIsotropic materials have mechanical properties that are the same for all directions loaded (golf ball).
Source: PDF 1, p. 4
QuestionWhat does Anisotropic materials have?
AnswerAnisotropic materials have mechanical properties that vary with the direction of the applied load (bone is stronger in axial load than with bending moment).
Source: PDF 1, p. 4
Corrosion#
QuestionWhat are Galvanic corrosion occurs when dissimilar metals?
AnswerGalvanic corrosion occurs when dissimilar metals are in direct contact (cobalt chrome and stainless steel).
Source: PDF 1, p. 4
QuestionWhat does Crevice corrosion occur?
AnswerCrevice corrosion occurs in fatigue cracks with low oxygen tension.
Source: PDF 1, p. 4
QuestionIn Testable concepts, what should you remember about: Fretting corrosion comes from small movements abrading the?
AnswerFretting corrosion comes from small movements abrading the outside layer.
Source: PDF 1, p. 4
QuestionWhat does Stress corrosion occur?
AnswerStress corrosion occurs in areas with high-stress gradients.
Source: PDF 1, p. 4
Joint aarthrodesis#
QuestionWhat is Hip?
AnswerHip: 20e35 degrees of flexion; 0e5 degrees of adduction,
Source: PDF 1, p. 4
QuestionWhat is Knee?
AnswerKnee: 5 degrees of valgus; 0e15 degrees of flexion, 0e10 degrees of external rotation
Source: PDF 1, p. 4
QuestionWhat is Ankle?
AnswerAnkle: 5 degrees of hindfoot valgus; 5e10 degrees of external rotation; neutral dorsiflexion
Source: PDF 1, p. 4
QuestionWhat is Sshoulder?
AnswerSsshoulder: 15e20 degrees of abduction; 20e25 of forward flexion; 40e50 degrees of internal rotation
Source: PDF 1, p. 4
QuestionWhat is Elbow?
AnswerElbow: 90 degrees of flexion, 0e7 degrees of valgus if unilateral; if bilateral, one at 65 degrees and one at 110 degrees
Source: PDF 1, p. 4
QuestionWhat is Wrist?
AnswerWrist: 10e20 degrees of dorsiflexion; if bilateral, the opposite should be in 10 degrees of palmar flexion.
Source: PDF 1, p. 4
source p. 5
QuestionIn Testable concepts, what should you remember about: The mnemonic “SAME” can be used to help?
AnswerThe mnemonic “SAME” can be used to help understand the function of nerves: sensory 1⁄4 afferent; motor 1⁄4 efferent.
Source: PDF 1, p. 5
SECTION 2 UPPER EXTREMITY#
QuestionWhat is Suprascapular notch?
AnswerSuprascapular notch: suprascapular artery passes superior to transverse scapular ligament and suprascapular nerve passes inferior to ligament through notch (mnemonic: “Army over Navy” for artery over nerve).
Source: PDF 1, p. 5
QuestionWhat is Coracoacromial ligament?
AnswerCoracoacromial ligament is the arthroscopic landmark for a complete release of the rotator interval, acromial branch of the thoracoacromial artery runs on medial aspect of the coracoacromial ligament.
Source: PDF 1, p. 5
QuestionWhat do Beware of the anterosuperior glenoid labral variant may cause?
AnswerBeware of the anterosuperior glenoid labral variant may cause loss of external rotation.
Source: PDF 1, p. 5
QuestionWhat is Posterior sternoclavicular ligament?
AnswerPosterior sternoclavicular ligament is the strongest and primary restraint to interoposterior instability.
Source: PDF 1, p. 5
QuestionWhat is Conoid ligament?
AnswerConoid ligament is closest to the chest (45 mm from AC joint), and trapezoid ligament is 25 mm from AC joint.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Radial head should line up with capitellum at?
AnswerRadial head should line up with capitellum at all arm positions in all radiographic views.
Source: PDF 1, p. 5
QuestionWhat is Anterior bundle of ulnar collateral ligament?
AnswerAnterior bundle of ulnar collateral ligament is the most important aspect of the ulnar collateral ligament against valgus stress.
Source: PDF 1, p. 5
QuestionWhere does Ossification of the bones of the wrist begin?
AnswerOssification of the bones of the wrist begins at the capitate (usually present at 1 year of age) and proceeds in a counterclockwise direction, according to posteroanterior radiographs of the right hand.
Source: PDF 1, p. 5
QuestionWhat is Space of Poirier?
AnswerSpace of Poirier: central weak area in floor of carpal tunnel; implicated in volar dislocation of lunate in perilunate dislocation.
Source: PDF 1, p. 5
QuestionWhat is Loss of reduction of the radiocarpal joint?
AnswerLoss of reduction of the radiocarpal joint is usually due to an intraarticular volar fragment attached to the long and short radiolunate ligaments.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: At the level of the wrist, FDS to?
AnswerAt the level of the wrist, FDS to the middle and ring fingers are volar to FDS to index and small fingers.
Source: PDF 1, p. 5
QuestionWhat is Four preclavicular brachial plexus branches?
AnswerFour preclavicular brachial plexus branches: dorsal scapular, long thoracic, suprascapular, and nerve to subclavius. Look for these structures to be involved in preganglionic plexus injuries.
Source: PDF 1, p. 5
QuestionWhat does All minor medial and lateral cord branches have?
AnswerAll minor medial and lateral cord branches have medial or lateral in their names. Posterior cord branches do not.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Innervation of all rotator cuff muscles derived from?
AnswerInnervation of all rotator cuff muscles derived from C5 and C6 of the brachial plexus.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Lateral winging due to spinal accessory nerve injury?
AnswerLateral winging due to spinal accessory nerve injury (cranial nerve XI) usually due to iatrogenic injury from neck surgery; medial winging is long thoracic.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Axillary nerve passes anterior to subscapularis muscle and?
AnswerAxillary nerve passes anterior to subscapularis muscle and inferior to shoulder capsule, traveling from anterior to posterior through quadrangular space. Anterior branch passes around humerus approximately 7 cm distal to acromion.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: PIN splits the supinator and supplies all of?
AnswerPIN splits the supinator and supplies all of the extensor muscles except the mobile wad (brachioradialis, ECRB, ECRL).
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Superficial branch of the radial nerve emerges through?
AnswerSuperficial branch of the radial nerve emerges through antebrachial fascia approximately 6 to 9 cm proximal to the radial styloid. Runs between the brachioradialis and ERCL to supply sensation to the dorsal radial surface distal forearm and hand.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Anterior interosseous nerve branches 4 cm distal to?
AnswerAnterior interosseous nerve branches 4 cm distal to elbow and runs between the FPL and FDP; supplies all the deep flexors except the ulnar half of the FDP. Terminates in the PQ.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Ulnar nerve enters the forearm between the two?
AnswerUlnar nerve enters the forearm between the two heads of the FCU (humeral and ulnar).
Source: PDF 1, p. 5
QuestionWhat does Each part of the axillary artery has?
AnswerEach part of the axillary artery has as many branches as the number of that part (e.g., the second part has two branches: thoracoacromial and lateral thoracic).
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Digital arteries arise from superficial palmar arch and?
AnswerDigital arteries arise from superficial palmar arch and run dorsal to digital nerves.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: During anterior approach to sshoulder, watch out for?
AnswerDuring anterior approach to shoulder, watch out for musculocutaneous nerve piercing deep aspect of conjoint tendon about 5 cm distal to coracoid and axillary nerve traveling through quadrangular space.
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Keep dissection above teres minor during posterior approach?
AnswerKeep dissection above teres minor during posterior approach to shoulder to avoid quadrangular space.
Source: PDF 1, p. 5
QuestionWhat does Brachialis may be split because it has?
AnswerBrachialis may be split because it has dual innervation (radial and musculocutaneous).
Source: PDF 1, p. 5
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Do not extend posterolateral (Kocher) approach to elbow?
AnswerDo not extend posterolateral (Kocher) approach to elbow distal to annular ligament to avoid risk of PIN injury.
Source: PDF 1, p. 5
SECTION 3 LOWER EXTREMITY#
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Iliac spine separates greater and lesser sciatic notch?
AnswerIliac spine separates greater and lesser sciatic notch; sacrospinous ligament (anterior sacrum to ischial spine) separates greater and lesser sciatic foramina.
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Pediatric femoral nail insertion at piriformis fossa threatens?
AnswerPediatric femoral nail insertion at piriformis fossa threatens the posterosuperior retinacular vessels (potential for femoral head AVN).
Source: PDF 1, p. 5
QuestionWhat do Posterior approach to the hip, quadratus transection leads to?
AnswerPosterior approach to the hip, quadratus transection leads to potential damage of MFCA which could jeopardize blood flow to the femoral head.
Source: PDF 1, p. 5
QuestionWhat does Slipped capital femoral epiphysis occur?
AnswerSlipped capital femoral epiphysis occurs through the femoral head physis (zone of hypertrophy).
Source: PDF 1, p. 5
QuestionWhat is Distal femur?
AnswerDistal femur is responsible for the highest percentage of growth in the lower eeextremity.
Source: PDF 1, p. 5
QuestionWhat is Iliofemoral ligament?
AnswerIliofemoral ligament is the strongest ligament in the body and attaches AIIS to intertrochanteric line.
Source: PDF 1, p. 5
QuestionWhat is Three lower eeeextremity muscles with dual innervation?
AnswerThree lower eeextremity muscles with dual innervation: pectineus (obturator/femoral), adductor magnus (obturator and tibial), and biceps femoris (tibial- long head and peroneal-short head).
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Shape of tibial plateau confers greater articular congruity?
AnswerShape of tibial plateau confers greater articular congruity medially than laterally (important when considering consequences of meniscectomy).
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Medial meniscus tears three times more often than?
AnswerMedial meniscus tears three times more often than the more mobile lateral meniscus.
Source: PDF 1, p. 5
QuestionWhat does ACL has?
AnswerACL has interomedial (tight in flexion) and posterolateral (tight in extension) bundles; PL bundle assessed with pivot shift test.
Source: PDF 1, p. 5
QuestionWhat do Posterior oblique ligament resists internal rotation and provide?
AnswerPosterior oblique ligament resists internal rotation and provides valgus stability, balances the medial side of the knee in full extension.
Source: PDF 1, p. 5
QuestionWhat does PCL has?
AnswerPCL has interolateral (tight in flexion) and posteromedial (tight in extension) bundles.
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: MPFL runs from proximal third of medial patella?
AnswerMPFL runs from proximal third of medial patella to Schottle point on the femur (between adductor tubercle and medial epicondyle); just distal to vastus medialis obliquus.
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Groove posterior for the tendon of the FHL.?
AnswerGroove posterior for the tendon of the FHL. Os trigonum (if present) lateral to FHL.
Source: PDF 1, p. 5
QuestionWhat is Primary blood supply to the talar body?
AnswerPrimary blood supply to the talar body is from the artery of the tarsal canal (posterior tibial artery).
Source: PDF 1, p. 5
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Sustentaculum tali of calcaneus supports the middle articular?
AnswerSustentaculum tali of calcaneus supports the middle articular surface above it and has an inferior groove for the FHL tendon. Anatomy 213
Source: PDF 1, p. 5
source p. 6
QuestionIn Testable concepts, what should you remember about: Iiiintermediate cuneiform does not extend as far distally?
AnswerIiintermediate cuneiform does not extend as far distally as the medial cuneiform, which allows the second metatarsal to
Source: PDF 1, p. 6
QuestionWhat do Bony avulsion of AITFL in adolescents may result in?
AnswerBony avulsion of AITFL in adolescents may result in a Tillaux fracture.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: CFL crosses both the ankle and the subtalar?
AnswerCFL crosses both the ankle and the subtalar joint.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Plantar calcaneonavicular ligament (spring ligament) supports head of?
AnswerPlantar calcaneonavicular ligament (spring ligament) supports head of talus; attenuated in pes planus deformity.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Lisfranc ligament connects medial (shortest) cuneiform to second?
AnswerLisfranc ligament connects medial (shortest) cuneiform to second (longest) metatarsal. No ligamentous connection between first and second metatarsal bases.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Digital nerve courses in a plantar direction under?
AnswerDigital nerve courses in a plantar direction under the transverse metatarsal ligament and is the spot where interdigital neuritis (Morton neuroma, usually the second or third interdigital space) occurs.
Source: PDF 1, p. 6
QuestionWhat is L5 nerve root on anterior sacrum?
AnswerL5 nerve root on anterior sacrum: at risk with anteriorly placed sacroiliac screw.
Source: PDF 1, p. 6
Mnemonic: “POP’S IQ” (nerves exiting below piriformis)#
QuestionIn Testable concepts, what should you remember about: Ppppudendal nerve, internal ppppudendal artery and vein, and?
AnswerPppudendal nerve, internal pppudendal artery and vein, and nerve to obturator internus exit the greater sciatic foramen and reenter the lesser foramen.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Femoral nerve lies between the iliacus and psoas?
AnswerFemoral nerve lies between the iliacus and psoas muscles. Iliacus hematoma may irritate the femoral nerve because of its proximity.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Pain from the hip can be referred to?
AnswerPain from the hip can be referred to the knee as a result of the continuation of the obturator nerve anteriorly, which can provide sensation to the medial side of the knee.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Sciatic nerve passes anterior to piriformis and posterior?
AnswerSciatic nerve passes anterior to piriformis and posterior to obturator internus and short external rotators.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Tibial nerve supplies all intrinsic foot muscles except?
AnswerTibial nerve supplies all intrinsic foot muscles except the EDB (deep peroneal nerve) and plantar sensation.
Source: PDF 1, p. 6
QuestionWhat is Most proximal branch of the lateral plantar nerve?
AnswerMost proximal branch of the lateral plantar nerve is the nerve to the abductor digiti quinti (Baxter nerve).
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Superior gluteal nerve approximately 5 cm proximal to?
AnswerSuperior gluteal nerve approximately 5 cm proximal to greater trochanter. Injury leads to Trendelenburg gait from gluteal dysfunction.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Obturator artery and vein jeopardized by anteroinferior screws?
AnswerObturator artery and vein jeopardized by anteroinferior screws and acetabular retractors.
Source: PDF 1, p. 6
QuestionWhat is Corona mortis?
AnswerCorona mortis is an anastomotic connection between the inferior epigastric branch of the external iliac vessels and the obturator vessels in the obturator canal.
Source: PDF 1, p. 6
QuestionIn Testable concepts, what should you remember about: Ascending branch of LFCA (at risk for injury?
AnswerAscending branch of LFCA (at risk for injury during interolateral approaches) proceeds to greater trochanteric region between TFL and rectus femoris.
Source: PDF 1, p. 6
SECTION 4 SPINE#
QuestionWhat is Normal spine sagittal alignment?
AnswerNormal spine sagittal alignment: plumb line from center of C7 to posterior superior corner of S1.
Source: PDF 1, p. 6
QuestionWhat do 50% of total neck flexion and extension occur?
Answer50% of total neck flexion and extension occurs at occiputeC1 articulation; 50% of total neck rotation occurs at atlantoaxial (C1e2) articulation.
Source: PDF 1, p. 6
QuestionIn SECTION 4 SPINE, what should you remember about: Vertebral artery travels in the transverse foramina of?
AnswerVertebral artery travels in the transverse foramina of C6 to C1 (not C7).
Source: PDF 1, p. 6
QuestionWhat does 66% of lordosis occur?
Answer66% of lordosis occurs in the region from L4 to the sacrum.
Source: PDF 1, p. 6
QuestionWhat is Lumbar spine the superior articular facet?
AnswerLumbar spine the superior articular facet is anterior and lateral to the inferior articular facet.
Source: PDF 1, p. 6
QuestionIn SECTION 4 SPINE, what should you remember about: Intradiscal pressure lowest in supine position and highest?
AnswerIntradiscal pressure lowest in supine position and highest in the sitting position and flexed forward with weights on the hands.
Source: PDF 1, p. 6
QuestionIn SECTION 4 SPINE, what should you remember about: In cervical spine, numbered nerve exits above the?
AnswerIn cervical spine, numbered nerve exits above the pedicle of the corresponding vertebral level. In the lumbar spine, the nerve exits under the pedicle.
Source: PDF 1, p. 6
QuestionIn SECTION 4 SPINE, what should you remember about: The distance from the spinous process of C1?
AnswerThe distance from the spinous process of C1 laterally to the vertebral artery is 2 cm (a safe distance for dissections would therefore be less than 2 cm).
Source: PDF 1, p. 6
QuestionWhat is Injury to the recurrent laryngeal nerve with right-sided approaches (paralysis?
AnswerInjury to the recurrent laryngeal nerve with right-sided approaches (paralysis is signified by a hoarse, scratchy voice caused by unilateral vocal cord paralysis, visualized with direct laryngoscopy).
Source: PDF 1, p. 6
QuestionWhat is Most commonly injured cranial nerve with halo traction?
AnswerMost commonly injured cranial nerve with halo traction is the abducens (cranial nerve VI); injury is recognized from the loss of lateral gaze.
Source: PDF 1, p. 6
source p. 7
SECTION 1 UPPER EXTREMITY#
QuestionIn SECTION 1 UPPER EXTREMITY, what should you remember about: Lack of biceps function 6 months after injury?
AnswerLack of biceps function 6 months after injury and presence of Horner syndrome carry a poor prognosis in brachial plexus palsy.
Source: PDF 1, p. 7
QuestionWhat is Sprengel deformity?
AnswerSprengel deformity is highly associated with Klippel-Feil syndrome.
Source: PDF 1, p. 7
QuestionWhat is Apert syndrome?
AnswerApert syndrome is due to an autosomal dominant mutation in the FGFr2 gene.
Source: PDF 1, p. 7
SECTION 2 LOWER EXTREMITY: GENERAL#
QuestionIn SECTION 2 LOWER EXTREMITY: GENERAL, what should you remember about: In-toeing due to increased femoral anteversion (most common)?
AnswerIn-toeing due to increased femoral anteversion (most common), internal tibial torsion, and metatarsus adductus.
Source: PDF 1, p. 7
QuestionIn SECTION 2 LOWER EXTREMITY: GENERAL, what should you remember about: Out-toeing due to hip external rotation contracture (infants)?
AnswerOut-toeing due to hip external rotation contracture (infants) and external tibial torsion; caution with unilateral out-toeing (potential sign of slipped capital femoral epiphysis [SCFE]).
Source: PDF 1, p. 7
QuestionIn SECTION 2 LOWER EXTREMITY: GENERAL, what should you remember about: Limb length discrepancies can be calculated on the?
AnswerLimb length discrepancies can be calculated on the basis of remaining growth, with the assumptions that females mature at age
Source: PDF 1, p. 7
QuestionWhat is Proximal femur?
AnswerProximal femur: one-eighth inch (3 mm) per year
Source: PDF 1, p. 7
QuestionWhat is Distal femur?
AnswerDistal femur: three-eighths inch (9 mm) per year
Source: PDF 1, p. 7
QuestionWhat is Proximal tibia?
AnswerProximal tibia: one-quarter inch (6 mm) per year
Source: PDF 1, p. 7
SECTION 3 HIP AND FEMUR#
QuestionWhat do Risk factors for developmental dysplasia of the hip (DDH) include?
AnswerRisk factors for developmental dysplasia of the hip (DDH) include breech positioning, firstborn child, female gender, and family history.
Source: PDF 1, p. 7
QuestionWhat do Obstructions to closed reduction for DDH include?
AnswerObstructions to closed reduction for DDH include iliopsoas tendon, pulvinar, hypertrophied ligamentum teres, contracted inferomedial capsule, transverse acetabular ligament, and inverted labrum.
Source: PDF 1, p. 7
QuestionWhat is the treatment for Pavlik harness treatment?
AnswerPavlik harness treatment is used first-line for DDH in newborns, followed by abduction orthosis.
Source: PDF 1, p. 7
QuestionWhat does Hyperflexion can cause?
AnswerHyperflexion can cause femoral nerve palsy.
Source: PDF 1, p. 7
QuestionWhat do If unsuccessful in helping with reduction, can cause?
AnswerIf unsuccessful in helping with reduction, can cause posterior wear of the acetabulum; proceed with closed reduction and casting under general anesthesia.
Source: PDF 1, p. 7
QuestionWhat is Most prognostic classification for Legg-Calvé-Perthes disease?
AnswerMost prognostic classification for Legg-Calvé-Perthes disease is the lateral pillar classification, based on the height of the lateral pillar (>50%).
Source: PDF 1, p. 7
QuestionWhat is Maintaining sphericity of the femoral head?
AnswerMaintaining sphericity of the femoral head is the most important factor in achieving a good result in Legg-Calvé-Perthes disease.
Source: PDF 1, p. 7
QuestionWhat does SCFE occur?
AnswerSCFE occurs with weakness in the perichondral ring and slippage through the hypertrophic zone of the growth plate.
Source: PDF 1, p. 7
QuestionWhat are Approximately 25% of SCFE cases?
AnswerApproximately 25% of SCFE cases are bilateral.
Source: PDF 1, p. 7
QuestionWhat does Treatment for SCFE include?
AnswerTreatment for SCFE includes pinning in situ; advanced treatments including surgical dislocation and reorientation are associated with significant risk for avascular necrosis.
Source: PDF 1, p. 7
QuestionWhat is Blood culture medium?
AnswerBlood culture medium is needed to isolate infections due to Kingella kingae.
Source: PDF 1, p. 7
QuestionWhat is Methicillin-resistant Staphylococcus aureus with a PVL gene mutation?
AnswerMethicillin-resistant Staphylococcus aureus with a PVL gene mutation is associated with deep venous thrombosis and septic emboli.
Source: PDF 1, p. 7
QuestionWhat are Joints with intraarticular metaphyses?
AnswerJoints with intraarticular metaphyses are the hip, elbow, shoulder, and ankle.
Source: PDF 1, p. 7
SECTION 4 KNEE AND LEG#
QuestionWhat does Blount disease treatment include?
AnswerBlount disease treatment includes bracing for patients with stage I or II disease who are younger than 3 years; patients with stages IV and V frequently require multiple procedures.
Source: PDF 1, p. 7
QuestionWhat is Posteromedial bowing?
AnswerPosteromedial bowing is associated with calcaneovalgus foot; the bowing commonly self-corrects, but the patient has a large residual limb length discrepancy that will require treatment.
Source: PDF 1, p. 7
QuestionWhat is Aiiinteromedial bowing?
AnswerAiinteromedial bowing is associated with fibular hemimelia and linked to the SHH gene.
Source: PDF 1, p. 7
QuestionWhat is Aiiinterolateral bowing?
AnswerAiinterolateral bowing is associated with congenital pseudoarthrosis of the tibia.
Source: PDF 1, p. 7
QuestionWhat are Healing rates for osteochondritis dissecans?
AnswerHealing rates for osteochondritis dissecans are highest with open physes.
Source: PDF 1, p. 7
SECTION 5 FOOT#
QuestionIn SECTION 5 FOOT, what should you remember about: CAVEdcavus, adduction of forefoot, varus of hindfoot, equinus.?
AnswerCAVEdcavus, adduction of forefoot, varus of hindfoot, equinus.
Source: PDF 1, p. 7
QuestionWhat does Also represent?
AnswerAlso represents order of correction in Ponseti method.
Source: PDF 1, p. 7
QuestionWhat does Most cases require?
AnswerMost cases require Achilles tenotomy at end of casting.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Associated with absence of or diminutive anterior tibial?
AnswerAssociated with absence of or diminutive anterior tibial artery.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Foot abduction brace critical for preventing recurrence.?
AnswerFoot abduction brace critical for preventing recurrence.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Recurrence treated with trial of recasting. II Pes?
AnswerRecurrence treated with trial of recasting. II Pes Cavus
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Up to 67% of cases due to neurologic?
AnswerUp to 67% of cases due to neurologic disorder.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Charcot-Marie-Tooth disease most common (PMP22).?
AnswerCharcot-Marie-Tooth disease most common (PMP22).
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Spinal magnetic resonance imaging (MRI) required to evaluate.?
AnswerSpinal magnetic resonance imaging (MRI) required to evaluate. III Congenital Vertical Talus
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Irreducible dorsal dislocation of the navicular on the?
AnswerIrreducible dorsal dislocation of the navicular on the talus.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Navicular does not reduce on forced plantar-flexion lateral?
AnswerNavicular does not reduce on forced plantar-flexion lateral view.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Initial treatment with serial manipulation and casting followed?
AnswerInitial treatment with serial manipulation and casting followed by limited surgery consisting of percutaneous Achilles tenotomy and minimal talonavicular capsulotomies and pin fixation. IV Tarsal Coalition
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Sinus tarsi pain caused by peroneal spasticity, flatfoot?
AnswerSinus tarsi pain caused by peroneal spasticity, flatfoot, and multiple ankle sprains.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Limited subtalar motion on examination.?
AnswerLimited subtalar motion on examination.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Computed tomography best study for assessing talocalcaneal (TC)?
AnswerComputed tomography best study for assessing talocalcaneal (TC) coalitions.
Source: PDF 1, p. 7
Treatment for TC coalitions#
QuestionWhat is Less than 50% of the middle facet involved?
AnswerLess than 50% of the middle facet involved: resection and interposition.
Source: PDF 1, p. 7
QuestionWhat is More than 50% of the middle facet involved?
AnswerMore than 50% of the middle facet involved: subtalar aaarthrodesis preferred. V Calcaneovalgus Foot
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Dorsiflexed (calcaneus) hindfoot.?
AnswerDorsiflexed (calcaneus) hindfoot.
Source: PDF 1, p. 7
QuestionWhat is In contrast to congenital vertical talus, in which hindfoot?
AnswerIn contrast to congenital vertical talus, in which hindfoot is plantar flexed (equinus).
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Associated with posteromedial bowing of tibia and leg?
AnswerAssociated with posteromedial bowing of tibia and leg length discrepancy (most common cause of surgical treatment). VI Kohler Disease (Oosteonecrosis of Navicular)
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Sclerosis and flattening of navicular.?
AnswerSclerosis and flattening of navicular.
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Spontaneous resolution; can be treated with immobilization. VII?
AnswerSpontaneous resolution; can be treated with immobilization. VII Pes Planus
Source: PDF 1, p. 7
QuestionIn SECTION 5 FOOT, what should you remember about: Asymptomatic patients should be monitored with observation.?
AnswerAsymptomatic patients should be monitored with observation.
Source: PDF 1, p. 7
QuestionWhat is Symptomatic patients?
AnswerSymptomatic patients: arch supports and shoes with stiffer soles may offer pain relief but do not result in deformity correction.
Source: PDF 1, p. 7
SECTION 6 SPINE#
QuestionIn SECTION 6 SPINE, what should you remember about: Abnormal neurologic findings, left thoracic curves, or painful?
AnswerAbnormal neurologic findings, left thoracic curves, or painful or rapidly progressive curves should prompt an MRI study. Pediatric Ooooorthopaedics 281
Source: PDF 1, p. 7
source p. 8
Observation#
QuestionIn Testable concepts, what should you remember about: Skeletally immature patients with curves less than 20?
AnswerSkeletally immature patients with curves less than 20 to 25 degrees.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Skeletally mature patients with curves less than 45?
AnswerSkeletally mature patients with curves less than 45 to 50 degrees.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Bracing for curves of more than 25 degrees?
AnswerBracing for curves of more than 25 degrees or of 20 degrees with documented progression in skeletally immature patients (Risser stages 0e2).
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: 90% effective when worn more than 12 to?
Answer90% effective when worn more than 12 to 13 hours/day.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Surgery (posterior spine fusion) for curves greater than?
AnswerSurgery (posterior spine fusion) for curves greater than 50 degrees.
Source: PDF 1, p. 8
QuestionWhat is Iiiintraoperative spinal cord monitoring?
AnswerIiintraoperative spinal cord monitoring is crucial.
Source: PDF 1, p. 8
QuestionWhat does If changes occur?
AnswerIf changes occur iiintraoperatively, the surgical team should check leads, raise blood pressure, transfuse, reverse steps of surgery, and reassess. II Infantile Idiopathic Scoliosis
Source: PDF 1, p. 8
QuestionWhat does Idiopathic scoliosis that manifest?
AnswerIdiopathic scoliosis that manifests before age 4 years.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Most curves resolve spontaneously.?
AnswerMost curves resolve spontaneously.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Rib-vertebra angle difference predicts risk of progression.?
AnswerRib-vertebra angle difference predicts risk of progression.
Source: PDF 1, p. 8
QuestionWhat is Less than 20 degrees?
AnswerLess than 20 degrees: low risk (<20%).
Source: PDF 1, p. 8
QuestionWhat is More than 20 degrees?
AnswerMore than 20 degrees: high risk (80%).
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Initial treatment with Mehta derotational cast. III Congenital?
AnswerInitial treatment with Mehta derotational cast. III Congenital Spinal Deformities
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: High incidence of associated abnormalities.?
AnswerHigh incidence of associated abnormalities.
Source: PDF 1, p. 8
QuestionWhat is Intraspinal abnormality?
AnswerIntraspinal abnormality: 20% to 40%; MRI required.
Source: PDF 1, p. 8
QuestionWhat is Cardiac system?
AnswerCardiac system: 12% to 26%.
Source: PDF 1, p. 8
QuestionWhat is Genitourinary system?
AnswerGenitourinary system: 20%.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Unilateral bar with contralateral fully segmented hemivertebrae associated?
AnswerUnilateral bar with contralateral fully segmented hemivertebrae associated with rapid and severe progression. IV Neuromuscular Scoliosis
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: DDDDuchenne muscular dystrophy.?
AnswerDDDuchenne muscular dystrophy.
Source: PDF 1, p. 8
QuestionWhat is Surgery indicated when curve?
AnswerSurgery indicated when curve is progressive and more than 25 to 30 degrees in patients whose forced vital capacity is greater than 40% of normal.
Source: PDF 1, p. 8
QuestionWhat is Curve progression?
AnswerCurve progression is rapid, and pulmonary and cardiac conditions worsen with time, precluding surgery.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Cerebral palsy (CP)?
AnswerCerebral palsy (CP)
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Fusion from T2 to the pelvis in nonambulatory?
AnswerFusion from T2 to the pelvis in nonambulatory children.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: High complication rates but improved caregiver satisfaction. V?
AnswerHigh complication rates but improved caregiver satisfaction. V Cervical Spine Disorders A Klippel-Feil
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Abnormalities in multiple cervical segments as a result?
AnswerAbnormalities in multiple cervical segments as a result of failure of normal segmentation or formation of cervical somites at 3 to
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Associated with renal and congenital heart disease, auditory?
AnswerAssociated with renal and congenital heart disease, auditory issues, and Sprengel deformity.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: With multilevel fusion of the cervical spine, any?
AnswerWith multilevel fusion of the cervical spine, any involvement of C2, or limited cervical motion, collision sports should be avoided. B Atlantoaxial Rotatory Displacement Or Subluxation
Source: PDF 1, p. 8
Treatment#
QuestionWhat is Symptoms for less than 1 week?
AnswerSymptoms for less than 1 week: cervical collar, analgesics, heat.
Source: PDF 1, p. 8
QuestionWhat is Symptoms for between 1 and 4 weeks?
AnswerSymptoms for between 1 and 4 weeks: traction and collar immobilization.
Source: PDF 1, p. 8
QuestionWhat is Symptoms for longer than 1 month?
AnswerSymptoms for longer than 1 month: traction, reduction, and halo immobilization.
Source: PDF 1, p. 8
QuestionWhat is Irreducible dislocation of C1eC2 or recurrent instability of C1eC2?
AnswerIrreducible dislocation of C1eC2 or recurrent instability of C1eC2: surgical reduction and fixation of C1eC2. VI Spondylolysis and Spondylolisthesis
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Seen in athletes who use hyperextension.?
AnswerSeen in athletes who use hyperextension.
Source: PDF 1, p. 8
QuestionWhat does Patient with high-grade listhesis (>50%) may have?
AnswerPatient with high-grade listhesis (>50%) may have flexed hip and knee posture with equinus, sacral prominence, and proximal hyperlordosis.
Source: PDF 1, p. 8
Slip angle#
QuestionIn Testable concepts, what should you remember about: Most important determinant for nonunion and pain.?
AnswerMost important determinant for nonunion and pain.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Angle larger than 45 to 50 degrees associated?
AnswerAngle larger than 45 to 50 degrees associated with greater risk of slip progression, instability, and development of postoperative pseudarthrosis.
Source: PDF 1, p. 8
Pelvic incidence (PI)#
QuestionWhat is Sum of pelvic tilt (PT) and sacral slope (SS)?
AnswerSum of pelvic tilt (PT) and sacral slope (SS): PI 1⁄4 PT þ SS.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Increased PI may predispose to spondylolisthesis.?
AnswerIncreased PI may predispose to spondylolisthesis.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Acute spondylolysis treated with an antilordotic brace (thoracolumbosacral?
AnswerAcute spondylolysis treated with an antilordotic brace (thoracolumbosacral orthosis with thigh extension). VII Other Spinal Conditions A Infectious Spondylitis
Source: PDF 1, p. 8
QuestionWhat is Loss of lumbar lordosis?
AnswerLoss of lumbar lordosis is first radiographic finding. B Osteoid Osteoma
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Night pain relieved by nonsteroidal anti-inflammatory drugs; central?
AnswerNight pain relieved by nonsteroidal anti-inflammatory drugs; central nidus <2 cm with ring of lucency on imaging.
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Can be associated with scoliosis. C Sacral Agenesis?
AnswerCan be associated with scoliosis. C Sacral Agenesis
Source: PDF 1, p. 8
QuestionIn Testable concepts, what should you remember about: Associated with maternal diabetes.?
AnswerAssociated with maternal diabetes.
Source: PDF 1, p. 8
QuestionWhat is Motor impairment?
AnswerMotor impairment is at the level of the agenesis, but sensory innervation is largely spared.
Source: PDF 1, p. 8
SECTION 7 CEREBRAL PALSY#
QuestionIn SECTION 7 CEREBRAL PALSY, what should you remember about: MRI of the brain in children with CP?
AnswerMRI of the brain in children with CP commonly reveals periventricular leukomalacia.
Source: PDF 1, p. 8
QuestionWhat is Botulinum toxin’s mechanism of action?
AnswerBotulinum toxin’s mechanism of action is presynaptic blockade of cholinergic receptors at the neuromuscular junction.
Source: PDF 1, p. 8
QuestionWhat do CP hips at risk include?
AnswerCP hips at risk include those with abduction of less than 45 degrees and those with uncovering of the femoral head on radiographs.
Source: PDF 1, p. 8
SECTION 8 NEUROMUSCULAR DISORDERS#
QuestionWhat is Lowest functional level in myelodysplasia?
AnswerLowest functional level in myelodysplasia: L4 is a key level because it indicates quadriceps function with some ambulation; L5 has a good prognosis for iiindependent ambulation with bracing.
Source: PDF 1, p. 8
QuestionWhat is Mmmmyelomeningocele?
AnswerMmmyelomeningocele is associated with folate deficiency in utero and a high prevalence of IgE-mediated latex allergy.
Source: PDF 1, p. 8
QuestionWhat is DDDDuchenne muscular dystrophy?
AnswerDDDuchenne muscular dystrophy is an X-linked recessive disorder due to a mutation of the dystrophin gene.
Source: PDF 1, p. 8
QuestionWhat is Friedreich ataxia?
AnswerFriedreich ataxia is an autosomal recessive disorder originating from the frataxin gene (GAA repeat at 9q13).
Source: PDF 1, p. 8
I. Achondroplasia#
QuestionIn I. Achondroplasia, what should you remember about: Most common disproportionate short-limbed dwarfism.?
AnswerMost common disproportionate short-limbed dwarfism.
Source: PDF 1, p. 8
QuestionIn I. Achondroplasia, what should you remember about: Most commonly caused by mutation in fibroblast growth?
AnswerMost commonly caused by mutation in fibroblast growth factor receptor 3 (FGFR3) gene.
Source: PDF 1, p. 8
QuestionIn I. Achondroplasia, what should you remember about: Leads to a gain-of-function mutation or uncontrolled activation.?
AnswerLeads to a gain-of-function mutation or uncontrolled activation.
Source: PDF 1, p. 8
QuestionIn I. Achondroplasia, what should you remember about: Thoracolumbar kyphosis usually resolves at time of ambulation.?
AnswerThoracolumbar kyphosis usually resolves at time of ambulation.
Source: PDF 1, p. 8
QuestionWhat is Pelvic radiographs?
AnswerPelvic radiographs: champagne glass pelvic outlet (wider than deep), tombstone pelvis (squaring of iliac wings).
Source: PDF 1, p. 8
source p. 9
QuestionIn Testable concepts, what should you remember about: Defect of cartilage oligomeric matrix protein (COMP) on?
AnswerDefect of cartilage oligomeric matrix protein (COMP) on chromosome 19. III Multiple Epiphyseal Dysplasia
Source: PDF 1, p. 9
QuestionWhat is Most common gene mutation?
AnswerMost common gene mutation is in COMP but also affects type IX collagen.
Source: PDF 1, p. 9
QuestionWhat is Can be confused with Legg-Calvé-Perthes disease. Multiple epiphyseal dysplasia?
AnswerCan be confused with Legg-Calvé-Perthes disease. Multiple epiphyseal dysplasia is bilateral and symmetric, characterized by early acetabular changes, and not accompanied by metaphyseal cysts. IV Mucopolysaccharidosis
Source: PDF 1, p. 9
QuestionWhat is Most autosomal recessive (except Hurler syndrome, which?
AnswerMost autosomal recessive (except Hurler syndrome, which is Xlinked recessive).
Source: PDF 1, p. 9
QuestionIn Testable concepts, what should you remember about: Preoperative cervical spine radiographs should always be obtained?
AnswerPreoperative cervical spine radiographs should always be obtained in the patient with Morquio syndrome, who may have upper cervical instability. V Diastrophic Dysplasia
Source: PDF 1, p. 9
QuestionIn Testable concepts, what should you remember about: Deficiency in DTDST gene, which codes for sulfate?
AnswerDeficiency in DTDST gene, which codes for sulfate transport protein.
Source: PDF 1, p. 9
QuestionIn Testable concepts, what should you remember about: Associated with rigid clubfeet, cauliflower ears, and hitchhiker’s?
AnswerAssociated with rigid clubfeet, cauliflower ears, and hitchhiker’s thumb. VI Ooosteopetrosis
Source: PDF 1, p. 9
QuestionIn Testable concepts, what should you remember about: Failure of osteoclastic resorption leading to dense bone?
AnswerFailure of osteoclastic resorption leading to dense bone (so-called marble bone).
Source: PDF 1, p. 9
QuestionWhat is mild form?
AnswerThe mild form is autosomal dominant; the “malignant” form is autosomal recessive.
Source: PDF 1, p. 9
QuestionWhat is Most common mutation in malignant form?
AnswerMost common mutation in malignant form is a defect in TCIRG1 that results in diminished carbonic anhydrase activity.
Source: PDF 1, p. 9
I. Down Syndrome#
QuestionIn I. Down Syndrome, what should you remember about: Most common chromosomal abnormality.?
AnswerMost common chromosomal abnormality.
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Associated with generalized laxity, pes planus, patellar and?
AnswerAssociated with generalized laxity, pes planus, patellar and hip instability.
Source: PDF 1, p. 9
Cervical spine instability general recommendations#
QuestionWhat is Atlantodens interval (ADI) less than 4.5 mm?
AnswerAtlantodens interval (ADI) less than 4.5 mm: no restrictions.
Source: PDF 1, p. 9
QuestionWhat is ADI 4.5 to 10 mm?
AnswerADI 4.5 to 10 mm: patient should avoid contact sports, diving, and gymnastics.
Source: PDF 1, p. 9
QuestionWhat is ADI over 10 mm or symptoms/cord signal changes on MRI?
AnswerADI over 10 mm or symptoms/cord signal changes on MRI: C1 to 2 fusion.
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Complication rate of up to 50% reported. II?
AnswerComplication rate of up to 50% reported. II Marfan Syndrome
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Defect in fibrillin-1 (FBN1).?
AnswerDefect in fibrillin-1 (FBN1).
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Autosomal dominant inheritance.?
AnswerAutosomal dominant inheritance.
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Associated with pectus deformities, scoliosis, acetabular protrusion.?
AnswerAssociated with pectus deformities, scoliosis, acetabular protrusion.
Source: PDF 1, p. 9
QuestionWhat are Echocardiographic and cardiologic evaluation?
AnswerEchocardiographic and cardiologic evaluation are required before surgery. III Beckwith-Wiedemann Syndrome
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Mutation of chromosome 11 near the IGF gene.?
AnswerMutation of chromosome 11 near the IGF gene.
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Hemihypertrophy, spasticity, organomegaly, omphalocele, macroglossia.?
AnswerHemihypertrophy, spasticity, organomegaly, omphalocele, macroglossia.
Source: PDF 1, p. 9
QuestionIn I. Down Syndrome, what should you remember about: Predisposition to Wilms tumor (patient must be screened?
AnswerPredisposition to Wilms tumor (patient must be screened regularly with kidney ultrasonography).
Source: PDF 1, p. 9
I. Sickle Cell Anemia#
QuestionIn I. Sickle Cell Anemia, what should you remember about: Mutation in both alleles of the b-globin gene?
AnswerMutation in both alleles of the b-globin gene, resulting in sickle hemoglobin (HbS).
Source: PDF 1, p. 9
QuestionWhat is Sickle cell trait?
AnswerSickle cell trait: one abnormal HbS allele.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: More severe but less common than sickle cell?
AnswerMore severe but less common than sickle cell anemia (8% prevalence).
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: At risk for exertional sickling (treat with oxygen?
AnswerAt risk for exertional sickling (treat with oxygen and hydration) and sudden death.
Source: PDF 1, p. 9
QuestionWhat is Oooosteomyelitis?
AnswerOoosteomyelitis: Salmonella infection more commonly seen than in normal population, but S. aureus still most common etiology. II Rickets
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Short stature and genu varum.?
AnswerShort stature and genu varum.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Physeal widening and metaphyseal cupping on radiographs.?
AnswerPhyseal widening and metaphyseal cupping on radiographs.
Source: PDF 1, p. 9
QuestionWhat is X-linked hypophosphatemic (vitamin Deresistant) rickets?
AnswerX-linked hypophosphatemic (vitamin Deresistant) rickets: defect in cellular endopeptidase (phosphate-regulating neutral endopeptidase). III Ooosteogenesis Imperfecta
Source: PDF 1, p. 9
QuestionWhat do Defect in type I collagen (COL1A1 and COL1A2 genes) that cause?
AnswerDefect in type I collagen (COL1A1 and COL1A2 genes) that causes abnormal cross-linking and leads to decreased collagen secretion.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Blue sclerae in types I and II.?
AnswerBlue sclerae in types I and II.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Basilar invagination in more severe types.?
AnswerBasilar invagination in more severe types.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Bisphosphonates reduce the incidence of fractures. IV Juvenile?
AnswerBisphosphonates reduce the incidence of fractures. IV Juvenile Idiopathic Arthritis
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Persistent noninfectious arthritis without other etiology lasting longer?
AnswerPersistent noninfectious arthritis without other etiology lasting longer than 6 weeks.
Source: PDF 1, p. 9
QuestionIn I. Sickle Cell Anemia, what should you remember about: Commonly involves the knee, wrist (flexed and ulnar?
AnswerCommonly involves the knee, wrist (flexed and ulnar deviated), and hand (fingers extended, swollen, radially deviated).
Source: PDF 1, p. 9
QuestionWhat is Ophthalmology consultation with slit-lamp examination?
AnswerOphthalmology consultation with slit-lamp examination is required twice yearly because progressive iridocyclitis can lead to rapid loss of vision if left untreated.
Source: PDF 1, p. 9
QuestionWhat do Cervical spine involvement can lead to?
AnswerCervical spine involvement can lead to kyphosis, facet ankylosis, and atlantoaxial subluxation. Pediatric Ooooorthopaedics 283
Source: PDF 1, p. 9
source p. 10
SECTION 1 KNEE#
QuestionWhat is The most common causes of an acute hemarthrosis?
AnswerThe most common causes of an acute hemarthrosis: anterior cruciate ligament (ACL) tear (70%), isolated meniscus tear (15%), osteochondral fracture, patellar dislocation.
Source: PDF 1, p. 10
QuestionWhat is vascular supply of the meniscus?
AnswerThe vascular supply of the meniscus is a primary determinant of healing potential; tears in the peripheral third have the highest potential for healing.
Source: PDF 1, p. 10
QuestionWhat is gold sstandard for meniscal repair?
AnswerThe gold standard for meniscal repair is the inside-out technique with vertical mattress sutures. The saphenous nerve is at risk in medial repairs; the peroneal nerve is at risk in lateral repairs.
Source: PDF 1, p. 10
QuestionWhat is ACL anatomy?
AnswerACL anatomy: interomedial bundle is an anterior restraint, and posterolateral bundle is a rotatory restraint.
Source: PDF 1, p. 10
QuestionWhat is superficial medial collateral ligament origin?
AnswerThe superficial medial collateral ligament origin is proximal and posterior to the medial epicondyle of the femur. Radiographically, the ligament originates slightly anterior to the junction of the posterior femoral cortex reference line and Blumensaat line.
Source: PDF 1, p. 10
QuestionWhat is posterior oblique ligament?
AnswerThe posterior oblique ligament is the primary stabilizer against internal rotation and valgus between 0 and 30 degrees of knee flexion.
Source: PDF 1, p. 10
QuestionWhat is medial patellofemoral ligament (MPFL) femoral attachment?
AnswerThe medial patellofemoral ligament (MPFL) femoral attachment is anterior and distal to the adductor tubercle; or proximal to the attachment of the superficial medial collateral ligament; or proximal and posterior to the medial epicondyle. Radiographically, the MPFL originates slightly anterior to the posterior femoral cortex reference line and immediately proximal to the most posterior aspect of the Blumensaat line (Schottle point).
Source: PDF 1, p. 10
QuestionWhat is lateral collateral ligament (LCL) femoral origin?
AnswerThe lateral collateral ligament (LCL) femoral origin is proximal and posterior to the lateral femoral epicondyle; or posterior and proximal to the insertion of the popliteus tendon.
Source: PDF 1, p. 10
QuestionWhat is popliteus femoral insertion?
AnswerThe popliteus femoral insertion is distal, anterior, and deep to the LCL. It rotates the tibia internally.
Source: PDF 1, p. 10
QuestionWhat is posterior horn of the medial meniscus?
AnswerThe posterior horn of the medial meniscus is a major sssecondary stabilizer against anterior tibial translation in an ACL-deficient knee.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Opening of the knee to varus or valgus?
AnswerOpening of the knee to varus or valgus stress testing at only 30 degrees of knee flexion indicates an isolated collateral injury. Opening of the knee in full extension indicates a combined cruciate and collateral injury.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: During knee arthroscopy, the posterolateral compartment can be?
AnswerDuring knee arthroscopy, the posterolateral compartment can be best visualized by placement of the arthroscope through the interval of the ACL and lateral femoral condyle or a posterolateral portal.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Partial meniscectomy increases peak stresses in the affected?
AnswerPartial meniscectomy increases peak stresses in the affected compartment.
Source: PDF 1, p. 10
QuestionWhat is gold sstandard for meniscal repair?
AnswerThe gold standard for meniscal repair is the inside-out technique with vertical mattress sutures. Regardless of the technique used, it is essential that the saphenous nerve branches (anterior to both the semitendinosus and gracilis muscles and posterior to the inferior border of the sartorius muscle) be protected during medial repairs, and the peroneal nerve (posterior to the biceps femoris) during lateral repairs.
Source: PDF 1, p. 10
QuestionWhat does Meniscal cysts occur?
AnswerMeniscal cysts occur primarily in conjunction with horizontal cleavage tears of the lateral meniscus.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Discoid menisci should be observed if asymptomatic.?
AnswerDiscoid menisci should be observed if asymptomatic.
Source: PDF 1, p. 10
QuestionWhat is If meniscal transplantation?
AnswerIf meniscal transplantation is considered, ligamentous deficiency and limb malalignment must be addressed. Contraindications include inflammatory arthritis, increased body mass index, and significant osteoarthritis.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Following meniscal transplantation, allograft tissue often remains hypocellular?
AnswerFollowing meniscal transplantation, allograft tissue often remains hypocellular or acellular. The most common complication is meniscal tear.
Source: PDF 1, p. 10
QuestionWhat is ACL injury rate?
AnswerThe ACL injury rate is two to eight times higher in female athletes than in male athletes because of smaller notches, smaller ligaments, increased generalized ligament laxity, increased knee laxity, and different landing biomechanics in women and girls.
Source: PDF 1, p. 10
QuestionWhat is Lachman test?
AnswerThe Lachman test is the most sensitive examination for acute ACL injuries, whereas results of the pivot-shift test are correlated most closely with outcome after ACL reconstruction. The pivot shift is a reduction of the subluxated lateral tibial plateau by the iliotibial band when the leg is moved from full extension to flexion.
Source: PDF 1, p. 10
QuestionWhat does Magnetic resonance imaging (MRI) evaluation of ACL injuries demonstrate?
AnswerMagnetic resonance imaging (MRI) evaluation of ACL injuries demonstrates characteristic “bone bruises” in more than half of cases; these bruises are typically located near the sulcus terminalis on the lateral femoral condyle and the posterolateral aspect of the tibia.
Source: PDF 1, p. 10
QuestionWhat is the treatment for Initial management consists of physical therapy for mobilization. Immobilization?
AnswerInitial management consists of physical therapy for mobilization. Immobilization is avoided. Full range of motion and good quadriceps control should be achieved prior to surgery.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: A more horizontal graft position may reduce rotational?
AnswerA more horizontal graft position may reduce rotational instability.
Source: PDF 1, p. 10
QuestionWhat does Boneepatellar tendonebone autografts demonstrate?
AnswerBoneepatellar tendonebone autografts demonstrate faster incorporation into the bone tunnels than do hamstring autografts and are often the graft of choice for patients desiring an early return to sports activity.
Source: PDF 1, p. 10
QuestionWhat is most common technical error in ACL surgery?
AnswerThe most common technical error in ACL surgery is placement of the femoral tunnel too far anteriorly, which results in limited flexion. Too-vertical graft placement results in decreased rotational stability.
Source: PDF 1, p. 10
QuestionWhat is Arthrofibrosis?
AnswerArthrofibrosis is the most common complication following ACL reconstruction and is associated with a loss of patellar translation.
Source: PDF 1, p. 10
QuestionIs there no high-level evidence to suggest that ACL reconstruction reduces the risk of arthritis.?
AnswerThere is no high-level evidence to suggest that ACL reconstruction reduces the risk of arthritis.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: ACL rehabilitation should avoid open kinetic chain quadricepsactivating?
AnswerACL rehabilitation should avoid open kinetic chain quadricepsactivating exercises from 0 to 30 degrees of knee flexion.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Posterior cruciate ligament (PCL) injuries often result from?
AnswerPosterior cruciate ligament (PCL) injuries often result from a fall onto the ground with a plantar-flexed foot.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: PCL reconstruction should be reserved for functionally unstable?
AnswerPCL reconstruction should be reserved for functionally unstable knees or combined injuries. Single-bundle reconstructions should be tensioned in 90 degrees of flexion. Tibial inlay has biomechanical advantages, such as avoiding the killer turn.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: PCL rehabilitation should avoid open kinetic chain hamstringactivating?
AnswerPCL rehabilitation should avoid open kinetic chain hamstringactivating exercises.
Source: PDF 1, p. 10
QuestionWhat does Multiple-ligament knee injuries require?
AnswerMultiple-ligament knee injuries require an immediate neurovascular examination. Vascular consultation should be obtained in any patient with absence of pulses or an ankle-brachial index less than 0.9.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Chronic grade III posterolateral corner injuries often necessitate?
AnswerChronic grade III posterolateral corner injuries often necessitate a valgus open-wedge osteotomy.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Osteochondritis dissecans should be monitored in children with?
AnswerOsteochondritis dissecans should be monitored in children with open physes. Adult lesions do not resolve and should be treated. The most common location is the lateral aspect of the medial femoral condyle.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Marrow-stimulating techniques, including microfracture, drilling, and abrasion arthroplasty?
AnswerMarrow-stimulating techniques, including microfracture, drilling, and abrasion arthroplasty, involve perforation of the subchondral bone after removal of the “tidemark” cartilage, with eventual clot formation and fibrocartilaginous repair tissue (type I collagen with inferior wear characteristics).
Source: PDF 1, p. 10
QuestionWhat does No definitive research has?
AnswerNo definitive research has demonstrated superiority of any cartilage restoration procedure. Current best available research suggests that, for smaller lesions, microfracture, osteochondral autograft transfer, and autologous chondrocyte implantation have similar recovery periods and functional results.
Source: PDF 1, p. 10
QuestionWhat is Patellar tendinitis?
AnswerPatellar tendinitis is associated with pain and tenderness near the inferior border of the patella (worse in extension than in flexion). Treatment is with nonsteroidal anti-inflammatory drugs and strengthening measures, including eccentric exercise and ultrasound. Sports Medicine 367
Source: PDF 1, p. 10
source p. 11
QuestionWhat do Iliotibial band friction syndrome manifest?
AnswerIliotibial band friction syndrome manifests as localized tenderness at the lateral femoral condyle that is worse with the knee flexed 30 degrees.
Source: PDF 1, p. 11
QuestionWhat do MRI evaluation of patellar dislocation demonstrate?
AnswerMRI evaluation of patellar dislocation demonstrates a classic bone bruise pattern involving the lateral femoral condyle and medial patella.
Source: PDF 1, p. 11
QuestionWhat is Patellofemoral pain syndrome?
AnswerPatellofemoral pain syndrome is most often due to muscular weakness, with weak quadriceps, hip abductors, and core musculature. Management is focused on prolonged rehabilitation.
Source: PDF 1, p. 11
QuestionWhat is the treatment for Conservative management?
AnswerConservative management is the mainstay of symptomatic bipartite patella.
Source: PDF 1, p. 11
QuestionIn Testable concepts, what should you remember about: Lateral patellar facet compression syndrome should be treated?
AnswerLateral patellar facet compression syndrome should be treated with a lateral release only in the setting of objective evidence of lateral tilt that has not responded to extensive nonoperative management. Lateral tilt is best evaluated by measuring the lateral patellofemoral angle.
Source: PDF 1, p. 11
SECTION 2 PELVIS, HIP, AND THIGH#
QuestionWhat are Qquadriceps contusions?
AnswerQquadriceps contusions are acutely managed with overnight immobilization in hyperflexion.
Source: PDF 1, p. 11
QuestionWhat is Athletic pubalgia (sports hernia)?
AnswerAthletic pubalgia (sports hernia) is the result of abdominal hyperextension and thigh hyperabduction, which result in injury to the rectus abdominus and adductor longus. Treatment is primarily nonoperative.
Source: PDF 1, p. 11
QuestionWhat is MRI?
AnswerMRI is the most specific method for detecting stress fractures. Treatment typically includes protected weight bearing, rest, crosstraining, analgesics, and therapeutic modalities.
Source: PDF 1, p. 11
QuestionWhat do Femoral neck stress fractures that occur?
AnswerFemoral neck stress fractures that occur on the inferior surface (compression side) can be treated nonoperatively.
Source: PDF 1, p. 11
QuestionWhat does Femoroacetabular impingement manifest?
AnswerFemoroacetabular impingement manifests as groin pain and limited range of motion (ROM), especially in flexion and internal rotation. A positive result of an anterior impingement test is reproduction of symptoms with passive flexion, adduction, and internal rotation.
Source: PDF 1, p. 11
QuestionWhat does External snapping hip occur?
AnswerExternal snapping hip occurs when the iliotibial band abruptly catches on the greater trochanter, whereas internal snapping hip occurs when the iliopsoas impinges on the hip capsule.
Source: PDF 1, p. 11
QuestionIn SECTION 2 PELVIS, HIP, AND THIGH, what should you remember about: Complications of hip arthroscopy typically result from traction?
AnswerComplications of hip arthroscopy typically result from traction injuries or iatrogenic neurovascular injury from aberrant portal placement. Use of an anterior portal puts the lateral femoral cutaneous nerve at risk. Use of an interolateral portal puts the superior gluteal nerve at risk. Use of a posterolateral portal puts the sciatic nerve at risk, especially when the hip is externally rotated.
Source: PDF 1, p. 11
SECTION 3 SHOULDER#
QuestionWhat is most common location for an os acromiale?
AnswerThe most common location for an os acromiale is at the junction of the mesoacromion and metaacromion.
Source: PDF 1, p. 11
QuestionWhat is Humeral head blood supply?
AnswerHumeral head blood supply is primarily from the posterior humeral circumflex artery.
Source: PDF 1, p. 11
QuestionWhat do contents of the rotator interval include?
AnswerThe contents of the rotator interval include the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), biceps tendon, and glenohumeral capsule. The SGHL and CHL limit inferior translation and external rotation when the arm is adducted and posterior translation when the arm is flexed forward, adducted, and internally rotated. Rotator interval closure results in decreased external rotation in shoulder adduction and posteroinferior translation.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: The inferior glenohumeral ligament (IGHL) complex serves as?
AnswerThe inferior glenohumeral ligament (IGHL) complex serves as the primary restraint to anterior, posterior, and inferior glenohumeral translation at 45 to 90 degrees of glenohumeral elevation. The anterior IGHL is important in external rotation, and the posterior IGHL in internal rotation.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: In the throwing sshoulder, the scapula must rotate?
AnswerIn the throwing shoulder, the scapula must rotate during throwing. It retracts during the late cocking phase and then protracts during the acceleration phase. The deceleration phase is associated with tensile failure of the posterior aspect of the supraspinatus and anterior half of the infraspinatus.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: In sshoulder arthroscopy, the posterior portal puts the?
AnswerIn shoulder arthroscopy, the posterior portal puts the axillary nerve, suprascapular nerve, and suprascapular artery at risk.
Source: PDF 1, p. 11
QuestionWhat is Traumatic anterior sshoulder dislocations typically result when the arm?
AnswerTraumatic anterior shoulder dislocations typically result when the arm is abducted and in external rotation. The axillary nerve is susceptible to injury.
Source: PDF 1, p. 11
QuestionWhat is Instability?
AnswerInstability is often associated with a Bankart lesion (anteroinferior labral tear) with disrupted medial scapular periosteum. A threedimensional computed tomography (CT) scan should be obtained for suspicion of glenoid bone loss.
Source: PDF 1, p. 11
QuestionWhat does A humeral avulsion of the glenohumeral ligaments lesion has?
AnswerA humeral avulsion of the glenohumeral ligaments lesion has an incidence between 1% and 9% and has typically necessitated open repair in the past because of its inferior location. However, newer arthroscopic techniques are being developed.
Source: PDF 1, p. 11
QuestionWhat is Age at time of initial dislocation?
AnswerAge at time of initial dislocation is an important risk factor for recurrent shoulder instability.
Source: PDF 1, p. 11
QuestionWhat does Several open and arthroscopic techniques have?
AnswerSeveral open and arthroscopic techniques have been developed to address instability. Glenoid deficiency greater than 25% of the humeral head is a specific indication for coracoid transfer (Latarjet procedure). Failure of rehabilitation for multidirectional instability is an indication for capsular shift. Chronic dislocation with a deficit greater than 40% of the articular surface is an indication for allograft in young patients and for prosthesis in older patients.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: Remplissage involves tenodesis of the posterior capsule and?
AnswerRemplissage involves tenodesis of the posterior capsule and infraspinatus into a Hill-Sachs lesion. Precise indications are not yet defined, but early evidence suggests medium to large or engaging Hill-Sachs lesions.
Source: PDF 1, p. 11
QuestionWhat is Post-thermal capsular necrosis?
AnswerPost-thermal capsular necrosis is treated with allograft anterior capsulolabral reconstruction.
Source: PDF 1, p. 11
QuestionWhat do Physical examination for posterior instability include?
AnswerPhysical examination for posterior instability includes load-and-shift and jerk testing.
Source: PDF 1, p. 11
QuestionWhat is A fixed posterior sshoulder dislocation?
AnswerA fixed posterior shoulder dislocation is diagnosed from lack of external rotation. Aiinteroposterior radiographs are unreliable but may demonstrate a lightbulb sign. An axillary lateral radiograph is critical to making the diagnosis.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: For chronic unrecognized posterior dislocations, several procedures may?
AnswerFor chronic unrecognized posterior dislocations, several procedures may be performed, depending on the extent of bone loss both in the humeral head and glenoid. The Neer modification of the McLaughlin procedure involves transfer of the lesser tuberosity and associated subscapularis tendon into the reverse Hill-Sachs lesion.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: Multidirectional instability should be treated with extended rehabilitation?
AnswerMultidirectional instability should be treated with extended rehabilitation that focuses on scapular stabilization before operative intervention is considered. Closed kinetic chain exercises should be emphasized.
Source: PDF 1, p. 11
QuestionWhat is The prevalence of asymptomatic rotator cuff tears increases with age?
AnswerThe prevalence of asymptomatic rotator cuff tears increases with age: 28% of those older than 60 years have full-thickness tears, compared with 65% of those older than 70 years.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: Asymptomatic full-thickness rotator cuff tears should be treated?
AnswerAsymptomatic full-thickness rotator cuff tears should be treated nonoperatively. The primary indication for surgical intervention is significant pain.
Source: PDF 1, p. 11
QuestionWhat is Blood flow to the repaired rotator cuff?
AnswerBlood flow to the repaired rotator cuff is achieved from the peribursal tissue and bone anchor site.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: Acute rotator cuff tears should be repaired early?
AnswerAcute rotator cuff tears should be repaired early because the disease process is accelerated in this setting.
Source: PDF 1, p. 11
QuestionIn SECTION 3 SHOULDER, what should you remember about: Patients receiving a corticosteroid injection within 6 months?
AnswerPatients receiving a corticosteroid injection within 6 months of rotator cuff repair are more likely to undergo revision rotator cuff repair.
Source: PDF 1, p. 11
source p. 12
QuestionIn Testable concepts, what should you remember about: Studies of rotator cuff repair rehabilitation show no?
AnswerStudies of rotator cuff repair rehabilitation show no difference in clinical outcomes or healing rates between early motion and delayed motion protocols.
Source: PDF 1, p. 12
QuestionIn Testable concepts, what should you remember about: Irreparable combined tears of the supraspinatus and infraspinatus?
AnswerIrreparable combined tears of the supraspinatus and infraspinatus may be treated with latissimus dorsi tendon transfer to the greater tuberosity. If pain is the major symptom and motion remains preserved, débridement with biceps tenotomy has been found to be useful. Inferior results have been reported for latissimus transfer in the patient with a subscapularis tear.
Source: PDF 1, p. 12
QuestionWhat do Signs of a subscapularis tear include?
AnswerSigns of a subscapularis tear include increased external rotation and the presence of a liftoff, modified liftoff, or belly-press sign. The appearance of an empty bicipital groove on axial MRI with tear of the transverse humeral ligament is often associated with subscapularis tear. At arthroscopy, a chronic subscapularis tear can be signified by the comma sign, which represents an avulsed SGHL and CHL (so-called comma tissue).
Source: PDF 1, p. 12
QuestionWhat does Athletes who participate in throwing activities have?
AnswerAthletes who participate in throwing activities have greater external rotation and a loss of internal rotation of the dominant shoulder than of the nondominant shoulder. Initial treatment consists of posterior and posteroinferior capsular stretching exercises, such as the sleeper stretch, as well as stretching of the pectoralis minor tendon.
Source: PDF 1, p. 12
QuestionWhat is Internal impingement?
AnswerInternal impingement is defined as contact between the articular side of the rotator cuff and the posterosuperior rim of the glenoid labrum when the arm is abducted and externally rotated. Alteration of glenohumeral kinematics causes a posterosuperior shift of the humeral head; abduction and external rotation of the arm, in turn, lead to the internal impingement.
Source: PDF 1, p. 12
QuestionWhat is the treatment for Superior labrum from anterior to posterior (SLAP) tear management?
AnswerSuperior labrum from anterior to posterior (SLAP) tear management is controversial. If repair is undertaken, stiffness is a common complication, and motion should begin early.
Source: PDF 1, p. 12
QuestionWhat is Biceps tenotomy without tenodesis?
AnswerBiceps tenotomy without tenodesis is associated with subjective cramping and potential for cosmetic deformity (Popeye deformity). Weakness is not associated with tenotomy.
Source: PDF 1, p. 12
QuestionWhat is the treatment for For type III acromioclavicular separations, recommended management?
AnswerFor type III acromioclavicular separations, recommended management is conservative in elderly patients, inactive patients, and patients who do not perform manual labor.
Source: PDF 1, p. 12
QuestionIn Testable concepts, what should you remember about: Distal clavicle resection for acromioclavicular joint arthritis should?
AnswerDistal clavicle resection for acromioclavicular joint arthritis should entail resection of less than 1 cm of the distal clavicle to preserve the posterior-superior capsule and avoid anterior and posterior instability and pain.
Source: PDF 1, p. 12
QuestionWhat is Sternoclavicular dislocation?
AnswerSternoclavicular dislocation is best diagnosed by CT. Posterior dislocation should be treated with closed reduction or with open reduction if necessary, particularly with compression of the posterior structures.
Source: PDF 1, p. 12
QuestionWhat is Calcifying tendinitis?
AnswerCalcifying tendinitis is a self-limiting condition of unknown origin that affects predominantly the supraspinatus tendon. Radiographs demonstrate characteristic calcification within the tendon.
Source: PDF 1, p. 12
QuestionWhat do Frozen sshoulder histologic evaluation demonstrate?
AnswerFrozen shoulder histologic evaluation demonstrates evidence of inflammation and fibrosis. There is a dense matrix of type III collagen containing fibroblasts and myofibroblasts that appear similar to those in Dupuytren disease. On examination, active ROM and passive ROM are equivalent.
Source: PDF 1, p. 12
QuestionIn Testable concepts, what should you remember about: Suprascapular nerve compression by a ganglion in the?
AnswerSuprascapular nerve compression by a ganglion in the spinoglenoid notch affects only the infraspinatus. Compression caused by a cyst in association with a SLAP lesion may respond to arthroscopic decompression and labral repair.
Source: PDF 1, p. 12
QuestionWhat is Qquadrilateral space syndrome?
AnswerQquadrilateral space syndrome is defined as axillary nerve or posterior humeral circumflex artery compression within the quadrilateral space, which results in pain and paresthesias with overhead activity, as well as weakness or atrophy of the teres minor and deltoid. This syndrome is most often seen in athletes who participate in throwing activities and is associated with late cocking and acceleration with the arm abducted, extended, and externally rotated.
Source: PDF 1, p. 12
QuestionWhat is Medial scapular winging?
AnswerMedial scapular winging is caused by damage to the long thoracic nerve. Lateral scapular winging is caused by damage to the spinal accessory nerve.
Source: PDF 1, p. 12
QuestionWhat does For total sshoulder arthroplasty, lesser tuberosity osteotomy and subscapularis peel have?
AnswerFor total shoulder arthroplasty, lesser tuberosity osteotomy and subscapularis peel have shown no difference in subscapularis strength and ROM.
Source: PDF 1, p. 12
QuestionIn Testable concepts, what should you remember about: Reverse total sshoulder arthroplasties medialize the center of?
AnswerReverse total shoulder arthroplasties medialize the center of rotation, and inferior placement of the baseplate further allows for improvement of deltoid efficiency.
Source: PDF 1, p. 12
SECTION 4 MEDICAL ASPECTS OF SPORTS MEDICINE#
QuestionWhat are history and physical examination?
AnswerThe history and physical examination are the most helpful and costeffective means of identifying musculoskeletal and medical problems in perspective athletes.
Source: PDF 1, p. 12
QuestionWhat is Hypertrophic cardiomyopathy?
AnswerHypertrophic cardiomyopathy is the most common cause of sudden death in young athletes. This condition contraindicates sports participation.
Source: PDF 1, p. 12
QuestionHow is Any athlete with diagnosed concussion diagnosed?
AnswerAny athlete with diagnosed concussion is not allowed to return to play/sport on the day of injury. The athlete must be cleared by a licensed health care professional prior to returning to play/sport.
Source: PDF 1, p. 12
QuestionWhat is Sickle cell trait?
AnswerSickle cell trait is not a contraindication to participation in any athletic activity. Important precautions must be taken: maintenance of hydration, ensuring adequate rest and recovery between intense exercises, access to supplemental oxygen (particularly when at altitude).
Source: PDF 1, p. 12
QuestionWhat does Adverse effects of anabolic steroids include?
AnswerAdverse effects of anabolic steroids include liver dysfunction, hypercholesterolemia, cardiomyopathy, testicular atrophy, gynecomastia, acne, mood disturbances (particularly increased aggression), and irreversible alopecia. Heart disease results from increased plasma levels of low-density lipoprotein cholesterol and decreased levels of high-density lipoprotein cholesterol.
Source: PDF 1, p. 12
QuestionIn SECTION 4 MEDICAL ASPECTS OF SPORTS MEDICINE, what should you remember about: The female athlete triad consists of low energy?
AnswerThe female athlete triad consists of low energy availability (with or without an eating disorder), menstrual dysfunction, and altered bone mineral density. Insufficient caloric intake is the most common cause of sssecondary amenorrhea.
Source: PDF 1, p. 12
QuestionWhat do Methicillin-resistant Staphylococcus aureus transmission occur?
AnswerMethicillin-resistant Staphylococcus aureus transmission occurs by direct person-to-person contact through disruptions in skin integrity.
Source: PDF 1, p. 12
QuestionIn SECTION 4 MEDICAL ASPECTS OF SPORTS MEDICINE, what should you remember about: Athletes with infectious mononucleosis should be restricted from?
AnswerAthletes with infectious mononucleosis should be restricted from contact sports participation for 3 to 5 weeks, and splenomegaly must have resolved before they return to play/sport.
Source: PDF 1, p. 12
QuestionWhat is Heat stroke?
AnswerHeat stroke is characterized by collapse, with neurologic deficits, tachycardia, tachypnea, hypotension, and anhidrosis. Treatment involves rapid cooling of the body’s core temperature and hydration. Sports Medicine 369
Source: PDF 1, p. 12
source p. 13
PAIN#
QuestionWhat is Impingement test result?
AnswerImpingement test result is positive when pain is reproduced by flexion of the hip to 90 degrees followed by adduction and internal rotation.
Source: PDF 1, p. 13
QuestionWhat are Radiographs?
AnswerRadiographs are the standard imaging modality.
Source: PDF 1, p. 13
QuestionIn PAIN, what should you remember about: MRI may be indicated for suspected osteonecrosis, labral?
AnswerMRI may be indicated for suspected osteonecrosis, labral pathology in the absence of significant arthritis, gluteus medius tears, and possible stress or insufficiency fractures.
Source: PDF 1, p. 13
SECTION 2 STRUCTURAL HIP DISORDERS IN THE ADULT HIP#
QuestionIn SECTION 2 STRUCTURAL HIP DISORDERS IN THE ADULT HIP, what should you remember about: Dysplasia typically involves a shallow acetabulum with lateral?
AnswerDysplasia typically involves a shallow acetabulum with lateral and anterior uncoverage of the femoral head.
Source: PDF 1, p. 13
QuestionWhat is Surgical correction of the dysplastic acetabulum?
AnswerSurgical correction of the dysplastic acetabulum is usually done with a periacetabular osteotomy, which keeps the posterior column intact.
Source: PDF 1, p. 13
QuestionWhat does majority of patients with FAI have?
AnswerThe majority of patients with FAI have both cam and pincer impingement.
Source: PDF 1, p. 13
QuestionIn SECTION 2 STRUCTURAL HIP DISORDERS IN THE ADULT HIP, what should you remember about: Surgical treatment of FAI varies according to pathoanatomy?
AnswerSurgical treatment of FAI varies according to pathoanatomy; labral repair or reconstruction is preferable to labral resection when possible.
Source: PDF 1, p. 13
QuestionWhat is THA?
AnswerTHA is the treatment of choice for both dysplasia and FAI when significant DJD is present.
Source: PDF 1, p. 13
SECTION 3 OSTEONECROSIS OF THE HIP#
QuestionIn SECTION 3 OSTEONECROSIS OF THE HIP, what should you remember about: End-stage result of vascular occlusion of the juxtaarticular?
AnswerEnd-stage result of vascular occlusion of the juxtaarticular sinusoids adjacent to the femoral head.
Source: PDF 1, p. 13
QuestionWhat is Staging?
AnswerStaging is performed with the modified Ficat system.
Source: PDF 1, p. 13
QuestionIn SECTION 3 OSTEONECROSIS OF THE HIP, what should you remember about: Joint-preserving strategies such as core decompression and free?
AnswerJoint-preserving strategies such as core decompression and free vascularized fibular grafting should be reserved for precollapse disease.
Source: PDF 1, p. 13
QuestionIn SECTION 3 OSTEONECROSIS OF THE HIP, what should you remember about: Transient osteoporosis of the hip shows diffuse signal?
AnswerTransient osteoporosis of the hip shows diffuse signal change on MRI and is treated nonoperatively.
Source: PDF 1, p. 13
SECTION 4 TREATMENT OF HIP ARTHRITIS#
QuestionWhat does Conservative management include?
AnswerConservative management includes activity modification, weight loss, NSAIDs, and intraarticular steroid injections; evidence does not support routine use of glucosamine sulfate.
Source: PDF 1, p. 13
QuestionWhat does Arthroscopy has?
AnswerArthroscopy has limited indications in patients with arthritis; preoperative joint space narrowing is negative predictor of good clinical outcome.
Source: PDF 1, p. 13
QuestionWhat is Hip aaaarthrodesis?
AnswerHip aaarthrodesis is largely a historic procedure as THA technology has improved.
Source: PDF 1, p. 13
QuestionWhat does Subsequent conversion of hip aaaarthrodesis to THA has?
AnswerSubsequent conversion of hip aaarthrodesis to THA has high complication rate, and function depends on integrity of abductors.
Source: PDF 1, p. 13
QuestionWhat is Hemiarthroplasty?
AnswerHemiarthroplasty is not routinely used for arthritis and is relegated to fracture treatment in an elderly, low-demand patient.
Source: PDF 1, p. 13
SECTION 5 TOTAL HIP ARTHROPLASTY#
QuestionWhat does Different surgical approaches have?
AnswerDifferent surgical approaches have different advantages and disadvantages, although no clear difference in patients outcomes.
Source: PDF 1, p. 13
QuestionWhat does direct anterior approach has?
AnswerThe direct anterior approach has been associated with a higher rate of femoral problems, including fracture and loosening.
Source: PDF 1, p. 13
QuestionWhat does posterior approach has?
AnswerThe posterior approach has been associated with a higher rate of dislocation.
Source: PDF 1, p. 13
QuestionWhat is Cementless fixation?
AnswerCementless fixation is preferred for the acetabular component; both cement fixation and cementless fixation may give durable results for the femoral component.
Source: PDF 1, p. 13
QuestionWhat is Cemented fixation of the femoral component?
AnswerCemented fixation of the femoral component is preferred in patients with poor bone and/or those with a femoral neck fracture due to lower rate of periprosthetic fracture.
Source: PDF 1, p. 13
QuestionWhat does Bone ingrowth require?
AnswerBone ingrowth requires live host bone, an appropriate ingrowth surface on the implant, and initial rigid fixation; motion of the prosthesis within the bone will lead to fibrous fixation or encapsulation.
Source: PDF 1, p. 13
QuestionWhat is Hydroxyapatite?
AnswerHydroxyapatite is an osteoconductive surface coating that may shorten the time to biologic fixation.
Source: PDF 1, p. 13
QuestionWhat does Femoral stress shielding leads to?
AnswerFemoral stress shielding leads to loss of proximal bone density and results from modulus mismatch between stem and femoral bone.
Source: PDF 1, p. 13
QuestionWhat does Femoral stem breakage occur?
AnswerFemoral stem breakage occurs from cantilever bending.
Source: PDF 1, p. 13
SECTION 6 REVISION TOTAL HIP ARTHROPLASTY#
QuestionWhat is Start-up pain?
AnswerStart-up pain is the most common initial presentation of implant loosening.
Source: PDF 1, p. 13
QuestionWhat is Segmental acetabular bone deficiency?
AnswerSegmental acetabular bone deficiency is loss of main bony support for acetabular cup.
Source: PDF 1, p. 13
QuestionWhat is Hemispheric porous cup with multiple screw fixation?
AnswerHemispheric porous cup with multiple screw fixation is most common solution and is used in the majority of acetabular revision cases.
Source: PDF 1, p. 13
QuestionWhat are Modular porous metal constructs?
AnswerModular porous metal constructs are increasingly being used for cases of severe bone loss; augments and cup-cage constructs can help achieve stability and porous bone ingrowth for a durable longterm solution.
Source: PDF 1, p. 13
QuestionIn SECTION 6 REVISION TOTAL HIP ARTHROPLASTY, what should you remember about: Custom triflange cups may be used in cases?
AnswerCustom triflange cups may be used in cases with severe bone loss in which defect-matching techniques (such as modular metal constructs) are limited.
Source: PDF 1, p. 13
QuestionIn SECTION 6 REVISION TOTAL HIP ARTHROPLASTY, what should you remember about: Screws placed into the anterior-superior quadrant (the so-called?
AnswerScrews placed into the anterior-superior quadrant (the so-called zone of death) risk laceration to the external iliac artery and veins, which can be fatal.
Source: PDF 1, p. 13
QuestionWhat does Pelvic discontinuity, which occur?
AnswerPelvic discontinuity, which occurs when the superior aspect of the pelvis is separated from the inferior pelvis, is a challenging problem and may be addressed with cup-cage constructs, custom triflange components, and/or distraction techniques.
Source: PDF 1, p. 13
QuestionWhat are Most femoral revisions?
AnswerMost femoral revisions are performed with a cementless diaphysisengaging implant; tapered fluted modular titanium stems have become the mainstay for treatment and are more commonly used than extensively porous-coated cylindrical stems.
Source: PDF 1, p. 13
SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA#
QuestionWhat does Irradiation of PE creates free radicals, which result in?
AnswerIrradiation of PE creates free radicals, which result in cross-linking.
Source: PDF 1, p. 13
QuestionWhat is Highly cross-linked PE?
AnswerHighly cross-linked PE is associated with less wear and osteolysis but has the disadvantage of reduced mechanical properties.
Source: PDF 1, p. 13
QuestionWhat are Submicron-sized PE particles?
AnswerSubmicron-sized PE particles are phagocytized by macrophages, leading to osteolysis; bone resorption is mediated via RANKL attachment to its receptor on the osteoclast.
Source: PDF 1, p. 13
QuestionWhat is Volumetric wear?
AnswerVolumetric wear is the main determinant of the number of PE particles produced.
Source: PDF 1, p. 13
QuestionIn SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA, what should you remember about: With HCLPE, wear rates tend to remain below?
AnswerWith HCLPE, wear rates tend to remain below the osteolytic threshold even with large femoral heads (36 mm or greater).
Source: PDF 1, p. 13
QuestionIn SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA, what should you remember about: Treatment of PE wear involves head and liner?
AnswerTreatment of PE wear involves head and liner exchange when the implants are well fixed and well positioned; dislocation is the most common postoperative complication.
Source: PDF 1, p. 13
QuestionWhat is Metal debris from MOM bearings?
AnswerMetal debris from MOM bearings is processed by the T lymphocyte; ALVAL is the common histologic finding.
Source: PDF 1, p. 13
QuestionWhat does Sstandard evaluation for a painful MOM THA or suspected trunnionosis include?
AnswerSsstandard evaluation for a painful MOM THA or suspected trunnionosis includes serum cobalt and chromium levels, as well as MRI with MARS.
Source: PDF 1, p. 13
QuestionWhat does Ceramic-on-ceramic bearings have?
AnswerCeramic-on-ceramic bearings have been associated with squeaking.
Source: PDF 1, p. 13
QuestionIn SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA, what should you remember about: Dual-mobility components increase the impingement-free range of motion?
AnswerDual-mobility components increase the impingement-free range of motion, as well as the jump distance, which should decrease the rate of dislocation.
Source: PDF 1, p. 13
source p. 14
QuestionIn Testable concepts, what should you remember about: Trunnion corrosion (trunnionosis) results from fretting corrosion and?
AnswerTrunnion corrosion (trunnionosis) results from fretting corrosion and metal ion release at the modular junction between the femoral head and stem; patients may experience adverse local soft tissue responses and pseudotumors; treatment involves revision of the metal femoral head to a ceramic head with a titanium sleeve adaptor.
Source: PDF 1, p. 14
FRACTURE#
QuestionWhat is Iiiintraoperative fracture?
AnswerIiintraoperative fracture is more common with cementless implants; a calcar crack may be treated with cerclage wires if stem remains stable.
Source: PDF 1, p. 14
QuestionWhat is Early postoperative fracture?
AnswerEarly postoperative fracture is often a result of unrecognized iiintraoperative fracture.
Source: PDF 1, p. 14
QuestionWhat is Vancouver classification?
AnswerVancouver classification is used to guide treatment.
Source: PDF 1, p. 14
QuestionWhat does A loose stem require?
AnswerA loose stem requires revision to a new femoral component; if the stem remains well fixed, ORIF of the fracture is performed.
Source: PDF 1, p. 14
SECTION 9 TOTAL HIP ARTHROPLASTYdMISCELLANEOUS#
QuestionIn SECTION 9 TOTAL HIP ARTHROPLASTYdMISCELLANEOUS, what should you remember about: Risk for sciatic nerve palsy increases with lengthening?
AnswerRisk for sciatic nerve palsy increases with lengthening of the leg by more than 3 to 5 cm.
Source: PDF 1, p. 14
QuestionIn SECTION 9 TOTAL HIP ARTHROPLASTYdMISCELLANEOUS, what should you remember about: A nerve palsy that develops postoperatively may be?
AnswerA nerve palsy that develops postoperatively may be due to hematoma, for which emergency evacuation is required.
Source: PDF 1, p. 14
QuestionIs there no effective treatment for heterotopic ossification in the early postoperative period once the process has started; resection may be performed later, once the process is mature or stable on serial radiographs.?
AnswerThere is no effective treatment for heterotopic ossification in the early postoperative period once the process has started; resection may be performed later, once the process is mature or stable on serial radiographs.
Source: PDF 1, p. 14
QuestionWhat is Iliopsoas impingement?
AnswerIliopsoas impingement is a cause of groin pain following THA and may be confirmed with an injection.
Source: PDF 1, p. 14
QuestionWhat is the treatment for Treatment of iliopsoas impingement depends upon whether there?
AnswerTreatment of iliopsoas impingement depends upon whether there is a prominent acetabular component (revision) or not (arthroscopy).
Source: PDF 1, p. 14
SECTION 10 TOTAL HIP ARTHROPLASTYdJOINT STABILITY#
QuestionIn SECTION 10 TOTAL HIP ARTHROPLASTYdJOINT STABILITY, what should you remember about: Primary arc of hip motion must be centered?
AnswerPrimary arc of hip motion must be centered within patient’s functional range to avoid impingement.
Source: PDF 1, p. 14
QuestionWhat is Best stability?
AnswerBest stability is achieved by maximizing head-neck ratio; large femoral heads have a greater jump distance.
Source: PDF 1, p. 14
QuestionWhat is Abductor complex?
AnswerAbductor complex is key to hip stability.
Source: PDF 1, p. 14
QuestionIn SECTION 10 TOTAL HIP ARTHROPLASTYdJOINT STABILITY, what should you remember about: Patients with fixed spinopelvic alignment during movement from?
AnswerPatients with fixed spinopelvic alignment during movement from standing to sitting position are at increased risk for instability.
Source: PDF 1, p. 14
QuestionIn SECTION 10 TOTAL HIP ARTHROPLASTYdJOINT STABILITY, what should you remember about: The treatment of instability involves identifying the reason?
AnswerThe treatment of instability involves identifying the reason for dislocation; malpositioned implants should always be revised; constrained liners should be reserved as a last resort for patients with soft tissue dysfunction.
Source: PDF 1, p. 14
SECTION 11 KNEE ARTHRITIS ASSESSMENT#
QuestionWhat are Weight-bearing x-rays?
AnswerWeight-bearing x-rays are required when assessing for knee arthritis.
Source: PDF 1, p. 14
QuestionIn SECTION 11 KNEE ARTHRITIS ASSESSMENT, what should you remember about: Weight-bearing 45 degrees posterior to anterior (with x-ray?
AnswerWeight-bearing 45 degrees posterior to anterior (with x-ray plate positioned parallel to tibia) is the next step when knee pain is significant and standing radiographs do not reveal notable narrowing.
Source: PDF 1, p. 14
QuestionWhat is KL classification for knee OA?
AnswerThe KL classification for knee OA is used for tests; arthroplasty is indicated in patients who have debilitating knee pain, failed conservative measures, and have KL Grade 4 findings.
Source: PDF 1, p. 14
SECTION 12 KNEE ARTHRITIS TREATMENT#
QuestionIn SECTION 12 KNEE ARTHRITIS TREATMENT, what should you remember about: Review Table 5.7, the 4-star recommendations for nonoperative?
AnswerReview Table 5.7, the 4-star recommendations for nonoperative treatment of OA; these recommendations have high levels of evidence for test.
Source: PDF 1, p. 14
QuestionWhat is Knee realignment osteotomy?
AnswerKnee realignment osteotomy is recommended in young, active patients (45 years for test) where occupation and/or activity level makes arthroplasty less appropriate.
Source: PDF 1, p. 14
QuestionIn SECTION 12 KNEE ARTHRITIS TREATMENT, what should you remember about: The most common complication of proximal tibial osteotomy?
AnswerThe most common complication of proximal tibial osteotomy (open and closed techniques) is patella baja.
Source: PDF 1, p. 14
QuestionWhat is Remember?
AnswerRemember: the patient’s reported pain must be localized to the compartment being replaced.
Source: PDF 1, p. 14
QuestionIn SECTION 12 KNEE ARTHRITIS TREATMENT, what should you remember about: With the ACL and PCL intact, recreating the?
AnswerWith the ACL and PCL intact, recreating the native posterior slope is required in order to maintain native knee kinematics.
Source: PDF 1, p. 14
QuestionWhat is absolute contraindication to UKA?
AnswerThe absolute contraindication to UKA is inflammatory arthritis.
Source: PDF 1, p. 14
QuestionIn SECTION 12 KNEE ARTHRITIS TREATMENT, what should you remember about: For test questions, look at suprapatellar pouch on?
AnswerFor test questions, look at suprapatellar pouch on x-rays for an extruded PE bearing.
Source: PDF 1, p. 14
SECTION 13 TOTAL KNEE ARTHROPLASTY#
QuestionWhat is To correct varus deformity, a medial compartment release?
AnswerTo correct varus deformity, a medial compartment release is needed.
Source: PDF 1, p. 14
QuestionWhat is Superficial MCL?
AnswerSuperficial MCL is the key structure for medial compartment release.
Source: PDF 1, p. 14
QuestionWhat is Posterior oblique portion?
AnswerPosterior oblique portion is tight in extension release needed for medial extension tightness.
Source: PDF 1, p. 14
QuestionWhat is Anterior portion?
AnswerAnterior portion is tight in flextension release needed for medial flexion tightness.
Source: PDF 1, p. 14
QuestionWhat is To correct valgus deformity, a lateral compartment release?
AnswerTo correct valgus deformity, a lateral compartment release is needed.
Source: PDF 1, p. 14
QuestionWhat are Iliotibial band and popliteus?
AnswerIliotibial band and popliteus are the key structures for lateral compartment release.
Source: PDF 1, p. 14
QuestionWhat is Iliotibial band?
AnswerIliotibial band is tight in extension release needed for lateral extension tightness.
Source: PDF 1, p. 14
QuestionWhat is Popliteus?
AnswerPopliteus is tight in flextension release needed for lateral flexion tightness. Sagittal Plane Balance:
Source: PDF 1, p. 14
QuestionWhat is most efficient way to answer the gap imbalance questions?
AnswerThe most efficient way to answer the gap imbalance questions is to utilize the McPherson pneumonic: STAF.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: Symmetrical gap problemTibia adjusted first.?
AnswerSymmetrical gap problemTibia adjusted first.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: Asymmetrical gap problemFemur adjusted first.?
AnswerAsymmetrical gap problemFemur adjusted first.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: For board questions, only learn the single-step solutions?
AnswerFor board questions, only learn the single-step solutions (Table 5.9).
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: Review Table 5.10, the 4-star recommendations for surgical?
AnswerReview Table 5.10, the 4-star recommendations for surgical management of OA; these recommendations have high levels of evidence for test. Perioperative Nerve Blocks:
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: Femoral nerve blockdmotor and sensory blockdknee will buckle?
AnswerFemoral nerve blockdmotor and sensory blockdknee will buckle with walking.
Source: PDF 1, p. 14
QuestionWhat is A knee immobilizer?
AnswerA knee immobilizer is required to walk.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: Adductor nerve block sensory block onlydknee will not?
AnswerAdductor nerve block sensory block onlydknee will not buckle with walking. Complications:
Source: PDF 1, p. 14
QuestionWhat does deformity most likely to cause?
AnswerThe deformity most likely to cause peroneal nerve palsy in TKA is a combined valgus flexion deformity.
Source: PDF 1, p. 14
QuestionWhat is When nerve palsy?
AnswerWhen nerve palsy is identified postoperatively, the first treatment is to remove compressive wraps and flex the knee.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: With a lateral retinacular release in TKA, the?
AnswerWith a lateral retinacular release in TKA, the artery at risk for transection is the lateral superior genicular artery; increases risk for osteonecrosis of the patella.
Source: PDF 1, p. 14
QuestionIn SECTION 13 TOTAL KNEE ARTHROPLASTY, what should you remember about: For arthrofibrosis following primary TKA, manipulation of the?
AnswerFor arthrofibrosis following primary TKA, manipulation of the knee should be performed between 4 and 12 weeks.
Source: PDF 1, p. 14
QuestionWhat does Osteolysis in TKA manifest?
AnswerOsteolysis in TKA manifests later in life of implant (7e15 years); radiographs show round lytic lesions behind implant (most common site is behind posterior femoral condyle). Adult Reconstruction 477
Source: PDF 1, p. 14
source p. 15
PDFFx rules#
QuestionWhat is #1?
Answer#1: If implants are loose/unstable, then revision TKA is part of the answer.
Source: PDF 1, p. 15
QuestionWhat is #2?
Answer#2: When a PS femur has a “closed box” (i.e., solid metal), do not use a retrograde IM nail.
Source: PDF 1, p. 15
QuestionWhat is #3?
Answer#3: For elderly patients with osteoporosis and significant comminution, a distal femoral replacement is the preferred answer.
Source: PDF 1, p. 15
QuestionWhat is #4?
Answer#4: Nonoperative management is never a preferred answer.
Source: PDF 1, p. 15
QuestionWhat is For a PDFFx where the implant?
AnswerFor a PDFFx where the implant is stable, ORIF with distal lateral locking plate is the preferred choice.
Source: PDF 1, p. 15
QuestionWhat is Submuscular plating?
AnswerSubmuscular plating is preferred.
Source: PDF 1, p. 15
QuestionWhat is A retrograde IM nail?
AnswerA retrograde IM nail is best suited for metadiaphyseal fractures.
Source: PDF 1, p. 15
QuestionWhat is A small arthrotomy?
AnswerA small arthrotomy is needed to prevent damage to the PE bearing.
Source: PDF 1, p. 15
QuestionWhat is sagittal deformity created?
AnswerThe sagittal deformity created is extension of the distal femur segment, as the entry point is typically lower due to the lowmetal trochlear flange. Periprosthetic Joint Infection:
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: The #1 reason for a painful TKA within?
AnswerThe #1 reason for a painful TKA within the first year of surgery is infection.
Source: PDF 1, p. 15
QuestionWhat is first step in evaluation?
AnswerThe first step in evaluation is an infection workup, including serum CRP, sedimentation rate, and a joint aspiration.
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: Test questions for diagnosis of PJI follow the?
AnswerTest questions for diagnosis of PJI follow the guidelines of ICM-18 (Table 5.12).
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: Review minor criteria for chronic PJI.?
AnswerReview minor criteria for chronic PJI.
Source: PDF 1, p. 15
QuestionWhat are only two major criteria for the diagnosis of a PJI, and only one is required to make the diagnosis:?
AnswerThere are only two major criteria for the diagnosis of a PJI, and only one is required to make the diagnosis:
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: Presence of a draining sinus that communicates to?
AnswerPresence of a draining sinus that communicates to the joint (this is the only absolute diagnosis).
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: Two positive cultures growing the same organism using?
AnswerTwo positive cultures growing the same organism using standard culture methods.
Source: PDF 1, p. 15
QuestionWhat is A chronic PJI?
AnswerA chronic PJI is characterized by the presence of a biofilm that envelops the implant and all other foreign biomaterials with the periprosthetic space.
Source: PDF 1, p. 15
QuestionWhat is Bone erosive changes/destructive changes on radiographic evidence means the infection?
AnswerBone erosive changes/destructive changes on radiographic evidence means the infection is chronic.
Source: PDF 1, p. 15
QuestionHow is An acute PJI diagnosis diagnosed?
AnswerAn acute PJI diagnosis is made when the signs/symptoms have been present for no longer than 3 weeks.
Source: PDF 1, p. 15
QuestionWhat is the treatment for Treatment?
AnswerTreatment is a radical débridement/lavage with exchange of modular parts, retention of implants, and parenteral antibiotics.
Source: PDF 1, p. 15
QuestionWhat is Arthroscopic lavage?
AnswerArthroscopic lavage is not acceptable.
Source: PDF 1, p. 15
QuestionWhat is the treatment for For treatment of a chronic PJI, the two-stage exchange?
AnswerFor treatment of a chronic PJI, the two-stage exchange is the preferred answer.
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: For the first-stage procedure, a high-dose antibiotic-loaded interpositional?
AnswerFor the first-stage procedure, a high-dose antibiotic-loaded interpositional cement spacer (PMMA) is placed; articulated spacers are preferred when soft tissues and bone allow for a stable, functional spacer.
Source: PDF 1, p. 15
QuestionWhat is medial gastrocnemius rotational flap?
AnswerThe medial gastrocnemius rotational flap is the main “workhorse” for soft tissue deficiencies about the knee.
Source: PDF 1, p. 15
QuestionWhat is blood supply?
AnswerThe blood supply is the medial sural artery.
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: This flap can cover medial and anterior knee?
AnswerThis flap can cover medial and anterior knee deficiencies.
Source: PDF 1, p. 15
Risk factors associated with PJI#
QuestionWhat is Smoking?
AnswerSmoking: cessation 30 days prior reduces risk.
Source: PDF 1, p. 15
QuestionWhat is Diabetes?
AnswerDiabetes: hemoglobin A1C 7.0 is preferred.
Source: PDF 1, p. 15
QuestionWhat is Malnutrition?
AnswerMalnutrition: albumin 3.5 g/dL increases risk.
Source: PDF 1, p. 15
QuestionWhat is Weight?
AnswerWeight: BMI 35 increases risk.
Source: PDF 1, p. 15
QuestionWhat is Age?
AnswerAge: >70 years old increases risk.
Source: PDF 1, p. 15
QuestionWhat is Prior surgery?
AnswerPrior surgery: especially traumatic knee with limited range.
Source: PDF 1, p. 15
QuestionWhat is Autoimmune disease states?
AnswerAutoimmune disease states: RA, PA, SLE.
Source: PDF 1, p. 15
QuestionWhat is Immune suppressive drugs?
AnswerImmune suppressive drugs: DMARDs, monoclonal antibody inhibitors, antirejection drugs.
Source: PDF 1, p. 15
QuestionIn Testable concepts, what should you remember about: Allogeneic blood transfusions.?
AnswerAllogeneic blood transfusions.
Source: PDF 1, p. 15
SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN#
QuestionWhat does Femoral cam jump occur?
AnswerFemoral cam jump occurs in posterior stabilized knees when the flexion gap is left too loose.
Source: PDF 1, p. 15
QuestionWhat is Closed reduction maneuver?
AnswerClosed reduction maneuver: with use of anesthesia, the knee is positioned at 90 degrees of flexion off the table (dependent dangle), and an anterior drawer maneuver is performed.
Source: PDF 1, p. 15
QuestionWhat does Patella clunk syndrome occur?
AnswerPatella clunk syndrome occurs in posterior stabilized knee designs when scar tissue superior to the patella gets caught in box as the knee moves from flexion into extension.
Source: PDF 1, p. 15
QuestionIn SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN, what should you remember about: Scar catches in box then releases with a?
AnswerScar catches in box then releases with a clunk.
Source: PDF 1, p. 15
QuestionWhat is the treatment for Treatment?
AnswerTreatment is removal of suprapatellar scar nodule.
Source: PDF 1, p. 15
QuestionWhat is Femoral implant design?
AnswerFemoral implant design is the most important risk factor for patella clunk.
Source: PDF 1, p. 15
QuestionIn SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN, what should you remember about: A wide box design increases risk by allowing?
AnswerA wide box design increases risk by allowing the patella to settle deeper into the box
Source: PDF 1, p. 15
QuestionIn SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN, what should you remember about: A tall box (box height >70% of total?
AnswerA tall box (box height >70% of total height) increases risk, as suprapatellar scar nodule is more likely to travel into the box
Source: PDF 1, p. 15
QuestionWhat does A constrained nonhinged TKA has?
AnswerA constrained nonhinged TKA has a high central post that substitutes for MCL and LCL functionda standard posterior stabilized post is not constrained.
Source: PDF 1, p. 15
QuestionWhat is indication for a constrained post?
AnswerThe indication for a constrained post is the inability to balance the knee with residual instability in extension and/or flexion.
Source: PDF 1, p. 15
QuestionWhat do Constrained high-post knee system require?
AnswerConstrained high-post knee system requires medullary stem support in femur and tibia to help distribute the load forces to bone, which are increased when a constrained post is used.
Source: PDF 1, p. 15
QuestionWhat is Painful TKA due to flexion instability?
AnswerPainful TKA due to flexion instability is characterized by knee effusion, chronic pain, inability to climb stairs with reciprocal gait, inability to arise from low chair, and buckling of knee.
Source: PDF 1, p. 15
QuestionWhat are In a hinged TKA, the femoral and tibial components?
AnswerIn a hinged TKA, the femoral and tibial components are linked with a connecting bar and bearings.
Source: PDF 1, p. 15
QuestionWhat are main indications for a hinged TKA?
AnswerThe main indications for a hinged TKA are global instability and hyperextension instability.
Source: PDF 1, p. 15
QuestionWhat is Hyperextension instability?
AnswerHyperextension instability is an absolute indication for a hinged TKA.
Source: PDF 1, p. 15
SECTION 15 REVISION TOTAL KNEE ARTHROPLASTY#
QuestionWhat is Periprosthetic joint infection?
AnswerPeriprosthetic joint infection is currently the number one reason for revision within the first 2 years of a primary TKA.
Source: PDF 1, p. 15
QuestionWhat are After exam and x-rays, blood tests?
AnswerAfter exam and x-rays, blood tests are the next step in evaluation: CRP and sedimentation rate.
Source: PDF 1, p. 15
QuestionWhat is If abnormal, a joint aspiration?
AnswerIf abnormal, a joint aspiration is required.
Source: PDF 1, p. 15
QuestionWhat is Mechanical loosening?
AnswerMechanical loosening is the second most common reason for revision TKA.
Source: PDF 1, p. 15
QuestionIn SECTION 15 REVISION TOTAL KNEE ARTHROPLASTY, what should you remember about: Smooth radiolucent lines around the cement mantle and?
AnswerSmooth radiolucent lines around the cement mantle and metallic implants on radiographs suggest aseptic loosening.
Source: PDF 1, p. 15
QuestionIn SECTION 15 REVISION TOTAL KNEE ARTHROPLASTY, what should you remember about: Irregular marginal bone erosions around the cement mantle?
AnswerIrregular marginal bone erosions around the cement mantle and metallic implants on radiographs suggest a chronic infection.
Source: PDF 1, p. 15
QuestionWhat are If two or more longitudinal incisions?
AnswerIf two or more longitudinal incisions are present in the anterior knee, the most lateral incision should be chosen for the revision procedure.
Source: PDF 1, p. 15
QuestionWhat is Difficult exposure sequence?
AnswerDifficult exposure sequence: (1) extended proximal arthrotomy; (2) external rotation of tibial bone from soft tissue envelope; (3) lateral knee débridement; (4) lateral retinacular release (only if needed); (5) quadriceps tendon snip transverse snip at most proximal region.
Source: PDF 1, p. 15
source p. 16
ARTHROPLASTY#
QuestionIn ARTHROPLASTY, what should you remember about: Review Table 5.13 (with pneumonic) for summary of?
AnswerReview Table 5.13 (with pneumonic) for summary of maneuvers to optimize patellar tracking.
Source: PDF 1, p. 16
QuestionWhat is Patellar resurfacing in TKA?
AnswerPatellar resurfacing in TKA is controversial.
Source: PDF 1, p. 16
QuestionWhat is absolute indication for resurfacing?
AnswerThe absolute indication for resurfacing is inflammatory arthritis.
Source: PDF 1, p. 16
QuestionIn ARTHROPLASTY, what should you remember about: Catastrophic wear describes the macroscopic failure of PE?
AnswerCatastrophic wear describes the macroscopic failure of PE due to multiple factors that act in concert.
Source: PDF 1, p. 16
Factors contributing to catastrophic wear#
QuestionWhat is PE thickness?
AnswerPE thickness: the minimum thickness at its thinnest section should be 6 mm.
Source: PDF 1, p. 16
QuestionWhat is Articular geometry?
AnswerArticular geometry: avoid flat PE designs.
Source: PDF 1, p. 16
QuestionWhat are Congruent bearing designs?
AnswerCongruent bearing designs are preferred, as they provide high contact area with low contact loads (force/area).
Source: PDF 1, p. 16
QuestionWhat is Knee kinematics?
AnswerKnee kinematics: sliding wear, which occurs when the ACL is sacrificed, is bad for PE; prosthetic designs must minimize sliding wear (i.e., PS and AS designs).
Source: PDF 1, p. 16
QuestionWhat is Surgical technique?
AnswerSurgical technique: a tight flexion gap significantly increases stress loads to the PE surface.
Source: PDF 1, p. 16
QuestionWhat is PE processing?
AnswerPE processing: irradiated PE in air (O2) is very bad, as it oxidizes PE and decreases its mechanical strength.
Source: PDF 1, p. 16
SECTION 18 OSTEONECROSIS OF THE KNEE#
Treatment principles#
QuestionWhat is the treatment for Once the subchondral bone has collapsed, treatment?
AnswerOnce the subchondral bone has collapsed, treatment is joint arthroplasty.
Source: PDF 1, p. 16
QuestionWhat does When the joint space has?
AnswerWhen the joint space has narrowed significantly (KL Grade 4), treatment is joint arthroplasty.
Source: PDF 1, p. 16
QuestionIn SECTION 18 OSTEONECROSIS OF THE KNEE, what should you remember about: Spontaneous osteonecrosis involves a single condyle (medial femoral?
AnswerSpontaneous osteonecrosis involves a single condyle (medial femoral condyle).
Source: PDF 1, p. 16
QuestionWhat is Pathology?
AnswerPathology is mechanical overload.
Source: PDF 1, p. 16
QuestionWhat is Classic radiographic appearance?
AnswerClassic radiographic appearance is the “sclerotic halo” with a central radiolucent zone.
Source: PDF 1, p. 16
QuestionWhat does Ssssecondary osteonecrosis has?
AnswerSssecondary osteonecrosis has diffuse involvement.
Source: PDF 1, p. 16
QuestionWhat is Pathology?
AnswerPathology is metabolic.
Source: PDF 1, p. 16
QuestionWhat is Classic appearance?
AnswerClassic appearance is sclerotic white areas of bone infarction throughout the knee.
Source: PDF 1, p. 16
QuestionIn SECTION 18 OSTEONECROSIS OF THE KNEE, what should you remember about: The “crescent sign” at the joint indicates subchondral?
AnswerThe “crescent sign” at the joint indicates subchondral bone collapse.
Source: PDF 1, p. 16
SECTION 19 GLENOHUMERAL ARTHRITIS#
QuestionIn SECTION 19 GLENOHUMERAL ARTHRITIS, what should you remember about: Primary and ssssecondary (e.g., trauma, surgery) causes.?
AnswerPrimary and sssecondary (e.g., trauma, surgery) causes.
Source: PDF 1, p. 16
QuestionWhat is Primary OA?
AnswerPrimary OA: joint space narrowing, inferior humeral osteophyte, posterior wear.
Source: PDF 1, p. 16
QuestionWhat is Inflammatory OA?
AnswerInflammatory OA: rotator cuff tears, central glenoid wear.
Source: PDF 1, p. 16
QuestionWhat is Rotator cuff tear arthropathy (CTA)?
AnswerRotator cuff tear arthropathy (CTA): superior migration of humeral head, superior glenoid wear.
Source: PDF 1, p. 16
QuestionWhat is Clinical exam is important?
AnswerClinical exam is important: focus on rotator cuff function, particularly the subscapularis.
Source: PDF 1, p. 16
QuestionWhat is Most important imaging study?
AnswerMost important imaging study: radiographs, including true AP and axillary view.
Source: PDF 1, p. 16
QuestionIn SECTION 19 GLENOHUMERAL ARTHRITIS, what should you remember about: MRI helpful for evaluation of the rotator cuff?
AnswerMRI helpful for evaluation of the rotator cuff; CT helpful for evaluation of glenoid bone and for preoperative planning.
Source: PDF 1, p. 16
QuestionIn SECTION 19 GLENOHUMERAL ARTHRITIS, what should you remember about: Nonoperative treatment first-line, similar options as hip and?
AnswerNonoperative treatment first-line, similar options as hip and knee OA, literature limited.
Source: PDF 1, p. 16
SECTION 20 SHOULDER HEMIARTHROPLASTY#
QuestionWhat is Iincidence?
AnswerIincidence is declining, very narrow indications.
Source: PDF 1, p. 16
QuestionWhat is Three main indications?
AnswerThree main indications: young patient with avascular necrosis and intact glenoid cartilage, head-splitting proximal humerus fracture in young patient with salvageable tuberosities; treatment of a failed reverse shoulder replacement with poor glenoid bone.
Source: PDF 1, p. 16
QuestionWhat is Late glenoid pain?
AnswerLate glenoid pain is a frequent complication when hemiarthroplasty performed for arthritis.
Source: PDF 1, p. 16
QuestionWhat is Reverse sshoulder replacement?
AnswerReverse shoulder replacement is now the favored treatment for CTA.
Source: PDF 1, p. 16
SECTION 21 TOTAL SHOULDER ARTHROPLASTY#
QuestionIn SECTION 21 TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Anatomic TSA remains the preferred treatment for glenohumeral?
AnswerAnatomic TSA remains the preferred treatment for glenohumeral OA in a patient with intact rotator cuff.
Source: PDF 1, p. 16
QuestionWhat is Iincidence of full-thickness cuff tears with primary glenohumeral OA?
AnswerIincidence of full-thickness cuff tears with primary glenohumeral OA is low (5%e10%).
Source: PDF 1, p. 16
QuestionIn SECTION 21 TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Glenoid retroversion must be corrected to <10 degrees?
AnswerGlenoid retroversion must be corrected to <10 degrees at time of surgery. Strategies to address retroversion include high side reaming, bone grafting, or augmented PE glenoid components.
Source: PDF 1, p. 16
QuestionIn SECTION 21 TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Rehabilitation after TSA should protect the subscapularis by?
AnswerRehabilitation after TSA should protect the subscapularis by avoiding excessive passive external rotation and active internal rotation early.
Source: PDF 1, p. 16
QuestionWhat does Complications of TSA include?
AnswerComplications of TSA include injury to the musculocutaneous and axillary nerves, subscapularis failure, and glenoid much more often than humeral loosening.
Source: PDF 1, p. 16
SECTION 22 REVERSE TOTAL SHOULDER ARTHROPLASTY#
QuestionIn SECTION 22 REVERSE TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Involves placing a baseplate and glenosphere on the?
AnswerInvolves placing a baseplate and glenosphere on the glenoid side and a humeral tray and stem on the humeral side.
Source: PDF 1, p. 16
QuestionIn SECTION 22 REVERSE TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Medializes and distalizes the center of rotation and?
AnswerMedializes and distalizes the center of rotation and resolves the problem of superior migration.
Source: PDF 1, p. 16
QuestionWhat is Elevation power?
AnswerElevation power is provided by the deltoid, so an intact axillary nerve is required.
Source: PDF 1, p. 16
QuestionIn SECTION 22 REVERSE TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Component position largely focuses on the glenosphere, which?
AnswerComponent position largely focuses on the glenosphere, which must be placed inferior on the glenoid face and with neutral or slight inferior tilt to enhance deltoid tension and avoid scapular notching.
Source: PDF 1, p. 16
QuestionWhat is most common location of instability after rTSA?
AnswerThe most common location of instability after rTSA is anterior; the classic mechanism is pushing up from a chair.
Source: PDF 1, p. 16
QuestionWhat was/were Rates of scapular notching?
AnswerRates of scapular notching were historically quite high; more modern lateralized prostheses have reduced this risk.
Source: PDF 1, p. 16
QuestionIn SECTION 22 REVERSE TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Periprosthetic fractures can occur, most importantly in the?
AnswerPeriprosthetic fractures can occur, most importantly in the acromion and scapular spine, owing to tension on the deltoid and various other patient and implant-related factors.
Source: PDF 1, p. 16
SECTION 23 INFECTION IN SHOULDER ARTHROPLASTY#
QuestionWhat does Periprosthetic sshoulder infections manifest?
AnswerPeriprosthetic shoulder infections manifest differently from periprosthetic hip and knee infections.
Source: PDF 1, p. 16
QuestionWhat are Cutibacterium acnes and coagulase-negative Staphylococcus?
AnswerCutibacterium acnes and coagulase-negative Staphylococcus are the most common organisms; cultures should be held for 14 to 28 days to allow growth.
Source: PDF 1, p. 16
QuestionIn SECTION 23 INFECTION IN SHOULDER ARTHROPLASTY, what should you remember about: Postoperative hematoma, young age, male sex, arthroplasty for?
AnswerPostoperative hematoma, young age, male sex, arthroplasty for trauma, and revision surgery have been the only identified risk factors.
Source: PDF 1, p. 16
QuestionWhat are Serum laboratory tests and aspiration with analysis of synovial fluid?
AnswerSerum laboratory tests and aspiration with analysis of synovial fluid are key in the workup, but neither is sufficiently sensitive or specific. The role of arthroscopy with synovial biopsy in diagnosing infection is increasing.
Source: PDF 1, p. 16
QuestionWhat is Tissue culture?
AnswerTissue culture is the gold standard for diagnosis.
Source: PDF 1, p. 16
QuestionWhat does Management options include?
AnswerManagement options include antibiotic suppression, irrigation, and débridement with PE exchange for acute infections, one-stage revisions, and two-stage revisions.
Source: PDF 1, p. 16
QuestionWhat are Antibiotic choices?
AnswerAntibiotic choices are guided by culture results. Adult Reconstruction 479
Source: PDF 1, p. 16
source p. 17
SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE#
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: Hindfoot consists of talus, calcaneus, and cuboid; subtalar?
AnswerHindfoot consists of talus, calcaneus, and cuboid; subtalar, calcaneocuboid (CC), and talonavicular (TN) joints are included; hindfoot functions primarily in inversion and eversion.
Source: PDF 1, p. 17
QuestionWhat does Ankle dorsiflexion results in?
AnswerAnkle dorsiflexion results in external rotation and proximal translation of fibula.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: Calcaneofibular ligament (CFL) extends from tip of lateral?
AnswerCalcaneofibular ligament (CFL) extends from tip of lateral malleolus to lateral aspect of calcaneus.
Source: PDF 1, p. 17
QuestionWhat does Can lead to?
AnswerCan lead to avulsion injuries of distal tip of fibula.
Source: PDF 1, p. 17
QuestionWhat are three parts to the Lisfranc ligament dorsal, plantar, and interosseous; interosseous is strongest.?
AnswerThere are three parts to the Lisfranc ligament dorsal, plantar, and interosseous; interosseous is strongest.
Source: PDF 1, p. 17
QuestionWhat is In hammer toes/crossover toes, the plantar plate?
AnswerIn hammer toes/crossover toes, the plantar plate is disrupted. It is the most important static stabilizer of the lesser metatarsophalangeal (MTP) toe joint.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: Intrinsic tendons pass plantar to MTP joint axis?
AnswerIntrinsic tendons pass plantar to MTP joint axis proximally (providing a flexion force) and pass dorsal to the axis distally (providing an extension force). Plantar migration of this metatarsal head after a Weil (oblique shortening) osteotomy leads to a relatively dorsal position of the intrinsic tendons. The tendons now lie dorsal to the axis of rotation, leading to a “floating” toe.
Source: PDF 1, p. 17
QuestionWhat is One full gait cycle from heel strike to heel strike?
AnswerOne full gait cycle from heel strike to heel strike is termed a stride. Each stride is composed of a stance phase (heel strike to toe-off; 62% of cycle) and a swing phase (toe-off to heel strike; 38% of cycle).
Source: PDF 1, p. 17
QuestionWhat are multiple soft-tissue contributions to gait mechanics. During swing phase, the anterior tibialis contracts concentrically; loss of function results in a footdrop and steppage gait.?
AnswerThere are multiple soft-tissue contributions to gait mechanics. During swing phase, the anterior tibialis contracts concentrically; loss of function results in a footdrop and steppage gait.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: At heel strike, the anterior tibialis contracts eccentrically.?
AnswerAt heel strike, the anterior tibialis contracts eccentrically. This motion controls the rate at which the foot strikes the ground. In patients with footdrop, the rapid strike of the foot can result in a loud “slap” during heel strike. The hindfoot is locked/inverted at initial strike; it will passively evert during transition from heel strike to foot flat. This eversion facilitates energy absorption. Failure of hindfoot eversion in patients with cavovarus deformity increases forces to the lateral foot, resulting in stress fractures (fifth metatarsal), callus formation, and ankle instability.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: During foot flat, the gastrocnemius-soleus complex contracts eccentrically.?
AnswerDuring foot flat, the gastrocnemius-soleus complex contracts eccentrically. The contraction helps to control forward progression of the body over the foot. Loss of function results in a calcaneus gait with heel pain. During foot flat, the hindfoot is unlocked/everted for ground accommodation. At terminal stance, the FDL tendon is most active.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: During toe-off, the gastrocnemius-soleus complex contracts concentrically. Additionally?
AnswerDuring toe-off, the gastrocnemius-soleus complex contracts concentrically. Additionally, as foot progresses from heel strike to toe-off, the foot undergoes changes allowing it to convert from a flexible shock absorber to a rigid propellant. The plantar fascia, which attaches to plantar medial heel and runs the length of the arch to the bases of each proximal phalanx, is tightened as MTP joints extend. The longitudinal arch is accentuated; this is known as the windlass mechanism. The hindfoot supinates, with firing of the posterior tibial tendon (PTT). The transverse tarsal joint locks and provides a rigid lever arm for toe-off. Creation of the rigid lever is limited if the PTT is dysfunctional.
Source: PDF 1, p. 17
QuestionWhat are multiple etiologies of flatfoot, and it is important to tease out where the apex of deformity is. It typically is midfoot- or hindfoot-driven.?
AnswerThere are multiple etiologies of flatfoot, and it is important to tease out where the apex of deformity is. It typically is midfoot- or hindfoot-driven.
Source: PDF 1, p. 17
SECTION 2 PHYSICAL EXAMINATION OF THE FOOT AND ANKLE#
QuestionWhat is Inability to sense a Semmes-Weinstein 5.07 monofilament (10 g)?
AnswerInability to sense a Semmes-Weinstein 5.07 monofilament (10 g) is consistent with neuropathy.
Source: PDF 1, p. 17
QuestionIn SECTION 2 PHYSICAL EXAMINATION OF THE FOOT AND ANKLE, what should you remember about: Deep peroneal nerve (anterior tarsal tunnel syndrome) at?
AnswerDeep peroneal nerve (anterior tarsal tunnel syndrome) at the anterior ankle and hindfoot; may be compressed at inferior extensor retinaculum.
Source: PDF 1, p. 17
QuestionIn SECTION 2 PHYSICAL EXAMINATION OF THE FOOT AND ANKLE, what should you remember about: Stability of the lateral ankle ligaments can be?
AnswerStability of the lateral ankle ligaments can be assessed with the anterior drawer and varus talar tilt tests; inversion of the ankle in dorsiflexion evaluates the CFL. The anterior drawer test is used to check the competence of the ATFL; inversion of the ankle in plantar flexion may also evaluate the ATFL.
Source: PDF 1, p. 17
QuestionIn SECTION 2 PHYSICAL EXAMINATION OF THE FOOT AND ANKLE, what should you remember about: Peroneus longus attaches to plantar aspect of first?
AnswerPeroneus longus attaches to plantar aspect of first metatarsal base and medial cuneiform.
Source: PDF 1, p. 17
QuestionWhat is Peroneus brevis?
AnswerPeroneus brevis is dorsal to the peroneus longus at level of peroneal tubercle.
Source: PDF 1, p. 17
QuestionWhat is In determining whether source of contracture?
AnswerIn determining whether source of contracture is Achilles tendon, gastrocnemius-soleus complex, or ankle soft tissue, a lack of tension on the Achilles with attempted Silfverskiöld test makes the posterior capsule the likely source.
Source: PDF 1, p. 17
SECTION 3 ADULT HALLUX VALGUS#
QuestionIn SECTION 3 ADULT HALLUX VALGUS, what should you remember about: In assessing radiographs for hallux valgus, one needs?
AnswerIn assessing radiographs for hallux valgus, one needs to evaluate the hallux valgus angle (HVA; normal <15 degrees), the intermetatarsal angle (IMA; normal <9 degrees), the distal metatarsal articular angle (DMAA; normal <10 degrees) and the hallux valgus interphalangeus angle (normal <10 degrees; associated with congruent deformity). One should also evaluate the congruency of the joint, to gauge soft tissue contracture versus elevated DMAA. The position of the sesamoids, which are often lateral (relative to the adducted metatarsal), should be checked.
Source: PDF 1, p. 17
QuestionWhat does Pronation leads to rounding of lateral head (which should have?
AnswerPronation leads to rounding of lateral head (which should have a flat contour with no rotational deformity).
Source: PDF 1, p. 17
QuestionIn SECTION 3 ADULT HALLUX VALGUS, what should you remember about: This can be hard to correct with distal?
AnswerThis can be hard to correct with distal first metatarsal osteotomy and requires rotational osteotomy or first tarsometatarsal (TMT) aaarthrodesis.
Source: PDF 1, p. 17
QuestionIn SECTION 3 ADULT HALLUX VALGUS, what should you remember about: In treatment of hallux valgus, soft tissue releases?
AnswerIn treatment of hallux valgus, soft tissue releases in isolation, medial eminence resection, and isolated osteotomy without soft tissue correction are associated with high rates of recurrence.
Source: PDF 1, p. 17
QuestionIn SECTION 3 ADULT HALLUX VALGUS, what should you remember about: With an IMA of 13 degrees or less?
AnswerWith an IMA of 13 degrees or less and/or HVA of 40 degrees or less, distal osteotomy (i.e., chevron) should be considered. With an IMA of 13 degrees or higher and/or HVA of more than 40 degrees, proximal metatarsal osteotomy should be considered. In the setting of hyperlaxity or instability of the first TMT, aaarthrodesis of the first TMT should be considered. Soft tissue release should be done in all scenarios.
Source: PDF 1, p. 17
QuestionWhat is Hallux valgus recurrence can follow any procedure but?
AnswerHallux valgus recurrence can follow any procedure but is highly associated with undercorrection of the IMA, isolated soft tissue correction, isolated resection of the medial eminence, and persistent lateral subluxation of the sesamoids.
Source: PDF 1, p. 17
QuestionWhat is risk of injury to the mediodorsal cutaneous nerve branch of the superficial peroneal nerve with medial approaches to the hallux.?
AnswerThere is risk of injury to the mediodorsal cutaneous nerve branch of the superficial peroneal nerve with medial approaches to the hallux.
Source: PDF 1, p. 17
SECTION 4 JUVENILE AND ADOLESCENT HALLUX VALGUS#
QuestionWhat is the treatment for In treatment of juvenile/adolescent hallux valgus, recurrence?
AnswerIn treatment of juvenile/adolescent hallux valgus, recurrence is most common postoperative complication.
Source: PDF 1, p. 17
QuestionWhat is If the IMA?
AnswerIf the IMA is greater than 13 degrees with an elevated DMAA, a proximal osteotomy (or open-wedge medial cuneiform osteotomy) must be completed in conjunction with a medial closed-wedge osteotomy distally (biplanar chevron) to tilt the joint back into position. Disorders of the Foot and Ankle 581
Source: PDF 1, p. 17
source p. 18
SECTION 5 HALLUX VARUS#
QuestionWhat does Hallux varus can occur?
AnswerHallux varus can occur from fibular sesamoidectomy, overcorrection of the IMA, over-resection of the medial eminence, or excessive lateral soft tissue release.
Source: PDF 1, p. 18
QuestionIn SECTION 5 HALLUX VARUS, what should you remember about: Operative management of hallux varus depends in part?
AnswerOperative management of hallux varus depends in part on flexibility of the deformity; with flexible deformities, a medial capsulotomy and abductor hallucis tenotomy need to be completed in conjunction with an extensor (extensor hallucis longus or extensor hallucis brevis) tendon transfer. The tendon transfer may be augmented with suture button techniques.
Source: PDF 1, p. 18
SECTION 6 LESSER-TOE DEFORMITIES#
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: Extrinsic muscles (extensor digitorum longus [EDL] and flexor?
AnswerExtrinsic muscles (extensor digitorum longus [EDL] and flexor digitorum longus [FDL]) overpower intrinsic muscles in positioning the lesser toes in hammer- and claw-toe deformities, with the EDL driving MTP joint extension and the FDL driving proximal interphalangeal (PIP) and distal interphalangeal joint flexion.
Source: PDF 1, p. 18
QuestionWhat is FDL contracture?
AnswerFDL contracture is the dynamic component contributing to development of a hammer-toe deformity. Treatment of claw toes or hammer toes depends on flexibility. Flexible deformities can be treated with flexor to extensor transfer or an FDL tenotomy; this may be done in conjunction with a PIP arthroplasty. Fixed deformities should be treated with PIP aaarthrodesis.
Source: PDF 1, p. 18
QuestionWhat do Flexor-to-extensor tendon transfer can lead to?
AnswerFlexor-to-extensor tendon transfer can lead to stiffness of the lesser toe MTP joint.
Source: PDF 1, p. 18
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: Crossover toe (second toe) deformity develops from disruption?
AnswerCrossover toe (second toe) deformity develops from disruption of the plantar plate (key component) and attenuation of the lateral collateral ligament.
Source: PDF 1, p. 18
QuestionWhat are Claw toes?
AnswerClaw toes are often neurogenic in etiology (i.e., Charcot-Marie-Tooth
Source: PDF 1, p. 18
QuestionWhat is For hammer-toe/claw-toe deformities, if there?
AnswerFor hammer-toe/claw-toe deformities, if there is skin breakdown at the PIP dorsally, surgical débridement (with obtaining of specimen cultures) and delay of definitive treatment must be considered.
Source: PDF 1, p. 18
QuestionWhat is Anterior drawer test of the lesser hallux MTP joint?
AnswerAnterior drawer test of the lesser hallux MTP joint is the most sensitive physical examination test to evaluate for plantar plate injury.
Source: PDF 1, p. 18
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: For plantar plate injury, nonoperative management with toe?
AnswerFor plantar plate injury, nonoperative management with toe taping and metatarsal pads/lesser toe orthotics should be considered.
Source: PDF 1, p. 18
QuestionWhat does In high-level athletes, repair of the plantar plate tear has?
AnswerIn high-level athletes, repair of the plantar plate tear has been advocated.
Source: PDF 1, p. 18
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: In Freiberg disease/infarction, a dorsal closed-wedge osteotomy of?
AnswerIn Freiberg disease/infarction, a dorsal closed-wedge osteotomy of the metatarsal head has been shown to have good results; this brings the often preserved plantar cartilage surface dorsally to articulate with the proximal phalanx.
Source: PDF 1, p. 18
SECTION 7 HYPERKERATOTIC PATHOLOGIES#
QuestionWhat is Bunionette deformity can cause shoewear issues and?
AnswerBunionette deformity can cause shoewear issues and is commonly seen in conjunction with ipsilateral hallux valgus (splayfoot).
Source: PDF 1, p. 18
QuestionWhat is Type I?
AnswerType I is bony exostosis, type II is lateral curve to the distal metatarsal shaft/metatarsal head, and type III is a widened fourthefifth IMA (normal 7e8 degrees or less).
Source: PDF 1, p. 18
QuestionWhat is Surgical management is based on the type?
AnswerSurgical management is based on the type: for type I, lateral exostectomy; for type II, fifth metatarsal head osteotomy; for type III, diaphyseal osteotomy (poor blood supply proximally); for recurrence or salvage, fifth metatarsal head resection.
Source: PDF 1, p. 18
SECTION 8 SESAMOIDS#
QuestionWhat is When there?
AnswerWhen there is concern for sesamoid injuries (i.e., turf toe), radiographs of the contralateral side should be obtained to compare position of sesamoids relative to the base of the proximal phalanx. The tibial sesamoid should be 10.4 mm from the base, and the fibular sesamoid should be 13.4 mm from the base; both measurements should be within 3 mm of those of the contralateral eeextremity.
Source: PDF 1, p. 18
QuestionIn SECTION 8 SESAMOIDS, what should you remember about: Turf toe often develops from forced dorsiflexion of?
AnswerTurf toe often develops from forced dorsiflexion of the foot in equinus, along with an axial load. Another less common mechanism is a hypereplantar flexion of the hallux MTP, with valgus force. This can be seen in beach volleyball players.
Source: PDF 1, p. 18
Turf toe comes in three grades (grade 1: capsular strain; grade 2#
QuestionWhat does For persistent sesamoid issues refractory to nonoperative measures, sesamoidectomy has?
AnswerFor persistent sesamoid issues refractory to nonoperative measures, sesamoidectomy has the most predictable results. If the fracture pattern allows, resection of nonunited segment (proximal or distal pole) can be performed. Complications of tibial or fibular sesamoidectomy include hallux valgus or hallux varus, respectively. Resection of both sesamoids leads to a cock-up toe.
Source: PDF 1, p. 18
QuestionWhat is Freiberg disease?
AnswerFreiberg disease: a long second metatarsal may be a risk factor (additionally, gastrocnemius contracture may be associated).
Source: PDF 1, p. 18
SECTION 9 NEUROLOGIC DISORDERS#
QuestionWhat is Interdigital neuromas have a higher predilection for female patients; this?
AnswerInterdigital neuromas have a higher predilection for female patients; this is likely related to shoewear with forced plantar flexion of the metatarsal heads. Diagnosis is primarily based on history and physical exam; patients may demonstrate burning in plantar webspace. Palpation between and just distal to the metatarsal heads elicits plantar tenderness.
Source: PDF 1, p. 18
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: Symptoms can be alleviated with metatarsal pads placed?
AnswerSymptoms can be alleviated with metatarsal pads placed proximal to the focus of pain, to prevent pressure and widen the intermetatarsal space during weight bearing. No injections have been demonstrated to confer long-term relief.
Source: PDF 1, p. 18
QuestionWhat does Neuromas often demonstrate?
AnswerNeuromas often demonstrate perineural fibrosis.
Source: PDF 1, p. 18
QuestionWhat do Lateral plantar nerve may be injured during surgical approaches that require?
AnswerLateral plantar nerve may be injured during surgical approaches that require a plantar incision, such as a tibiotalocalcaneal aaarthrodesis with an intramedullary nail. However, if no evidence of paresthesias and persistent hindfoot pain, evaluation for nonunion of the ankle or subtalar joints is needed.
Source: PDF 1, p. 18
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: Wasting of the abductor hallucis (ABH) or abductor?
AnswerWasting of the abductor hallucis (ABH) or abductor digiti quinti may be seen if the medial or lateral plantar nerve is involved, respectively.
Source: PDF 1, p. 18
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: Tibial nerve innervates all foot intrinsics except for?
AnswerTibial nerve innervates all foot intrinsics except for extensor hallucis brevis and digitorum brevis.
Source: PDF 1, p. 18
QuestionWhat is Tarsal tunnel?
AnswerTarsal tunnel: muscle atrophy and abnormal signal on magnetic resonance imaging (MRI) may be seen in plantar medial foot muscles, including flexor digitorum brevis and ABH.
Source: PDF 1, p. 18
QuestionWhat do Patients with anterior tarsal tunnel syndrome present?
AnswerPatients with anterior tarsal tunnel syndrome present with burning pain and paresthesias along the medial second toe, lateral hallux, and first web space, or even vague dorsal foot pain. Surgical release involves incising the distal half of the inferior extensor retinaculum, releasing both branches of the nerve, excising bone spurs, and carefully repairing the bony capsule to avoid exposing the nerve to bleeding bone, while protecting the dorsalis pedis artery.
Source: PDF 1, p. 18
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: The superficial peroneal nerve can also be damaged?
AnswerThe superficial peroneal nerve can also be damaged or entrapped in scar tissue at the interolateral portal following ankle arthroscopic procedures.
Source: PDF 1, p. 18
source p. 19
QuestionWhat do Popliteal nerve blocks do not typically include?
AnswerPopliteal nerve blocks do not typically include the saphenous nerve.
Source: PDF 1, p. 19
QuestionWhat is CMT disease?
AnswerCMT disease is a hereditary sensory motor neuropathy. Type I is most common and is usually autosomal dominant. The basis of CMT is an abnormality of the peripheral myelin sheath protein (PMP22) as a result of duplication of chromosome 17. There is a genetic anticipation component: the earlier the age of onset, the more severe the findings.
Source: PDF 1, p. 19
QuestionWhat are Deformity and awkward gait?
AnswerDeformity and awkward gait are common initial complaints, with weakness, lateral ankle instability, and lateral foot pain presenting later. Often patients may have bilateral pes cavovarus, which results from overpull of the PTT/peroneus longus (PL) relative to the tibialis anterior/peroneus brevis. The PL overpull causes plantar flexion of the first ray. The hindfoot varus develops from the overpull of the PTT. Intrinsic muscles are often affected first because they have the longest axons; this leads to dorsiflexion of the phalanges across all of the toes, and the phalanx drives the metatarsals in plantar flexion. The loss of MTP flexion facilitates development of claw toes.
Source: PDF 1, p. 19
QuestionIn Testable concepts, what should you remember about: Correction of cavovarus deformity depends on flexibility of?
AnswerCorrection of cavovarus deformity depends on flexibility of the deformity and whether the varus is hindfoot- or forefoot-driven.
Source: PDF 1, p. 19
QuestionIn Testable concepts, what should you remember about: First branch of the lateral plantar nerve (Baxter?
AnswerFirst branch of the lateral plantar nerve (Baxter nerve) may be a source of chronic plantar medial heel pain.
Source: PDF 1, p. 19
SECTION 10 ARTHRITIC DISEASE#
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Gout involves deposition of monosodium urate crystals into?
AnswerGout involves deposition of monosodium urate crystals into synovium-lined joints or into soft tissues. May be caused by trauma, alcohol, purine-rich foods, postoperative state, or certain medications. Great toe MTP joint is most commonly involved (podagra). Definitive diagnosis is based on needle aspiration of the joint; pathognomonic microscopic signs include needle-shaped monosodium urate crystals, which under polarized light are strongly negatively birefringent. Treatment of acute attacks involves use of colchicine (microtubule inhibitor); chronic disease is treated with allopurinol (xanthine oxidase inhibitor, use of which can actually precipitate acute gout).
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Ruling out an acute septic jointdwhich would be?
AnswerRuling out an acute septic jointdwhich would be determined from the aspirate Gram stain and culturedis critical.
Source: PDF 1, p. 19
QuestionWhat is White blood cell (WBC) count of the aspirate?
AnswerWhite blood cell (WBC) count of the aspirate is 50,000 per high powered field or higher.
Source: PDF 1, p. 19
QuestionWhat does Infected joint require?
AnswerInfected joint requires operative irrigation/débridement.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: In pseudogout, polarized light microscopy examination of joint?
AnswerIn pseudogout, polarized light microscopy examination of joint aspirate reveals weakly positive birefringent crystals with varied shapes.
Source: PDF 1, p. 19
QuestionWhat are Seronegative spondyloarthropathies?
AnswerSeronegative spondyloarthropathies are defined as inflammatory arthritides in which the rheumatoid factor is absent. Often have a higher incidence of entheses involvement (where collagen is inserting onto bone); implicated in psoriatic arthritis, Reiter syndrome, and inflammatory bowel disease. Are often more destructive of collagen and fibrocartilage. May manifest as plantar fasciitis/Achilles tendinitis/posterior tibial tendinopathy. Surgical intervention may be required for small joint erosion, refractory Achilles tendon issues, and plantar fasciitis.
Source: PDF 1, p. 19
QuestionWhat do Nonoperative treatment of osteoarthritis of the foot/ankle should include?
AnswerNonoperative treatment of osteoarthritis of the foot/ankle should include antiinflammatory drugs, orthotics, bracing, and corticosteroid injections. In hallux rigidus, a carbon fiber shank with an extension for the great toe (Morton extension) is often used. Midfoot arthritis can be treated with a stiff-soled or carbon fiber shankemodified shoe with a rocker bottom; hindfoot arthritis with an Arizona brace or an ankle-foot orthosis (AFO). For ankle arthritis, nonsteroidal antiinflammatory drugs, AFO/Arizona brace, and a rocker-bottom shoe may be of benefit.
Source: PDF 1, p. 19
QuestionWhat do Osteophytes at dorsal talonavicular (TN) joint may cause?
AnswerOsteophytes at dorsal talonavicular (TN) joint may cause irritation to the deep peroneal nerve; if the joint space is preserved, can do osteophyte removal and limited retinacular release.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: For hallux rigidus grades I and II (pain?
AnswerFor hallux rigidus grades I and II (pain at extreme range of motion only), operative management often involves dorsal cheilectomy (removal of all osteophytes, including portion of dorsal metatarsal head with loss of cartilage).
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Failure of partial or total joint replacement of?
AnswerFailure of partial or total joint replacement of the hallux (osteolysis/ implant loosening) may necessitate implant removal and aaarthrodesis with structural grafting.
Source: PDF 1, p. 19
QuestionWhat is Fusion of the great toe?
AnswerFusion of the great toe: positiondneutral rotation, 10 to 15 degrees dorsiflexion, and 5 degrees valgus.
Source: PDF 1, p. 19
QuestionWhat is Best way to check sagittal alignment?
AnswerBest way to check sagittal alignment is to simulate weight bearing.
Source: PDF 1, p. 19
QuestionWhat is Toe?
AnswerToe is slightly elevated (4e6 mm off the simulated weightbearing surface), such that the toe will be in contact with ground with flexion of interphalangeal (IP) joint.
Source: PDF 1, p. 19
QuestionWhat do Placement of plate too proximal (6 mm) can lead to?
AnswerPlacement of plate too proximal (6 mm) can lead to increased dorsiflexion of great toe (8 degrees).
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Ankle aaaarthrodesis often indicated in patients with peripheral?
AnswerAnkle aaarthrodesis often indicated in patients with peripheral neuropathy and insensate foot.
Source: PDF 1, p. 19
QuestionWhat is Open aaaarthrodesis?
AnswerOpen aaarthrodesis is ideal for severe deformity.
Source: PDF 1, p. 19
QuestionWhat do Ankle aaaarthrodesis malunion may lead to?
AnswerAnkle aaarthrodesis malunion may lead to anterior talar translation of the talus. This can elongate the lever arm of the foot and needs a revision aaarthrodesis of the ankle. If excessive plantar flexion, will develop excessive hyperextension of the knee.
Source: PDF 1, p. 19
QuestionWhat was/were If fibula?
AnswerIf fibula was taken as part of ankle fusion, total ankle replacement (TAR) is not possible.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: TAR can be used for valgus arthritis of?
AnswerTAR can be used for valgus arthritis of ankle with flexible hindfoot (i.e., stage 4 variant). Contraindications include severe coronal plane deformity, avascular necrosis (AVN) (talus or tibia; however, focal AVN is not a contraindication to TAR or aaarthrodesis), Charcot arthropathy, young age, and history of infection. Ipsilateral hindfoot arthritis is an indication for TAR.
Source: PDF 1, p. 19
QuestionWhat was/were Ssssyndesmotic fusion when the Agility ankle replacement system?
AnswerSssyndesmotic fusion when the Agility ankle replacement system was previously used was associated with lower rate of failure. Medialization of extramedullary tibial cutting guides can lead to fracture of the medial malleolus.
Source: PDF 1, p. 19
QuestionWhat is Salvage of implant failure?
AnswerSalvage of implant failure is difficult given the amount of bone loss and current lack of available revision components. The most reliable current technique is a bone-block ankle aaarthrodesis (femoral head) with or without additional subtalar fusion.
Source: PDF 1, p. 19
QuestionWhat do Wound breakdown in the acute period (3 weeks) after TAR require?
AnswerWound breakdown in the acute period (3 weeks) after TAR requires débridement and polyethylene exchange; if 6 weeks or longer after TAR, removal of implant and placement of antibiotic spacer should be considered.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Osteolysis.?
AnswerOsteolysis.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Best evaluated with a computed tomography (CT) scan.?
AnswerBest evaluated with a computed tomography (CT) scan.
Source: PDF 1, p. 19
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: May be three times greater in comparison to?
AnswerMay be three times greater in comparison to x-rays.
Source: PDF 1, p. 19
SECTION 11 POSTURAL DISORDERS#
QuestionWhat is Most common cause of adult-acquired flatfoot?
AnswerMost common cause of adult-acquired flatfoot is posterior tibial tendon dysfunction.
Source: PDF 1, p. 19
QuestionWhat are Tarsal coalitions cause rigid flatfeet and?
AnswerTarsal coalitions cause rigid flatfeet and are the result of failure of segmentation of mesenchymal tissue. May see C-sign/dorsal talar beaking on x-ray (middle facet coalition). Elongated anterior process of calcaneus on lateral (calcaneonavicular coalition). Disorders of the Foot and Ankle 583
Source: PDF 1, p. 19
source p. 20
QuestionWhat is spring (calcaneonavicular) ligament?
AnswerThe spring (calcaneonavicular) ligament is the primary static stabilizer of the TN joint; most commonly the superomedial band (70%); originates from the interomedial sustentaculum.
Source: PDF 1, p. 20
QuestionIn Testable concepts, what should you remember about: Patients may complain of medial ankle foot pain?
AnswerPatients may complain of medial ankle foot pain, progressive arch collapse, and lateral hindfoot pain (subfibular impingement). Physical examination may demonstrate asymmetric hindfoot valgus, depressed arch, and an abducted forefoot. Pain or inability to perform single-limb heel rise indicates insufficient PTT. The patient may have lateral impaction syndrome or subfibular impingement with significant valgus of the heel, such that it abuts the fibula; abutment of the lateral process of the talus and the calcaneus can occur as well. Gastrocnemius complex is often contracted; it originates off of the posterior femur.
Source: PDF 1, p. 20
QuestionWhat is the treatment for Operative management of PTT dysfunction (PTTD)?
AnswerOperative management of PTT dysfunction (PTTD) is reserved for patients for whom 6 months or more of conservative measures have failed. Lateral column lengthening addresses hindfoot valgus and improves the longitudinal arch of the foot/medial column of the foot. Cotton osteotomy (dorsal open-wedge osteotomy of the cuneiform) is used to plantar flex the first ray, to correct forefoot varus. Stage 3 PTTD is treated with double or triple aaarthrodesis.
Source: PDF 1, p. 20
QuestionWhat does If subtalar aaaarthrodesis (alone or as part of triple) has?
AnswerIf subtalar aaarthrodesis (alone or as part of triple) has been malunited in valgus, with tenderness in the lateral subfibular region, aaarthrodesis takedown and revision aaarthrodesis may be required. Severely abducted deformities may need an all-medial approach to limit the risk of wound-healing issues with the sinus tarsi approach. Some authors argue that the calcaneocuboid (CC) joint is challenging to see, but cadaveric studies have demonstrated the ability to see more than 90% of each joint from the medial approach alone.
Source: PDF 1, p. 20
QuestionIn Testable concepts, what should you remember about: Patients with pes cavus may complain of painful?
AnswerPatients with pes cavus may complain of painful calluses under the first metatarsal, fifth metatarsal, and medial heel. There may be pain along the peroneal tendons as well.
Source: PDF 1, p. 20
QuestionIn Testable concepts, what should you remember about: On an adequate weight-bearing, lateral foot radiograph, visibility?
AnswerOn an adequate weight-bearing, lateral foot radiograph, visibility of the middle facet of the subtalar joint indicates hindfoot varus. Often associated with lateral ankle ligament instability, peroneal tendon pathology.
Source: PDF 1, p. 20
QuestionWhat does Nonoperative modalities include?
AnswerNonoperative modalities include orthotics with lateral heel wedge, accommodative arch, and depressed first ray.
Source: PDF 1, p. 20
SECTION 12 TENDON DISORDERS#
QuestionIn SECTION 12 TENDON DISORDERS, what should you remember about: Acute rupture of the peroneus longus tendon at?
AnswerAcute rupture of the peroneus longus tendon at or through a fracture of the os peroneum can occur. Radiographs show a retraction or fracture of the os peroneum.
Source: PDF 1, p. 20
QuestionWhat are Peroneal tendons?
AnswerPeroneal tendons are the most common cause of chronic pain following an ankle sprain or with chronic instability.
Source: PDF 1, p. 20
QuestionWhat is Peroneal tendon subluxation-dislocation?
AnswerPeroneal tendon subluxation-dislocation is caused by forced eversion and dorsiflexion leading to disruption of superior peroneal retinaculum (SPR). MRI may demonstrate displacement of peroneal tendons interolateral to the retrofibular region. Groove deepening if shallow fibular groove and peroneal retinacular repair if evidence of tendon subluxation. For peroneal subluxation or dislocation, chronic injury requires repair/ reconstruction of the SPR and fibular groove deepening. Acute injury requires SPR repair/reconstruction.
Source: PDF 1, p. 20
QuestionWhat does If conservative management (immobilization/physical therapy) has?
AnswerIf conservative management (immobilization/physical therapy) has failed, operative management of degenerative tears of the peroneal tendons includes tenosynovectomy, débridement, and repair.
Source: PDF 1, p. 20
QuestionIn SECTION 12 TENDON DISORDERS, what should you remember about: For anterior tibial tendon ruptures, primary repair generally?
AnswerFor anterior tibial tendon ruptures, primary repair generally improves functional results regardless of patient age. Tendon grafting augmentation may be warranted if there is adequate excursion of the myotendinous unit and the muscle is healthy. Need to consider adding gastrocnemius recession/Achilles lengthening to take tension off of the anterior tibial tendon reconstruction.
Source: PDF 1, p. 20
QuestionWhat does Stenosis occur?
AnswerStenosis occurs along course of flexor hallucis longus (FHL) between the posterolateral and posteromedial tubercles of the talus.
Source: PDF 1, p. 20
SECTION 13 HEEL PAIN#
QuestionWhat are In evaluation of plantar fasciitis, weight-bearing x-rays?
AnswerIn evaluation of plantar fasciitis, weight-bearing x-rays are an important first diagnostic step to evaluate for stress injuries, subtalar arthritis, tumor, and insertional enthesophytes. Advanced imaging (MRI) may demonstrate thickening of the plantar fascia and surrounding inflammation.
Source: PDF 1, p. 20
QuestionWhat is the treatment for Nonoperative management?
AnswerNonoperative management is the cornerstone of management; this involves cushioned heel inserts, night splints, and Achilles/plantar fasciaespecific stretching. Cortisone injections may alleviate symptoms (short-term, w1 month) but can lead to fat pad atrophy/ plantar fascial rupture; number leading to rupture is 2.67. Overall,
Source: PDF 1, p. 20
QuestionIn SECTION 13 HEEL PAIN, what should you remember about: Operative treatment indicated in less than 5% of?
AnswerOperative treatment indicated in less than 5% of patients. Gastrocnemius recession has been advocated and should be considered in isolation in patients with clear evidence of a gastrocnemius contracture without evidence of jogger’s foot/Baxter neuritis. Baxter neuritis is entrapment of the first branch of the lateral plantar nerve that often manifests as heel pain akin to that seen in plantar fasciitis. There is pain over the medial aspect of the ABH. Electromyography/nerve conduction velocity tests may demonstrate increased motor latency within the abductor digiti quinti. MRI may show fatty infiltration of the abductor digiti quinti. Nonoperative treatment consists of heel cord stretching and cushioned inserts. Operative treatment includes open release of the nerve and fascial release of the ABH.
Source: PDF 1, p. 20
QuestionWhat is Sever disease?
AnswerSever disease is a calcaneal apophysitis seen in young males (10e14 years old, often in running/jumping) either prior to or during a growth spurt. Treatment includes activity modification, gastrocnemius stretching, and cushioned heel orthotics. No correlation between symptoms and fragmentation of apophysis.
Source: PDF 1, p. 20
QuestionIn SECTION 13 HEEL PAIN, what should you remember about: In management of insertional Achilles tendinosis, evaluation of?
AnswerIn management of insertional Achilles tendinosis, evaluation of the Achilles tendon should include a physical examination; bony prominence, tendon thickening, and area of tenderness should be checked. The Silfverskiöld test should be used to evaluate for contracture. Activity and shoewear modification, heel lifts, stretching, physical therapy with heavy-load eccentric training, and use of silicone heel sleeves/pads to decrease pain from direct pressure are mainstays of conservative treatment.
Source: PDF 1, p. 20
QuestionWhat do Patients with noninsertional Achilles tendinopathy often present?
AnswerPatients with noninsertional Achilles tendinopathy often present with pain, swelling, and impaired performance, especially with running. There is often a tender area of fusiform thickening localized about 2 to 6 cm proximal to the insertion of the tendon. MRI demonstrates thickening of the tendon, with intrasubstance iiintermediate signal intensity consistent with the disorganized tissue. In the setting of a chronic rupture, a large gap is present between the hypoechoic (dark) tendon ends. Nonoperative management with heavy-load eccentric strengthening has demonstrated the highest success rate.
Source: PDF 1, p. 20
QuestionIn SECTION 13 HEEL PAIN, what should you remember about: Operative management of a chronic Achilles tendon rupture?
AnswerOperative management of a chronic Achilles tendon rupture with a gap between the ends (after débridement) greater than 5 cm is with an FHL transfer and possible turndown procedure. If the gap between ends is between 2 and 5 cm, a V-Y reconstruction is possible. If the gap is less than 2 cm, an end-to-end repair is possible.
Source: PDF 1, p. 20
QuestionWhat does Plantaris rupture may have?
AnswerPlantaris rupture may have similar mechanism as Achilles ruptures but can be managed initially with a tall boot.
Source: PDF 1, p. 20
source p. 21
QuestionWhat is Achilles ruptures?
AnswerAchilles ruptures: Initial management should involve immobilization with the foot in plantar flexion.
Source: PDF 1, p. 21
SECTION 14 ANKLE PAIN AND SPORTS INJURIES#
QuestionIn SECTION 14 ANKLE PAIN AND SPORTS INJURIES, what should you remember about: Lateral ankle sprains, which often result from plantar?
AnswerLateral ankle sprains, which often result from plantar flexion/ inversion mechanisms, can lead to injury to branches of the superficial peroneal nerve and cause numbness over the dorsal midfoot. Direct trauma to the area may also cause injury, herniation, and subsequent entrapment of the superficial peroneal nerve. Patients may develop complex regional pain syndrome; dysfunction in motor, sensory and autonomic nerve systems. Pain is out of proportion to findings on exam; most cases in lower eeextremity develop after trauma or elective surgery. Physical exam is the most important tool for diagnosis.
Source: PDF 1, p. 21
QuestionIn SECTION 14 ANKLE PAIN AND SPORTS INJURIES, what should you remember about: If nerve symptoms persist, neurotomy and burial may?
AnswerIf nerve symptoms persist, neurotomy and burial may be needed. Initial management should involve RICE (rest, ice, compression, elevation) protocol with limited weight bearing if there is marked ankle jointeline tenderness or pain with weight-bearing activity.
Source: PDF 1, p. 21
QuestionWhat is the treatment for In lateral ankle sprain, physical therapy?
AnswerIn lateral ankle sprain, physical therapy is important for balance and proprioception and peroneal strengthening and is associated with a decreased rate of reinjury. Functional bracing along with neuromuscular (i.e., proprioceptive) training decreases the risk of recurrence of low ankle sprains more than neuromuscular training alone.
Source: PDF 1, p. 21
QuestionWhat is the treatment for Additional physical therapy should be considered if there?
AnswerAdditional physical therapy should be considered if there is no evidence of peroneal tendon injury on examination or if the patient has not completed an adequate amount of rehabilitation.
Source: PDF 1, p. 21
QuestionWhat does Ankle instability can occur?
AnswerAnkle instability can occur without ligamentous issues (peroneal tendinopathy, osteochondral defects, fracture nonunion, anterior ankle impingement).
Source: PDF 1, p. 21
QuestionWhat is Posterior ankle impingement?
AnswerPosterior ankle impingement is common in ballet dancers, gymnasts, soccer players, and downhill runners. Pain is exacerbated and reproducible with maximum plantar flexion of ankle and pushoff maneuvers. (An anomalous soleus muscle can cause similar symptoms.) Operative intervention includes arthroscopic or open débridement of posterior inflamed synovium and excision of symptomatic os trigonum/impinging bone.
Source: PDF 1, p. 21
QuestionWhat are Osteochondral defects?
AnswerOsteochondral defects are commonly treated with arthroscopic management. Linear fluid signal deep to subchondral bone indicates unstable injury. For lesions smaller than 1.5 cm2
Source: PDF 1, p. 21
QuestionWhat do Large lesions need alternative treatment; autologous osteochondral grafting produce?
AnswerLarge lesions need alternative treatment; autologous osteochondral grafting produces hyaline cartilage with minimal degradation over time, chondroplasty/microfracture generates type 1 collagen based fibrocartilage, and osteochondral allograft contains high volume of viable chondrocytes if transplanted less than 2 weeks from time of harvest (high rates of collapse/resorption reported; 60% of patients have joint space narrowing 44 months postoperatively). Autologous chondrocyte implantation can lead to hyaline cartilage or fibrocartilage.
Source: PDF 1, p. 21
QuestionWhat do Larger lesions with cystic component may require?
AnswerLarger lesions with cystic component may require medial malleolar osteotomy and bone grafting. Treatment of tibial defects has a lower success rate than that of talar lesions.
Source: PDF 1, p. 21
QuestionWhat do Chronic exertional compartment syndrome manifest?
AnswerChronic exertional compartment syndrome manifests in runners/ cyclists. It results from pressure buildup in the anterior compartment, most commonly during running. Compartment pressures are measured before, during, and after exercises. Pressures higher than 30 mm Hg 1 minute after exercise, 20 mm Hg 5 minutes after exercise, or absolute values higher than 15 mm Hg during rest can help establish the diagnosis. Fasciotomy is indicated in refractory cases.
Source: PDF 1, p. 21
QuestionWhat are the complications of most common complication after ankle arthroscopy?
AnswerThe most common complication after ankle arthroscopy is nerve injury, with the superficial peroneal nerve (dorsal/dorsolateral foot sensation) being most commonly affected. Establishing initial anterior portal risks injury to anterior tibial tendon.
Source: PDF 1, p. 21
QuestionWhat is Gastrocnemius strain?
AnswerGastrocnemius strain: posterior calf injury occurring at the myotendinous junction. Occurs with eccentric contraction.
Source: PDF 1, p. 21
SECTION 15 THE DIABETIC FOOT#
QuestionWhat is Glucose assessment?
AnswerGlucose assessment is ideally evaluated with A1c measurement (indicative of past 3 months of glucose control).
Source: PDF 1, p. 21
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Loss of protective sensation (inability to perceive the?
AnswerLoss of protective sensation (inability to perceive the 5.07 Semmes- Weinstein monofilament) is most common cause of plantar foot ulcers; this loss is associated with a 30% risk of development of an ulcer.
Source: PDF 1, p. 21
QuestionWhat do Peripheral vascular disease can lead to?
AnswerPeripheral vascular disease can lead to falsely elevated ankle brachial indices. It is present in 60% to 70% of patients who have had diabetes for more than 10 years. Transcutaneous oxygen values for the toes greater than 40 mm Hg have been found to be predictive of healing.
Source: PDF 1, p. 21
Classifying ulcers can help guide management. Depth grade 0#
QuestionWhat is Plastazote (closed cellecross linked polyethylene)?
AnswerPlastazote (closed cellecross linked polyethylene) is often used to line the shoe and offload prominent areas. It is lightweight, can absorb shock, and is able to be soft and compliant.
Source: PDF 1, p. 21
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Dorsal toe ulcers best served with flexor tenotomies.?
AnswerDorsal toe ulcers best served with flexor tenotomies.
Source: PDF 1, p. 21
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Ischemia-based classification; grade A (normal vascularity), grade B?
AnswerIschemia-based classification; grade A (normal vascularity), grade B (ischemia without gangrene), grade C (partial forefoot gangrene), grade D (complete foot gangrene).
Source: PDF 1, p. 21
QuestionWhat does Treatment often require?
AnswerTreatment often requires Achilles lengthening to prevent recurrence of forefoot/midfoot ulceration. Toe deformities often require joint resection or amputation. Plantar hallux IP joint ulcers for which contact casting has failed should be treated with a Keller arthroplasty.
Source: PDF 1, p. 21
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Presence of infection may be reason why ulcers?
AnswerPresence of infection may be reason why ulcers do not heal with conservative management. Débridement of infected tissue with use of negative-pressure dressings is recommended.
Source: PDF 1, p. 21
QuestionWhat is Charcot arthropathy?
AnswerCharcot arthropathy is common in patients with diabetic neuropathy. Patients complain of swelling, warmth, redness, and deformity. Pain is present in up to 50% of patients. Midfoot is most commonly affected, followed by ankle and then hindfoot. Acute Charcot may be treated/resolved with TCC for 4 to 6 weeks. Fragmentation to consolidation may take 6 to 18 months. TNF-alpha and IL-1B lead to increased levels of NF-KB, which is responsible for increased osteoclast production and loss of bone.
Source: PDF 1, p. 21
QuestionWhat is the treatment for Initial treatment of Charcot arthropathy?
AnswerInitial treatment of Charcot arthropathy is noneweight-bearing status with a TCC.
Source: PDF 1, p. 21
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Unstable/unbraceable deformities should be addressed with a tibiotalocalcaneal?
AnswerUnstable/unbraceable deformities should be addressed with a tibiotalocalcaneal aaarthrodesis to afford a braceable/plantigrade foot while reducing risk of ulceration. Use of an intramedullary rod will afford internal stability and can be left indefinitely, in contrast to a multiplanar external fixator. Even with radiographic evidence of nonunion, many patients can be pain-free. Disorders of the Foot and Ankle 585
Source: PDF 1, p. 21
source p. 22
QuestionWhat are Infections in the diabetic foot or ankle?
AnswerInfections in the diabetic foot or ankle are either isolated soft tissue infections (cellulitis or abscess) or ooosteomyelitis. If abscess is suspected, completed needle aspiration or MRI (renal issues may preclude MRI) is needed.
Source: PDF 1, p. 22
QuestionWhat is Labeled WBC scan or dual-image technetium/indium (Tc/In) scan?
AnswerLabeled WBC scan or dual-image technetium/indium (Tc/In) scan is more sensitive and specific for ooosteomyelitis than isolated Tc scan.
Source: PDF 1, p. 22
QuestionWhat does Contiguous oooosteomyelitis present?
AnswerContiguous ooosteomyelitis present in 67% of foot ulcerations that reach bone.
Source: PDF 1, p. 22
QuestionWhat is Oooosteomyelitis?
AnswerOoosteomyelitis is treated with antibiotics and surgical débridement.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: Elevated A1c increases risk for failure of transmetatarsal?
AnswerElevated A1c increases risk for failure of transmetatarsal amputation.
Source: PDF 1, p. 22
QuestionWhat does Syme amputation require?
AnswerSyme amputation requires intact heel pad.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: Transtibial amputations.?
AnswerTranstibial amputations.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: 25% more energy exerted compared to baseline (trauma).?
Answer25% more energy exerted compared to baseline (trauma).
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: 40% more energy exerted compared to baseline (vasculopathy).?
Answer40% more energy exerted compared to baseline (vasculopathy).
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: Transfemoral.?
AnswerTransfemoral.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: Increased rates of oxygen consumption, metabolic rate, heart?
AnswerIncreased rates of oxygen consumption, metabolic rate, heart rate and perceived exertion.
Source: PDF 1, p. 22
QuestionWhat is Traumatic?
AnswerTraumatic: 68% more energy.
Source: PDF 1, p. 22
QuestionWhat is Vascular?
AnswerVascular: 100% more energy.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: No significant difference with regards to stride length?
AnswerNo significant difference with regards to stride length, step length, or step cadence from able individuals.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: To avoid deformity of Chopart amputation, anterior tibialis?
AnswerTo avoid deformity of Chopart amputation, anterior tibialis must be transferred to the talus to prevent varus, and Achilles lengthening must be completed to prevent equinus.
Source: PDF 1, p. 22
QuestionIn Testable concepts, what should you remember about: Reduced total protein less than 6.0 g/dL, WBC?
AnswerReduced total protein less than 6.0 g/dL, WBC count less than 1500 cells/mm3
Source: PDF 1, p. 22
SECTION 16 TRAUMA#
QuestionWhat do Excessive loading of second metatarsal can lead to?
AnswerExcessive loading of second metatarsal can lead to stress injury. Risk factors include a long second metatarsal and hallux rigidus/ valgus. Radiographs may demonstrate periosteal reaction or evidence of callus formation near diaphyseal region of affected metatarsal after 3 to 4 weeks. A normal radiographic appearance prior to this time does not exclude a stress fracture.
Source: PDF 1, p. 22
QuestionWhat is Second metatarsal stress fracture?
AnswerSecond metatarsal stress fracture is the most common and is classically described in amenorrheal ballet dancers.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: In female athletes, the triad of anorexia, osteoporosis/stress?
AnswerIn female athletes, the triad of anorexia, osteoporosis/stress injuries, and menstrual dysfunction must be considered.
Source: PDF 1, p. 22
QuestionWhat is Jones fracture of the base of the fifth metatarsal base?
AnswerJones fracture of the base of the fifth metatarsal base is a fracture that extends into the fourth-fifth intermetatarsal articulation. There is a 15% to 25% risk of nonunion with nonoperative management. Elite athletes should be treated with intramedullary screw fixation. The minimum screw diameter is typically 4 mm, with later data demonstrating that the mean diameter is 5 mm. Fixation provides highest chance of successful healing. Chronic injury requires screw fixation (large, solid vs. cannulated).
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Fifth metatarsal diaphyseal injuries (dancer’s fracture).?
AnswerFifth metatarsal diaphyseal injuries (dancer’s fracture).
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Occur from twisting mechanism.?
AnswerOccur from twisting mechanism.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: High union rates.?
AnswerHigh union rates.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: May be treated conservatively with hard-soled shoe.?
AnswerMay be treated conservatively with hard-soled shoe.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Diaphyseal stress injuries of the fifth metatarsal should?
AnswerDiaphyseal stress injuries of the fifth metatarsal should be treated with intramedullary screw fixation.
Source: PDF 1, p. 22
QuestionWhat is Fracture of all five metatarsals?
AnswerFracture of all five metatarsals is predictive of amputation in setting of mid/hindfoot fractures after high-energy trauma.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Dislocation of the ankle, a lower Sanders calcaneal?
AnswerDislocation of the ankle, a lower Sanders calcaneal fracture classification, presence of sensation are not predictive; talar fracture does not increase risk for amputation.
Source: PDF 1, p. 22
QuestionWhat is Lisfranc articulation?
AnswerThe Lisfranc articulation is a stable construct because of its bony architecture and strong ligaments. The base of the second metatarsal fits into a mortise formed by the proximally recessed middle cuneiform (keystone configuration). Lisfranc ligament is critical to stabilizing the second metatarsal and maintaining midfoot arch. It runs between the medial cuneiform and the base of the second metatarsal; the interosseous component is stiffest and strongest, dorsal is the weakest. Plantar ecchymosis should raise suspicion for a TMT/Lisfranc injury.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Aiiinteroposterior (AP), lateral, and oblique radiographs should be?
AnswerAiinteroposterior (AP), lateral, and oblique radiographs should be obtained. Lateral translation of the second metatarsal relative to the middle cuneiform is diagnostic of a Lisfranc injury. The fleck sign (a small, bony avulsion from the base of the second metatarsal seen in the first intermetatarsal space) is diagnostic of a Lisfranc injury.
Source: PDF 1, p. 22
QuestionWhat are Cuboid injuries (nutcracker cuboid)?
AnswerCuboid injuries (nutcracker cuboid) are often sustained from an abduction force and may be associated with Lisfranc injuries.
Source: PDF 1, p. 22
QuestionWhat is If there?
AnswerIf there is tenting of the skin, the injury needs to be reduced urgently to reduce risk of compartment syndrome.
Source: PDF 1, p. 22
QuestionWhat is Anatomic reduction?
AnswerAnatomic reduction is most predictive of good clinical results.
Source: PDF 1, p. 22
QuestionWhat is Anatomic reduction?
AnswerAnatomic reduction is mandatory and open reduction is often required as opposed to closed reduction with percutaneous fixation. Historically stabilized with screw fixation across the involved joints.
Source: PDF 1, p. 22
QuestionWhat is Primary aaaarthrodesis?
AnswerPrimary aaarthrodesis is an alternative treatment option, with some benefits seen in patients with purely ligamentous high-energy injury (dorsal subluxation or dislocation) or significant intraarticular comminution.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Has advantage of reduced rates of hardware removal?
AnswerHas advantage of reduced rates of hardware removal
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Reduced costs compared to open reduction and internal?
AnswerReduced costs compared to open reduction and internal fixation (ORIF).
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: One randomized study demonstrated no difference in patient-reported?
AnswerOne randomized study demonstrated no difference in patient-reported outcome on Short Mmusculoskeletal Functional Assessment or Short Form 36 between aaarthrodesis or ORIF.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Can be used in chronic injury patterns.?
AnswerCan be used in chronic injury patterns.
Source: PDF 1, p. 22
QuestionWhat do Missed diagnosis or improper treatment may lead to?
AnswerMissed diagnosis or improper treatment may lead to traumatic planovalgus deformity or posttraumatic arthritis. Open reduction and midfoot aaarthrodesis should be considered in this setting.
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Navicular stress fractures often happen in the central?
AnswerNavicular stress fractures often happen in the central third of the navicular and are sssecondary to repetitive trauma. Cavus foot is a risk factor. Plain radiographs may not be revealing. CT is the gold standard of identification. Fracture line often extends from dorsolateral to plantar medial. Conservative measures for nondisplaced fractures are noneweight-bearing status and a cast for 6 to
Source: PDF 1, p. 22
QuestionIn SECTION 16 TRAUMA, what should you remember about: Talonavicular dislocations need to be reduced closed rather?
AnswerTalonavicular dislocations need to be reduced closed rather than open; dorsal dislocation can be irreducible sssecondary to the posterior tibial tendon.
Source: PDF 1, p. 22
source p. 23
QuestionIn Testable concepts, what should you remember about: Lateral process acts as dividing line between talar?
AnswerLateral process acts as dividing line between talar body and talar neck injuries.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: For treatment of talar neck fractures, medial compression?
AnswerFor treatment of talar neck fractures, medial compression screw may worsen varus deformity if comminution is present. A fully threaded screw or plate should be used medially to avoid this complication.
Source: PDF 1, p. 23
QuestionWhat are the complications of most common complication after a talar neck fracture?
AnswerThe most common complication after a talar neck fracture is subtalar arthritis.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Most later studies show no correlation between time?
AnswerMost later studies show no correlation between time to fixation and development of osteonecrosis (likely sssecondary to maintenance of posterior vessels).
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Early fixation may be associated with increased risk?
AnswerEarly fixation may be associated with increased risk of wound healing complications (up to 77% of cases) and infection.
Source: PDF 1, p. 23
QuestionWhat do Failure to restore alignment leads to?
AnswerFailure to restore alignment leads to varus malunion and hindfoot stiffness.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: In the setting of AVN of the talus?
AnswerIn the setting of AVN of the talus and arthritis of the ankle, consider ankle aaarthrodesis, because distraction arthroplasty has not been shown to have good results; TAR is not an option.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Lateral transfibular approach to a tibiotalocalcaneal aaaarthrodesis to?
AnswerLateral transfibular approach to a tibiotalocalcaneal aaarthrodesis to allow for the fibula to be used as a source of graft and assess extent of vascularity of talus.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Talar body extrusions need to be evaluated closely.?
AnswerTalar body extrusions need to be evaluated closely. With minimal contamination and any remaining soft tissue attachment, talar body should be copiously irrigated, washed (chlorhexidine), débrided, and reimplanted. In the presence of gross contamination, it may be appropriate to disregard the body and perform a delayed reconstruction. However, all attempts at salvage should be made. Rates of deep infection and overall failure are very high.
Source: PDF 1, p. 23
QuestionWhat are the complications of Most frequent complication?
AnswerMost frequent complication is AVN. Majority do not have collapse but do revascularize.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Small or comminuted lateral process fractures can be?
AnswerSmall or comminuted lateral process fractures can be excised; if arthritis, subtalar aaarthrodesis; best way to evaluate lateral process injuries, CT scan.
Source: PDF 1, p. 23
QuestionWhat are Avulsion fractures of the calcaneal tuberosity?
AnswerAvulsion fractures of the calcaneal tuberosity are caused by forceful Achilles contraction. Eaandangers posterior skin with displacement. These injuries necessitate urgent operative reduction and fixation to prevent skin compromise (including smokers). Percutaneous fixation achieved with lag screws from the posterior superior tuberosity directed inferior and distal.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: With calcaneal fractures one must evaluate for concomitant?
AnswerWith calcaneal fractures one must evaluate for concomitant injuries such as vertebral fractures. The Broden oblique view of the ankle is helpful to evaluate posterior facet displacement. The more internal rotation of leg allows anterior portion of the joint to be seen; less internal rotation of leg allows posterior portion of the joint to be seen.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Patients with an overall normal morphology of the?
AnswerPatients with an overall normal morphology of the hindfoot but intraarticular incongruity may not benefit from operative intervention.
Source: PDF 1, p. 23
QuestionWhat are Clinical outcomes?
AnswerClinical outcomes are better with operative than with nonoperative management in patients with the following characteristics: significant intraarticular displacement, flattened Böhler angle, female sex, age younger than
Source: PDF 1, p. 23
QuestionWhat is lateral wall?
AnswerThe lateral wall is “blown out,” causing subfibular impingement and peroneal tendon impingement or dislocation.
Source: PDF 1, p. 23
QuestionWhat does 20% of patients may have?
Answer20% of patients may have peroneal tendon dislocation.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Best seen on axial CT sequences.?
AnswerBest seen on axial CT sequences.
Source: PDF 1, p. 23
QuestionWhat does Extensile lateral exposure provide?
AnswerExtensile lateral exposure provides access to subtalar and CC joints and allows for lateral plate placement, but has a high rate of wound complications.
Source: PDF 1, p. 23
QuestionWhat do Delayed wound healing can occur?
AnswerDelayed wound healing can occur in 25% to 30% of patients treated with an extensile approach. Risk of a deep infection is much lower (1%e4%).
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Treat wound issues initially with dressing changes and?
AnswerTreat wound issues initially with dressing changes and immobilization.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: In cases with significant loss of calcaneal height?
AnswerIn cases with significant loss of calcaneal height, horizontal talus, and resultant anterior ankle pain, boneblock distraction aaarthrodesis of the subtalar joint is required. A posterolateral approach should be considered to avoid the soft tissue healing issues associated with application of bone block through the sinus tarsi approach.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Near 90% of medial subtalar dislocations can be?
AnswerNear 90% of medial subtalar dislocations can be reduced with adequate sedation/relaxation.
Source: PDF 1, p. 23
QuestionHow is Diagnosis of ankle fractures diagnosed?
AnswerDiagnosis of ankle fractures is based on plain radiographs. Stress radiographs (gravity/external rotation) are used to identify evidence of deep deltoid injury and an unstable injury pattern. CT can be used for evaluating more complex injury patterns and posterior malleolar fracture.
Source: PDF 1, p. 23
QuestionWhat are Measurements for ssssyndesmotic issues?
AnswerMeasurements for sssyndesmotic issues are made at 10 mm above the plafond. The tibiofibular clear space should be less than 6 mm on AP and mortise views (abnormality of this value is most predictive of sssyndesmotic disruption). The tibiofibular overlap should be more than 6 mm on AP and more than 1 mm on mortise views.
Source: PDF 1, p. 23
QuestionWhat is Ankle fracture spur sign (at inferomedial tibial metaphysis)?
AnswerAnkle fracture spur sign (at inferomedial tibial metaphysis) is indicative of a hyperflexion variant injury; after reduction of injury, CT scan should be obtained to evaluate articular surface more clearly.
Source: PDF 1, p. 23
QuestionWhat are Multiple classifications systems of ankle fractures. Lauge- Hansen and Danis-Weber?
AnswerMultiple classifications systems of ankle fractures. Lauge- Hansen and Danis-Weber are commonly used. Lauge-Hansen system describes position of foot/deforming mechanism. Danis- Weber system describes fibular fracture line in relation to the syndesmosis.
Source: PDF 1, p. 23
QuestionWhat is Log splitter injury?
AnswerLog splitter injury: Ankle fracture dislocation resulting with talus is displaced into sssyndesmotic space. High risk of posttraumatic arthritis: 54% to 85%.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Medial clear space widening with stress indicates deep?
AnswerMedial clear space widening with stress indicates deep deltoid disruption and implies unstable fracture pattern.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: External rotation may be helpful to indicate evidence?
AnswerExternal rotation may be helpful to indicate evidence of medial ankle instability.
Source: PDF 1, p. 23
QuestionWhat is One millimeter of lateral talar shift?
AnswerOne millimeter of lateral talar shift is associated with a 42% decrease in tibiotalar contact area.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Braking response time for vehicle driving returns (on?
AnswerBraking response time for vehicle driving returns (on average) 9 weeks after operative fixation of ankle fractures.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: Stabilization of the posterior malleolus restores 70% of?
AnswerStabilization of the posterior malleolus restores 70% of the stability of the syndesmosis.
Source: PDF 1, p. 23
QuestionIn Testable concepts, what should you remember about: With lateral approaches, need to protect the superficial?
AnswerWith lateral approaches, need to protect the superficial peroneal nerve to avoid causing numbness to dorsolateral foot.
Source: PDF 1, p. 23
QuestionWhat are Supination-adduction injuries?
AnswerSupination-adduction injuries are associated with second ooorthopaedic injuries.
Source: PDF 1, p. 23
QuestionWhat is Malreduction of the syndesmosis?
AnswerMalreduction of the syndesmosis is the most common complication after sssyndesmotic fixation. Although many studies report 0% to 16% risk of malreduction, it may be as high as 52%. Disorders of the Foot and Ankle 587
Source: PDF 1, p. 23
source p. 24
ANATOMY#
QuestionWhat is Central slip?
AnswerCentral slip: terminal extension of extensor digitorum communis (EDC), aids in PIP extension.
Source: PDF 1, p. 24
QuestionWhat is Lateral bands?
AnswerLateral bands: convergence of intrinsics and EDC, extends DIP joint.
Source: PDF 1, p. 24
QuestionWhat is Transverse retinacular ligament?
AnswerTransverse retinacular ligament: prevents dorsal subluxation of lateral bands.
Source: PDF 1, p. 24
QuestionWhat is Injury?
AnswerInjury: swan-neck deformity.
Source: PDF 1, p. 24
QuestionWhat is Triangular ligament?
AnswerTriangular ligament: prevents volar subluxation of lateral bands.
Source: PDF 1, p. 24
QuestionWhat is Injury?
AnswerInjury: boutonnière deformity.
Source: PDF 1, p. 24
QuestionWhat is Vascular supply of flexor tendons?
AnswerVascular supply of flexor tendons: both intrinsic (direct feeding vessels) and extrinsic (diffusion via synovial sheath to flexor tendons).
Source: PDF 1, p. 24
QuestionWhat is A2 and A4 pulleys?
AnswerA2 and A4 pulleys: critical to prevent bowstringing of flexor tendon.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: The carpal tunnel contains the median nerve and?
AnswerThe carpal tunnel contains the median nerve and nine flexor tendons (one flexor pollicis longus [FPL], four flexor digitorum superficialis [FDS], and four flexor digitorum profundus [FDP]).
Source: PDF 1, p. 24
QuestionWhat is FPL?
AnswerFPL is most radial; the long and ring FDS tendons are volar to index and small FDS tendons.
Source: PDF 1, p. 24
QuestionWhat is Lumbrical muscles?
AnswerLumbrical muscles: originate on radial aspect of FDP tendons, pass volar to transverse metacarpal ligaments, and insert on radial aspect of the extensor hood with lateral bands.
Source: PDF 1, p. 24
QuestionWhat is Intrinsic tightness?
AnswerIntrinsic tightness: limited PIP flexion with MCP joints held in extension.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Intrinsics on stretch, extrinsics relaxed.?
AnswerIntrinsics on stretch, extrinsics relaxed.
Source: PDF 1, p. 24
QuestionWhat is Bunnell test?
AnswerBunnell test: extended MCP leads to limited PIP flexion, while flexed MCP enables PIP flexion.
Source: PDF 1, p. 24
QuestionWhat is Treatment?
AnswerTreatment: therapy to stretch intrinsics or surgical intrinsic release.
Source: PDF 1, p. 24
QuestionWhat is Extrinsic tightness?
AnswerExtrinsic tightness: limited PIP flexion with MCP joints held in flexion.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Extrinsics on stretch, intrinsics relaxed.?
AnswerExtrinsics on stretch, intrinsics relaxed.
Source: PDF 1, p. 24
QuestionWhat is Treatment?
AnswerTreatment: therapy to stretch extrinsics or tenolysis.
Source: PDF 1, p. 24
QuestionWhat is Median nerve?
AnswerMedian nerve: innervates pronator teres, FDS, flexor carpi radialis (FCR), palmaris longus (PL), radial two lumbricals.
Source: PDF 1, p. 24
QuestionWhat is Ulnar nerve?
AnswerUlnar nerve: innervates flexor carpi ulnaris (FCU), ring/small digit FDPs, long FDP (50% of time), ulnar two lumbricals.
Source: PDF 1, p. 24
QuestionWhat is Radial nerve proper?
AnswerRadial nerve proper: innervates lateral portion of brachialis (also musculocutaneous), triceps, anconeus, brachioradialis, extensor carpi radialis longus (ECRL).
Source: PDF 1, p. 24
QuestionWhat is Posterior interosseous nerve (PIN)?
AnswerPosterior interosseous nerve (PIN): innervates all remaining extensors.
Source: PDF 1, p. 24
QuestionWhat is Anastomoses?
AnswerAnastomoses: Martin-Gruber (median-ulnar in forearm ), Riche- Cannieu (median-ulnar in palm). DISTAL RADIUS FRACTURES
Source: PDF 1, p. 24
QuestionWhat is Concomitant injuries?
AnswerConcomitant injuries: scaphoid fracture, scapholunate (SL) injury, ulnar styloid fracture.
Source: PDF 1, p. 24
QuestionWhat is Acute carpal tunnel syndrome (CTS)?
AnswerAcute carpal tunnel syndrome (CTS): evolving paresthesias/pain requires emergent release.
Source: PDF 1, p. 24
QuestionWhat is Normal anatomy (11?
AnswerNormal anatomy (11:22:11).
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Radial height 11 mm, radial inclination 22 degrees?
AnswerRadial height 11 mm, radial inclination 22 degrees, volar tilt 11 degrees.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Acceptable reduction.?
AnswerAcceptable reduction.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Radial shortening less than 3 mm, dorsal tilt?
AnswerRadial shortening less than 3 mm, dorsal tilt less than 10 degrees, intraarticular step-off less than 2 mm.
Source: PDF 1, p. 24
QuestionWhat is Nonoperative treatment?
AnswerNonoperative treatment: minimally displaced fracture.
Source: PDF 1, p. 24
QuestionWhat is Complications?
AnswerComplications: stiffness and disuse osteopenia.
Source: PDF 1, p. 24
QuestionWhat is Surgical treatment?
AnswerSurgical treatment: ORIF ( volar) for volarly displaced fractures (Smith and volar Barton); also become standard for dorsally displaced fractures (Colles).
Source: PDF 1, p. 24
QuestionWhat is Dorsal approach?
AnswerDorsal approach: direct visualization of the articular surface; intraarticular pathology, such as of the SL, should be addressed.
Source: PDF 1, p. 24
QuestionWhat is The most common complication after distal radius fracture?
AnswerThe most common complication after distal radius fracture: median nerve dysfunction.
Source: PDF 1, p. 24
Extensor pollicis longus (EPL) tendon rupture#
QuestionIn ANATOMY, what should you remember about: Occurs after ORIF because of long screw, or?
AnswerOccurs after ORIF because of long screw, or after nonoperative treatment because of attritional wear and/or vascular insufficiency near the Lister tubercle.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Treated with extensor indicis proprius (EIP)-to-EPL tendon transfer.?
AnswerTreated with extensor indicis proprius (EIP)-to-EPL tendon transfer.
Source: PDF 1, p. 24
QuestionWhat is FPL rupture?
AnswerFPL rupture is the most common flexor injury after volar plating (watershed line).
Source: PDF 1, p. 24
QuestionWhat is Associated distal ulnar styloid fracture?
AnswerAssociated distal ulnar styloid fracture: treated nonoperatively if distal radioulnar joint (DRUJ) stable.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: triangular fibrocartilage complex (TFCC) injury most common associated?
Answertriangular fibrocartilage complex (TFCC) injury most common associated intraarticular problem (most treated nonoperatively unless DRUJ unstable).
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: Vitamin C (500 mg/day for 50 days) prescribed?
AnswerVitamin C (500 mg/day for 50 days) prescribed postoperatively to prevent complex regional pain syndrome.
Source: PDF 1, p. 24
QuestionWhat is DRUJ instability?
AnswerDRUJ instability: increased risk if open fracture, coronal shift of the distal fragment, or >6 mm of prereduction positive ulnar variation. CARPAL FRACTURES AND INSTABILITY
Source: PDF 1, p. 24
QuestionWhat is Scaphoid fracture?
AnswerScaphoid fracture: most common carpal bone fracture; retrograde blood supply from dorsal branch of radial artery.
Source: PDF 1, p. 24
QuestionWhat is Radiographs nondiagnostic in one-third of cases?
AnswerRadiographs nondiagnostic in one-third of cases: immobilization for 2 weeks plus advanced imaging.
Source: PDF 1, p. 24
QuestionWhat is Acute operative indications?
AnswerAcute operative indications: more than 1 mm of displacement, intrascaphoid angle more than 35 degrees, perilunate fracturedislocation, proximal pole fracture.
Source: PDF 1, p. 24
QuestionIn ANATOMY, what should you remember about: ORIF with long, central screw (percutaneous/arthroscopic procedure for?
AnswerORIF with long, central screw (percutaneous/arthroscopic procedure for nondisplaced fracture; open procedure for displaced or chronic fracture).
Source: PDF 1, p. 24
QuestionWhat is Approach?
AnswerApproach: dorsal for proximal pole; volar for distal fracture (less disruptive to vascularity).
Source: PDF 1, p. 24
QuestionWhat is Scaphoid fracture complications?
AnswerScaphoid fracture complications: scaphoid nonunion advanced collapse (SNAC), nonunion, avascular proximal pole.
Source: PDF 1, p. 24
SNAC#
QuestionWhat is Stage 1?
AnswerStage 1: radial styloid.
Source: PDF 1, p. 24
QuestionWhat is Stage 2?
AnswerStage 2: radioscaphoid joint.
Source: PDF 1, p. 24
QuestionWhat is Stage 3?
AnswerStage 3: scaphocapitate and lunocapitate.
Source: PDF 1, p. 24
QuestionWhat is Radiolunate joint?
AnswerRadiolunate joint is least affected (proximal row carpectomy
Source: PDF 1, p. 24
QuestionWhat is Nonunion?
AnswerNonunion: treated with bone graft (for vascularity and structure): for example, iliac crest for humpback deformity with vascularity, 1,2 intercompartmental supraretinacular artery for avascular proximal pole without humpback deformity, medial femoral condyle bone for avascular proximal pole with humpback deformity.
Source: PDF 1, p. 24
QuestionWhat is Lunate fracture?
AnswerLunate fracture: Kienböck disease or perilunate dislocation should be considered.
Source: PDF 1, p. 24
QuestionWhat is Triquetrum fracture?
AnswerTriquetrum fracture: dorsal capsular avulsion (wrist sprain) or lunotriquetral (LT) injury should be considered.
Source: PDF 1, p. 24
QuestionWhat is Capitate neck fracture?
AnswerCapitate neck fracture: often occurs in combination with perilunate dislocation or scaphoid fracture.
Source: PDF 1, p. 24
QuestionWhat is Pisiform fracture?
AnswerPisiform fracture: rare, treated with cast immobilization; excision for painful nonunion.
Source: PDF 1, p. 24
QuestionWhat is Hook of hamate fracture?
AnswerHook of hamate fracture: frequently associated with racket sports or baseball.
Source: PDF 1, p. 24
QuestionWhat is Diagnosis?
AnswerDiagnosis: carpal tunnel radiographic view or computed tomography. Hand, Upper Eeextremity, and Microvascular Surgery 677
Source: PDF 1, p. 24
source p. 25
QuestionWhat is Treatment?
AnswerTreatment: cast (nonoperative), excision (quickest recovery), or ORIF.
Source: PDF 1, p. 25
QuestionWhat is Four types of carpal instability?
AnswerFour types of carpal instability: carpal instability dissociative, carpal instability nondissociative, carpal instability adaptive, carpal instability complex (CIC).
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Dissociative (same row; e.g., dorsal intercalated segmental instability?
AnswerDissociative (same row; e.g., dorsal intercalated segmental instability [DISI], volar intercalated segmental instability [VISI]), nondissociative (different rows; e.g., midcarpal, radiocarpal), adaptive (malunited distal radius fracture), complex (perilunate dislocation).
Source: PDF 1, p. 25
QuestionWhat is DISI?
AnswerDISI is the most common form of carpal instability (increased SL angle).
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: SL ligament (dorsal portion strongest).?
AnswerSL ligament (dorsal portion strongest).
Source: PDF 1, p. 25
QuestionWhat is SL advanced collapse (SLAC) wrist?
AnswerSL advanced collapse (SLAC) wrist: untreated chronic instability; stages similar to those of SNAC wrist.
Source: PDF 1, p. 25
QuestionWhat is VISI?
AnswerVISI is the second most common (decreased SL angle or increased LT angle).
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: LT ligament (volar portion strongest).?
AnswerLT ligament (volar portion strongest).
Source: PDF 1, p. 25
QuestionWhat are Perilunate dislocations?
AnswerPerilunate dislocations are an example of CIC.
Source: PDF 1, p. 25
QuestionWhat is Mayfield described four stages of progressive disruption?
AnswerMayfield described four stages of progressive disruption: I, SL; II, midcarpal; III, LT; IV, circumferential.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Prompt treatment with closed reduction (especially in acute?
AnswerPrompt treatment with closed reduction (especially in acute CTS).
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Definitive treatment with early ORIF using dorsal with?
AnswerDefinitive treatment with early ORIF using dorsal with or without volar approach.
Source: PDF 1, p. 25
QuestionWhat is LT coalition (fusion of the lunate to the triquetrum)?
AnswerLT coalition (fusion of the lunate to the triquetrum) is a normal anatomic variant that does not require intervention. METACARPAL AND PHALANGEAL INJURIES
Source: PDF 1, p. 25
QuestionWhat are Most metacarpal and phalangeal fractures?
AnswerMost metacarpal and phalangeal fractures are treated nonoperatively.
Source: PDF 1, p. 25
QuestionWhat is Operative indications?
AnswerOperative indications: displacement, intraarticular fracture, malrotation, open or multiple fracture.
Source: PDF 1, p. 25
QuestionWhat do Volar PIP joint dislocation require?
AnswerVolar PIP joint dislocation requires central slip repair with splint in full extension to prevent a boutonnière deformity.
Source: PDF 1, p. 25
QuestionWhat is Rotatory dislocation?
AnswerRotatory dislocation: condyle is buttonholed between central slip and lateral band.
Source: PDF 1, p. 25
QuestionWhat is PIP joint fracture-dislocations?
AnswerPIP joint fracture-dislocations: classified according to amount of middle phalanx (P2) articular surface involved.
Source: PDF 1, p. 25
QuestionWhat is Less than 30% involvement?
AnswerLess than 30% involvement: treated nonoperatively with dorsal block splint/pin.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Unstable injuries with larger (>30%) P2 base fragments?
AnswerUnstable injuries with larger (>30%) P2 base fragments treated with operative intervention: dorsal block pinning, ORIF, hemihamate reconstruction, or volar plate arthroplasty.
Source: PDF 1, p. 25
QuestionWhat is Irreducibility of MCP and DIP dislocations?
AnswerIrreducibility of MCP and DIP dislocations is typically due to interposition of the volar plate.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Treated via open reduction and extraction of the?
AnswerTreated via open reduction and extraction of the volar plate.
Source: PDF 1, p. 25
QuestionWhat is MCP head fracture?
AnswerMCP head fracture: fight bite; ORIF if more than 1 mm articular step-off.
Source: PDF 1, p. 25
QuestionWhat is MCP neck fracture?
AnswerMCP neck fracture: boxer’s fracture; Jahss maneuver for reduction.
Source: PDF 1, p. 25
QuestionWhat is Acceptable angulation?
AnswerAcceptable angulation: index/long, less than 15 to 20 degrees; ring, less than 30 to 40 degrees; small, less than 60 to 70 degrees.
Source: PDF 1, p. 25
QuestionWhat is MCP shaft fracture?
AnswerMCP shaft fracture: high risk of malrotation.
Source: PDF 1, p. 25
QuestionWhat is Acceptable angulation?
AnswerAcceptable angulation: index/long, less than 10 degrees; ring/ small, less than 30 degrees; less than 5 mm of shortening also acceptable.
Source: PDF 1, p. 25
QuestionWhat is Most common PIP joint dislocation?
AnswerMost common PIP joint dislocation is dorsal; results from volar plate and collateral ligament injury.
Source: PDF 1, p. 25
QuestionWhat is Bennett fracture?
AnswerBennett fracture is a fracture-dislocation of thumb CMC joint.
Source: PDF 1, p. 25
QuestionWhat does Abductor pollicis longus (APL) and extensors cause?
AnswerAbductor pollicis longus (APL) and extensors cause proximal, dorsal, and radial displacement of metacarpal shaft.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Anterior oblique or “beak” ligament keeps volar-ulnar base?
AnswerAnterior oblique or “beak” ligament keeps volar-ulnar base fragment reduced to trapezium.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Skier’s thumb (acute ulnar collateral ligament [UCL] injury)?
AnswerSkier’s thumb (acute ulnar collateral ligament [UCL] injury) and gamekeeper’s thumb (chronic UCL injury): proximal phalanx supinates around intact radial collateral ligament (RCL).
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Instability in 30 degrees of flexion indicates injury?
AnswerInstability in 30 degrees of flexion indicates injury to true UCL.
Source: PDF 1, p. 25
QuestionWhat does Stener lesion occur?
AnswerStener lesion occurs in more than 85% of complete MCP ligament injuries when the adductor pollicis aponeurosis is interposed between the avulsed UCL and its insertion on the base of the proximal phalanx.
Source: PDF 1, p. 25
QuestionWhat is RCL instability?
AnswerRCL instability is due to overpull of adductor, which causes proximal phalanx to pronate around intact UCL. TENDON INJURIES AND OVERUSE SYNDROMES
Source: PDF 1, p. 25
QuestionWhat is Mallet finger (zone I)?
AnswerMallet finger (zone I): nonoperative treatment (DIP extension splinting) if less than 12 weeks from injury.
Source: PDF 1, p. 25
QuestionWhat is Controversial indication for surgery?
AnswerControversial indication for surgery: displaced bony injury with volar subluxation of P3.
Source: PDF 1, p. 25
QuestionWhat is Dorsal extensor tendon injury over the PIP (zone III)?
AnswerDorsal extensor tendon injury over the PIP (zone III): danger to central slip insertion.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Boutonnière deformity (PIP flexion, DIP extension).?
AnswerBoutonnière deformity (PIP flexion, DIP extension).
Source: PDF 1, p. 25
QuestionWhat does Central slip injury cause?
AnswerCentral slip injury causes lateral bands to sublux volarly.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Acute injuries treated with PIP extension splinting.?
AnswerAcute injuries treated with PIP extension splinting.
Source: PDF 1, p. 25
QuestionWhat is Chronic boutonnière deformity?
AnswerChronic boutonnière deformity: central slip reconstruction if flexible.
Source: PDF 1, p. 25
QuestionWhat is Extensor hood over MCP (zone V) (fight bite)?
AnswerExtensor hood over MCP (zone V) (fight bite): surgical débridement and intravenous (IV) antibiotics.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Principles of partial laceration treatment.?
AnswerPrinciples of partial laceration treatment.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Painful catching in tendon sheath treated with “trimming.”?
AnswerPainful catching in tendon sheath treated with “trimming.”
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Lacerations more than 60% of tendon width treated?
AnswerLacerations more than 60% of tendon width treated with primary repair within 10 days of injury.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Principles of flexor tendon repair.?
AnswerPrinciples of flexor tendon repair.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Increasing strength with increasing number of core sutures?
AnswerIncreasing strength with increasing number of core sutures (greater than four).
Source: PDF 1, p. 25
QuestionWhat are Dorsally placed core sutures?
AnswerDorsally placed core sutures are stronger than volarly placed sutures.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Gap formation decreased with use of a locking-loop?
AnswerGap formation decreased with use of a locking-loop configuration and higher-caliber suture.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Overall strength increased (w10%e50%) with epitendinous repair.?
AnswerOverall strength increased (w10%e50%) with epitendinous repair.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Purchase distance 0.7 to 1.2 cm from ends?
AnswerPurchase distance 0.7 to 1.2 cm from ends with minimal-touch technique.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Preservation of A2 (most important) and A4 (oblique?
AnswerPreservation of A2 (most important) and A4 (oblique in thumb) pulleys prevents bowstringing.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Early protected range of motion (ROM) increases tendon?
AnswerEarly protected range of motion (ROM) increases tendon excursion and strength and decreases adhesion formation.
Source: PDF 1, p. 25
QuestionWhat does Active flexion to reduce adhesions require?
AnswerActive flexion to reduce adhesions requires minimum four-strand core suture repair.
Source: PDF 1, p. 25
QuestionWhat do Young children unable to comply with protocols; require?
AnswerYoung children unable to comply with protocols; require cast immobilization for 4 weeks.
Source: PDF 1, p. 25
QuestionWhat is Rugger jersey finger (zone I)?
AnswerRugger jersey finger (zone I): forced DIP extension causes closed FDP avulsion.
Source: PDF 1, p. 25
QuestionWhat is Quadrigia?
AnswerQuadrigia: middle-ring-small FDP tendons have common muscle belly, so advancement of one more than 1 cm compromises flexion of others.
Source: PDF 1, p. 25
QuestionWhat is Zone II (“no man’s land”) flexor tendon injury?
AnswerZone II (“no man’s land”) flexor tendon injury: direct repair plus early mobilization to prevent rerupture and adhesions.
Source: PDF 1, p. 25
QuestionIn Testable concepts, what should you remember about: Tendon lacerations may be at different level from?
AnswerTendon lacerations may be at different level from skin laceration.
Source: PDF 1, p. 25
source p. 26
QuestionWhat is Trigger finger (stenosing flexor tenosynovitis)?
AnswerTrigger finger (stenosing flexor tenosynovitis): treated surgically with release of A1 pulley after nonoperative treatment (e.g., injections) fails.
Source: PDF 1, p. 26
QuestionWhat is Key pulleys?
AnswerKey pulleys: A2 pulley (digits), oblique pulley (thumb).
Source: PDF 1, p. 26
QuestionWhat is Comorbidities?
AnswerComorbidities: diabetes, inflammatory arthritis (e.g., rheumatoid arthritis [RA]).
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Failure of injection higher with diabetes.?
AnswerFailure of injection higher with diabetes.
Source: PDF 1, p. 26
QuestionWhat is Pediatric trigger thumb?
AnswerPediatric trigger thumb: fixed flexion deformity of thumb interphalangeal (IP) joint; Notta node pathognomonic.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Treatment involves A1 release at 2 to 4?
AnswerTreatment involves A1 release at 2 to 4 years of age.
Source: PDF 1, p. 26
QuestionWhat is Radial digital nerve?
AnswerRadial digital nerve is in danger during release.
Source: PDF 1, p. 26
QuestionWhat is Pediatric trigger finger (less common than trigger thumb)?
AnswerPediatric trigger finger (less common than trigger thumb): aberrant anatomy.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Treated with A1 pulley release and procedures to?
AnswerTreated with A1 pulley release and procedures to address aberrant anatomy (e.g., FDS ulnar slip excision).
Source: PDF 1, p. 26
QuestionWhat is de Quervain tenosynovitis?
Answerde Quervain tenosynovitis: first extensor compartment; middle-aged women, new mothers, and golfers.
Source: PDF 1, p. 26
QuestionWhat is Nonoperative treatment for most?
AnswerNonoperative treatment for most: corticosteroid injection has more than 80% success.
Source: PDF 1, p. 26
QuestionWhat is Surgical release?
AnswerSurgical release: often multiple slips of APL and/or separate dorsal extensor pollicis brevis compartment.
Source: PDF 1, p. 26
QuestionWhat is Iiiintersection syndrome?
AnswerIiintersection syndrome: at junction of first and second extensor compartments; rowers.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Treatment nonoperative in vast majority.?
AnswerTreatment nonoperative in vast majority.
Source: PDF 1, p. 26
QuestionWhat is Extensor carpi ulnaris (ECU) tendinitis?
AnswerExtensor carpi ulnaris (ECU) tendinitis: racket sports; worse in supination; nonoperative treatment in most cases.
Source: PDF 1, p. 26
QuestionWhat is ECU subluxation?
AnswerECU subluxation: forceful hypersupination plus ulnar deviation leads to ECU subsheath injury.
Source: PDF 1, p. 26
QuestionWhat is Treatment?
AnswerTreatment: immobilization in pronation and wrist radial deviation in acute cases.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Subsheath reconstruction if immobilization fails. DRUJ, TFCC, WRIST?
AnswerSubsheath reconstruction if immobilization fails. DRUJ, TFCC, WRIST ARTHROSCOPY
Source: PDF 1, p. 26
QuestionWhat is Components of TFCC?
AnswerComponents of TFCC: dorsal and volar radioulnar ligaments, the articular disc, a meniscus homologue, ECU, and ulnolunate and ulnotriquetral ligaments.
Source: PDF 1, p. 26
QuestionWhat is Neutral variance?
AnswerNeutral variance: 80% compressive loads through radius and
Source: PDF 1, p. 26
QuestionWhat is þ2 mm variance?
Answerþ2 mm variance: 60% through radius and 40% through ulna.
Source: PDF 1, p. 26
QuestionWhat are Acute (class I) TFCC tears?
AnswerAcute (class I) TFCC tears are most commonly avulsions at the ulnar periphery (type IB) and amenable to repair (periphery well vascularized).
Source: PDF 1, p. 26
QuestionWhat is Arthroscopy?
AnswerArthroscopy: gold standard for diagnosis.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: No clear clinical outcome difference between open and?
AnswerNo clear clinical outcome difference between open and arthroscopic repair techniques.
Source: PDF 1, p. 26
QuestionWhat is Surgical treatment?
AnswerSurgical treatment: peripheral (repair) or central (débridement).
Source: PDF 1, p. 26
QuestionWhat are Degenerative (class II) tears?
AnswerDegenerative (class II) tears are associated with positive ulnar variance and ulnocarpal impaction syndrome.
Source: PDF 1, p. 26
QuestionWhat is Treatment?
AnswerTreatment: ulnar shortening osteotomy (no arthrosis) or wafer resection (arthrosis).
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Chronic DRUJ instability treated with TFCC repair or?
AnswerChronic DRUJ instability treated with TFCC repair or ligament reconstruction.
Source: PDF 1, p. 26
QuestionWhat is DRUJ osteoarthritis (OA) treatment?
AnswerDRUJ osteoarthritis (OA) treatment: hemiresection interposition arthroplasty, Darrach resection (low-demand patient), Sauvé- Kapandji aaarthrodesis (e.g., RA) or prosthetic arthroplasty.
Source: PDF 1, p. 26
QuestionWhat is Wrist arthroscopy?
AnswerWrist arthroscopy: gold standard for diagnosis of ulnar-sided wrist pain.
Source: PDF 1, p. 26
QuestionWhat is Most common complication?
AnswerMost common complication: injury to superficial sensory nerves. NAIL AND FINGERTIP INJURIES
Source: PDF 1, p. 26
QuestionWhat is Nail bed injuries?
AnswerNail bed injuries: in all cases, tetanus prophylaxis and antibiotic coverage.
Source: PDF 1, p. 26
QuestionWhat is Subungual hematoma less than 50% nail area?
AnswerSubungual hematoma less than 50% nail area: treated without nail plate removal (nail trephination for pain).
Source: PDF 1, p. 26
QuestionWhat is Subungual hematoma more than 50% nail area?
AnswerSubungual hematoma more than 50% nail area: treated with nail plate removal and matrix repair/
Source: PDF 1, p. 26
QuestionWhat is Repair technique?
AnswerRepair technique: digital block, finger tourniquet, nail plate in povidone-iodine, 6-0 suture or cyanoacrylate tissue adhesive (Dermabond) for matrix repair.
Source: PDF 1, p. 26
QuestionWhat is Complications?
AnswerComplications: nail ridging (crush injury), hook nail (distal matrix advancement), hypersensitivity (resolves in up to 1 year).
Source: PDF 1, p. 26
QuestionWhat is Principles of fingertip injury treatment?
AnswerPrinciples of fingertip injury treatment: preservation of digit length, maintenance of sensate fingertip pulp, prevention of joint contracture, pain-free use of digit.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Treatment guided by orientation of amputation, degree of?
AnswerTreatment guided by orientation of amputation, degree of soft tissue loss, and presence or absence of exposed bone.
Source: PDF 1, p. 26
QuestionWhat is Less than 1 cm2 exposed bone?
AnswerLess than 1 cm2 exposed bone: healing by sssecondary intention.
Source: PDF 1, p. 26
QuestionWhat is Larger wounds without exposed bone?
AnswerLarger wounds without exposed bone: skin graft.
Source: PDF 1, p. 26
QuestionWhat is Fingertip injury with more than 1 cm2 exposed bone?
AnswerFingertip injury with more than 1 cm2 exposed bone: flap for coverage.
Source: PDF 1, p. 26
QuestionWhat is Volar oblique injury?
AnswerVolar oblique injury: cross-finger or thenar flap.
Source: PDF 1, p. 26
QuestionWhat is Transverse or dorsal oblique injury?
AnswerTransverse or dorsal oblique injury: V-Y (digit) or Moberg (thumb) advancement flap to preserve length.
Source: PDF 1, p. 26
QuestionWhat is Alternative?
AnswerAlternative: skeletal shortening and closure at level with available skin.
Source: PDF 1, p. 26
QuestionWhat is Dorsal thumb injury?
AnswerDorsal thumb injury: kite flap from the index (first dorsal metacarpal artery).
Source: PDF 1, p. 26
QuestionWhat is Lumbrical-plus finger?
AnswerLumbrical-plus finger: surgical shortening of an injury that acutely violates the FDP insertion.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: FDP tendon retracts, leading to PIP extension through?
AnswerFDP tendon retracts, leading to PIP extension through intact lumbrical with active finger flexion.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Treated with release of the radial lateral band.?
AnswerTreated with release of the radial lateral band.
Source: PDF 1, p. 26
QuestionWhat is Quadrigia effect?
AnswerQuadrigia effect: FDP tendons (middle, ring, small) have a common muscle belly, so distal advancement of one tendon compromises flexion of the adjacent digits. Thus, FDP flexion on involved digit is associated with weak flexion of adjacent digits.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Complete finger amputations.?
AnswerComplete finger amputations.
Source: PDF 1, p. 26
QuestionWhat is Index?
AnswerIndex: ray resection preserves palmar width (improved hand function).
Source: PDF 1, p. 26
QuestionWhat is Middle/ring?
AnswerMiddle/ring: ray resection to prevent gap between fingers. SOFT TISSUE COVERAGE AND MICROSURGERY
Source: PDF 1, p. 26
QuestionWhat is Reconstruction priorities?
AnswerReconstruction priorities: provide coverage of deep structures, provide barrier to bacteria, restore dynamic function of limb, and achieve cosmetic appearance (sssecondary).
Source: PDF 1, p. 26
QuestionWhat is Primary closure?
AnswerPrimary closure: indicated only with minimal contamination and less than 6 hours from injury.
Source: PDF 1, p. 26
QuestionWhat is Healing by second intention (vacuum-assisted closure)?
AnswerHealing by second intention (vacuum-assisted closure): used with no exposure of nerves, vessels, tendons, or bone.
Source: PDF 1, p. 26
QuestionWhat is Skin grafts?
AnswerSkin grafts: full-thickness skin grafts are preferred for volar hand and fingertip wounds because they are more durable, contract less, and provide better sensation.
Source: PDF 1, p. 26
QuestionWhat is Split-thickness skin grafts?
AnswerSplit-thickness skin grafts: dorsal hand wounds.
Source: PDF 1, p. 26
QuestionWhat is Flap failure?
AnswerFlap failure: caused by inadequate arterial flow, vasospasm, seroma/hematoma.
Source: PDF 1, p. 26
QuestionIn Testable concepts, what should you remember about: Primary indications for replantation. Hand, Upper Eeeextremity, and?
AnswerPrimary indications for replantation. Hand, Upper Eeextremity, and Microvascular Surgery 679
Source: PDF 1, p. 26
source p. 27
QuestionIn Testable concepts, what should you remember about: Level of amputation outside of zone II flexor?
AnswerLevel of amputation outside of zone II flexor tendon sheath (less stiffness, pain).
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Amputation of multiple digits or thumb, proximal amputations?
AnswerAmputation of multiple digits or thumb, proximal amputations, and any injury in a child.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Primary contraindications to replantation.?
AnswerPrimary contraindications to replantation.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Level of amputation within zone II flexor tendon?
AnswerLevel of amputation within zone II flexor tendon sheath, single digit amputation (especially index, except thumb), segmental, crushed part, prolonged ischemia, multisystem injuries.
Source: PDF 1, p. 27
QuestionWhat is Ischemia?
AnswerIschemia: warm (>6 hours if proximal to carpus; >12 hours if distal to carpus); cold (>12 hours if proximal to carpus; >24 hours if distal to carpus).
Source: PDF 1, p. 27
QuestionWhat is Replantation sequence?
AnswerReplantation sequence: BEFAVNS (bone, extensor tendon, flexor tendon, artery, vein, nerve, skin).
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Structure-by-structure technique better than finger-by-finger.?
AnswerStructure-by-structure technique better than finger-by-finger.
Source: PDF 1, p. 27
QuestionWhat is Factor most predictive of digit survival after replantation?
AnswerFactor most predictive of digit survival after replantation is mechanism of injury.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Failure less than 12 hours due to arterial?
AnswerFailure less than 12 hours due to arterial thrombosis; treated by release of bandages, placement in dependent position, administration of heparin, performance of stellate ganglion block.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Failure more than 12 hours due to venous?
AnswerFailure more than 12 hours due to venous thrombosis; treated with leech therapy (and antibiotics effective against Aeromonas hydrophila).
Source: PDF 1, p. 27
QuestionWhat is Tenolysis?
AnswerTenolysis is the most commonly performed sssecondary procedure following successful replantation.
Source: PDF 1, p. 27
QuestionWhat is Forearm replantation?
AnswerForearm replantation: arterial inflow is established before skeletal stabilization.
Source: PDF 1, p. 27
QuestionWhat is Ring avulsion injury?
AnswerRing avulsion injury: forceful avulsion of soft tissues; salvage outcomes often poor.
Source: PDF 1, p. 27
QuestionWhat is Thumb reconstruction?
AnswerThumb reconstruction is performed whenever possible because thumb provides 40% of hand function. VASCULAR DISORDERS
Source: PDF 1, p. 27
QuestionWhat is Allen test?
AnswerAllen test is used to determine the presence or absence of a complete arterial arch in the palm.
Source: PDF 1, p. 27
QuestionWhat does Approximately 20% of hands have?
AnswerApproximately 20% of hands have an iiincomplete arch.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Ulnar arch mainly supplies superficial palmar arch, and?
AnswerUlnar arch mainly supplies superficial palmar arch, and radial artery mainly the deep palmar arch.
Source: PDF 1, p. 27
QuestionWhat is Other tests?
AnswerOther tests: cold stimulation test, digital-brachial index, three-phase bone scan, arteriography.
Source: PDF 1, p. 27
QuestionWhat is Hhhhypothenar hammer syndrome?
AnswerHhhypothenar hammer syndrome: most common posttraumatic vascular occlusive condition of the upper eeextremity; involves the ulnar artery in the proximal palm.
Source: PDF 1, p. 27
QuestionWhat is Diagnosis?
AnswerDiagnosis: noninvasive vascular studies or arteriography.
Source: PDF 1, p. 27
QuestionWhat is Treatment?
AnswerTreatment: resection of the thrombosed segment, interposition vein graft or arterial conduit (better patency rate).
Source: PDF 1, p. 27
QuestionWhat is Raynaud phenomenon?
AnswerRaynaud phenomenon: vasospastic disease with a known underlying cause.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Treatment focused on underlying cause.?
AnswerTreatment focused on underlying cause.
Source: PDF 1, p. 27
QuestionWhat is Raynaud disease?
AnswerRaynaud disease: vasospastic disease without a known underlying cause.
Source: PDF 1, p. 27
QuestionWhat is Treatment?
AnswerTreatment: calcium channel blockers, biofeedback, digital sympathectomy.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Smoking cessation and avoidance of cold exposure for?
AnswerSmoking cessation and avoidance of cold exposure for both Raynaud phenomenon and Raynaud disease.
Source: PDF 1, p. 27
QuestionWhat is Compartment syndrome?
AnswerCompartment syndrome: from crush injury, supracondylar humerus fracture (children).
Source: PDF 1, p. 27
QuestionWhat is Ten hand compartments?
AnswerTen hand compartments: thenar, hhhypothenar, adductor pollicis, four dorsal interosseous, and three volar interosseous (carpal tunnel is not a compartment).
Source: PDF 1, p. 27
QuestionWhat is Diagnosis?
AnswerDiagnosis: increased pain with passive stretch of affected compartment is most sensitive indicator.
Source: PDF 1, p. 27
QuestionWhat is Volkmann ischemic contracture?
AnswerVolkmann ischemic contracture: FDP and FPL muscles are most vulnerable.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Claw hand or intrinsic-minus posture.?
AnswerClaw hand or intrinsic-minus posture.
Source: PDF 1, p. 27
QuestionWhat is Frostbite treatment?
AnswerFrostbite treatment: initial rapid rewarming, analgesia, local wound management. COMPRESSION NEUROPATHY
Source: PDF 1, p. 27
QuestionWhat is Sequence of sensory losses?
AnswerSequence of sensory losses: light touch / pressure/vibration / pain/temperature.
Source: PDF 1, p. 27
QuestionWhat is Electrodiagnostics?
AnswerElectrodiagnostics: electromyography (EMG; muscle innervation) or nerve conduction study (conduction along nerve).
Source: PDF 1, p. 27
QuestionWhat is Double-crush phenomenon?
AnswerDouble-crush phenomenon: blockage of axonal transport at one point makes entire axon more susceptible to compression distally. Median Nerve
Source: PDF 1, p. 27
QuestionWhat is CTS?
AnswerCTS: idiopathic (adults); due to mucopolysaccharidosis (children).
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Associated with vibratory exposure at work but not?
AnswerAssociated with vibratory exposure at work but not repetitive activities (e.g., keyboarding).
Source: PDF 1, p. 27
QuestionWhat is Clinical diagnosis?
AnswerClinical diagnosis: 80% probability of CTS with all six features: symptoms along median nerveeinnervated digits, night-time symptoms, thenar atrophy/weakness, positive Tinel test result, positive Phalen test result, loss of two-point discrimination.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Treatment?
AnswerTreatment
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Corticosteroid injection, which achieves pain relief in approximately?
AnswerCorticosteroid injection, which achieves pain relief in approximately 80% at 6 weeks but only 20% at 1 year.
Source: PDF 1, p. 27
QuestionWhat is Carpal tunnel release (CTR)?
AnswerCarpal tunnel release (CTR): division of TCL.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Neurolysis and flexor tenosynovectomy offer no additional benefit.?
AnswerNeurolysis and flexor tenosynovectomy offer no additional benefit.
Source: PDF 1, p. 27
QuestionWhat is At risk?
AnswerAt risk: recurrent motor branch of median nerve (radial) or ulnar nerve (ulnar)
Source: PDF 1, p. 27
QuestionWhat is Endoscopic CTR?
AnswerEndoscopic CTR: short-term benefits (less scar tenderness, better satisfaction, earlier return to work) but equivalent longterm results.
Source: PDF 1, p. 27
QuestionWhat does Adults with chronic severe CTS may have?
AnswerAdults with chronic severe CTS may have iiincomplete neurologic recovery after surgery.
Source: PDF 1, p. 27
QuestionWhat is Pronator syndrome?
AnswerPronator syndrome: compression of the median nerve in the arm/ forearm.
Source: PDF 1, p. 27
QuestionWhat is Sites of compression (SLAPS)?
AnswerSites of compression (SLAPS): supracondylar process, ligament of Struthers (courses between the supracondylar process and medial epicondyle), lacertus fibrosis FDS aponeurotic arch, two heads of pronator teres.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Differentiated from CTS by presence of proximal forearm?
AnswerDifferentiated from CTS by presence of proximal forearm pain and paresthesias in the distribution of the palmar cutaneous branch of the median nerve.
Source: PDF 1, p. 27
QuestionWhat is Anterior interosseous nerve syndrome?
AnswerAnterior interosseous nerve syndrome: involves motor loss of FPL, index with or without long FDPs, pronator quadratus.
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: Precision sign (ask patient to make “OK” sign).?
AnswerPrecision sign (ask patient to make “OK” sign).
Source: PDF 1, p. 27
QuestionIn Testable concepts, what should you remember about: No sensory loss. Ulnar Nerve?
AnswerNo sensory loss. Ulnar Nerve
Source: PDF 1, p. 27
Signs of motor weakness#
QuestionWhat is Froment?
AnswerFroment: thumb IP flexion during key pinch due to a weak adductor muscle.
Source: PDF 1, p. 27
QuestionWhat is Jeanne?
AnswerJeanne: thumb MCP hyperextension during key pinch due to a weak adductor muscle.
Source: PDF 1, p. 27
QuestionWhat is Wartenberg?
AnswerWartenberg: abduction/extension of small digit during attempted adduction due to unopposed pull by extensor digiti quinti (radial nerve) from a weak third volar interosseous muscle (ulnar nerve).
Source: PDF 1, p. 27
source p. 28
QuestionWhat is Cubital tunnel syndrome?
AnswerCubital tunnel syndrome: pain, numbness, weakness.
Source: PDF 1, p. 28
QuestionWhat is Potential sites of compression (AO TEAM)?
AnswerPotential sites of compression (AO TEAM): arcade of Struthers, Osborne ligament, medial head of triceps, anconeus epitrochlearis, aponeurosis of FDS or two heads of FCU, medial intermuscular septum.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: No difference between in situ decompression and anterior?
AnswerNo difference between in situ decompression and anterior transposition.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Better outcome after surgery if performed before motor?
AnswerBetter outcome after surgery if performed before motor symptoms appear.
Source: PDF 1, p. 28
QuestionWhat is Ulnar tunnel syndrome (compression in Guyon canal)?
AnswerUlnar tunnel syndrome (compression in Guyon canal): sssecondary to an extrinsic mass (e.g., ganglion, lipoma, aneurysm).
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Zone I (mixed motor/sensory), zone II (motor), zone?
AnswerZone I (mixed motor/sensory), zone II (motor), zone III (sensory).
Source: PDF 1, p. 28
QuestionWhat is Concurrent CTS?
AnswerConcurrent CTS: Guyon canal decompressed by release of TCL. Radial Nerve
Source: PDF 1, p. 28
QuestionWhat is Palsy of radial nerve proper (Saturday night palsy)?
AnswerPalsy of radial nerve proper (Saturday night palsy) is differentiated from PIN compression by additional weakness of muscles innervated by radial nerve proper (triceps, brachioradialis, ECRL) and sensory disturbances in distribution of superficial sensory branch (SBRN).
Source: PDF 1, p. 28
QuestionWhat is PIN compression syndrome?
AnswerPIN compression syndrome: distal muscle weakness.
Source: PDF 1, p. 28
QuestionWhat is Potential sites of compression (LEAFS)?
AnswerPotential sites of compression (LEAFS): recurrent leash of Henry, proximal edge of the extensor carpi radialis brevis (ECRB) tendon, arcade of Frohse (proximal edge of supinator), fascial band at the radial head, distal edge of supinator.
Source: PDF 1, p. 28
QuestionWhat is Radial tunnel syndrome?
AnswerRadial tunnel syndrome is marked by lateral proximal forearm pain (pain several centimeters distal to lateral epicondyle) rather than distal motor weakness of the hand and wrist.
Source: PDF 1, p. 28
QuestionWhat is Sites of compression?
AnswerSites of compression: same as in PIN syndrome.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Outcome of surgical decompression less predictable than for?
AnswerOutcome of surgical decompression less predictable than for PIN syndrome.
Source: PDF 1, p. 28
QuestionWhat is Cheiralgia paresthetica (Wartenberg syndrome)?
AnswerCheiralgia paresthetica (Wartenberg syndrome): compressive neuropathy of SBRN.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Inability to wear wristwatch; pain and paresthesias over?
AnswerInability to wear wristwatch; pain and paresthesias over dorsoradial hand (SBRN). Thoracic Outlet Syndrome
Source: PDF 1, p. 28
QuestionWhat is Vascular?
AnswerVascular: subclavian vein compression.
Source: PDF 1, p. 28
QuestionWhat is Adson test?
AnswerAdson test: patient hyperextends neck and rotates it to affected side; decreased radial pulse during inhalation is positive result.
Source: PDF 1, p. 28
QuestionWhat is Neurogenic?
AnswerNeurogenic: entrapment of the lower brachial plexus.
Source: PDF 1, p. 28
QuestionWhat is Roos sign?
AnswerRoos sign: presence of heaviness in hands after they are held above head for more than 1 minute.
Source: PDF 1, p. 28
QuestionWhat is Nonspecific?
AnswerNonspecific: paresthesias, fatigue.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Pancoast tumor should be ruled out with chest?
AnswerPancoast tumor should be ruled out with chest radiograph.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Nonoperative management should be maximized, including sshoulder and?
AnswerNonoperative management should be maximized, including shoulder and scapular strengthening exercises, injections, activity modification.
Source: PDF 1, p. 28
QuestionWhat does If present?
AnswerIf present cervical rib should be resected. NERVE INJURIES AND TENDON TRANSFERS
Source: PDF 1, p. 28
QuestionWhat is Good prognosis?
AnswerGood prognosis: stretch injuries, clean wounds, direct surgical repair.
Source: PDF 1, p. 28
QuestionWhat is Poor prognosis?
AnswerPoor prognosis: crush injuries, scarring or infection, delayed repair.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Seddon classification divides nerve injury into neurapraxia (stretch)?
AnswerSeddon classification divides nerve injury into neurapraxia (stretch), axonotmesis (iiincomplete), and neurotmesis (complete) (in order of increasing severity).
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Wallerian degeneration for axonotmesis and neurotmesis.?
AnswerWallerian degeneration for axonotmesis and neurotmesis.
Source: PDF 1, p. 28
QuestionWhat is Peripheral nerve repair?
AnswerPeripheral nerve repair: best if procedure is performed early (<14 days), repair is tension-free, and wound bed is clean.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: No technique deemed superior.?
AnswerNo technique deemed superior.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Gaps may be addressed with nerve conduit, decellularized?
AnswerGaps may be addressed with nerve conduit, decellularized nerve allograft, or autograft.
Source: PDF 1, p. 28
QuestionWhat is Brachial plexus injury?
AnswerBrachial plexus injury: usually observed for 3 months to allow recovery before intervention
Source: PDF 1, p. 28
QuestionWhat is Preganglionic lesions?
AnswerPreganglionic lesions: Horner syndrome (sympathetic chain), scapular winging (long thoracic, rhomboids), motor deficits with intact sensory function (cell bodies in dorsal root ganglia).
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: EMG (loss of innervation to paraspinal muscles), chest?
AnswerEMG (loss of innervation to paraspinal muscles), chest radiograph (elevated hemidiaphragm).
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Nerve transfers considered for irreparable nerve injuries.?
AnswerNerve transfers considered for irreparable nerve injuries.
Source: PDF 1, p. 28
QuestionWhat is Advantage?
AnswerAdvantage is providing shorter innervation distance to end-target muscle.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Classic nerve transfers for upper brachial plexus injury.?
AnswerClassic nerve transfers for upper brachial plexus injury.
Source: PDF 1, p. 28
QuestionWhat is Oberlin?
AnswerOberlin: ulnar motor branch to FCU coapted to musculocutaneous nerve (elbow flexion).
Source: PDF 1, p. 28
QuestionWhat is Leechavengvong?
AnswerLeechavengvong: radial nerve motor branch to triceps coapted to axillary nerve (shoulder abduction).
Source: PDF 1, p. 28
QuestionWhat is Tendon/muscle transfers?
AnswerTendon/muscle transfers: indicated if no meaningful recovery of shoulder/elbow for 6 to 12 months.
Source: PDF 1, p. 28
QuestionWhat is Priorities?
AnswerPriorities: elbow flexion > shoulder function > finger function.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Basic tenets of tendon transfers.?
AnswerBasic tenets of tendon transfers.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Donor must be expendable.?
AnswerDonor must be expendable.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Donor must be of similar excursion and power.?
AnswerDonor must be of similar excursion and power.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: One transfer should perform one function.?
AnswerOne transfer should perform one function.
Source: PDF 1, p. 28
QuestionWhat are Synergistic transfers?
AnswerSynergistic transfers are easier to rehabilitate.
Source: PDF 1, p. 28
QuestionWhat is A straight line of pull?
AnswerA straight line of pull is optimal.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: One grade of motor strength will be lost?
AnswerOne grade of motor strength will be lost after transfer.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Tendon transfers for high radial nerve palsy.?
AnswerTendon transfers for high radial nerve palsy.
Source: PDF 1, p. 28
QuestionWhat is Wrist extension?
AnswerWrist extension: pronator teres to ECRB.
Source: PDF 1, p. 28
QuestionWhat is Finger extension?
AnswerFinger extension: FCU or FCR to EDC.
Source: PDF 1, p. 28
QuestionWhat is Thumb extension?
AnswerThumb extension: PL to EPL.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: Tendon transfer (opponensplasty) options for low median nerve?
AnswerTendon transfer (opponensplasty) options for low median nerve palsy.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: FDS of ring digit, EIP, abductor digiti minimi?
AnswerFDS of ring digit, EIP, abductor digiti minimi, and PL all transferred to abductor pollicis brevis.
Source: PDF 1, p. 28
QuestionWhat is Voluntary muscle control?
AnswerVoluntary muscle control is most important predictor of success in patients with cerebral palsy undergoing surgery to augment upper eeextremity function. ARTHRITIS
Source: PDF 1, p. 28
QuestionWhat is Hand OA?
AnswerHand OA: affects joints in following order: DIP, thumb CMC, PIP, MCP.
Source: PDF 1, p. 28
QuestionIn Testable concepts, what should you remember about: MCP more commonly involved in inflammatory arthritis.?
AnswerMCP more commonly involved in inflammatory arthritis.
Source: PDF 1, p. 28
QuestionWhat is Surgical treatment?
AnswerSurgical treatment: DIP joint, aaarthrodesis; PIP joint index finger, aaarthrodesis; PIP joint other fingers, arthroplasty; MCP joint, arthroplasty.
Source: PDF 1, p. 28
QuestionWhat is PIP fusion position?
AnswerPIP fusion position: index, 40 degrees; long, 45 degrees; ring,
Source: PDF 1, p. 28
QuestionWhat is Thumb CMC joint (basal joint or trapeziometacarpal)?
AnswerThumb CMC joint (basal joint or trapeziometacarpal): from anterior oblique ligament attenuation.
Source: PDF 1, p. 28
QuestionWhat is Nonoperative treatment?
AnswerNonoperative treatment: injections, activity modification.
Source: PDF 1, p. 28
QuestionWhat is Surgical treatment?
AnswerSurgical treatment: trapeziectomy with LRTI or suspensionplasty.
Source: PDF 1, p. 28
QuestionWhat is Aaaarthrodesis (young laborers)?
AnswerAaarthrodesis (young laborers): 20 degrees of radial abduction and
Source: PDF 1, p. 28
QuestionWhat is MCP hyperextension?
AnswerMCP hyperextension: can consider volar capsulodesis (e.g., 20e40 degrees) or MCP aaarthrodesis (if arthritis or >40 degrees hyperextension).
Source: PDF 1, p. 28
QuestionWhat is RA?
AnswerRA: systemic autoimmune disease that often affects the synovium surrounding small joints of the hand and wrist.
Source: PDF 1, p. 28
QuestionWhat is Manifestations?
AnswerManifestations: rheumatoid nodules, tenosynovitis, tendon rupture, ulnar drift at MCP joint, swan neck/ boutonnière deformities, caput ulnae syndrome, carpal subluxation, and SLAC wrist. Hand, Upper Eeextremity, and Microvascular Surgery 681
Source: PDF 1, p. 28
source p. 29
QuestionWhat is Vaughan-Jackson syndrome?
AnswerVaughan-Jackson syndrome: rupture of extensor tendons, starting with extensor digiti minimi and continuing radially, from attrition over a prominent distal ulnar head.
Source: PDF 1, p. 29
QuestionWhat is Mannerfelt syndrome?
AnswerMannerfelt syndrome: rupture of FPL and/or index FDP sssecondary to attrition over a volar scaphotrapeziotrapezoid (STT) osteophyte.
Source: PDF 1, p. 29
QuestionWhat is Caput ulnae syndrome?
AnswerCaput ulnae syndrome: DRUJ instability from ECU tendon subluxation.
Source: PDF 1, p. 29
QuestionWhat is Rheumatoid wrist?
AnswerRheumatoid wrist: carpus subluxes in volar and ulnar direction.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Total wrist arthroplasty versus total wrist aaaarthrodesis for?
AnswerTotal wrist arthroplasty versus total wrist aaarthrodesis for late disease.
Source: PDF 1, p. 29
QuestionWhat is Z deformity?
AnswerZ deformity: ulnar translocation and radial deviation of wrist, ulnar deviation of digits.
Source: PDF 1, p. 29
QuestionWhat is Common procedures?
AnswerCommon procedures: synovectomy/tenosynovectomy, tendon transfers, extensor centralization at MCP joints, silicone arthroplasty, and wrist aaarthrodesis versus wrist arthroplasty. IDIOPATHIC OSTEONECROSIS OF THE CARPUS
Source: PDF 1, p. 29
QuestionWhat is Kienböck disease (idiopathic osteonecrosis of the lunate)?
AnswerKienböck disease (idiopathic osteonecrosis of the lunate): most common in young men; manifests as atraumatic dorsal wrist pain and decreased grip strength.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Unexplained dorsal wrist pain in a young adult?
AnswerUnexplained dorsal wrist pain in a young adult with negative ulnar variance should prompt magnetic resonance imaging (MRI) evaluation.
Source: PDF 1, p. 29
QuestionWhat is Risks?
AnswerRisks: ulnar negative variance, decreased radial inclination, repetitive trauma, vascular patterns of the lunate.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Lichtman classification directs treatment.?
AnswerLichtman classification directs treatment.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Stage IIIA (lunate collapse with normal carpal alignment?
AnswerStage IIIA (lunate collapse with normal carpal alignment and height).
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Stage IIIB (fixed scaphoid rotation with decreased carpal?
AnswerStage IIIB (fixed scaphoid rotation with decreased carpal height and proximal migration of capitate).
Source: PDF 1, p. 29
QuestionWhat is First-line surgical treatment?
AnswerFirst-line surgical treatment: joint-leveling procedure or core decompression of radius.
Source: PDF 1, p. 29
QuestionWhat is Ulnar-negative variance?
AnswerUlnar-negative variance: radial shortening osteotomy.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Supplemental vascularized bone grafting described.?
AnswerSupplemental vascularized bone grafting described.
Source: PDF 1, p. 29
QuestionWhat is Stage IIIB?
AnswerStage IIIB: salvage procedure for associated carpal instability and/or degenerative OA: PRC.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Preiser disease (idiopathic osteonecrosis of scaphoid).?
AnswerPreiser disease (idiopathic osteonecrosis of scaphoid).
Source: PDF 1, p. 29
QuestionWhat does Initial treatment nonoperative; surgical procedures include?
AnswerInitial treatment nonoperative; surgical procedures include core decompression, vascularize graft, PRC, and partial wrist fusion. DUPUYTREN DISEASE
Source: PDF 1, p. 29
QuestionWhat is Benign fibroproliferative disorder that?
AnswerBenign fibroproliferative disorder that is sometimes inherited and sometimes sporadic.
Source: PDF 1, p. 29
QuestionWhat is Myofibroblasts?
AnswerMyofibroblasts: predominant cell type found on histologic analysis of fascia in Dupuytren disease.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Increase in ratio of type III to type?
AnswerIncrease in ratio of type III to type I collagen.
Source: PDF 1, p. 29
QuestionWhat are Cleland (dorsal) ligaments?
AnswerCleland (dorsal) ligaments are not involved; Grayson (volar) ligaments are involved.
Source: PDF 1, p. 29
QuestionWhat is PIP contracture?
AnswerPIP contracture: associated with spiral cord.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Neurovascular bundle at risk during surgery from central?
AnswerNeurovascular bundle at risk during surgery from central and superficial displacement.
Source: PDF 1, p. 29
QuestionWhat is Surgical indications?
AnswerSurgical indications: inability to place hand flat on tabletop (Hueston test), MCP flexion contracture greater than 30 degrees, any PIP flexion contracture.
Source: PDF 1, p. 29
QuestionWhat is Open limited fasciectomy?
AnswerOpen limited fasciectomy is preferred technique.
Source: PDF 1, p. 29
QuestionWhat is Complications?
AnswerComplications: recurrence (most common), digital nerve injury, wound breakdown.
Source: PDF 1, p. 29
QuestionWhat is Use of collagenase injection or needle aponeurotomy?
AnswerUse of collagenase injection or needle aponeurotomy is increasing.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Pooled study results show average MCP correction up?
AnswerPooled study results show average MCP correction up to 85% and PIP correction up to 60%.
Source: PDF 1, p. 29
QuestionWhat are Pain, swelling, and bruising?
AnswerPain, swelling, and bruising are likely temporary adverse effects of injection.
Source: PDF 1, p. 29
QuestionWhat are Skin tears?
AnswerSkin tears are more common complication than flexor tendon rupture. HAND TUMORS
Source: PDF 1, p. 29
QuestionWhat are Ganglions?
AnswerGanglions are the most common soft tissue mass of the hand and wrist.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Dorsal wristdSL articulation.?
AnswerDorsal wristdSL articulation.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Volar wristdradioscaphoid or STT joint.?
AnswerVolar wristdradioscaphoid or STT joint.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: IP joint osteophyte.?
AnswerIP joint osteophyte.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Distal palmdflexor tendon sheath.?
AnswerDistal palmdflexor tendon sheath.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Giant cell tumor of tendon sheath, the second?
AnswerGiant cell tumor of tendon sheath, the second most common soft tissue tumor, manifests as a slow-growing firm mass often on the volar aspect of a digit.
Source: PDF 1, p. 29
QuestionWhat is the treatment for Treatment?
AnswerTreatment is marginal excision, but recurrence rate is relatively high.
Source: PDF 1, p. 29
QuestionWhat is Other soft tissue tumors in the differential diagnosis?
AnswerOther soft tissue tumors in the differential diagnosis: epidermal inclusion cyst, lipoma, schwannoma, glomus tumor, hemangioma, poosteogenic granuloma.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: Box 7.3 lists the most common tumors (and?
AnswerBox 7.3 lists the most common tumors (and metastases) of the hand and upper eeextremity. HAND INFECTIONS
Source: PDF 1, p. 29
QuestionWhat is Staphylococcus aureus?
AnswerStaphylococcus aureus is the most common pathogen.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: MRSA more common in urban areas.?
AnswerMRSA more common in urban areas.
Source: PDF 1, p. 29
QuestionIn Testable concepts, what should you remember about: IV treatment with vancomycin or clindamycin; oral treatment?
AnswerIV treatment with vancomycin or clindamycin; oral treatment with trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin.
Source: PDF 1, p. 29
QuestionWhat is Gram-negative and anaerobic bacteria?
AnswerGram-negative and anaerobic bacteria: in IV drug users and diabetic patients, and after farmyard injuries or bite wounds.
Source: PDF 1, p. 29
QuestionWhat is Paronychia (nail fold)?
AnswerParonychia (nail fold): S. aureus; incision and drainage (I&D), nail plate removal, oral antibiotics.
Source: PDF 1, p. 29
QuestionWhat is Felon (fingertip pulp)?
AnswerFelon (fingertip pulp): S. aureus; I&D, second intention, oral antibiotics.
Source: PDF 1, p. 29
QuestionWhat is Human bites (fight bite)?
AnswerHuman bites (fight bite): potentially serious infection treated promptly with I&D, especially if joint or tendon sheath is violated.
Source: PDF 1, p. 29
QuestionWhat are Most commonly isolated organisms?
AnswerMost commonly isolated organisms are group A streptococci,
Source: PDF 1, p. 29
S. aureus, Eikenella corrodens, and Bacteroides spp.#
QuestionWhat does Dog bites occur?
AnswerDog bites occur more frequently than cat bites, but cat bites more commonly result in serious infections that require surgical intervention.
Source: PDF 1, p. 29
QuestionIn S. aureus, Eikenella corrodens, and Bacteroides spp., what should you remember about: Antibiotic therapy should cover Pasteurella canis, Pasteurella multocida?
AnswerAntibiotic therapy should cover Pasteurella canis, Pasteurella multocida, Staphylococcus, and Streptococcus: ampicillin/ sulbactam and amoxicillin/clavulanate.
Source: PDF 1, p. 29
QuestionWhat is Pooosteogenic flexor tenosynovitis?
AnswerPoosteogenic flexor tenosynovitis is a suppurative infection of the flexor tendon sheath.
Source: PDF 1, p. 29
QuestionWhat is Kanavel signs?
AnswerKanavel signs: flexed resting posture of digit, fusiform swelling of the digit, tenderness of flexor tendon sheath, pain with passive digit extension.
Source: PDF 1, p. 29
Early (<24e48 hours) with less than four Kanavel signs#
QuestionIn S. aureus, Eikenella corrodens, and Bacteroides spp., what should you remember about: If signs improve within first 24 hours, surgery?
AnswerIf signs improve within first 24 hours, surgery may be avoided.
Source: PDF 1, p. 29
QuestionWhat is Late (>24e48 hours) or all four Kanavel signs?
AnswerLate (>24e48 hours) or all four Kanavel signs: I&D of flexor tendon sheath (open or closed catheter irrigation).
Source: PDF 1, p. 29
QuestionWhat is Deep potential-space infections?
AnswerDeep potential-space infections: collar-button abscess (digit webspace), midpalmar, thenar or hhhypothenar infection; all require I&D and antibiotics.
Source: PDF 1, p. 29
QuestionWhat is Necrotizing fasciitis?
AnswerNecrotizing fasciitis: mortality correlates with time to initiation of treatment.
Source: PDF 1, p. 29
QuestionIn S. aureus, Eikenella corrodens, and Bacteroides spp., what should you remember about: Most commonly b-hemolytic Streptococcus.?
AnswerMost commonly b-hemolytic Streptococcus.
Source: PDF 1, p. 29
QuestionWhat is Groups at risk?
AnswerGroups at risk: immunocompromised people, IV drug users, persons with alcohol use disorder.
Source: PDF 1, p. 29
source p. 30
QuestionWhat is Gas gangrene?
AnswerGas gangrene: Clostridium perfringens and other Clostridium spp. (gram-positive rods).
Source: PDF 1, p. 30
QuestionWhat is Herpetic whitlow?
AnswerHerpetic whitlow: most common in toddlers, dental hygienists, other health care workers; treated nonoperatively.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Atypical mycobacterial infections (e.g., Mmmmycobacterium marinum) commonly involve?
AnswerAtypical mycobacterial infections (e.g., Mmmycobacterium marinum) commonly involve the hand.
Source: PDF 1, p. 30
QuestionWhat does Treatment generally require?
AnswerTreatment generally requires surgical débridement and oral antibiotics such as ethambutol, trimethoprim-sulfamethoxazole, clarithromycin, azithromycin, or tetracycline.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: High-pressure injection injuries can be devastating.?
AnswerHigh-pressure injection injuries can be devastating.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Rate of digital amputation high with organic solvent?
AnswerRate of digital amputation high with organic solvent in oil-based paint.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Treated urgently with I&D. CONGENITAL HAND DIFFERENCES?
AnswerTreated urgently with I&D. CONGENITAL HAND DIFFERENCES
Source: PDF 1, p. 30
The three signaling centers that control limb development#
QuestionIn Testable concepts, what should you remember about: The apical ectodermal ridge controls proximal-to-distal growth.?
AnswerThe apical ectodermal ridge controls proximal-to-distal growth.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: The zone of polarizing activity formation controls radial-to-ulnar?
AnswerThe zone of polarizing activity formation controls radial-to-ulnar growth.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Wingless-type controls dorsal-to-volar growth.?
AnswerWingless-type controls dorsal-to-volar growth.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Radial clubhand.?
AnswerRadial clubhand.
Source: PDF 1, p. 30
QuestionWhat is Associated with systemic syndromes?
AnswerAssociated with systemic syndromes: thrombocytopenia with absence of the radius syndrome, Holt-Oram syndrome, VACTERL (vertebral, anal, cardiac, tracheal, esophageal, renal, and limb anomalies) syndrome, and Fanconi anemia (life-threatening).
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Wrist centralization performed if elbow ROM adequate.?
AnswerWrist centralization performed if elbow ROM adequate.
Source: PDF 1, p. 30
QuestionWhat is Ulnar clubhand?
AnswerUlnar clubhand: often associated with digit absence or sssyndactyly.
Source: PDF 1, p. 30
QuestionWhat is Cleft hand?
AnswerCleft hand: often bilateral and familial; also involves feet.
Source: PDF 1, p. 30
QuestionWhat is Radioulnar synostosis?
AnswerRadioulnar synostosis: associated with duplication of sex chromosomes.
Source: PDF 1, p. 30
QuestionWhat is Camptodactyly?
AnswerCamptodactyly: usually small finger PIP flexion deformity.
Source: PDF 1, p. 30
QuestionWhat is Clinodactyly?
AnswerClinodactyly: congenital curvature of digit in radioulnar plane.
Source: PDF 1, p. 30
QuestionWhat is Flexed thumb?
AnswerFlexed thumb: due to pediatric trigger finger or congenital clasped thumb.
Source: PDF 1, p. 30
QuestionWhat is Arthrogryposis?
AnswerArthrogryposis: congenital curved joints (contractures); neurogenic (90%) or moosteogenic (10%).
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Duplication can be preaxial (radial) or postaxial (ulnar).?
AnswerDuplication can be preaxial (radial) or postaxial (ulnar).
Source: PDF 1, p. 30
QuestionWhat is Preaxial polydactyly (thumb duplication)?
AnswerPreaxial polydactyly (thumb duplication): most commonly Wassel type IV with duplicate proximal phalanx.
Source: PDF 1, p. 30
QuestionWhat is Postaxial polydactyly (small finger duplication)?
AnswerPostaxial polydactyly (small finger duplication): 10 times more common in Black than White population.
Source: PDF 1, p. 30
QuestionWhat is Ssssyndactyly?
AnswerSssyndactyly: failure of apoptosis to separate digits.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Characterized as simple (soft tissue) or complex (bony)?
AnswerCharacterized as simple (soft tissue) or complex (bony) and as complete or iiincomplete.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Long-ring most common.?
AnswerLong-ring most common.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Border digit ssssyndactyly released earlier.?
AnswerBorder digit sssyndactyly released earlier.
Source: PDF 1, p. 30
QuestionWhat is Web creep?
AnswerWeb creep is a frequent delayed complication following surgical separation.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Poland syndrome (absence of pectoralis major, abnormalities of?
AnswerPoland syndrome (absence of pectoralis major, abnormalities of chest wall) and Apert syndrome (acrosssyndactyly, mental retardation) are commonly associated with sssyndactyly.
Source: PDF 1, p. 30
QuestionWhat is Macrodactyly?
AnswerMacrodactyly: if single digit, most favorable outcome is associated with amputation.
Source: PDF 1, p. 30
QuestionWhat is Thumb hypoplasia?
AnswerThumb hypoplasia: treatment based on CMC joint (separates Blauth type IIIA from IIIB); absence of thumb CMC necessitates index pollicization.
Source: PDF 1, p. 30
QuestionWhat is Madelung deformity?
AnswerMadelung deformity: disruption of volar ulnar physis of distal radius by tethering of Vickers ligament; treated by release of ligament. ELBOW
Source: PDF 1, p. 30
QuestionWhat is Anterior bundle of the medial (ulnar) collateral ligament?
AnswerAnterior bundle of the medial (ulnar) collateral ligament is the primary restraint to valgus stress.
Source: PDF 1, p. 30
QuestionWhat is Lateral ulnar collateral ligament (LUCL)?
AnswerLateral ulnar collateral ligament (LUCL) is primary restraint to varus and external rotational stress (posterolateral rotatory instability).
Source: PDF 1, p. 30
QuestionWhat is Lateral epicondylitis (tennis elbow)?
AnswerLateral epicondylitis (tennis elbow): degenerative tendinopathy of the ECRB origin.
Source: PDF 1, p. 30
QuestionWhat does Histologic examination demonstrate?
AnswerHistologic examination demonstrates angiofibroblastic hyperplasia.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: No clear benefit from corticosteroid injection.?
AnswerNo clear benefit from corticosteroid injection.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Operative treatment for select recalcitrant cases in which?
AnswerOperative treatment for select recalcitrant cases in which prolonged conservative management fails (open 1⁄4 arthroscopic in results).
Source: PDF 1, p. 30
QuestionWhat is Medial epicondylitis (golfer’s elbow)?
AnswerMedial epicondylitis (golfer’s elbow): pain with resisted pronation and wrist flexion.
Source: PDF 1, p. 30
QuestionWhat is Distal biceps tendon rupture?
AnswerDistal biceps tendon rupture: supination strength diminished more than flexion strength.
Source: PDF 1, p. 30
QuestionWhat is Diagnosis?
AnswerDiagnosis: abnormal hook test result.
Source: PDF 1, p. 30
QuestionWhat does Partial ruptures occur?
AnswerPartial ruptures occur primarily on the radial side of the tuberosity footprint, owing to its function as a supinator.
Source: PDF 1, p. 30
QuestionWhat is Untreated?
AnswerUntreated: approximately 50% supination and approximately
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Complete tears with retraction treated expediently.?
AnswerComplete tears with retraction treated expediently.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Single-incision technique risks the lateral antebrachial cutaneous nerve?
AnswerSingle-incision technique risks the lateral antebrachial cutaneous nerve and PIN.
Source: PDF 1, p. 30
QuestionWhat does Two-incision technique has?
AnswerTwo-incision technique has higher risk of radioulnar synostosis or HO, but slightly higher supination strength given more anatomic location.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Biceps muscle belly unlikely to be proximally retracted?
AnswerBiceps muscle belly unlikely to be proximally retracted if lacertus fibrosis (bicipital aponeurosis) remains intact
Source: PDF 1, p. 30
QuestionWhat does Titanium fixation button (Endobutton) has?
AnswerTitanium fixation button (Endobutton) has been shown to have superior fixation strength.
Source: PDF 1, p. 30
QuestionWhat do Chronic untreated tears may require?
AnswerChronic untreated tears may require autograft or allograft reconstruction.
Source: PDF 1, p. 30
QuestionWhat is Distal triceps injury?
AnswerDistal triceps injury: Elbow extension still intact due to intact anconeus
Source: PDF 1, p. 30
QuestionWhat is Risks?
AnswerRisks: Anabolic steroids, multiple corticosteroid injections, olecranon bursitis
Source: PDF 1, p. 30
QuestionWhat is “Flake Sign”?
Answer“Flake Sign”: bone fragment from posterior olecranon pathognomic for distal triceps rupture and MRI is indicated.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Distal humerus fracture?
AnswerDistal humerus fracture
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Nonoperative treatment only in elderly patients with comorbidities?
AnswerNonoperative treatment only in elderly patients with comorbidities
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: Surgical treatment?
AnswerSurgical treatment
Source: PDF 1, p. 30
QuestionWhat is ORIF?
AnswerORIF: Plate orientation 90-90 or parallel equivalent
Source: PDF 1, p. 30
QuestionWhat is TEA (semi-constrained)?
AnswerTEA (semi-constrained): Possibly better for healthy, active elderly patients with severe articular comminution to allow early motion
Source: PDF 1, p. 30
QuestionWhat is Radial head fracture?
AnswerRadial head fracture: Mechanical block in forearm rotation should be assessed.
Source: PDF 1, p. 30
QuestionWhat is Associated injuries?
AnswerAssociated injuries: Forearm fracture, Essex-Lopresti (DRUJ injury)
Source: PDF 1, p. 30
QuestionWhat is Olecranon fracture?
AnswerOlecranon fracture: From direct blow to forearm; tension band for simple fracture, plate ORIF for complex fracture.
Source: PDF 1, p. 30
QuestionIn Testable concepts, what should you remember about: “Terrible triad” injury consists of radial head fracture?
Answer“Terrible triad” injury consists of radial head fracture, coronoid fracture, and elbow dislocation
Source: PDF 1, p. 30
QuestionWhat is Treatment?
AnswerTreatment: ORIF of coronoid process, ORIF or arthroplasty of radial head, and lateral MCL repair Hand, Upper Eeextremity, and Microvascular Surgery 683
Source: PDF 1, p. 30
source p. 31
SECTION 1 INTRODUCTION#
QuestionWhat is Careful history?
AnswerCareful history is vital to accurate diagnosis and management of spinal pathology.
Source: PDF 1, p. 31
QuestionWhat does Physical examination should include?
AnswerPhysical examination should include motor, sensory, and reflex assessment and, when appropriate, rectal examination.
Source: PDF 1, p. 31
QuestionWhat are In absence of trauma and red-flag signs, plain radiographs?
AnswerIn absence of trauma and red-flag signs, plain radiographs are not required unless symptoms have persisted longer than 4 to 6 weeks.
Source: PDF 1, p. 31
QuestionWhat is False-positive magnetic resonance imaging (MRI)?
AnswerFalse-positive magnetic resonance imaging (MRI) is common, and imaging should be correlated carefully with history and physical examination.
Source: PDF 1, p. 31
SECTION 2 CERVICAL SPINE#
QuestionWhat do Cervical spondylosis most commonly occur?
AnswerCervical spondylosis most commonly occurs at C5 to C6, followed by C6 to C7.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Cervical nerve roots exit above their corresponding vertebrae?
AnswerCervical nerve roots exit above their corresponding vertebrae (e.g., C5 exits at C4eC5 neural foramen). Consequently, disc herniations at C5eC6 involve the C6 nerve root.
Source: PDF 1, p. 31
QuestionWhat is Natural history of cervical spondylotic myelopathy?
AnswerNatural history of cervical spondylotic myelopathy is most commonly characterized by stepwise deterioration followed by a period of stability.
Source: PDF 1, p. 31
QuestionWhat are False-positive MRIs?
AnswerFalse-positive MRIs are common, with 25% of asymptomatic patients older than 40 years demonstrating a herniated nucleus pulposus or foraminal stenosis.
Source: PDF 1, p. 31
QuestionWhat does Operative indications include?
AnswerOperative indications include myelopathy with motor and/or gait impairment and radiculopathy with persistent disabling pain that has failed nonoperative measures.
Source: PDF 1, p. 31
QuestionWhat do Complications of anterior cervical discectomy and fusion include?
AnswerComplications of anterior cervical discectomy and fusion include recurrent laryngeal nerve injury, dysphagia, airway obstruction, nonunion, and adjacent segment disease. Nonunion should be treated with posterior spinal fusion.
Source: PDF 1, p. 31
QuestionWhat is Canal-expanding laminoplasty?
AnswerCanal-expanding laminoplasty is used for multilevel spondylosis, congenital cervical stenosis, and ossification of the posterior longitudinal ligament. It is contraindicated in the setting of fixed kyphosis.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: In selected cases, cervical total disc replacement may?
AnswerIn selected cases, cervical total disc replacement may be considered. However, presence of spinal deformity, segmental spinal instability, facet arthropathy, and inability to adequately radiographically visualize the implant iiintraoperatively are contraindications to cervical total disc replacement placement, and anterior cervical discectomy and fusion should be considered instead.
Source: PDF 1, p. 31
QuestionWhat are Surgical options for discogenic neck pain?
AnswerSurgical options for discogenic neck pain are limited and should be avoided.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Cervical stenosis.?
AnswerCervical stenosis.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Pavlov (Torg) ratio of less than 0.80 or?
AnswerPavlov (Torg) ratio of less than 0.80 or a sagittal diameter of less than 14 mm are considered risk factors for late neurologic involvement.
Source: PDF 1, p. 31
QuestionWhat is Absolute stenosis?
AnswerAbsolute stenosis is defined as anterior-posterior canal diameter of less than 10 mm.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Rheumatoid spondylitis.?
AnswerRheumatoid spondylitis.
Source: PDF 1, p. 31
QuestionWhat do In the cervical spine can commonly be asymptomatic but can present?
AnswerIn the cervical spine can commonly be asymptomatic but can present as occipital headaches due to compression of the greater occipital nerve (C2).
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Progressive cervical instability ssssecondary to pannus formation and?
AnswerProgressive cervical instability sssecondary to pannus formation and erosion of the joint sand capsular structures occurs in up to
Source: PDF 1, p. 31
QuestionWhat is AAS?
AnswerAAS is most common. A posterior atlantodens interval less than
Source: PDF 1, p. 31
QuestionWhat is Surgery?
AnswerSurgery is less successful in Ranawat grade IIIB patients but should still be considered.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Consideration for flexion/extension lateral cervical spine radiographs should?
AnswerConsideration for flexion/extension lateral cervical spine radiographs should be considered before elective surgery in patients with rheumatoid arthritis.
Source: PDF 1, p. 31
QuestionWhat does Ankylosing spondylitis (AS) patients who present?
AnswerAnkylosing spondylitis (AS) patients who present with neck pain should be carefully evaluated for an occult cervical spine fracture.
Source: PDF 1, p. 31
QuestionIn SECTION 2 CERVICAL SPINE, what should you remember about: Cervical spine injury can be associated with spinal?
AnswerCervical spine injury can be associated with spinal shock and/or neurogenic shock.
Source: PDF 1, p. 31
QuestionWhat is Spinal shock?
AnswerSpinal shock is over with return of the bulbocavernosus reflex.
Source: PDF 1, p. 31
QuestionWhat is Neurogenic shock?
AnswerNeurogenic shock is hypotension sssecondary to loss of sympathetic tone with bradycardia.
Source: PDF 1, p. 31
QuestionWhat are Iiiincomplete spinal cord syndromes?
AnswerIiincomplete spinal cord syndromes are anatomically classified, and all involve some sparing of distal function.
Source: PDF 1, p. 31
QuestionWhat is Central cord syndrome?
AnswerCentral cord syndrome is most common, typically affecting elderly patients with a spondylotic cervical spine. It presents as motor and sensory loss greater in the upper than lower extremities. Iiindependent ambulation is regained in approximately half of elderly patients and almost all young patients.
Source: PDF 1, p. 31
QuestionWhat is Anterior cord syndrome?
AnswerAnterior cord syndrome is the second most common and has the worst prognosis of ambulation. It presents as greater motor loss in the legs than in the arms.
Source: PDF 1, p. 31
QuestionWhat does Brown-Séquard syndrome present?
AnswerBrown-Séquard syndrome presents as ipsilateral motor weakness on the side of injury, with contralateral loss of pain and temperature. It has the best overall prognosis.
Source: PDF 1, p. 31
QuestionWhat is Posterior cord syndrome?
AnswerPosterior cord syndrome is most uncommon and results in loss of proprioception, vibratory sensation, and deep pressure sensation due to injury to the dossal column.
Source: PDF 1, p. 31
QuestionWhat is Autonomic dysreflexia?
AnswerAutonomic dysreflexia is a syndrome of uncontrolled sympathetic nervous output occurring in patients with a spinal cord injury above T6. It presents as hypertension, pupillary dilatation, headache, pallor, and reflex tachycardia. Treat with urinary catheterization, fecal disimpaction, antihypertensives, and atropine in severe cases.
Source: PDF 1, p. 31
SECTION 3 THORACIC SPINE#
QuestionWhat are Most thoracic herniated discs?
AnswerMost thoracic herniated discs are treated symptomatically and nonoperatively.
Source: PDF 1, p. 31
QuestionWhat does Indications for surgery include?
AnswerIndications for surgery include progressive thoracic myelopathy and persistent unremitting radicular pain.
Source: PDF 1, p. 31
QuestionWhat do Anterior transthoracic approaches allow direct access to the herniation but require?
AnswerAnterior transthoracic approaches allow direct access to the herniation but require entering into the chest cavity. Discectomy and hemicorpectomy are performed as needed.
Source: PDF 1, p. 31
QuestionWhat is Posterior laminectomy alone?
AnswerPosterior laminectomy alone is contraindicated because of an inability to retract the spinal cord and a high associated rate of neurologic injury.
Source: PDF 1, p. 31
QuestionIn SECTION 3 THORACIC SPINE, what should you remember about: Posterior transpedicular, costotransversectomy, or posterolateral extracavitary approaches may?
AnswerPosterior transpedicular, costotransversectomy, or posterolateral extracavitary approaches may allow for access to the disc herniation while avoiding the need to enter into the chest cavity; however, they require stabilization and fusion to reduce the risk of late spinal instability.
Source: PDF 1, p. 31
I. Lumbar Degenerative Disc Disease#
QuestionWhat is Lumbar disc?
AnswerLumbar disc is innervated by the sinuvertebral nerve.
Source: PDF 1, p. 31
QuestionWhat is Most herniations are posterolateral, where the posterior longitudinal ligament?
AnswerMost herniations are posterolateral, where the posterior longitudinal ligament is the weakest, and typically affect the traversing (caudal) nerve root. Therefore, L4eL5 posterolateral disc herniation results in L5 nerve root compression. Spine 741
Source: PDF 1, p. 31
source p. 32
QuestionIn Testable concepts, what should you remember about: Far lateral herniation or foraminal stenosis involves the?
AnswerFar lateral herniation or foraminal stenosis involves the exiting (cephalad) nerve root. Therefore, L4eL5 far-lateral disc herniation results in L4 nerve root compression.
Source: PDF 1, p. 32
QuestionIn Testable concepts, what should you remember about: Greater than 90% of patients seeking treatment for?
AnswerGreater than 90% of patients seeking treatment for back and leg pain recover within 1 to 3 months of onset of symptoms with conservative measures.
Source: PDF 1, p. 32
QuestionWhat are Failure to improve after 6 weeks warrants further investigation. Radiographs?
AnswerFailure to improve after 6 weeks warrants further investigation. Radiographs are generally the first imaging studies performed, even before MRI.
Source: PDF 1, p. 32
QuestionWhat is Surgery?
AnswerSurgery is indicated in the presence of persistent symptoms despite
Source: PDF 1, p. 32
QuestionIn Testable concepts, what should you remember about: Outcomes from the Spine Patient Outcomes Research Trial?
AnswerOutcomes from the Spine Patient Outcomes Research Trial (SPORT) trial (2-year follow-up):
Source: PDF 1, p. 32
QuestionIn Testable concepts, what should you remember about: No significant differences in primary outcome measures for?
AnswerNo significant differences in primary outcome measures for operative compared with nonoperative groups.
Source: PDF 1, p. 32
QuestionIn Testable concepts, what should you remember about: However, trends favoring surgical intervention in primary outcome?
AnswerHowever, trends favoring surgical intervention in primary outcome measures.
Source: PDF 1, p. 32
QuestionIn Testable concepts, what should you remember about: Statistically significant improvement in ssssecondary outcome measures for?
AnswerStatistically significant improvement in sssecondary outcome measures for surgical intervention, sciatica bothersomeness, and self-rated improvement.
Source: PDF 1, p. 32
QuestionWhat are Workers’ compensation patients?
AnswerWorkers’ compensation patients are more likely to continue to receive disability compensation and have worse symptoms, functional status, and satisfaction outcomes.
Source: PDF 1, p. 32
QuestionWhat does Complications include?
AnswerComplications include vascular injury, nerve root injury, infection (1% but increased in diabetics), discitis, cauda equine syndrome, and dural tears.
Source: PDF 1, p. 32
QuestionWhat do Treatment of dural tear include?
AnswerTreatment of dural tear includes bedrest and subarachnoid drain placement. If adequately repaired, clinical outcomes are generally unaffected.
Source: PDF 1, p. 32
II. Lumbar Spinal Stenosis#
QuestionIn II. Lumbar Spinal Stenosis, what should you remember about: Spinal stenosis can be classified anatomically into central?
AnswerSpinal stenosis can be classified anatomically into central, lateral recess, and foraminal stenosis. “Tandem stenosis” is the occurrence of both cervical and lumbar stenosis and can present as neurogenic claudication, radiculopathy, and myelopathy.
Source: PDF 1, p. 32
QuestionWhat is Central stenosis?
AnswerCentral stenosis is narrowing of the central spinal canal bordered laterally by the medial border of the superior articular process.
Source: PDF 1, p. 32
QuestionWhat is Lateral stenosis?
AnswerLateral stenosis is narrowing of the subarticular recess, bounded by the takeoff of the nerve root from the common dural sac to the medial border of the pedicle.
Source: PDF 1, p. 32
QuestionWhat is Foraminal stenosis?
AnswerForaminal stenosis is narrowing of the neural foramen, bounded by the disc anteriorly, pars intraarticularis posteriorly, and pedicles superiorly and inferiorly.
Source: PDF 1, p. 32
QuestionIn II. Lumbar Spinal Stenosis, what should you remember about: Central stenosis that fails nonoperative management should be?
AnswerCentral stenosis that fails nonoperative management should be treated with laminectomy and partial medial facetectomy. Surgical instability (via removal of a facet), a pars defect, spondylolisthesis, scoliosis, and radiographic instability are indications for inclusion of fusion.
Source: PDF 1, p. 32
QuestionIn II. Lumbar Spinal Stenosis, what should you remember about: Lateral recess stenosis that fails nonoperative management should?
AnswerLateral recess stenosis that fails nonoperative management should be treated with decompression of the hypertrophied lamina and ligamentum flavum, and partial medial facetectomy.
Source: PDF 1, p. 32
QuestionWhat is Residual foraminal stenosis?
AnswerResidual foraminal stenosis is a common reason for persistent radicular pain after laminectomy.
Source: PDF 1, p. 32
QuestionIn II. Lumbar Spinal Stenosis, what should you remember about: Outcomes from the SPORT trial (4-year follow-up) demonstrated?
AnswerOutcomes from the SPORT trial (4-year follow-up) demonstrated significant improvement in pain and function for operative compared with nonoperative groups.
Source: PDF 1, p. 32
III. Spondylolysis And Spondylolisthesis#
QuestionWhat is Spondylolysis?
AnswerSpondylolysis is a defect in the pars interarticularis without slippage, while spondylolisthesis is slippage of one vertebra in relationship to another.
Source: PDF 1, p. 32
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Wiltse classification divided spondylolisthesis into six types, with?
AnswerWiltse classification divided spondylolisthesis into six types, with the isthmic type occurring most commonly at L5eS1, while degenerative types occur most commonly at L4eL5.
Source: PDF 1, p. 32
QuestionWhat does Isthmic spondylolisthesis can present?
AnswerIsthmic spondylolisthesis can present in childhood or in adults.
Source: PDF 1, p. 32
Pediatric#
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Low-grade (<50%) slips typically respond to nonoperative treatment?
AnswerLow-grade (<50%) slips typically respond to nonoperative treatment but should be followed serially to watch for possible progression.
Source: PDF 1, p. 32
QuestionWhat are High-grade (>50%) slips?
AnswerHigh-grade (>50%) slips are typically more symptomatic and have a higher rate of progression. Surgical stabilization with posterolateral fusion, frequently from L4 to S1, should be considered.
Source: PDF 1, p. 32
Adult#
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Associated with increased pelvic incidence.?
AnswerAssociated with increased pelvic incidence.
Source: PDF 1, p. 32
QuestionWhat does Operative treatment frequently require?
AnswerOperative treatment frequently requires associated decompression for neurologic compression, stabilization, and posterolateral fusion.
Source: PDF 1, p. 32
QuestionWhat is Degenerative spondylolisthesis?
AnswerDegenerative spondylolisthesis is more common in women.
Source: PDF 1, p. 32
QuestionWhat does Can present?
AnswerCan present with symptoms of both central and lateral recess spinal stenosis
Source: PDF 1, p. 32
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Operative treatment for degenerative spondylolisthesis involves decompression of?
AnswerOperative treatment for degenerative spondylolisthesis involves decompression of nerve roots and stabilization with posterolateral fusion.
Source: PDF 1, p. 32
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Outcomes from the SPORT trial (4-year follow-up) demonstrated?
AnswerOutcomes from the SPORT trial (4-year follow-up) demonstrated significant improvement of pain and function for operative compared with nonoperative groups.
Source: PDF 1, p. 32
IV. Cauda Equina#
QuestionIn IV. Cauda Equina, what should you remember about: Typically ssssecondary to large extruded disc, surgical trauma?
AnswerTypically sssecondary to large extruded disc, surgical trauma, and/or hematoma.
Source: PDF 1, p. 32
QuestionIn IV. Cauda Equina, what should you remember about: Presents with bowel and bladder dysfunction, saddle anesthesia?
AnswerPresents with bowel and bladder dysfunction, saddle anesthesia, and varying degrees of lower eeextremity weakness.
Source: PDF 1, p. 32
QuestionIn IV. Cauda Equina, what should you remember about: Urgent/emergent MRI can help assess for compression of?
AnswerUrgent/emergent MRI can help assess for compression of the cauda equina, with surgical decompression as soon as possible.
Source: PDF 1, p. 32
I. ScoliosisdCoronal Plane Deformity#
QuestionWhat is Adult scoliosis?
AnswerAdult scoliosis is typically lumbar/thoracolumbar and more symptomatic than its childhood counterpart.
Source: PDF 1, p. 32
QuestionWhat are Right thoracic curves greater than 50 degrees?
AnswerRight thoracic curves greater than 50 degrees are at the highest risk for progression (usually 1 degree/year), followed by right lumbar curves.
Source: PDF 1, p. 32
QuestionWhat is Sagittal plane imbalance?
AnswerSagittal plane imbalance is a strong predictor of disability, and preservation of normal sagittal alignment is critical.
Source: PDF 1, p. 32
QuestionWhat is Whether to end a fusion at L5 or S1 distally?
AnswerWhether to end a fusion at L5 or S1 distally is controversial. Fusion to L5 is associated with development of L5 to S1 degenerative disc disease and progressive sagittal imbalance. Fusion to the sacrum is associated with increased incidence of pseudarthrosis and gait disturbance.
Source: PDF 1, p. 32
II. KyphosisdSagittal Plane Deformity#
QuestionWhat is Kyphosis?
AnswerKyphosis is a sagittal plane deformity and can occur with or without an associated coronal plane deformity (scoliosis).
Source: PDF 1, p. 32
QuestionWhat do Can occur ssssecondary to a variety of sources; however, common cause?
AnswerCan occur sssecondary to a variety of sources; however, common causes include osteoporotic compression fractures, postlaminectomy kyphosis, and junctional kyphosis above and below a previous surgical site.
Source: PDF 1, p. 32
source p. 33
SECTION 6 SACROPELVIS#
QuestionWhat are Sacroiliac joint dysfunction and coccygodynia?
AnswerSacroiliac joint dysfunction and coccygodynia are typically selflimiting and treated nonoperatively.
Source: PDF 1, p. 33
QuestionIn SECTION 6 SACROPELVIS, what should you remember about: In selected cases, sacroiliac fusions may be an?
AnswerIn selected cases, sacroiliac fusions may be an option if conservative treatments fail and symptoms are severe and persistent.
Source: PDF 1, p. 33
QuestionWhat do Sacral insufficiency fractures can occur?
AnswerSacral insufficiency fractures can occur in patients with osteopenia/ osteoporosis and should therefore be part of the evaluation and management.
Source: PDF 1, p. 33
SECTION 7 SPINAL TUMORS#
QuestionWhat is Metastatic disease?
AnswerMetastatic disease is the most common malignancy of the spine and most commonly involves the vertebral body.
Source: PDF 1, p. 33
QuestionWhat do Red flags for metastatic disease include?
AnswerRed flags for metastatic disease include a history of cancer, unexplained weight loss, night pain, and age older than 50 years.
Source: PDF 1, p. 33
QuestionWhat is Multispecialty involvement?
AnswerMultispecialty involvement is important.
Source: PDF 1, p. 33
QuestionWhat is MRI with gadolinium?
AnswerMRI with gadolinium is the imaging technique of choice.
Source: PDF 1, p. 33
QuestionIn SECTION 7 SPINAL TUMORS, what should you remember about: CT scan of chest, abdomen, and pelvis can?
AnswerCT scan of chest, abdomen, and pelvis can help identify possible primary lesions.
Source: PDF 1, p. 33
QuestionWhat is Wide excision?
AnswerWide excision is typically performed for primary bone tumors without known metastases and solitary metastases with likelihood of prolonged survival.
Source: PDF 1, p. 33
Decompressive surgery techniques#
QuestionIn SECTION 7 SPINAL TUMORS, what should you remember about: Upper cervical spine (occiptio-atlanto-axial junction) typically posterior approach?
AnswerUpper cervical spine (occiptio-atlanto-axial junction) typically posterior approach combined with stabilization.
Source: PDF 1, p. 33
QuestionIn SECTION 7 SPINAL TUMORS, what should you remember about: Posterior element tumors addressed posteriorly with or without?
AnswerPosterior element tumors addressed posteriorly with or without stabilization.
Source: PDF 1, p. 33
QuestionIn SECTION 7 SPINAL TUMORS, what should you remember about: Vertebral body tumors typically addressed anteriorly with or?
AnswerVertebral body tumors typically addressed anteriorly with or without stabilization.
Source: PDF 1, p. 33
QuestionIn SECTION 7 SPINAL TUMORS, what should you remember about: Multilevel involvement.?
AnswerMultilevel involvement.
Source: PDF 1, p. 33
I. Osteodiscitis#
QuestionWhat does Most commonly present?
AnswerMost commonly presents as pain and elevated erythrocyte sedimentation rate and C-reactive protein levels.
Source: PDF 1, p. 33
QuestionWhat are Radiographs?
AnswerRadiographs are often normal, with loss of lumbar lordosis and disc space narrowing the earliest findings.
Source: PDF 1, p. 33
QuestionWhat is the treatment for Treatment?
AnswerTreatment is with IV antibiotics, and C-reactive protein should be used to monitor the response.
Source: PDF 1, p. 33
QuestionWhat are Surgical irrigation and débridement and bone grafting?
AnswerSurgical irrigation and débridement and bone grafting are reserved for cases refractory to medical management.
Source: PDF 1, p. 33
QuestionWhat is Pooosteogenic vertebral oooosteomyelitis?
AnswerPoosteogenic vertebral ooosteomyelitis is usually from hematogenous spread and involves Staphylococcus aureus in 50% to 75% of cases.
Source: PDF 1, p. 33
II. Epidural Abscess#
QuestionWhat does Typically present?
AnswerTypically presents with patients being more systemically ill than osteodiscitis and ooosteomyelitis patients.
Source: PDF 1, p. 33
QuestionWhat is the treatment for Management?
AnswerManagement is typically surgical, with irrigation and débridement of infected tissue and drainage of abscess.
Source: PDF 1, p. 33
III. Tuberculosis Spondylitis#
Differs from posteogenic infections in several ways#
QuestionIn III. Tuberculosis Spondylitis, what should you remember about: Disc spaces typically preserved with tuberculosis spondylitis.?
AnswerDisc spaces typically preserved with tuberculosis spondylitis.
Source: PDF 1, p. 33
QuestionIn III. Tuberculosis Spondylitis, what should you remember about: Associated spinal deformity more common (typically kyphosis).?
AnswerAssociated spinal deformity more common (typically kyphosis).
Source: PDF 1, p. 33
QuestionIn III. Tuberculosis Spondylitis, what should you remember about: More typically associated with large paravertebral abscess/ phlegmon.?
AnswerMore typically associated with large paravertebral abscess/ phlegmon.
Source: PDF 1, p. 33
QuestionIn III. Tuberculosis Spondylitis, what should you remember about: More likely to spread along anterior longitudinal ligament?
AnswerMore likely to spread along anterior longitudinal ligament to involve adjacent vertebral bodies.
Source: PDF 1, p. 33
IV. Ankylosing Spondylitis#
QuestionWhat does Associated with HLA-B27, but only 2% of patients with HLA-B27 have?
AnswerAssociated with HLA-B27, but only 2% of patients with HLA-B27 have AS; therefore, this is not used in the diagnosis.
Source: PDF 1, p. 33
QuestionIn IV. Ankylosing Spondylitis, what should you remember about: Sacroiliac joint obliteration (iliac side affected first) and?
AnswerSacroiliac joint obliteration (iliac side affected first) and marginal syndesmophytes allow radiographic differentiation from diffuse idiopathic skeletal hyperostosis.
Source: PDF 1, p. 33
QuestionIn IV. Ankylosing Spondylitis, what should you remember about: Spine often becomes fused in kyphosis. Posterior extension?
AnswerSpine often becomes fused in kyphosis. Posterior extension osteotomies and fusion can be utilized to address the deformity.
Source: PDF 1, p. 33
V. Diffuse Idiopathic Skeletal Hyperostosis#
QuestionIn V. Diffuse Idiopathic Skeletal Hyperostosis, what should you remember about: Typically seen in older patients and more common?
AnswerTypically seen in older patients and more common in the thoracic spine.
Source: PDF 1, p. 33
QuestionWhat does Radiographs typically demonstrate?
AnswerRadiographs typically demonstrate undulating “nonmarginal syndesmophytes.”
Source: PDF 1, p. 33
I. Upper Cervical Spine Injuries (C1eC2)#
QuestionWhat is American Spine Injury Association classification of spinal cord injury?
AnswerAmerican Spine Injury Association classification of spinal cord injury is based on motor strength and complete versus iiincomplete sensory deficit.
Source: PDF 1, p. 33
QuestionIn I. Upper Cervical Spine Injuries (C1eC2), what should you remember about: C1 ring fractures may be stable or unstable?
AnswerC1 ring fractures may be stable or unstable depending on the integrity of the transverse ligament. Combined lateral mass displacement of greater than 6.9 mm indicates transverse ligament disruption. Posterior spinal fusion is recommended.
Source: PDF 1, p. 33
QuestionWhat is the treatment for Odontoid fracture treatment?
AnswerOdontoid fracture treatment is based on their risk of developing nonunion.
Source: PDF 1, p. 33
QuestionWhat is Type I?
AnswerType I: avulsion of tip of dens; treated in rigid orthosis.
Source: PDF 1, p. 33
QuestionWhat is Type 2?
AnswerType 2: through waist of dens; highest risk of nonunion.
Source: PDF 1, p. 33
QuestionWhat do Risk factors for nonunion include?
AnswerRisk factors for nonunion include displacement greater than 5 mm, angulation greater than 100 degrees, posterior displacement, age older than 50 years, and delayed treatment.
Source: PDF 1, p. 33
QuestionWhat is the treatment for Surgical treatment?
AnswerSurgical treatment is typically posterior C1eC2 fusion. In selected cases, anterior odontoid screw may be an option if the fracture is reducible and fracture obliquity is amenable to fixation.
Source: PDF 1, p. 33
QuestionWhat is Type 3?
AnswerType 3: through body of C2; treated in rigid orthosis.
Source: PDF 1, p. 33
Traumatic spondylolisthesis of C2 (hangman’s fracture)#
QuestionIn I. Upper Cervical Spine Injuries (C1eC2), what should you remember about: Fracture through pars of C2.?
AnswerFracture through pars of C2.
Source: PDF 1, p. 33
QuestionWhat is Trial of external rigid orthosis?
AnswerTrial of external rigid orthosis is option for patients with less than 4 mm translation and 10 degrees of angulation.
Source: PDF 1, p. 33
QuestionWhat are Axial distraction with significant angulation/flexion (type IIa)?
AnswerAxial distraction with significant angulation/flexion (type IIa) are at higher risk for neurologic injuries.
Source: PDF 1, p. 33
II. Lower Cervical Spine (C3eC7)#
QuestionWhat does Bilateral facet joint dislocations demonstrate?
AnswerBilateral facet joint dislocations demonstrate greater than
Source: PDF 1, p. 33
QuestionWhat is Timing of MRI in reduction of facet dislocations?
AnswerTiming of MRI in reduction of facet dislocations is controversial.
Source: PDF 1, p. 33
QuestionIn II. Lower Cervical Spine (C3eC7), what should you remember about: Most authors recommend obtaining an MRI prior to?
AnswerMost authors recommend obtaining an MRI prior to closed reduction in the obtunded, noncommunicative, or unexaminable patient.
Source: PDF 1, p. 33
QuestionIn II. Lower Cervical Spine (C3eC7), what should you remember about: Closed reduction before MRI can be considered in?
AnswerClosed reduction before MRI can be considered in the awake, alert, and cooperative patient who can participate in a full neurologic examination. Spine 743
Source: PDF 1, p. 33
source p. 34
QuestionWhat are syndromes most commonly associated with osteosarcoma?
AnswerThe syndromes most commonly associated with osteosarcoma are Li-Fraumeni syndrome (P53 gene) and congenital bilateral retinoblastoma (RB1 gene); with chondrosarcoma is multiple hereditary exostoses; and with malignant peripheral nerve sheath tumor is neurofibroma type 1 (NF1 gene).
Source: PDF 1, p. 34
QuestionWhat is A mass that?
AnswerA mass that is more than 5 cm, growing, and deep to the superficial fascia should be presumed to be a soft tissue sarcoma (STS) until proven otherwise, and it should be assessed with three-dimensional imaging first (ideally magnetic resonance imaging [MRI]).
Source: PDF 1, p. 34
QuestionWhat is the treatment for Radiation therapy?
AnswerRadiation therapy is an important adjunct to surgery in the treatment of STSs and is the standard of care.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: External beam irradiation (most common) can be delivered?
AnswerExternal beam irradiation (most common) can be delivered preoperatively or postoperatively with the same oncologic outcome.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Radiation may be delivered preoperatively (5000 cGy/50 Gy)?
AnswerRadiation may be delivered preoperatively (5000 cGy/50 Gy), followed by resection of the lesion with increased risk of wound healing.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Postoperative external beam irradiation (6600 cGy/66 Gy) yields?
AnswerPostoperative external beam irradiation (6600 cGy/66 Gy) yields equal local control rates, with a lower postoperative wound complication rate but a higher incidence of postoperative fibrosis and bone fracture.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Residual tumor may exist at the site of?
AnswerResidual tumor may exist at the site of the operative wound, and in all patients with an unplanned removal, repeat excision should be performed (may be combined with radiation therapy).
Source: PDF 1, p. 34
QuestionWhat is STS metastasis?
AnswerSTS metastasis: lung is the most common site of STS metastases.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Epithelioid sarcoma, synovial sarcoma, angiosarcoma, rhabdomyosarcoma, and clear-cell?
AnswerEpithelioid sarcoma, synovial sarcoma, angiosarcoma, rhabdomyosarcoma, and clear-cell sarcoma (mnemonic: ESARC) are the tumors that most commonly metastasize to the lymph nodes.
Source: PDF 1, p. 34
QuestionWhat is Immunohistochemistry (IHC) marker that differentiates lipoma from liposarcoma?
AnswerImmunohistochemistry (IHC) marker that differentiates lipoma from liposarcoma is MDM2 (atypical lipomatous tumors and liposarcomas are MDM2þ).
Source: PDF 1, p. 34
QuestionWhat is Synovial sarcoma?
AnswerSynovial sarcoma is the most common sarcoma in the foot.
Source: PDF 1, p. 34
QuestionWhat does Translocation between chromosome 18 and the X chromosome dt(X;18)dis always present?
AnswerTranslocation between chromosome 18 and the X chromosome dt(X;18)dis always present in tumor cells, and staining of the tumor cells yields positive results for keratin and epithelial membrane antigen.
Source: PDF 1, p. 34
QuestionWhat does balanced translocation results in?
AnswerThe balanced translocation results in gene fusion products. The two most common are SYT-SSX1 and SYT-SSX2.
Source: PDF 1, p. 34
QuestionWhat is the treatment for Wide surgical resection with adjuvant radiotherapy?
AnswerWide surgical resection with adjuvant radiotherapy is the most common method of treatment.
Source: PDF 1, p. 34
QuestionWhat is Synovial sarcoma?
AnswerSynovial sarcoma is an unusual STS in which chemotherapy has shown a clinical benefit.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Lymph nodes may be involved (ESARC).?
AnswerLymph nodes may be involved (ESARC).
Source: PDF 1, p. 34
QuestionWhat is Epithelioid sarcoma?
AnswerEpithelioid sarcoma is the most common sarcoma of the hand.
Source: PDF 1, p. 34
QuestionWhat is IHC?
AnswerIHC: loss of INI1 expression.
Source: PDF 1, p. 34
QuestionWhat is Differential diagnosis?
AnswerDifferential diagnosis: Granuloma, rheumatoid nodule, or inclusion cyst. Often misdiagnosed as benign process.
Source: PDF 1, p. 34
QuestionWhat is Desmoid fibromatosis IHC?
AnswerDesmoid fibromatosis IHC: positivity for estrogen receptor b and b-catenin (nuclear).
Source: PDF 1, p. 34
QuestionWhat is Neurofibromatosis (von Recklinghausen disease)dgenes?
AnswerNeurofibromatosis (von Recklinghausen disease)dgenes: NF1 and NF2.
Source: PDF 1, p. 34
QuestionWhat does colony-stimulating factor-1 pathway that has?
AnswerThe colony-stimulating factor-1 pathway that has been targeted for therapy for tenosynovial giant cell tumor of tendon sheath.
Source: PDF 1, p. 34
QuestionWhat are Bone sarcomas metastasize primarily via the hematogenous route; the lungs?
AnswerBone sarcomas metastasize primarily via the hematogenous route; the lungs are the most common site.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Osteosarcoma and Ewing sarcoma may also metastasize to?
AnswerOsteosarcoma and Ewing sarcoma may also metastasize to other bone sites either at initial manifestation or later in disease.
Source: PDF 1, p. 34
QuestionWhat does Osteoid osteoma has?
AnswerOsteoid osteoma has a characteristic night pain or diurnal pain pattern relieved with aspirin or nonsteroidal anti-inflammatory drugs.
Source: PDF 1, p. 34
QuestionWhat is nidus?
AnswerThe nidus is less than 1 cm in diameter, although the area of reactive bone sclerosis may be greater.
Source: PDF 1, p. 34
QuestionWhat is Computed tomographyeguided radiofrequency ablation?
AnswerComputed tomographyeguided radiofrequency ablation is the standard of care.
Source: PDF 1, p. 34
QuestionWhat is Osteoblastoma?
AnswerOsteoblastoma: pain that is NOT diurnal, rather persistent and chronic.
Source: PDF 1, p. 34
QuestionWhat is Size?
AnswerSize is greater than 2 cm.
Source: PDF 1, p. 34
QuestionWhat is Osteosarcoma?
AnswerOsteosarcoma: Osteosarcoma metastasizes most commonly to the lung and next most commonly to bone.
Source: PDF 1, p. 34
QuestionWhat is IHC?
AnswerIHC: SATB2 and MDM2.
Source: PDF 1, p. 34
QuestionWhat is Osteosarcoma?
AnswerOsteosarcoma is associated with an abnormality in the tumor suppressor genes RB1 (retinoblastoma) and P53 (Li-Fraumeni syndrome).
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Parosteal osteosarcoma (low-grade surface).?
AnswerParosteal osteosarcoma (low-grade surface).
Source: PDF 1, p. 34
QuestionWhat is Resection with a wide margin?
AnswerResection with a wide margin is curative.
Source: PDF 1, p. 34
QuestionWhat is Low-grade lesion?
AnswerLow-grade lesion: chemotherapy NOT required.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Ollier and Maffuci.?
AnswerOllier and Maffuci.
Source: PDF 1, p. 34
QuestionWhat are Patients with multiple enchondromatosis?
AnswerPatients with multiple enchondromatosis are at increased risk of malignancy (in Ollier disease, 30%; in Maffucci syndrome,
Source: PDF 1, p. 34
QuestionWhat does Patients with Maffucci syndrome also have?
AnswerPatients with Maffucci syndrome also have a markedly increased risk of visceral malignancies, such as astrocytomas and gastrointestinal malignancies.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Osteochondroma?
AnswerOsteochondroma
Source: PDF 1, p. 34
QuestionWhat is Underlying cortex?
AnswerUnderlying cortex is covered by a thin cap of cartilage (usually only 2e3 mm thick; in a growing child, the cap thickness may exceed 1e2 cm).
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Multiple hereditary exostoses?
AnswerMultiple hereditary exostoses
Source: PDF 1, p. 34
QuestionWhat is This?
AnswerThis is an autosomal dominant condition with mutations in the EXT1 and EXT2 gene loci. In approximately 10% of patients with multiple exostoses, a sssecondary chondrosarcoma develops. EXT1 mutation is associated with a greater burden of disease and higher risk of malignancy.
Source: PDF 1, p. 34
QuestionWhat is Chondroblastoma treatment?
AnswerChondroblastoma treatment: intralesional resection with curettage and reconstruction.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Chondromas of the hand (enchondromas)dthe lesions in patients?
AnswerChondromas of the hand (enchondromas)dthe lesions in patients with Ollier disease and Maffucci syndrome and periosteal chondromas may have atypical histopathologic features.
Source: PDF 1, p. 34
QuestionWhat is Chondrosarcoma IHC?
AnswerChondrosarcoma IHC: IDH1 and IDH2.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Treatment.?
AnswerTreatment.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Wide surgical resection.?
AnswerWide surgical resection.
Source: PDF 1, p. 34
QuestionWhat does Chemotherapy has?
AnswerChemotherapy has not been shown to improve survival.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Lymphoma of bone (non-Hodgkin lymphoma).?
AnswerLymphoma of bone (non-Hodgkin lymphoma).
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: A large soft tissue mass out of proportion?
AnswerA large soft tissue mass out of proportion to the amount of bone destruction is characteristic of lymphoma of bone.
Source: PDF 1, p. 34
QuestionWhat is IHC?
AnswerIHC: CD45- and leukocyte common antigenepositive.
Source: PDF 1, p. 34
Treatment#
QuestionWhat is the treatment for Multiagent chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone)?
AnswerMultiagent chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) is curative.
Source: PDF 1, p. 34
QuestionWhat is Surgery?
AnswerSurgery is used only to stabilize fractures.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Giant cell tumor of bone.?
AnswerGiant cell tumor of bone.
Source: PDF 1, p. 34
QuestionWhat does Stromal malignant cells produce?
AnswerStromal malignant cells produce receptor activator for nuclear factor kB ligand (RANKL).
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Multinucleated giant cells express receptor activator for nuclear?
AnswerMultinucleated giant cells express receptor activator for nuclear factor kB (RANK) and are responsible for the osteolytic aspect of giant cell tumor.
Source: PDF 1, p. 34
QuestionIn Testable concepts, what should you remember about: Aimed at removing the lesion, with preservation of?
AnswerAimed at removing the lesion, with preservation of the involved joint.
Source: PDF 1, p. 34
QuestionWhat do Denosumab (Prolia), a human monoclonal antibody that binds RANKL, inhibit?
AnswerDenosumab (Prolia), a human monoclonal antibody that binds RANKL, inhibits the maturation of osteoclasts. Ooorthopaedic Pathology 781
Source: PDF 1, p. 34
source p. 35
QuestionIn Testable concepts, what should you remember about: Extensive intralesional resection (removal of a large cortical?
AnswerExtensive intralesional resection (removal of a large cortical window over the lesion) is performed using curettage with manual and power instruments.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Chemical cauterization may be used (phenol, peroxide).?
AnswerChemical cauterization may be used (phenol, peroxide).
Source: PDF 1, p. 35
QuestionWhat is Area of defect?
AnswerArea of defect is usually reconstructed with subchondral bone grafts, methylmethacrylate, or both.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Ewing sarcoma?
AnswerEwing sarcoma
Source: PDF 1, p. 35
QuestionWhat is soft tissue component?
AnswerThe soft tissue component is distinctively large, the plain x-ray may show little destruction while the MRI shows a large soft tissue mass.
Source: PDF 1, p. 35
QuestionWhat is ICH?
AnswerICH: CD99 and FLI-1 positivity.
Source: PDF 1, p. 35
QuestionWhat is A classic t(11?
AnswerA classic t(11:22) chromosomal translocation produces the EWS- FLI1 fusion gene.
Source: PDF 1, p. 35
QuestionWhat is Bone marrow biopsy?
AnswerBone marrow biopsy is performed for staging purposes.
Source: PDF 1, p. 35
QuestionWhat is Treatment?
AnswerTreatment: a multimodal approach with multiagent chemotherapy, irradiation, and surgical resection.
Source: PDF 1, p. 35
QuestionWhat does Sstandard treatment include?
AnswerSsstandard treatment includes chemotherapy.
Source: PDF 1, p. 35
QuestionWhat is Sstandard for local tumor control?
AnswerSsstandard for local tumor control is surgery.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Radiation therapy may be used primarily for pelvic?
AnswerRadiation therapy may be used primarily for pelvic and spine disease, where resection would be morbid, or as an adjunct to surgery to maintain function while sparing critical structures.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Metastatic disease involves the lungs (50%), bone (25%)?
AnswerMetastatic disease involves the lungs (50%), bone (25%), and bone marrow (20%).
Source: PDF 1, p. 35
Poor prognostic factors include the following#
QuestionIn Testable concepts, what should you remember about: Spine and pelvic tumors.?
AnswerSpine and pelvic tumors.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Tumors greater than 100 cm3 in diameter.?
AnswerTumors greater than 100 cm3 in diameter.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: A poor response to chemotherapy (<90% tumor cell?
AnswerA poor response to chemotherapy (<90% tumor cell necrosis).
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: P53 mutation and gene fusion products other than?
AnswerP53 mutation and gene fusion products other than EWS-FLI1.
Source: PDF 1, p. 35
QuestionWhat is Treatment?
AnswerTreatment: wide-margin surgical resection.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Aneurysmal bone cyst?
AnswerAneurysmal bone cyst
Source: PDF 1, p. 35
QuestionWhat is IHC?
AnswerIHC: USP6-positive (chromosome 17p13).
Source: PDF 1, p. 35
QuestionWhat is Treatment?
AnswerTreatment: curettage and reconstruction, which may include bone grafting or fixation in the setting of a fracture.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Fibrous dysplasia?
AnswerFibrous dysplasia
Source: PDF 1, p. 35
QuestionWhat is Genetic mutation?
AnswerGenetic mutation is an activating mutation of the GSa surface protein.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Increased production of cAMP.?
AnswerIncreased production of cAMP.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: When endocrine abnormalities (especially precocious puberty) accompany multiple?
AnswerWhen endocrine abnormalities (especially precocious puberty) accompany multiple bone lesions and skin abnormalities, the condition is called McCuneeAlbright syndrome.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: Metastatic bone disease?
AnswerMetastatic bone disease
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: In a patient older than 50 years with?
AnswerIn a patient older than 50 years with a single destructive bone lesion but without a known primary tumor, metastatic disease must be the primary consideration.
Source: PDF 1, p. 35
QuestionWhat are five carcinomas that?
AnswerThe five carcinomas that are most likely to metastasize to bone are those of the breast, lung, thyroid, kidney, and prostate (mnemonic: “BLT and a kosher pickle”).
Source: PDF 1, p. 35
QuestionWhat does Tumor cells secrete parathyroid hormone related peptide (PTHrP), which stimulate?
AnswerTumor cells secrete parathyroid hormone related peptide (PTHrP), which stimulates the release of RANKL from the osteoblasts and marrow stromal cells.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: RANKL binds to the RANK receptor on the?
AnswerRANKL binds to the RANK receptor on the osteoclast precursor cells.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: In the presence of granulocyte colony-stimulating factor, the?
AnswerIn the presence of granulocyte colony-stimulating factor, the osteoclast precursor cells differentiate into active osteoclasts that resorb the trabecular and cortical bone.
Source: PDF 1, p. 35
QuestionIn Testable concepts, what should you remember about: With bone resorption, transforming growth factor-b, insulin-like growth?
AnswerWith bone resorption, transforming growth factor-b, insulin-like growth factor-1, and calcium are released, and these factors stimulate the tumor cells to multiply and release more PTHrP.
Source: PDF 1, p. 35
QuestionWhat are Lesions distal to elbow and knee?
AnswerLesions distal to elbow and knee are usually from lung or renal primary.
Source: PDF 1, p. 35
QuestionWhat is Lung primary?
AnswerLung primary is the most common for occult metastatic disease.
Source: PDF 1, p. 35
QuestionWhat are Cortical metastases?
AnswerCortical metastases are common in lung cancer.
Source: PDF 1, p. 35
source p. 36
QuestionWhat is gait cycle?
AnswerThe gait cycle is divided into stance and swing phases, with 20% to 30% of the gait cycle spent in double-limb support. Energy expenditure from walking decreases as the vertical and horizontal displacement of the body’s center of gravity is minimized.
Source: PDF 1, p. 36
QuestionWhat is Muscle action across the joints?
AnswerMuscle action across the joints is associated with the relationship of the joints of interest with ground reaction force, the mean loadingbearing vector throughout the gait cycle.
Source: PDF 1, p. 36
QuestionWhat do Loss of gluteus medius function leads to?
AnswerLoss of gluteus medius function leads to pelvic tilt and midstance instability.
Source: PDF 1, p. 36
QuestionIn Testable concepts, what should you remember about: The soft tissue in the residual limb serves?
AnswerThe soft tissue in the residual limb serves as the interface through which load transfer or weight bearing takes place. Transected muscles can be sutured to antagonist muscles (myoplasty) or anchored directly to the distal end of a bone (myodesis), the latter providing better residual limb control.
Source: PDF 1, p. 36
QuestionWhat is Risk factors for poor outcomes after amputation?
AnswerRisk factors for poor outcomes after amputation: level of amputation, comorbid disease, prior level of function, transcutaneous partial pressure of oxygen less than 20 mm Hg.
Source: PDF 1, p. 36
QuestionWhat do Common complications of amputation include?
AnswerCommon complications of amputation include phantom limb sensation, pain (somatic and neuropathic), edema, joint contracture, and skin problems. The prosthetic systems for upper limb amputation can be myoelectric, traditional body-powered, or hybrid.
Source: PDF 1, p. 36
QuestionWhat is More energy expenditure?
AnswerMore energy expenditure is required for more proximal amputation level (exception is ankle disarticulation that is more efficient than midfoot amputation).
Source: PDF 1, p. 36
QuestionWhat is Pistoning of the transtibial prosthesis during swing phase?
AnswerPistoning of the transtibial prosthesis during swing phase is usually due to ineffective suspension system.
Source: PDF 1, p. 36
QuestionWhat is Pistoning of the transtibial prosthesis during the stance phase?
AnswerPistoning of the transtibial prosthesis during the stance phase is from poor socket fit or volume changes in the stump.
Source: PDF 1, p. 36
QuestionIn Testable concepts, what should you remember about: Amputees ascend stairs by leading with the normal?
AnswerAmputees ascend stairs by leading with the normal limb and descend by leading with the prosthetic limb (up with the good, down with the bad).
Source: PDF 1, p. 36
QuestionWhat do Medicare functional classification level provide?
AnswerMedicare functional classification level provides recommendations on prosthesis prescription for lower limb amputations.
Source: PDF 1, p. 36
QuestionWhat are Orthoses?
AnswerOrthoses are used to control the motion of certain body parts, which can be indicated for the protection of long bones and unstable joints, support of flexible deformities, or substitution for functional deficits.
Source: PDF 1, p. 36
QuestionIn Testable concepts, what should you remember about: Oooorthopedic surgery can be considered for spasticity if?
AnswerOoorthopedic surgery can be considered for spasticity if maximal spontaneous motor recovery is achieved, and the patient retains adequate cognitive capacity, motivation, and body image awareness. Rehabilitation 809
Source: PDF 1, p. 36
source p. 37
TOP TESTABLE CONCEPTS#
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Damage control oooorthopaedic principles involve staging the definitive?
AnswerDamage control ooorthopaedic principles involve staging the definitive care of the patient to avoid adding to the early overall physiologic insult and should be considered in patients not well resuscitated.
Source: PDF 1, p. 37
QuestionWhat do Early appropriate care can lead to?
AnswerEarly appropriate care can lead to reduced risk of pulmonary complications, and early definitive fixation should be considered when adequately resuscitated.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Lactate to <4.0 mmol/L.?
AnswerLactate to <4.0 mmol/L.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: pH >7.25.?
AnswerpH >7.25.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Base excess >5.5 mmol/L.?
AnswerBase excess >5.5 mmol/L.
Source: PDF 1, p. 37
QuestionWhat is Post-traumatic stress disorder (PTSD)?
AnswerPost-traumatic stress disorder (PTSD) is common.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Early identification of PTSD can shorten recovery.?
AnswerEarly identification of PTSD can shorten recovery.
Source: PDF 1, p. 37
QuestionWhat are Women?
AnswerWomen are more affected than men, and the symptoms often last longer in women. Open Fracture Management
Source: PDF 1, p. 37
QuestionWhat is Antibioticsdadminister within 3 hours of injury. This?
AnswerAntibioticsdadminister within 3 hours of injury. This is the most effective way to decrease infection risk.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Wounds should be primarily closed without undue tension?
AnswerWounds should be primarily closed without undue tension if possible.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Goal of definitive coverage in <7 days for?
AnswerGoal of definitive coverage in <7 days for wounds unable to be primarily closed. Basics of Fracture Healing and Fixation
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: To correct angular deformity when nailingda blocking screw?
AnswerTo correct angular deformity when nailingda blocking screw goes in the concavity of the deformity on the short side of the fracture. Specific Trauma Scenarios
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Compartment syndrome diagnosis intracompartmental pressure within 30 mm?
AnswerCompartment syndrome diagnosis intracompartmental pressure within 30 mm Hg of the diastolic pressure (DP) is diagnostic. Proximal Humerus Fractures
Source: PDF 1, p. 37
QuestionWhat is Tuberosity healing?
AnswerTuberosity healing is important for function/outcomes.
Source: PDF 1, p. 37
QuestionWhat are Low-demand/elderly patients most often?
AnswerLow-demand/elderly patients most often are indicated for nonoperative treatment.
Source: PDF 1, p. 37
QuestionWhat is Medial metadiaphyseal extension less than 8 mm (calcar <8 mm)?
AnswerMedial metadiaphyseal extension less than 8 mm (calcar <8 mm) is associated with humeral head ischemia. Humerus Shaft Fractures
Source: PDF 1, p. 37
Indications for open reduction and internal fixation (ORIF)#
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Acute ORIF indicated for polytraumatized patients to facilitate?
AnswerAcute ORIF indicated for polytraumatized patients to facilitate early use/mobilization.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: After nonoperative trialdtest gross mobility at 6 weeks?
AnswerAfter nonoperative trialdtest gross mobility at 6 weeks postinjury; if unstable this predicts nonunion, and ORIF is indicated. Elbow Injuries
Source: PDF 1, p. 37
QuestionWhat is Elbow instability?
AnswerElbow instability is most commonly posterolateral rotatory instability (80%).
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Terrible triad of the elbow elbow dislocation with?
AnswerTerrible triad of the elbow elbow dislocation with lateral collateral ligament injury, radial head fracture, and coronoid fracture. Pelvic Ring Injuries and Sacral Fractures
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Aiiinteroposterior (AP) pelvis during the initial trauma evaluation?
AnswerAiinteroposterior (AP) pelvis during the initial trauma evaluation critical to be able to immediately recognize an injury with increased pelvic volume.
Source: PDF 1, p. 37
QuestionWhat is If there?
AnswerIf there is an injury with increased pelvic volume, apply a sheet or binder immediately.
Source: PDF 1, p. 37
QuestionWhat is If there?
AnswerIf there is concern for arterial bleeding on computed tomography (CT) scan, proceed to angiographic embolization.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: The pelvic outlet view allows optimal visualization of?
AnswerThe pelvic outlet view allows optimal visualization of the S1 neural foramina to avoid injury.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: The pelvic inlet view helps identify and minimize?
AnswerThe pelvic inlet view helps identify and minimize anterior sacral breach.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: The lateral sacral view identifies the iliac cortical?
AnswerThe lateral sacral view identifies the iliac cortical density and helps minimize risk to the L5 nerve root in combination with the inlet view. Acetabulum Fractures
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Posterior wall fracture >15% should be stressed in?
AnswerPosterior wall fracture >15% should be stressed in the operating room to determine stability.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Debride the gluteus minimus to minimize the risk?
AnswerDebride the gluteus minimus to minimize the risk of heterotopic ossification.
Source: PDF 1, p. 37
QuestionWhat is Supra-acetabular corridor?
AnswerSupra-acetabular corridor is the same as a supraacetabular external fixator half pindobturator oblique outlet image shows the corridor; iliac oblique to avoid inferior (joint, sciatic notch) breach; obturator inlet to avoid medial (intrapelvic)/lateral (extrapelvic) breach.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Superior ramus screw uses the inlet to avoid?
AnswerSuperior ramus screw uses the inlet to avoid anterior (extrapelvic)/posterior (intrapelvic) breach and the obturator oblique outlet to avoid superior/inferior (joint) breach.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Sciatic nerve injury associated with posterior dislocations, especially?
AnswerSciatic nerve injury associated with posterior dislocations, especially peroneal division (<50% with full recovery).
Source: PDF 1, p. 37
QuestionWhat is Transverse posterior wall?
AnswerTransverse posterior wall is the pattern associated with the highest rate of nerve injury.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Conversion to a total hip arthroplasty (THA) more?
AnswerConversion to a total hip arthroplasty (THA) more common with a femoral head lesion; age >46 years had a 4.6 times risk of conversion. Geriatric Hip Fractures
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Comanagement care teams should be used in the?
AnswerComanagement care teams should be used in the care of hip fracture patients to decrease complications and improve outcomes.
Source: PDF 1, p. 37
QuestionWhat is the treatment for Timingddefinitive treatment in 24 hours?
AnswerTimingddefinitive treatment in 24 hours is associated with a reduced 30-day and 1-year mortality.
Source: PDF 1, p. 37
QuestionWhat is Multimodal analgesia incorporating preoperative nerve block?
AnswerMultimodal analgesia incorporating preoperative nerve block is recommended.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Tranexamic acid should be administered to reduce blood?
AnswerTranexamic acid should be administered to reduce blood loss and transfusions.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Goal of treatment to allow early weight bearing?
AnswerGoal of treatment to allow early weight bearing to minimize complications.
Source: PDF 1, p. 37
QuestionWhat is Hemiarthroplasty?
AnswerHemiarthroplasty is associated with a lower risk of dislocation compared with a THA, especially in patients unable to comply with dislocation precautions.
Source: PDF 1, p. 37
QuestionWhat is Cemented femoral component?
AnswerCemented femoral component is recommended when treating femoral neck fractures .
Source: PDF 1, p. 37
QuestionWhat is THA?
AnswerTHA is indicated for “active” elderly patients with displaced fractures and provides the best functional outcome at an increased risk of complication.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: 1-year mortality rate in elderly patients approximately 30%.?
Answer1-year mortality rate in elderly patients approximately 30%.
Source: PDF 1, p. 37
QuestionWhat is Sliding hip screw (SHS)?
AnswerSliding hip screw (SHS) is indicated for stable intertrochanteric fractures.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Lag screw placed in centerdcenter position with tip-apex?
AnswerLag screw placed in centerdcenter position with tip-apex distance of less than 25 mm associated with lowest screw failure rate.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Cephalomedullary nail (CMN) should be used in all?
AnswerCephalomedullary nail (CMN) should be used in all unstable intertrochanteric fractures.
Source: PDF 1, p. 37
QuestionWhat is SHS cheaper than short CMN, which?
AnswerSHS cheaper than short CMN, which is cheaper than long CMN.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: For atypical subtrochanteric fractures, make sure to get?
AnswerFor atypical subtrochanteric fractures, make sure to get contralateral femur x-rays. Young Adult Proximal Femur Injuries
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Hip dislocation divergent open reduction if irreducible after?
AnswerHip dislocation divergent open reduction if irreducible after closed reduction.
Source: PDF 1, p. 37
QuestionIn TOP TESTABLE CONCEPTS, what should you remember about: Postreduction radiographs (AP pelvis and Judet views) and?
AnswerPostreduction radiographs (AP pelvis and Judet views) and CT to rule out associated acetabular fracture, femoral head fracture, and intra-articular loose bodies. Trauma 867
Source: PDF 1, p. 37
source p. 38
QuestionWhat does Femoral head fracturesPipkin type III; associated femoral neck fracture has?
AnswerFemoral head fracturesPipkin type III; associated femoral neck fracture has the worst outcomes.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Femoral neck fracturedincreased vertical orientation associated with more?
AnswerFemoral neck fracturedincreased vertical orientation associated with more shear force and less inherent stability.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Nonunion and avascular necrosis associated with vertical patterns?
AnswerNonunion and avascular necrosis associated with vertical patterns (Pauwels type III).
Source: PDF 1, p. 38
QuestionWhat is Femoral neck nonuniondin young patients this?
AnswerFemoral neck nonuniondin young patients this is traditionally treated with a valgus-producing osteotomy. Femur Fractures
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Femur shaft.?
AnswerFemur shaft.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Early stabilization reduces systemic complications associated with multiply?
AnswerEarly stabilization reduces systemic complications associated with multiply injured patients.
Source: PDF 1, p. 38
QuestionWhat does High incidence of malrotation use of a fracture table has?
AnswerHigh incidence of malrotation use of a fracture table has a higher incidence of rotational malunion than manual traction.
Source: PDF 1, p. 38
QuestionWhat are Associated neck fractures?
AnswerAssociated neck fractures are uncommon (<10%), but when present they are often missed (up to 50%). Any patient who complains of hip pain during the early postoperative period following treatment of a femoral shaft fracture should receive dedicated hip x-rays.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Can be diagnosed with soft tissue windowing on?
AnswerCan be diagnosed with soft tissue windowing on CT scans to look for intracapsular hematoma.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Hypertrophic shaft nonuniondtreat with exchange nailing with larger?
AnswerHypertrophic shaft nonuniondtreat with exchange nailing with larger size.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Distal femur fractures.?
AnswerDistal femur fractures.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: CT to evaluate for intra-articular extension or coronal?
AnswerCT to evaluate for intra-articular extension or coronal shear injuries.
Source: PDF 1, p. 38
QuestionWhat does Geriatric patients have?
AnswerGeriatric patients have a high 1-year mortality; decreased mortality in patients who undergo ORIF within 48 hours. Knee Injuries
Source: PDF 1, p. 38
QuestionWhat is Knee dislocationdif concern for vascular injury?
AnswerKnee dislocationdif concern for vascular injury: reduce knee, re-evaluate.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Ankle-brachial index <0.9, CT angiography?
AnswerAnkle-brachial index <0.9, CT angiography
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Patella fractures.?
AnswerPatella fractures.
Source: PDF 1, p. 38
QuestionWhat is Nonoperative treatment?
AnswerNonoperative treatment: for nondisplaced with intact extensor mechanism, hinged knee brace in extension, and progressive flexion after 2 to 3 weeks.
Source: PDF 1, p. 38
QuestionWhat is Tension band wiring?
AnswerTension band wiring: most common technique for simple fracture patterns; can be done with K-wires or cannulated screws (biomechanically stronger); wire or braided nonabsorbable suture may also be used (less hardware irritation).
Source: PDF 1, p. 38
QuestionWhat does Quad tendondsuture anchor fixation shown to have?
AnswerQuad tendondsuture anchor fixation shown to have less gap formation during cadaveric cyclic loading and higher strength than transosseous suture fixation. Tibia Plateau/Shaft Fractures
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Tibia plateau fracture.?
AnswerTibia plateau fracture.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Lateral meniscus tears most common in split depression?
AnswerLateral meniscus tears most common in split depression (Schatzker type II) fractures.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Nonoperative treatment indicated in stable knees (<10 degrees?
AnswerNonoperative treatment indicated in stable knees (<10 degrees coronal plane instability with the knee in full extension) with <3-mm articular step-off.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Maintenance of mechanical axis correlates most with a?
AnswerMaintenance of mechanical axis correlates most with a satisfactory clinical outcome.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Best treatment to prevent loss of articular reduction?
AnswerBest treatment to prevent loss of articular reduction in a split-depression tibial plateau fracture consists of a lateral plate, rafting screws, and calcium phosphate cement.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Tibia shaft fracture.?
AnswerTibia shaft fracture.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: High rate of compartment syndrome higher in younger?
AnswerHigh rate of compartment syndrome higher in younger age, treat with emergent fasciotomies.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Semiextended nailingdimproved ease of iiiintraoperative imaging; improved reduction?
AnswerSemiextended nailingdimproved ease of iiintraoperative imaging; improved reduction of distal fractures.
Source: PDF 1, p. 38
QuestionWhat does Suprapatellar has?
AnswerSuprapatellar has equivalent or improved knee pain compared to infrapatellar.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Proximal-third tibial fractures associated with valgus and apex?
AnswerProximal-third tibial fractures associated with valgus and apex anterior angulation.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Blocking screws placed in the metaphyseal segment at?
AnswerBlocking screws placed in the metaphyseal segment at the concave side of the deformity narrow the available intramedullary space and direct the nail toward a more centralized position.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Tibia shaft nonunion.?
AnswerTibia shaft nonunion.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Infection must be ruled out.?
AnswerInfection must be ruled out.
Source: PDF 1, p. 38
QuestionWhat is Reamed-exchange nailing?
AnswerReamed-exchange nailing is preferred treatment for middiaphyseal tibial nonunions. Pediatric Trauma General Topics
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Corner fractures (at junction of metaphysis and physis)?
AnswerCorner fractures (at junction of metaphysis and physis) and posterior rib fractures are described as pathognomonic for abuse.
Source: PDF 1, p. 38
QuestionWhat is In pediatric patients, multiorgan failure from polytrauma?
AnswerIn pediatric patients, multiorgan failure from polytrauma is often immediately after admission during the resuscitation phase. Pediatric Elbow
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Supracondylar humerus fracture.?
AnswerSupracondylar humerus fracture.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Anterior interosseous nerve injury most common for extension-type?
AnswerAnterior interosseous nerve injury most common for extension-type fractures; usually neurapraxia.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Ulnar nerve injury usually iatrogenic from medial pinning?
AnswerUlnar nerve injury usually iatrogenic from medial pinning and also the most common nerve injury from flexion-type.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Immediate surgery indicated in presence of vascular compromise?
AnswerImmediate surgery indicated in presence of vascular compromise (pale, cool hand)
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Well-perfused hand, absence of pulse (“pink, pulseless hand”)dpulse?
AnswerWell-perfused hand, absence of pulse (“pink, pulseless hand”)dpulse returns in majority of cases. If not, inpatient observation and splinting of eeextremity.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Poorly perfused hand, absence of pulse then emergent?
AnswerPoorly perfused hand, absence of pulse then emergent closed reduction and percutaneous pinning.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Medial epicondyle.?
AnswerMedial epicondyle.
Source: PDF 1, p. 38
QuestionWhat is If apophysis?
AnswerIf apophysis is missing from an AP view, lateral and oblique views should be carefully evaluated for possible iiincarceration.
Source: PDF 1, p. 38
QuestionWhat is Iiiincarceration of the fragment?
AnswerIiincarceration of the fragment is an indication for surgical treatment. Pediatric Femur Fractures
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Femur shaft fracture.?
AnswerFemur shaft fracture.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Patient younger than 5 years can be treated?
AnswerPatient younger than 5 years can be treated with spica casting if acceptable (<2 cm) shortening.
Source: PDF 1, p. 38
QuestionWhat is Compartment syndrome?
AnswerCompartment syndrome is a risk with spica casting and should be monitored.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Rigid nailingdtrochanteric or lateral entry nailing required.?
AnswerRigid nailingdtrochanteric or lateral entry nailing required.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Piriformis entry nailing must be avoided because it?
AnswerPiriformis entry nailing must be avoided because it risks the vascularity to the femoral head.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Distal femur.?
AnswerDistal femur.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Smooth wires can be placed across the physis?
AnswerSmooth wires can be placed across the physis temporarily to hold the physeal reduction.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Fixation across the Thurston-Holland fragment to the rest?
AnswerFixation across the Thurston-Holland fragment to the rest of the metaphysis with screws may be adequate.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: Growth arrest very common (30%e50%); patients and families?
AnswerGrowth arrest very common (30%e50%); patients and families should be counseled about issue at the time of initial evaluation; can also result in leg-length discrepancy and angular deformities, depending on the amount of physis arrested and the age of the patient.
Source: PDF 1, p. 38
QuestionIn Testable concepts, what should you remember about: This should be monitored for 1 to 2?
AnswerThis should be monitored for 1 to 2 years.
Source: PDF 1, p. 38
source p. 39
QuestionWhat is Four major principles in medical ethics?
AnswerFour major principles in medical ethics: nonmaleficence: “do no harm”; beneficence, do good; autonomy, respecting personal rule of the self; justice, promoting equitable treatment of patients and the responsibility to fair allocation of limited healthcare resources.
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QuestionWhat are Conflicts of interest?
AnswerConflicts of interest are common and must be resolved in the patient’s best interest.
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QuestionWhat is Most common conflicts?
AnswerMost common conflicts: facility ownership and relationships with industry where physicians should disclose payment to patients.
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QuestionWhat do American Academy of Oooorthopaedic Surgeons Ssstandards of Professionalism represent?
AnswerAmerican Academy of Ooorthopaedic Surgeons Ssstandards of Professionalism represent the minimal level of acceptable conduct to remain a member of our academy. Violations can be reported to the National Practitioner Data Bank, state medical licensing boards, and the American Board of Ooorthopaedic Surgery.
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QuestionWhat does Child abuse laws require?
AnswerChild abuse laws require reporting all suspected cases of child abuse to local authorities.
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QuestionWhat is Medical negligence comprises four elements?
AnswerMedical negligence comprises four elements: duty e physician accepts care; breach of duty e acts of omission or commission; causation e the breach was responsible for injury; and damages e financial payments paid by the defendant to the plaintiff.
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QuestionWhat is Physician-patient communication?
AnswerPhysician-patient communication is the most common factor cited in malpractice cases.
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QuestionWhat are Supervisors?
AnswerSupervisors are responsible for their trainees (vicarious liability).
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QuestionWhat are Residents/fellows?
AnswerResidents/fellows are held to the same standard as board-certified surgeons. Principles of Practice 877
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QuestionIn Testable concepts, what should you remember about: Observational research designs can be prospective, retrospective, or?
AnswerObservational research designs can be prospective, retrospective, or longitudinal. Common observational designs are summarized in Fig. 13.2.
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QuestionWhat are Clinical trials?
AnswerClinical trials are experimental research studies designed to allocate treatments and track outcomes prospectively to test a specific hypothesis and/or identify a mechanism of efficacy for a particular treatment or intervention.
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QuestionIn Testable concepts, what should you remember about: The gold sstandard and highest level of evidence?
AnswerThe gold standard and highest level of evidence in clinical trials is the randomized controlled trial.
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QuestionWhat are Pragmatic clinical research studies (whether experimental or observational)?
AnswerPragmatic clinical research studies (whether experimental or observational) are designed to merge with routine medical practice. These studies test hypotheses and evaluate the efficacy/safety of interventions in real-life scenarios. These studies are easier to conduct, may be more generalizable but more difficult to control for sources of bias or other confounding factors. Common Flaws in Research Designs
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QuestionWhat are Confounding variables?
AnswerConfounding variables are factors extraneous to a research design that potentially influence the outcome.
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QuestionWhat is Bias?
AnswerBias is an unintentional systematic error that will threaten the internal validity of a study. Sources of bias include selection (sampling) bias, nonresponder (loss to follow-up) bias, observer/interviewer bias, and recall bias.
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QuestionIn Testable concepts, what should you remember about: Control groups can help account for potential influence?
AnswerControl groups can help account for potential influence from bias, confounding factors, or placebo effects of interventions. How Many Subjects Are Needed to Complete a Research Study?
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QuestionWhat are Studies that have adequate statistical “power”?
AnswerStudies that have adequate statistical “power” are capable of finding hypothesized relationships if they exist.
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QuestionWhat is More subjects/samples/observations are needed if you hypothesize the expected effect?
AnswerMore subjects/samples/observations are needed if you hypothesize the expected effect is very small or if the variability in your outcome measure(s) is very high.
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QuestionWhat does Studies with low statistical power have?
AnswerStudies with low statistical power have higher likelihood of missing statistical differences (or relationships) when they actually exist (i.e., type II error). Describing Your Data With Simple Statistics
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QuestionWhat are Mean, median, mode, range, and sstandard deviation?
AnswerMean, median, mode, range, and standard deviation are commonly used measures to describe fundamental characteristics of a dataset.
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QuestionIn Testable concepts, what should you remember about: The confidence interval quantifies the precision of the?
AnswerThe confidence interval quantifies the precision of the mean or other statistic, such as an odds ratio or relative risk.
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QuestionWhat are Outliers?
AnswerOutliers are data points that are considerably different from the rest of the dataset. Outliers can cause data distributions to be skewed. Concepts in Epidemiologic Research Studies
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QuestionWhat is Prevalence?
AnswerPrevalence is the proportion of existing injuries/disease cases conditions within a particular population.
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QuestionWhat are the complications of Iincidence (absolute risk)?
AnswerIincidence (absolute risk) is the proportion of new injuries/disease cases within a specified time interval (requires a follow-up period).
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QuestionIn Testable concepts, what should you remember about: Odds ratios and relative risks can be calculated?
AnswerOdds ratios and relative risks can be calculated from clinical studies that are designed to determine associations between risk factor exposure and patient outcomes.
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QuestionIn Testable concepts, what should you remember about: Relative risk and odds ratio describe the risk?
AnswerRelative risk and odds ratio describe the risk and odds, respectively, of the incidences of a particular outcome of interest in two groups, typically, a group in which subjects are treated or exposed and a reference or control group. Relative risk is calculated as the ratio between the incidence rates of an outcome in two cohorts.
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QuestionWhat is Sensitivity?
AnswerSensitivity: the likelihood of a positive test result in patients who actually DO have the disease/condition of interest (i.e., ability to detect true positives among those with a disease).
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QuestionWhat is Specificity?
AnswerSpecificity: the likelihood of a negative test result in those patients who actually DO NOT have the disease/condition of interest (i.e., ability to detect true negatives among those without a disease).
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QuestionWhat are Receiver operating characteristic curves?
AnswerReceiver operating characteristic curves are graphical representations of the overall clinical utility of a particular diagnostic test that can be used to compare the accuracy of different tests in diagnosing a particular condition (see Fig. 13.5). What Statistical Test to Use for Different Analyses in Research
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QuestionWhat are Parametric statistics?
AnswerParametric statistics are appropriate for continuous data and rely on the assumption that data are normally distributed; nonparametric statistics are alternatives that are appropriate for categorical and nonnormally distributed data.
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QuestionWhat are In general, t-tests?
AnswerIn general, t-tests are used to compare two sample means, while analysis of variance (ANOVA) tests are used to compare three or more.
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QuestionWhat is Post hoc testing?
AnswerPost hoc testing is necessary after any ANOVA test to determine the exact locations of differences among the compared groups.
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QuestionIn Testable concepts, what should you remember about: Correlation coefficients range in value from 1.0 to?
AnswerCorrelation coefficients range in value from 1.0 to 1.0; values closer to 1 are stronger; positive values are direct relationships, and negative values are indirect relationships.
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QuestionWhat is Regression?
AnswerRegression is used to predict an outcome from one variable (simple regression) or many (multivariate linear regression) variables. The higher the R2 values resulting from regression equations, the better the predictive ability; that is, the variance in the outcome variable explained by the predictor(s).
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QuestionWhat is Logistic regression?
AnswerLogistic regression is used when the outcome is categorical and the predictor variables can be either categorical or nonenormally distributed continuous data.
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QuestionIn Testable concepts, what should you remember about: Chi-square (c2?
AnswerChi-square (c2
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QuestionIn Testable concepts, what should you remember about: Accuracy/validity describes alignment with grounded truth/reality.?
AnswerAccuracy/validity describes alignment with grounded truth/reality.
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QuestionIn Testable concepts, what should you remember about: Precision/reliability describes the ability to replicate/agree with repeated?
AnswerPrecision/reliability describes the ability to replicate/agree with repeated measurements.
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QuestionIn Testable concepts, what should you remember about: Intraclass correlation coefficients range from 0 to 1.0?
AnswerIntraclass correlation coefficients range from 0 to 1.0 (1.0 1⁄4 perfect accuracy/precision) and test the agreement between two sets of data. Iiinterpretation of Statistical Test Results
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QuestionWhat is P values less than 0.05 mean there?
AnswerP values less than 0.05 mean there is less than 5% chance of a type I error and commonly defined as “statistically significant.”
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QuestionIn Testable concepts, what should you remember about: However, statistical significance does not imply clinical importance.?
AnswerHowever, statistical significance does not imply clinical importance.
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QuestionWhat is Minimal clinically important differences?
AnswerMinimal clinically important differences is a method to describe the importance of an observed difference during a statistical test.
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QuestionWhat are Effect sizes?
AnswerEffect sizes are a standardized method of expressing the magnitude of differences between means expressed relative to the data standard deviation. (Effect size 1⁄4 1 means that the mean difference equals the SD.) The larger the effect size, the greater the effect (e.g., of treatment).
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QuestionWhat is Type I error (alpha [a] error)?
AnswerType I error (alpha [a] error): the probability that a statistical test is wrong when the null hypothesis is rejected (i.e., claiming that groups are different when they actually are not).
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QuestionWhat is Type II error (beta [b] error)?
AnswerType II error (beta [b] error): the probability that a statistical test is wrong when failing to reject the null hypothesis (i.e., claiming that two groups are NOT different when they actually are). Biostatistics and Research Design 891
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