[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.
The cards preserve the testable concepts from the supplied 41-page PDF and are intended for revision. Verify clinical decisions against current guidelines and local protocols.
source p. 1
I. Bone#
QuestionWhat is the key point about Haversian canals?
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 is the key point about Osteoblasts?
AnswerOsteoblasts are derived from undifferentiated MSCs
Source: PDF 1, p. 1
QuestionWhat is the key point about 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 is the key point about Wnt/Beta-catenin (B-catenin) pathways?
AnswerWnt/Beta-catenin (B-catenin) pathways are involved in osteoblast differentiation.
Source: PDF 1, p. 1
QuestionIn Cellular biology, 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
QuestionIn Cellular biology, what should you remember about: Sclerostin and Dkk-1 inhibit binding of the Wnt?
AnswerSclerostin and Dkk-1 inhibit binding of the Wnt molecule to LRP5/6.
Source: PDF 1, p. 1
QuestionIn Cellular biology, what should you remember about: 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
QuestionIn Cellular biology, what should you remember about: BMPs work through SMAD to cause osteoblastic differentiation.?
AnswerBMPs work through SMAD to cause osteoblastic differentiation.
Source: PDF 1, p. 1
QuestionIn Cellular biology, what should you remember about: Osteoblasts produce type I collagen (i.e., bone), alkaline?
AnswerOsteoblasts produce type I collagen (i.e., bone), alkaline phosphatase, osteocalcin, osteonectin, osteoprotegerin (OPG), bone sialoprotein, and RANKL.
Source: PDF 1, p. 1
QuestionWhat is the key point about 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 is the key point about 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 Cellular biology, 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 the key point about 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 Cellular biology, 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 the key point about Bone matrix?
AnswerBone matrix is removed by proteolytic digestion through the lysosomal enzyme cathepsin K.
Source: PDF 1, p. 1
QuestionIn Cellular biology, what should you remember about: 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 Cellular biology, 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 should you know about 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 is the key point about There?
AnswerThere are three major types of bone formation.
Source: PDF 1, p. 1
QuestionWhat is the key point about Endochondral formation?
AnswerEndochondral formation occurs with a cartilage model. Bone replaces cartilage.
Source: PDF 1, p. 1
QuestionWhat is the key point about Intramembranous formation?
AnswerIntramembranous formation occurs without a cartilage model. Aggregates of undifferentiated mesenchymal differentiate into osteoblasts, which form bone.
Source: PDF 1, p. 1
QuestionIn Cellular biology, 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 Cellular biology, 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 is the key point about Primary bone healing?
AnswerPrimary bone healing occurs via Haversian remodeling.
Source: PDF 1, p. 1
QuestionIn Cellular biology, what should you remember about: Absolute stability compression plate?
AnswerAbsolute stability compression plate
Source: PDF 1, p. 1
QuestionWhat should you know about Secondary bone healing occurs in three stages?
AnswerSecondary bone healing occurs in three stages: inflammation, repair, and remodeling.
Source: PDF 1, p. 1
QuestionIn Cellular biology, what should you remember about: In closed treatment, healing occurs through periosteal bridging?
AnswerIn closed treatment, healing occurs through periosteal bridging callus and interfragmentary endochondral ossification.
Source: PDF 1, p. 1
QuestionIn Cellular biology, 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 the key point about BMP-2?
AnswerBMP-2 is used for acute open tibia fractures; BMP-7 is used for tibial nonunions. BMP-3 has no osteogenic activity.
Source: PDF 1, p. 1
QuestionIn Cellular biology, 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 Bone grafts have three properties, what should you remember about: Osteoconductive acts as a scaffold for bone growth?
AnswerOsteoconductive acts as a scaffold for bone growth; demineralized bone matrices (DBMs)
Source: PDF 1, p. 1
QuestionIn Bone grafts have three properties, what should you remember about: Osteoinductivedgrowth factors that stimulate bone formation; BMP?
AnswerOsteoinductivedgrowth factors that stimulate bone formation; BMP
Source: PDF 1, p. 1
QuestionIn Bone grafts have three properties, what should you remember about: Osteogenicdcells that will produce bone; primitive mesenchymal cells?
AnswerOsteogenicdcells that will produce bone; primitive mesenchymal cells, osteoblasts, and osteocytes
Source: PDF 1, p. 1
QuestionWhat is the key point about 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 should you know about Resorption rates?
AnswerResorption rates: calcium sulfate > tricalcium phosphate > hydroxyapatite
Source: PDF 1, p. 1
QuestionWhat is the key point about The primary homeostatic regulators of serum calcium?
AnswerThe primary homeostatic regulators of serum calcium are PTH and 1,25(OH)2D3. PTH results in increased serum Ca2þ level and decreased inorganic phosphate level.
Source: PDF 1, p. 1
QuestionIn Bone grafts have three properties, 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 the key point about Both urinary hydroxyproline and pyridinoline cross-links?
AnswerBoth urinary hydroxyproline and pyridinoline cross-links are elevated when there is bone resorption.
Source: PDF 1, p. 1
QuestionIn Bone grafts have three properties, 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 the key point about The 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 the key point about Renal osteodystrophy?
AnswerRenal osteodystrophy is a spectrum of disorders observed in chronic renal disease. The majority of cases are caused by phosphorous retention and secondary hyperparathyroidism.
Source: PDF 1, p. 1
QuestionWhat is the key point about 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 the key point about 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 the key point about 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 is the key point about Loss of function of the OPG gene?
AnswerLoss of function of the OPG gene results in osteoporosis.
Source: PDF 1, p. 1
QuestionWhat is the key point about Treatment of osteoporosis?
AnswerTreatment of osteoporosis includes calcium supplements of 1200-1500 mg/day as well as bisphosphonates.
Source: PDF 1, p. 1
QuestionWhat is the key point about Scurvy?
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.
Source: PDF 1, p. 1
source p. 2
QuestionWhat is the key point about Osteogenesis imperfecta?
AnswerOsteogenesis imperfecta is caused primarily by a mutation in genes responsible for metabolism and synthesis of collagen type I.
Source: PDF 1, p. 2
II Cartilage and Joint#
QuestionWhat is the key point about Cartilage?
AnswerCartilage is viscoelastic (properties vary depending on rate of force application).
Source: PDF 1, p. 2
QuestionIn II Cartilage and Joint, what should you remember about: Composed of water (75%) > collagen (25% wet?
AnswerComposed of water (75%) > collagen (25% wet weight, 90%-95% is type II) > proteoglycans (10% wet weight) > noncollagenous protein > cells
Source: PDF 1, p. 2
QuestionIn II Cartilage and Joint, what should you remember about: Collagen contributes to viscoelastic behavior by restraining “swelling”?
AnswerCollagen contributes to viscoelastic behavior by restraining “swelling” of aggrecan.
Source: PDF 1, p. 2
QuestionWhat is the key point about Aggrecan?
AnswerAggrecan is the most common proteoglycan.
Source: PDF 1, p. 2
QuestionWhat is the key point about Increases osmotic pressure and?
AnswerIncreases osmotic pressure and is responsible for ECM’s hydrophilic behavior
Source: PDF 1, p. 2
QuestionWhat is the key point about Chondrocytes?
AnswerChondrocytes are the only cell in cartilage.
Source: PDF 1, p. 2
QuestionIn II Cartilage and Joint, 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 II Cartilage and Joint, 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 is the key point about Zone 1 (superficial)?
AnswerZone 1 (superficial) has highest concentration of collagen and lowest of PG.
Source: PDF 1, p. 2
QuestionWhat is the key point about Zone 2 (middle or transition)?
AnswerZone 2 (middle or transition) has high levels of PG and water
Source: PDF 1, p. 2
QuestionWhat is the key point about Zone 3 (deep)?
AnswerZone 3 (deep) has highest concentration of PG
Source: PDF 1, p. 2
QuestionIn Articular (hyaline) cartilage layers, 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#
QuestionIn Growth factors, what should you remember about: IL-1 stimulates MMP, COX-2, and nitric oxide synthetase?
AnswerIL-1 stimulates MMP, COX-2, and nitric oxide synthetase, which degrades cartilage
Source: PDF 1, p. 2
QuestionIn Growth factors, what should you remember about: TGF-b stimulates synthesis of ECM and decreased activity?
AnswerTGF-b stimulates synthesis of ECM and decreased activity of IL-
Source: PDF 1, p. 2
Mechanical Stress Response#
QuestionWhat is the key point about Physiologic loading?
AnswerPhysiologic loading is chondroprotective
Source: PDF 1, p. 2
QuestionIn Mechanical Stress Response, what should you remember about: Physiologic stress stimulates matrix synthesis?
AnswerPhysiologic stress stimulates matrix synthesis
Source: PDF 1, p. 2
QuestionIn Mechanical Stress Response, what should you remember about: Excess stress promotes chondrolysis?
AnswerExcess stress promotes chondrolysis
Source: PDF 1, p. 2
QuestionIn Mechanical Stress Response, what should you remember about: Both strenuous loading and underloading lead to cartilage?
AnswerBoth strenuous loading and underloading lead to cartilage thinning and proteoglycan loss
Source: PDF 1, p. 2
Changes with aging#
QuestionIn Changes with aging, what should you remember about: Fewer chondrocytes but larger?
AnswerFewer chondrocytes but larger
Source: PDF 1, p. 2
QuestionIn Changes with aging, what should you remember about: Decreased chondroitin but increased keratin?
AnswerDecreased chondroitin but increased keratin
Source: PDF 1, p. 2
QuestionIn Changes with aging, 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 Changes with aging, what should you remember about: Increased advanced glycosylation end products?
AnswerIncreased advanced glycosylation end products
Source: PDF 1, p. 2
QuestionIn Changes with aging, what should you remember about: Increased stiffness (modulus of elasticity)?
AnswerIncreased stiffness (modulus of elasticity)
Source: PDF 1, p. 2
Changes with arthritis#
QuestionIn Changes with arthritis, 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 Changes with arthritis, 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 Changes with arthritis, what should you remember about: Decreased stiffness (modulus of elasticity)?
AnswerDecreased stiffness (modulus of elasticity)
Source: PDF 1, p. 2
QuestionIn Changes with arthritis, 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 the key point about Lubricin?
AnswerLubricin is a mucinous glycoprotein that binds to hyaluronic acid and contributes to boundary lubrication.
Source: PDF 1, p. 2
QuestionWhat is the key point about 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 the key point about Rheumatoid factor?
AnswerRheumatoid factor is antibody (IgM) against the Fc portion of IgG
Source: PDF 1, p. 2
QuestionIn Rheumatoid arthritis, 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 should you know about Target TNF-a?
AnswerTarget TNF-a: etanercept, infliximab, adalimumab
Source: PDF 1, p. 2
QuestionWhat should you know about Target IL-1?
AnswerTarget IL-1: anakinra
Source: PDF 1, p. 2
QuestionWhat should you know about Target CD20?
AnswerTarget CD20: rituximab
Source: PDF 1, p. 2
QuestionIn DMARDs, 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 should you know about Gout?
AnswerGout: monosodium urate (strongly negatively birefringent, needle-shaped crystals)
Source: PDF 1, p. 2
QuestionWhat should you know about Pseudogout?
AnswerPseudogout: calcium pyrophosphate dehydrate (CPP) (weakly positive birefringent, rhomboid-shaped crystals)
Source: PDF 1, p. 2
III Muscle#
QuestionWhat is the key point about A-band?
AnswerA-band represents thick filaments composed of myosin.
Source: PDF 1, p. 2
QuestionWhat is the key point about I-band?
AnswerI-band represents thin filaments composed of actin.
Source: PDF 1, p. 2
QuestionWhat is the key point about Z-disk?
AnswerZ-disk represents the terminus of sarcomere.
Source: PDF 1, p. 2
QuestionWhat is the key point about Motor unit?
AnswerMotor unit is composed of the a-motoneuron and the myofibers it innervates.
Source: PDF 1, p. 2
Contraction#
QuestionIn Contraction, 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 the key point about Myasthenia gravis?
AnswerMyasthenia 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 Contraction, 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
QuestionIn Contraction, what should you remember about: Following muscle injury, TGF-b stimulates proliferation of myofibroblasts?
AnswerFollowing muscle injury, TGF-b stimulates proliferation of myofibroblasts and increases fibrosis.
Source: PDF 1, p. 2
QuestionWhat is the key point about Delayed-onset muscle soreness?
AnswerDelayed-onset muscle soreness is more common after eccentric exercises and may be associated with changes in I-band.
Source: PDF 1, p. 2
IV Tendon#
QuestionIn IV Tendon, what should you remember about: Composed of water (50%-60%), collagen (75% dry weight?
AnswerComposed of water (50%-60%), collagen (75% dry weight, 95% is type I), PG, and elastin.
Source: PDF 1, p. 2
QuestionWhat is the key point about Elastin?
AnswerElastin is a highly elastic protein responsible for the “toe region” of stress-strain curve.
Source: PDF 1, p. 2
QuestionWhat is the key point about Decorin?
AnswerDecorin is the most predominant PG, regulates fibril diameter, and inhibits TGF-b1.
Source: PDF 1, p. 2
QuestionWhat is the key point about Sheathed tendons?
AnswerSheathed tendons have vincula (extensions of synovium), which carry blood supply.
Source: PDF 1, p. 2
QuestionWhat should you know about Note?
AnswerNote: Both the FDS and FDP tendons have 2 vincula
Source: PDF 1, p. 2
QuestionIn IV Tendon, what should you remember about: Following injury, the inflammatory stage is the weakest?
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 IV Tendon, what should you remember about: Tendon enthesis responsible for nociception.?
AnswerTendon enthesis responsible for nociception.
Source: PDF 1, p. 2
QuestionIn IV Tendon, 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
QuestionIn V. Ligament, what should you remember about: Following injury, healing ligament demonstrates increased collagen fibers?
AnswerFollowing injury, healing ligament demonstrates increased collagen fibers but fewer mature cross-links at 1 year.
Source: PDF 1, p. 2
QuestionIn V. Ligament, what should you remember about: Like tendons, ligaments have direct or indirect (Sharpey?
AnswerLike tendons, ligaments have direct or indirect (Sharpey fibers) insertions.
Source: PDF 1, p. 2
VI Neural Tissue and Intervertebral Disc#
QuestionWhat is the key point about Myelin sheath?
AnswerMyelin sheath is composed of galactocerebroside and speeds wave propagation (thicker sheath increases speed).
Source: PDF 1, p. 2
QuestionIn VI Neural Tissue and Intervertebral Disc, 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
Intervertebral disc#
QuestionWhat is the key point about Nucleus pulposus derived from notochord and?
AnswerNucleus pulposus derived from notochord and has a high concentration of proteoglycan
Source: PDF 1, p. 2
QuestionIn Intervertebral disc, what should you remember about: Annulus fibrosis derived from mesoderm?
AnswerAnnulus fibrosis derived from mesoderm
Source: PDF 1, p. 2
QuestionIn Intervertebral disc, 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
source p. 3
QuestionWhat is the key point about Early degenerative disc disease?
AnswerEarly degenerative disc disease is an irreversible process, with IL1b stimulating the release of MMPs, NO, IL-6, and PGE2.
Source: PDF 1, p. 3
QuestionWhat is the key point about Aging disc?
AnswerAging disc has decreased water content because of fewer large PGs.
Source: PDF 1, p. 3
QuestionIn this topic, 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 is the key point about 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 is the key point about Alterations in ploidy?
AnswerAlterations in ploidy occur during mitosis and gametogenesis, resulting in conditions such as trisomy-21.
Source: PDF 1, p. 3
QuestionWhat is the key point about 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 the key point about Duchenne muscular dystrophy?
AnswerDuchenne muscular dystrophy is an example of a disorder with Xlinked recessive inheritance.
Source: PDF 1, p. 3
QuestionWhat is the key point about 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 should you know about t(X;18)?
Answert(X;18): synovial sarcoma
Source: PDF 1, p. 3
QuestionWhat should you know about t(11;22)?
Answert(11;22): in Ewing sarcoma
Source: PDF 1, p. 3
QuestionWhat should you know about t(12;22)?
Answert(12;22): in clear cell sarcoma
Source: PDF 1, p. 3
QuestionWhat is the key point about Bacterial lipopolysaccharide?
AnswerBacterial lipopolysaccharide is recognized by TLRs on innate immune system cells.
Source: PDF 1, p. 3
QuestionWhat is the key point about Adaptive immunity?
AnswerAdaptive immunity is conferred with the production of antibodies.
Source: PDF 1, p. 3
QuestionWhat is the key point about Cell-mediated hypersensitivity (type IV)?
AnswerCell-mediated hypersensitivity (type IV) causes reaction to orthopaedic implants.
Source: PDF 1, p. 3
II Infection and Microbiology#
QuestionIn II Infection and Microbiology, what should you remember about: Roughly 80% of orthopaedic infections are due to?
AnswerRoughly 80% of orthopaedic infections are due to Staphylococcus.
Source: PDF 1, p. 3
QuestionWhat should you know about 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 the key point about 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 the key point about Necrotizing fasciitis?
AnswerNecrotizing fasciitis is most commonly polymicrobial and associated with diabetes.
Source: PDF 1, p. 3
QuestionIn II Infection and Microbiology, 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 is the key point about 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 should you know about 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 II Infection and Microbiology, what should you remember about: Superantigens like TSS toxin-1 trigger cytokine release from?
AnswerSuperantigens like TSS toxin-1 trigger cytokine release from T cells.
Source: PDF 1, p. 3
QuestionWhat is the key point about Smoking?
AnswerSmoking leads to two to four times more infections/osteomyelitis.
Source: PDF 1, p. 3
QuestionIn II Infection and Microbiology, 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 II Infection and Microbiology, 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
QuestionIn II Infection and Microbiology, what should you remember about: Clostridium tetani produces an exotoxin leading to tetanospasm.?
AnswerClostridium tetani produces an exotoxin leading to tetanospasm. Td vaccine is recommended every 10 years.
Source: PDF 1, p. 3
QuestionWhat is the key point about Sequestrum?
AnswerSequestrum is the dead bone nidus with surrounding granulation tissue. Involucrum is periosteal new bone formation.
Source: PDF 1, p. 3
QuestionWhat is the key point about MRI?
AnswerMRI is the best method to show early osteomyelitis but may overestimate the extent of disease.
Source: PDF 1, p. 3
QuestionIn II Infection and Microbiology, 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 the key point about Staphylococcus epidermidis?
AnswerStaphylococcus epidermidis is the most common organism in implant-associated infections.
Source: PDF 1, p. 3
QuestionIn II Infection and Microbiology, what should you remember about: Antibiotic therapy according to the Gustilo classification of?
AnswerAntibiotic therapy according to the Gustilo classification of open fractures:
Source: PDF 1, p. 3
QuestionWhat should you know about Gustilo I and II?
AnswerGustilo I and II: first-generation cephalosporins
Source: PDF 1, p. 3
QuestionWhat should you know about Gustilo IIIA?
AnswerGustilo IIIA: first-generation cephalosporin plus an aminoglycoside
Source: PDF 1, p. 3
QuestionWhat should you know about Gustilo IIIB (grossly contaminated)?
AnswerGustilo IIIB (grossly contaminated): first-generation cephalosporin plus aminoglycoside plus penicillin
Source: PDF 1, p. 3
Antibiotics#
QuestionIn Antibiotics, what should you remember about: Aminoglycosides inhibit translation through irreversible binding of the?
AnswerAminoglycosides inhibit translation through irreversible binding of the 30S ribosomal subunit, inhibiting translation of proteins.
Source: PDF 1, p. 3
QuestionIn Antibiotics, what should you remember about: Cephalosporins inhibit cell wall production by preventing peptidoglycan?
AnswerCephalosporins inhibit cell wall production by preventing peptidoglycan cross-linkage.
Source: PDF 1, p. 3
QuestionIn Antibiotics, what should you remember about: Glycopeptides, such as vancomycin, inhibit cell wall production?
AnswerGlycopeptides, such as vancomycin, inhibit cell wall production by interfering with the addition of cell wall subunits.
Source: PDF 1, p. 3
QuestionIn Antibiotics, what should you remember about: Rifamycin inhibits DNA-dependent RNA polymerase F and displays?
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 Antibiotics, 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
QuestionIn Antibiotics, what should you remember about: Fluoroquinolones, such as ciprofloxacin, inhibit DNA gyrase.?
AnswerFluoroquinolones, such as ciprofloxacin, inhibit DNA gyrase.
Source: PDF 1, p. 3
QuestionIn Antibiotics, what should you remember about: Beta-lactam antibiotics, like penicillin, inhibit peptidoglycan synthesis by?
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 should you know about 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 the key point about Rivaroxaban?
AnswerRivaroxaban is a direct factor Xa inhibitor.
Source: PDF 1, p. 3
QuestionWhat is the key point about Lactate?
AnswerLactate is an indirect marker of tissue hyperperfusion and is the best measure of resuscitation.
Source: PDF 1, p. 3
II Perioperative Disease and Comorbidities#
QuestionWhat should you know about Ratio of 1?
AnswerRatio of 1:1:1 blood product resuscitation is superior to saline fluid.
Source: PDF 1, p. 3
QuestionIn II Perioperative Disease and Comorbidities, 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 the key point about Malignant hyperthermia?
AnswerMalignant hyperthermia is autosomal dominantly inherited defect in ryanodine receptor.
Source: PDF 1, p. 3
QuestionIn II Perioperative Disease and Comorbidities, 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 II Perioperative Disease and Comorbidities, what should you remember about: Triggered by volatile anesthetics (and succinylcholine)?
AnswerTriggered by volatile anesthetics (and succinylcholine)
Source: PDF 1, p. 3
QuestionWhat is the key point about Early sign?
AnswerEarly sign is increasing end-tidal CO2
Source: PDF 1, p. 3
QuestionWhat is the key point about Treatment?
AnswerTreatment is 100% O2 and dantrolene (stabilizes sarcoplasmic reticulum)
Source: PDF 1, p. 3
Increased radiation exposure associated with#
QuestionIn Increased radiation exposure associated with, what should you remember about: Imaging of larger body parts?
AnswerImaging of larger body parts
Source: PDF 1, p. 3
QuestionIn Increased radiation exposure associated with, what should you remember about: Positioning the extremity closer to the x-source?
AnswerPositioning the extremity closer to the x-source
Source: PDF 1, p. 3
QuestionIn Increased radiation exposure associated with, 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
QuestionIn Increased radiation exposure associated with, what should you remember about: 3.0 T MRI has 9x greater proton energy?
Answer3.0 T MRI has 9x greater proton energy than 1.5T.
Source: PDF 1, p. 3
source p. 4
II Biomaterials and Biomechanics#
QuestionWhat is the key point about Work?
AnswerWork is the product of force and the displacement it causes (Joule).
Source: PDF 1, p. 4
QuestionWhat is the key point about Energy?
AnswerEnergy is the ability to perform work.
Source: PDF 1, p. 4
QuestionWhat is the key point about Potential energy?
AnswerPotential energy is stored
Source: PDF 1, p. 4
QuestionWhat should you know about Kinetic energy is energy caused by motion?
AnswerKinetic energy is energy caused by motion: 1/2 mv2 .
Source: PDF 1, p. 4
QuestionWhat is the key point about Stress?
AnswerStress is the internal resistance of body to a load (force/area).
Source: PDF 1, p. 4
QuestionWhat is the key point about Strain?
AnswerStrain is relative measure of deformation 1⁄4 change in length/ original length (no units).
Source: PDF 1, p. 4
QuestionIn II Biomaterials and Biomechanics, 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 II Biomaterials and Biomechanics, what should you remember about: Unique for every material?
AnswerUnique for every material
Source: PDF 1, p. 4
QuestionWhat should you know about 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 the key point about Viscoelastic materials?
AnswerViscoelastic materials have a stress-strain behavior that is time/rate dependent.
Source: PDF 1, p. 4
QuestionWhat is the key point about Isotropic materials?
AnswerIsotropic materials have mechanical properties that are the same for all directions loaded (golf ball).
Source: PDF 1, p. 4
QuestionWhat is the key point about Anisotropic materials?
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 is the key point about Galvanic corrosion?
AnswerGalvanic corrosion occurs when dissimilar metals are in direct contact (cobalt chrome and stainless steel).
Source: PDF 1, p. 4
QuestionWhat is the key point about Crevice corrosion?
AnswerCrevice corrosion occurs in fatigue cracks with low oxygen tension.
Source: PDF 1, p. 4
QuestionIn Corrosion, 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 is the key point about Stress corrosion?
AnswerStress corrosion occurs in areas with high-stress gradients.
Source: PDF 1, p. 4
Joint arthrodesis#
QuestionWhat should you know about Hip?
AnswerHip: 20e35 degrees of flexion; 0-5 degrees of adduction, 5-10 degrees of external rotation
Source: PDF 1, p. 4
QuestionWhat should you know about Knee?
AnswerKnee: 5 degrees of valgus; 0-15 degrees of flexion, 0-10 degrees of external rotation
Source: PDF 1, p. 4
QuestionWhat should you know about Ankle?
AnswerAnkle: 5 degrees of hindfoot valgus; 5-10 degrees of external rotation; neutral dorsiflexion
Source: PDF 1, p. 4
QuestionWhat should you know about Shoulder?
AnswerShoulder: 15-20 degrees of abduction; 20-25 of forward flexion; 40-50 degrees of internal rotation
Source: PDF 1, p. 4
QuestionWhat should you know about Elbow?
AnswerElbow: 90 degrees of flexion, 0-7 degrees of valgus if unilateral; if bilateral, one at 65 degrees and one at 110 degrees
Source: PDF 1, p. 4
QuestionWhat should you know about Wrist?
AnswerWrist: 10-20 degrees of dorsiflexion; if bilateral, the opposite should be in 10 degrees of palmar flexion.
Source: PDF 1, p. 4
source p. 5
QuestionIn this topic, 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 should you know about 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 the key point about 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
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Beware of the anterosuperior glenoid labral variantdmay cause?
AnswerBeware of the anterosuperior glenoid labral variantdmay cause loss of external rotation.
Source: PDF 1, p. 5
QuestionWhat is the key point about Posterior sternoclavicular ligament?
AnswerPosterior sternoclavicular ligament is the strongest and primary restraint to anteroposterior instability.
Source: PDF 1, p. 5
QuestionWhat is the key point about 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 the key point about 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
QuestionIn SECTION 2 UPPER EXTREMITY, what should you remember about: Ossification of the bones of the wrist begins?
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 should you know about 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 the key point about 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 should you know about 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 is the key point about All minor medial and lateral cord branches?
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 is the key point about Each part of the axillary artery?
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 shoulder, 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 is the key point about Brachialis?
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
QuestionIn SECTION 3 LOWER EXTREMITY, what should you remember about: Posterior approach to the hip, quadratus transection leads?
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 is the key point about Slipped capital femoral epiphysis?
AnswerSlipped capital femoral epiphysis occurs through the femoral head physis (zone of hypertrophy).
Source: PDF 1, p. 5
QuestionWhat is the key point about Distal femur?
AnswerDistal femur is responsible for the highest percentage of growth in the lower extremity.
Source: PDF 1, p. 5
QuestionWhat is the key point about Iliofemoral ligament?
AnswerIliofemoral ligament is the strongest ligament in the body and attaches AIIS to intertrochanteric line.
Source: PDF 1, p. 5
QuestionWhat should you know about Three lower extremity muscles with dual innervation?
AnswerThree lower extremity 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 is the key point about ACL?
AnswerACL has anteromedial (tight in flexion) and posterolateral (tight in extension) bundles; PL bundle assessed with pivot shift test.
Source: PDF 1, p. 5
QuestionWhat is the key point about Posterior oblique ligament resists internal rotation and?
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 is the key point about PCL?
AnswerPCL has anterolateral (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 the key point about 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.
Source: PDF 1, p. 5
source p. 6
QuestionIn this topic, what should you remember about: Intermediate cuneiform does not extend as far distally?
AnswerIntermediate cuneiform does not extend as far distally as the medial cuneiform, which allows the second metatarsal to “key” into place.
Source: PDF 1, p. 6
QuestionWhat is the key point about Bony avulsion of AITFL in adolescents?
AnswerBony avulsion of AITFL in adolescents may result in a Tillaux fracture.
Source: PDF 1, p. 6
QuestionIn this topic, 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 this topic, 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 this topic, 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 this topic, 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 should you know about 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), what should you remember about: Pudendal nerve, internal pudendal artery and vein, and?
AnswerPudendal nerve, internal pudendal artery and vein, and nerve to obturator internus exit the greater sciatic foramen and reenter the lesser foramen.
Source: PDF 1, p. 6
QuestionIn Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 the key point about 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), 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 the key point about 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 Mnemonic: “POP’S IQ” (nerves exiting below piriformis), what should you remember about: Ascending branch of LFCA (at risk for injury?
AnswerAscending branch of LFCA (at risk for injury during anterolateral approaches) proceeds to greater trochanteric region between TFL and rectus femoris.
Source: PDF 1, p. 6
SECTION 4 SPINE#
QuestionWhat should you know about 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
QuestionIn SECTION 4 SPINE, what should you remember about: 50% of total neck flexion and extension occurs?
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
QuestionIn SECTION 4 SPINE, what should you remember about: 66% of lordosis occurs in the region from?
Answer66% of lordosis occurs in the region from L4 to the sacrum.
Source: PDF 1, p. 6
QuestionWhat is the key point about Lumbar spinedthe superior articular facet?
AnswerLumbar spinedthe 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
QuestionIn SECTION 4 SPINE, what should you remember about: Injury to the recurrent laryngeal nerve with right-sided?
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 the key point about 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 the key point about Sprengel deformity?
AnswerSprengel deformity is highly associated with Klippel-Feil syndrome.
Source: PDF 1, p. 7
QuestionWhat is the key point about 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 14 years and males at age 16 years:
Source: PDF 1, p. 7
QuestionWhat should you know about Proximal femur?
AnswerProximal femur: one-eighth inch (3 mm) per year
Source: PDF 1, p. 7
QuestionWhat should you know about Distal femur?
AnswerDistal femur: three-eighths inch (9 mm) per year
Source: PDF 1, p. 7
QuestionWhat should you know about Proximal tibia?
AnswerProximal tibia: one-quarter inch (6 mm) per year
Source: PDF 1, p. 7
SECTION 3 HIP AND FEMUR#
QuestionWhat is the key point about Risk factors for developmental dysplasia of the hip (DDH)?
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 is the key point about Obstructions to closed reduction for DDH?
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 key point about Pavlik harness treatment?
AnswerPavlik harness treatment is used first-line for DDH in newborns, followed by abduction orthosis.
Source: PDF 1, p. 7
QuestionIn SECTION 3 HIP AND FEMUR, what should you remember about: Hyperflexion can cause femoral nerve palsy.?
AnswerHyperflexion can cause femoral nerve palsy.
Source: PDF 1, p. 7
QuestionIn SECTION 3 HIP AND FEMUR, what should you remember about: 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
QuestionIn SECTION 3 HIP AND FEMUR, what should you remember about: Most prognostic classification for Legg-Calvé-Perthes disease is the?
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 the key point about 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 is the key point about SCFE?
AnswerSCFE occurs with weakness in the perichondral ring and slippage through the hypertrophic zone of the growth plate.
Source: PDF 1, p. 7
QuestionIn SECTION 3 HIP AND FEMUR, what should you remember about: Approximately 25% of SCFE cases are bilateral.?
AnswerApproximately 25% of SCFE cases are bilateral.
Source: PDF 1, p. 7
QuestionWhat is the key point about Treatment for SCFE?
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 the key point about Blood culture medium?
AnswerBlood culture medium is needed to isolate infections due to Kingella kingae.
Source: PDF 1, p. 7
QuestionIn SECTION 3 HIP AND FEMUR, what should you remember about: 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 is the key point about 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 is the key point about Blount disease treatment?
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 the key point about 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 the key point about Anteromedial bowing?
AnswerAnteromedial bowing is associated with fibular hemimelia and linked to the SHH gene.
Source: PDF 1, p. 7
QuestionWhat is the key point about Anterolateral bowing?
AnswerAnterolateral bowing is associated with congenital pseudoarthrosis of the tibia.
Source: PDF 1, p. 7
QuestionWhat is the key point about Healing rates for osteochondritis dissecans?
AnswerHealing rates for osteochondritis dissecans are highest with open physes.
Source: PDF 1, p. 7
I Clubfoot#
QuestionIn I Clubfoot, 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 is the key point about Also?
AnswerAlso represents order of correction in Ponseti method.
Source: PDF 1, p. 7
QuestionIn I Clubfoot, what should you remember about: Most cases require Achilles tenotomy at end of?
AnswerMost cases require Achilles tenotomy at end of casting.
Source: PDF 1, p. 7
QuestionIn I Clubfoot, 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 I Clubfoot, 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 I Clubfoot, what should you remember about: Recurrence treated with trial of recasting.?
AnswerRecurrence treated with trial of recasting.
Source: PDF 1, p. 7
II Pes Cavus#
QuestionIn II Pes Cavus, 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 II Pes Cavus, 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 II Pes Cavus, what should you remember about: Spinal magnetic resonance imaging (MRI) required to evaluate.?
AnswerSpinal magnetic resonance imaging (MRI) required to evaluate.
Source: PDF 1, p. 7
III Congenital Vertical Talus#
QuestionIn III Congenital Vertical Talus, 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 III Congenital Vertical Talus, 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 III Congenital Vertical Talus, 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.
Source: PDF 1, p. 7
IV Tarsal Coalition#
QuestionWhat is the key point about Sinus tarsi pain?
AnswerSinus tarsi pain caused by peroneal spasticity, flatfoot, and multiple ankle sprains.
Source: PDF 1, p. 7
QuestionIn IV Tarsal Coalition, what should you remember about: Limited subtalar motion on examination.?
AnswerLimited subtalar motion on examination.
Source: PDF 1, p. 7
QuestionIn IV Tarsal Coalition, 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 should you know about 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 should you know about More than 50% of the middle facet involved?
AnswerMore than 50% of the middle facet involved: subtalar arthrodesis preferred.
Source: PDF 1, p. 7
V Calcaneovalgus Foot#
QuestionIn V Calcaneovalgus Foot, what should you remember about: Dorsiflexed (calcaneus) hindfoot.?
AnswerDorsiflexed (calcaneus) hindfoot.
Source: PDF 1, p. 7
QuestionIn V Calcaneovalgus Foot, what should you remember about: In contrast to congenital vertical talus, in which?
AnswerIn contrast to congenital vertical talus, in which hindfoot is plantar flexed (equinus).
Source: PDF 1, p. 7
QuestionIn V Calcaneovalgus 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).
Source: PDF 1, p. 7
VI Kohler Disease (Osteonecrosis of Navicular)#
QuestionIn VI Kohler Disease (Osteonecrosis of Navicular), what should you remember about: Sclerosis and flattening of navicular.?
AnswerSclerosis and flattening of navicular.
Source: PDF 1, p. 7
QuestionIn VI Kohler Disease (Osteonecrosis of Navicular), what should you remember about: Spontaneous resolution; can be treated with immobilization.?
AnswerSpontaneous resolution; can be treated with immobilization.
Source: PDF 1, p. 7
VII Pes Planus#
QuestionIn VII Pes Planus, 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 should you know about 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
I Adolescent Idiopathic Scoliosis#
QuestionIn I Adolescent Idiopathic Scoliosis, 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.
Source: PDF 1, p. 7
source p. 8
Observation#
QuestionIn Observation, 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 Observation, 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 Observation, 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 Observation, 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 Observation, 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 the key point about Intraoperative spinal cord monitoring?
AnswerIntraoperative spinal cord monitoring is crucial.
Source: PDF 1, p. 8
QuestionWhat is the key point about If changes?
AnswerIf changes occur intraoperatively, the surgical team should check leads, raise blood pressure, transfuse, reverse steps of surgery, and reassess.
Source: PDF 1, p. 8
II Infantile Idiopathic Scoliosis#
QuestionWhat is the key point about Idiopathic scoliosis that?
AnswerIdiopathic scoliosis that manifests before age 4 years.
Source: PDF 1, p. 8
QuestionIn II Infantile Idiopathic Scoliosis, what should you remember about: Most curves resolve spontaneously.?
AnswerMost curves resolve spontaneously.
Source: PDF 1, p. 8
QuestionIn II Infantile Idiopathic Scoliosis, 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 should you know about Less than 20 degrees?
AnswerLess than 20 degrees: low risk (<20%).
Source: PDF 1, p. 8
QuestionWhat should you know about More than 20 degrees?
AnswerMore than 20 degrees: high risk (80%).
Source: PDF 1, p. 8
QuestionIn II Infantile Idiopathic Scoliosis, what should you remember about: Initial treatment with Mehta derotational cast.?
AnswerInitial treatment with Mehta derotational cast.
Source: PDF 1, p. 8
III Congenital Spinal Deformities#
QuestionIn III Congenital Spinal Deformities, what should you remember about: High incidence of associated abnormalities.?
AnswerHigh incidence of associated abnormalities.
Source: PDF 1, p. 8
QuestionWhat should you know about Intraspinal abnormality?
AnswerIntraspinal abnormality: 20% to 40%; MRI required.
Source: PDF 1, p. 8
QuestionWhat should you know about Cardiac system?
AnswerCardiac system: 12% to 26%.
Source: PDF 1, p. 8
QuestionWhat should you know about Genitourinary system?
AnswerGenitourinary system: 20%.
Source: PDF 1, p. 8
QuestionIn III Congenital Spinal Deformities, 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.
Source: PDF 1, p. 8
IV Neuromuscular Scoliosis#
QuestionIn IV Neuromuscular Scoliosis, what should you remember about: Duchenne muscular dystrophy.?
AnswerDuchenne muscular dystrophy.
Source: PDF 1, p. 8
QuestionWhat is the key point about 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 the key point about Curve progression?
AnswerCurve progression is rapid, and pulmonary and cardiac conditions worsen with time, precluding surgery.
Source: PDF 1, p. 8
QuestionIn IV Neuromuscular Scoliosis, what should you remember about: Cerebral palsy (CP)?
AnswerCerebral palsy (CP)
Source: PDF 1, p. 8
QuestionIn IV Neuromuscular Scoliosis, 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 IV Neuromuscular Scoliosis, what should you remember about: High complication rates but improved caregiver satisfaction.?
AnswerHigh complication rates but improved caregiver satisfaction.
Source: PDF 1, p. 8
A Klippel-Feil#
QuestionIn A Klippel-Feil, 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 8 weeks’ gestation.
Source: PDF 1, p. 8
QuestionIn A Klippel-Feil, what should you remember about: Associated with renal and congenital h-art disease, auditory?
AnswerAssociated with renal and congenital h-art disease, auditory issues, and Sprengel deformity.
Source: PDF 1, p. 8
QuestionIn A Klippel-Feil, 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.
Source: PDF 1, p. 8
Treatment#
QuestionWhat should you know about Symptoms for less than 1 week?
AnswerSymptoms for less than 1 week: cervical collar, analgesics, heat.
Source: PDF 1, p. 8
QuestionWhat should you know about Symptoms for between 1 and 4 weeks?
AnswerSymptoms for between 1 and 4 weeks: traction and collar immobilization.
Source: PDF 1, p. 8
QuestionWhat should you know about Symptoms for longer than 1 month?
AnswerSymptoms for longer than 1 month: traction, reduction, and halo immobilization.
Source: PDF 1, p. 8
QuestionWhat should you know about Irreducible dislocation of C1eC2 or recurrent instability of C1eC2?
AnswerIrreducible dislocation of C1eC2 or recurrent instability of C1eC2: surgical reduction and fixation of C1eC2.
Source: PDF 1, p. 8
VI Spondylolysis and Spondylolisthesis#
QuestionIn VI Spondylolysis and Spondylolisthesis, what should you remember about: Seen in athletes who use hyperextension.?
AnswerSeen in athletes who use hyperextension.
Source: PDF 1, p. 8
QuestionIn VI Spondylolysis and Spondylolisthesis, what should you remember about: Patient with high-grade listhesis (>50%) may have flexed?
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 Slip angle, 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 Slip angle, 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 should you know about 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
QuestionWhat is the key point about Increased PI?
AnswerIncreased PI may predispose to spondylolisthesis.
Source: PDF 1, p. 8
QuestionIn Pelvic incidence (PI), 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).
Source: PDF 1, p. 8
A Infectious Spondylitis#
QuestionWhat is the key point about Loss of lumbar lordosis?
AnswerLoss of lumbar lordosis is first radiographic finding.
Source: PDF 1, p. 8
B Osteoid Osteoma#
QuestionIn B Osteoid Osteoma, 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 B Osteoid Osteoma, what should you remember about: Can be associated with scoliosis.?
AnswerCan be associated with scoliosis.
Source: PDF 1, p. 8
C Sacral Agenesis#
QuestionIn C Sacral Agenesis, what should you remember about: Associated with maternal diabetes.?
AnswerAssociated with maternal diabetes.
Source: PDF 1, p. 8
QuestionWhat is the key point about 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 the key point about 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 is the key point about CP hips at risk?
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 should you know about 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 independent ambulation with bracing.
Source: PDF 1, p. 8
QuestionWhat is the key point about Myelomeningocele?
AnswerMyelomeningocele is associated with folate deficiency in utero and a high prevalence of IgE-mediated latex allergy.
Source: PDF 1, p. 8
QuestionWhat is the key point about Duchenne muscular dystrophy?
AnswerDuchenne muscular dystrophy is an X-linked recessive disorder due to a mutation of the dystrophin gene.
Source: PDF 1, p. 8
QuestionWhat is the key point about 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
QuestionWhat is the key point about Most commonly?
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 should you know about 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
II Pseudoachondroplasia#
QuestionIn II Pseudoachondroplasia, what should you remember about: Defect of cartilage oligomeric matrix protein (COMP) on?
AnswerDefect of cartilage oligomeric matrix protein (COMP) on chromosome 19.
Source: PDF 1, p. 9
III Multiple Epiphyseal Dysplasia#
QuestionWhat is the key point about Most common gene mutation?
AnswerMost common gene mutation is in COMP but also affects type IX collagen.
Source: PDF 1, p. 9
QuestionIn III Multiple Epiphyseal Dysplasia, what should you remember about: Can be confused with Legg-Calvé-Perthes disease. Multiple epiphyseal?
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.
Source: PDF 1, p. 9
IV Mucopolysaccharidosis#
QuestionIn IV Mucopolysaccharidosis, what should you remember about: Most autosomal recessive (except Hurler syndrome, which is?
AnswerMost autosomal recessive (except Hurler syndrome, which is Xlinked recessive).
Source: PDF 1, p. 9
QuestionIn IV Mucopolysaccharidosis, what should you remember about: Pr-operative cervical spine radiographs should always be obtained?
AnswerPr-operative cervical spine radiographs should always be obtained in the patient with Morquio syndrome, who may have upper cervical instability.
Source: PDF 1, p. 9
V Diastrophic Dysplasia#
QuestionIn V Diastrophic Dysplasia, 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 V Diastrophic Dysplasia, what should you remember about: Associated with rigid clubfeet, cauliflower ears, and hitchhiker’s?
AnswerAssociated with rigid clubfeet, cauliflower ears, and hitchhiker’s thumb.
Source: PDF 1, p. 9
VI Osteopetrosis#
QuestionIn VI Osteopetrosis, 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 the key point about The mild form?
AnswerThe mild form is autosomal dominant; the “malignant” form is autosomal recessive.
Source: PDF 1, p. 9
QuestionWhat is the key point about 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 should you know about Atlantodens interval (ADI) less than 4.5 mm?
AnswerAtlantodens interval (ADI) less than 4.5 mm: no restrictions.
Source: PDF 1, p. 9
QuestionWhat should you know about 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
QuestionIn Cervical spine instability general recommendations, what should you remember about: ADI over 10 mm or symptoms/cord signal changes?
AnswerADI over 10 mm or symptoms/cord signal changes on MRI: C1 to 2 fusion.
Source: PDF 1, p. 9
QuestionIn Cervical spine instability general recommendations, what should you remember about: Complication rate of up to 50% reported.?
AnswerComplication rate of up to 50% reported.
Source: PDF 1, p. 9
II Marfan Syndrome#
QuestionIn II Marfan Syndrome, what should you remember about: Defect in fibrillin-1 (FBN1).?
AnswerDefect in fibrillin-1 (FBN1).
Source: PDF 1, p. 9
QuestionIn II Marfan Syndrome, what should you remember about: Autosomal dominant inheritance.?
AnswerAutosomal dominant inheritance.
Source: PDF 1, p. 9
QuestionIn II Marfan 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 is the key point about Echocardiographic and cardiologic evaluation?
AnswerEchocardiographic and cardiologic evaluation are required before surgery.
Source: PDF 1, p. 9
III Beckwith-Wiedemann Syndrome#
QuestionIn III Beckwith-Wiedemann 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 III Beckwith-Wiedemann Syndrome, what should you remember about: Hemihypertrophy, spasticity, organomegaly, omphalocele, macroglossia.?
AnswerHemihypertrophy, spasticity, organomegaly, omphalocele, macroglossia.
Source: PDF 1, p. 9
QuestionIn III Beckwith-Wiedemann 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 should you know about 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 should you know about Osteomyelitis?
AnswerOsteomyelitis: Salmonella infection more commonly seen than in normal population, but S. aureus still most common etiology.
Source: PDF 1, p. 9
II Rickets#
QuestionIn II Rickets, what should you remember about: Short stature and genu varum.?
AnswerShort stature and genu varum.
Source: PDF 1, p. 9
QuestionIn II Rickets, 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 should you know about X-linked hypophosphatemic (vitamin D-resistant) rickets?
AnswerX-linked hypophosphatemic (vitamin D-resistant) rickets: defect in cellular endopeptidase (phosphate-regulating neutral endopeptidase).
Source: PDF 1, p. 9
III Osteogenesis Imperfecta#
QuestionWhat is the key point about Defect in type I collagen (COL1A1 and COL1A2 genes) that?
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 III Osteogenesis Imperfecta, 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 III Osteogenesis Imperfecta, what should you remember about: Basilar invagination in more severe types.?
AnswerBasilar invagination in more severe types.
Source: PDF 1, p. 9
QuestionIn III Osteogenesis Imperfecta, what should you remember about: Bisphosphonates reduce the incidence of fractures.?
AnswerBisphosphonates reduce the incidence of fractures.
Source: PDF 1, p. 9
IV Juvenile Idiopathic Arthritis#
QuestionIn IV Juvenile Idiopathic Arthritis, 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
QuestionWhat is the key point about Commonly?
AnswerCommonly involves the knee, wrist (flexed and ulnar deviated), and hand (fingers extended, swollen, radially deviated).
Source: PDF 1, p. 9
QuestionWhat is the key point about 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
QuestionIn IV Juvenile Idiopathic Arthritis, what should you remember about: Cervical spine involvement can lead to kyphosis, facet?
AnswerCervical spine involvement can lead to kyphosis, facet ankylosis, and atlantoaxial subluxation.
Source: PDF 1, p. 9
source p. 10
SECTION 1 KNEE#
QuestionWhat should you know about 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 the key point about The 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 the key point about The gold standard 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 should you know about ACL anatomy?
AnswerACL anatomy: anteromedial bundle is an anterior restraint, and posterolateral bundle is a rotatory restraint.
Source: PDF 1, p. 10
QuestionWhat is the key point about The 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 the key point about The 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 the key point about The 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 the key point about The 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 the key point about The 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 the key point about The posterior horn of the medial meniscus?
AnswerThe posterior horn of the medial meniscus is a major secondary 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 the key point about The gold standard for meniscal repair?
AnswerThe gold standard for meniscal repair is the inside-out technique with vertical mattress sutures. Regar less 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 is the key point about Meniscal cysts?
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 the key point about 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 the key point about The 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 the key point about The 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 is the key point about Magnetic resonance imaging (MRI) evaluation of ACL injuries?
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
QuestionIn SECTION 1 KNEE, what should you remember about: Initial management consists of physical therapy for mobilization.?
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
QuestionWhat is the key point about A more horizontal graft position?
AnswerA more horizontal graft position may reduce rotational instability.
Source: PDF 1, p. 10
QuestionIn SECTION 1 KNEE, what should you remember about: Boneepatellar tendonebone autografts demonstrate faster incorporation into the?
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 the key point about The 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 the key point about Arthrofibrosis?
AnswerArthrofibrosis is the most common complication following ACL reconstruction and is associated with a loss of patellar translation.
Source: PDF 1, p. 10
QuestionWhat is the key point about There?
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
QuestionIn SECTION 1 KNEE, what should you remember about: Multiple-ligament knee injuries require an immediate neurovascular examination.?
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 is the key point about No definitive research?
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 the key point about 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.
Source: PDF 1, p. 10
source p. 11
QuestionWhat is the key point about Iliotibial band friction syndrome?
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 is the key point about MRI evaluation of patellar dislocation?
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 the key point about 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 key point about Conservative management?
AnswerConservative management is the mainstay of symptomatic bipartite patella.
Source: PDF 1, p. 11
QuestionIn this topic, 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 is the key point about Quadriceps contusions?
AnswerQuadriceps contusions are acutely managed with overnight immobilization in hyperflexion.
Source: PDF 1, p. 11
QuestionWhat is the key point about 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 the key point about 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 is the key point about Femoral neck stress fractures that?
AnswerFemoral neck stress fractures that occur on the inferior surface (compression side) can be treated nonoperatively.
Source: PDF 1, p. 11
QuestionWhat is the key point about Femoroacetabular impingement?
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 is the key point about External snapping hip?
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 anterolateral 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 the key point about The 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 the key point about Humeral head blood supply?
AnswerHumeral head blood supply is primarily from the posterior humeral circumflex artery.
Source: PDF 1, p. 11
QuestionWhat is the key point about The contents of the rotator interval?
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 shoulder, 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 shoulder 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
QuestionIn SECTION 3 SHOULDER, what should you remember about: Traumatic anterior shoulder dislocations typically result when the?
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 the key point about 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 is the key point about A humeral avulsion of the glenohumeral ligaments lesion?
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 the key point about 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 is the key point about Several open and arthroscopic techniques?
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
QuestionWhat is the key point about Remplissage?
AnswerRemplissage involves tenodesis of the posterior capsule and infraspinatus into a HilleSachs lesion. Precise indications are not yet defined, but early evidence suggests medium to large or engaging HilleSachs lesions.
Source: PDF 1, p. 11
QuestionWhat is the key point about Post-thermal capsular necrosis?
AnswerPost-thermal capsular necrosis is treated with allograft anterior capsulolabral reconstruction.
Source: PDF 1, p. 11
QuestionWhat is the key point about Physical examination for posterior instability?
AnswerPhysical examination for posterior instability includes load-and-shift and jerk testing.
Source: PDF 1, p. 11
QuestionWhat is the key point about A fixed posterior shoulder dislocation?
AnswerA fixed posterior shoulder dislocation is diagnosed from lack of external rotation. Anteroposterior 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 HilleSachs 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
QuestionIn SECTION 3 SHOULDER, what should you remember about: The prevalence of asymptomatic rotator cuff tears increases?
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 the key point about 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 this topic, 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
QuestionWhat is the key point 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 is the key point about Signs of a subscapularis tear?
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 is the key point about Athletes who participate in throwing activities?
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 the key point about 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 key point about 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 the key point about 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
QuestionIn this topic, what should you remember about: For type III acromioclavicular separations, recommended management is?
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 this topic, 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 the key point about 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 the key point about 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 is the key point about Frozen shoulder histologic evaluation?
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 this topic, 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 the key point about Quadrilateral space syndrome?
AnswerQuadrilateral 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 the key point about 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
QuestionIn this topic, what should you remember about: For total shoulder arthroplasty, lesser tuberosity osteotomy and?
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 this topic, what should you remember about: Reverse total shoulder arthroplasties medialize the center of?
AnswerReverse total shoulder arthroplasties medialize the center of rotation, and inferior placement of the bas-plate further allows for improvement of deltoid efficiency.
Source: PDF 1, p. 12
SECTION 4 MEDICAL ASPECTS OF SPORTS MEDICINE#
QuestionWhat is the key point about The 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 the key point about 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
QuestionWhat is the key point about Any athlete with diagnosed concussion?
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 the key point about 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 is the key point about Adverse effects of anabolic steroids?
AnswerAdverse effects of anabolic steroids include liver dysfunction, hypercholesterolemia, cardiomyopathy, testicular atrophy, gynecomastia, acne, mood disturbances (particularly increased aggression), and irreversible alopecia. H-art 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 secondary amenorrhea.
Source: PDF 1, p. 12
QuestionWhat is the key point about Methicillin-resistant Staphylococcus aureus transmission?
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 the key point about 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.
Source: PDF 1, p. 12
source p. 13
PAIN#
QuestionWhat is the key point about 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 is the key point about Radiographs?
AnswerRadiographs are the standard imaging modality.
Source: PDF 1, p. 13
QuestionWhat is the key point about MRI?
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#
QuestionWhat is the key point about Dysplasia typically?
AnswerDysplasia typically involves a shallow acetabulum with lateral and anterior uncoverage of the femoral head.
Source: PDF 1, p. 13
QuestionWhat is the key point about 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 is the key point about The majority of patients with FAI?
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 the key point about 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 the key point about 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 is the key point about Conservative management?
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 is the key point about Arthroscopy?
AnswerArthroscopy has limited indications in patients with arthritis; pr-operative joint space narrowing is negative predictor of good clinical outcome.
Source: PDF 1, p. 13
QuestionWhat is the key point about Hip arthrodesis?
AnswerHip arthrodesis is largely a historic procedure as THA technology has improved.
Source: PDF 1, p. 13
QuestionWhat is the key point about Subsequent conversion of hip arthrodesis to THA?
AnswerSubsequent conversion of hip arthrodesis to THA has high complication rate, and function depends on integrity of abductors.
Source: PDF 1, p. 13
QuestionWhat is the key point about Hemiarthroplasty?
AnswerHemiarthroplasty is not routinely used for arthritis and is r-legated to fracture treatment in an elderly, low-demand patient.
Source: PDF 1, p. 13
SECTION 5 TOTAL HIP ARTHROPLASTY#
QuestionWhat is the key point about Different surgical approaches?
AnswerDifferent surgical approaches have different advantages and disadvantages, although no clear difference in patients outcomes.
Source: PDF 1, p. 13
QuestionWhat is the key point about The direct anterior approach?
AnswerThe direct anterior approach has been associated with a higher rate of femoral problems, including fracture and loosening.
Source: PDF 1, p. 13
QuestionWhat is the key point about The posterior approach?
AnswerThe posterior approach has been associated with a higher rate of dislocation.
Source: PDF 1, p. 13
QuestionWhat is the key point about 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 the key point about 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 is the key point about Bone ingrowth?
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 the key point about Hydroxyapatite?
AnswerHydroxyapatite is an osteoconductive surface coating that may shorten the time to biologic fixation.
Source: PDF 1, p. 13
QuestionWhat is the key point about Femoral stress shielding?
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 is the key point about Femoral stem breakage?
AnswerFemoral stem breakage occurs from cantilever bending.
Source: PDF 1, p. 13
SECTION 6 REVISION TOTAL HIP ARTHROPLASTY#
QuestionWhat is the key point about Start-up pain?
AnswerStart-up pain is the most common initial presentation of implant loosening.
Source: PDF 1, p. 13
QuestionWhat is the key point about Segmental acetabular bone deficiency?
AnswerSegmental acetabular bone deficiency is loss of main bony support for acetabular cup.
Source: PDF 1, p. 13
QuestionWhat is the key point about 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 is the key point about 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
QuestionWhat is the key point about Custom triflange cups?
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
QuestionIn SECTION 6 REVISION TOTAL HIP ARTHROPLASTY, what should you remember about: Pelvic discontinuity, which occurs when the superior aspect?
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 is the key point about 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#
QuestionIn SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA, what should you remember about: Irradiation of PE creates free radicals, which result?
AnswerIrradiation of PE creates free radicals, which result in cross-linking.
Source: PDF 1, p. 13
QuestionWhat is the key point about 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 is the key point about 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 the key point about 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
QuestionWhat is the key point about Treatment of PE wear?
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 the key point about 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
QuestionIn SECTION 7 ARTICULAR BEARINGS AND CORROSION IN THA, what should you remember about: Standard evaluation for a painful MOM THA or?
AnswerStandard evaluation for a painful MOM THA or suspected trunnionosis includes serum cobalt and chromium levels, as well as
Source: PDF 1, p. 13
MRI with MARS.#
QuestionWhat is the key point about Ceramic-on-ceramic bearings?
AnswerCeramic-on-ceramic bearings have been associated with squeaking.
Source: PDF 1, p. 13
QuestionIn MRI with MARS., 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
QuestionWhat is the key point about Trunnion corrosion (trunnionosis)?
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 the key point about Intraoperative fracture?
AnswerIntraoperative 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 the key point about Early postoperative fracture?
AnswerEarly postoperative fracture is often a result of unrecognized intraoperative fracture.
Source: PDF 1, p. 14
QuestionWhat is the key point about Vancouver classification?
AnswerVancouver classification is used to guide treatment.
Source: PDF 1, p. 14
QuestionWhat is the key point about A loose stem?
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
QuestionWhat is the key point about A nerve palsy that develops postoperatively?
AnswerA nerve palsy that develops postoperatively may be due to hematoma, for which emergency evacuation is required.
Source: PDF 1, p. 14
QuestionWhat is the key point about There?
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 the key point about 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 key point about 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 the key point about 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 the key point about 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
QuestionWhat is the key point about The treatment of instability?
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 is the key point about 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 the key point about The 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 the key point about 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 should you know about 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 the key point about The 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
Coronal Plane Balance:#
QuestionIn Coronal Plane Balance:, what should you remember about: To correct varus deformity, a medial compartment release?
AnswerTo correct varus deformity, a medial compartment release is needed. n Superficial MCL is the key structure for medial compartment release. n Posterior oblique portion is tight in extensiondrelease needed for medial extension tightness. n Anterior portion is tight in flexiondrelease needed for medial flexion tightness.
Source: PDF 1, p. 14
QuestionIn Coronal Plane Balance:, what should you remember about: To correct valgus deformity, a lateral compartment release?
AnswerTo correct valgus deformity, a lateral compartment release is needed. n Iliotibial band and popliteus are the key structures for lateral compartment release. n Iliotibial band is tight in extensiondrelease needed for lateral extension tightness. n Popliteus is tight in flexiondrelease needed for lateral flexion tightness.
Source: PDF 1, p. 14
Sagittal Plane Balance:#
QuestionWhat is the key point about The 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. n Symmetrical gap problemdTibia adjusted first. n Asymmetrical gap problemdFemur adjusted first.
Source: PDF 1, p. 14
QuestionIn Sagittal Plane Balance:, 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 Sagittal Plane Balance:, 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.
Source: PDF 1, p. 14
Perioperative Nerve Blocks:#
QuestionIn Perioperative Nerve Blocks:, what should you remember about: Femoral nerve blockdmotor and sensory blockdknee will buckle?
AnswerFemoral nerve blockdmotor and sensory blockdknee will buckle with walking. n A knee immobilizer is required to walk.
Source: PDF 1, p. 14
QuestionIn Perioperative Nerve Blocks:, what should you remember about: Adductor nerve blockdsensory block onlydknee will not buckle?
AnswerAdductor nerve blockdsensory block onlydknee will not buckle with walking. Complications:
Source: PDF 1, p. 14
QuestionWhat is the key point about The deformity most likely to cause peroneal nerve palsy in TKA?
AnswerThe deformity most likely to cause peroneal nerve palsy in TKA is a combined valgus flexion deformity. n When nerve palsy is identified postoperatively, the first treatment is to remove compressive wraps and flex the knee.
Source: PDF 1, p. 14
QuestionIn Perioperative Nerve Blocks:, 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 Perioperative Nerve Blocks:, 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 is the key point about Osteolysis in TKA?
AnswerOsteolysis in TKA manifests later in life of implant (7-15 years); radiographs show round lytic lesions behind implant (most common site is behind posterior femoral condyle).
Source: PDF 1, p. 14
source p. 15
PDFFx rules#
QuestionWhat is the key point about For a PDFFx where the implant?
AnswerFor a PDFFx where the implant is stable, ORIF with distal lateral locking plate is the preferred choice. n Submuscular plating is preferred.
Source: PDF 1, p. 15
QuestionWhat is the key point about A retrograde IM nail?
AnswerA retrograde IM nail is best suited for metadiaphyseal fractures. n A small arthrotomy is needed to prevent damage to the PE bearing. n The sagittal deformity created is extension of the distal femur segment, as the entry point is typically lower due to the lowmetal trochlear flange.
Source: PDF 1, p. 15
Periprosthetic Joint Infection:#
QuestionIn Periprosthetic Joint Infection:, 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. n The first step in evaluation is an infection workup, including serum CRP, sedimentation rate, and a joint aspiration.
Source: PDF 1, p. 15
QuestionIn Periprosthetic Joint Infection:, 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). n Review minor criteria for chronic PJI.
Source: PDF 1, p. 15
QuestionWhat is the key point about There?
AnswerThere are only two major criteria for the diagnosis of a PJI, and only one is required to make the diagnosis: n Presence of a draining sinus that communicates to the joint (this is the only absolute diagnosis). n Two positive cultures growing the same organism using standard culture methods.
Source: PDF 1, p. 15
QuestionWhat is the key point about 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
QuestionIn Periprosthetic Joint Infection:, what should you remember about: Bone erosive changes/destructive changes on radiographic evidence means?
AnswerBone erosive changes/destructive changes on radiographic evidence means the infection is chronic.
Source: PDF 1, p. 15
QuestionWhat is the key point about An acute PJI diagnosis?
AnswerAn acute PJI diagnosis is made when the signs/symptoms have been present for no longer than 3 weeks. n Treatment is a radical débridement/lavage with exchange of modular parts, retention of implants, and parenteral antibiotics. n Arthroscopic lavage is not acceptable.
Source: PDF 1, p. 15
QuestionIn Periprosthetic Joint Infection:, what should you remember about: For treatment of a chronic PJI, the two-stage?
AnswerFor treatment of a chronic PJI, the two-stage exchange is the preferred answer. n For 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 the key point about The medial gastrocnemius rotational flap?
AnswerThe medial gastrocnemius rotational flap is the main “workhorse” for soft tissue deficiencies about the knee. n The blood supply is the medial sural artery. n This flap can cover medial and anterior knee deficiencies.
Source: PDF 1, p. 15
SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN#
QuestionWhat is the key point about Femoral cam jump?
AnswerFemoral cam jump occurs in posterior stabilized knees when the flexion gap is left too loose. n Closed 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 is the key point about Patella clunk syndrome?
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. n Scar catches in box then releases with a clunk. n Treatment is removal of suprapatellar scar nodule. n Femoral implant design is the most important risk factor for patella clunk. n A wide box design increases risk by allowing the patella to settle deeper into the box n A tall box (box height >70% of total height) increases risk, as suprapatellar scar nodule is more likely to travel into the box “capture zone.”
Source: PDF 1, p. 15
QuestionWhat is the key point about A constrained nonhinged TKA?
AnswerA constrained nonhinged TKA has a high central post that substitutes for MCL and LCL functionda standard posterior stabilized post is not constrained. n The indication for a constrained post is the inability to balance the knee with residual instability in extension and/or flexion. n Constrained 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 the key point about 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
QuestionIn SECTION 14 TOTAL KNEE ARTHROPLASTY DESIGN, what should you remember about: In a hinged TKA, the femoral and tibial?
AnswerIn a hinged TKA, the femoral and tibial components are linked with a connecting bar and bearings. n The main indications for a hinged TKA are global instability and hyperextension instability. n Hyperextension instability is an absolute indication for a hinged TKA.
Source: PDF 1, p. 15
SECTION 15 REVISION TOTAL KNEE ARTHROPLASTY#
QuestionWhat is the key point about Periprosthetic joint infection?
AnswerPeriprosthetic joint infection is currently the number one reason for revision within the first 2 years of a primary TKA. n After exam and x-rays, blood tests are the next step in evaluation: CRP and sedimentation rate. n If abnormal, a joint aspiration is required.
Source: PDF 1, p. 15
QuestionWhat is the key point about 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 is the key point about 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 should you know about 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 snipdtransverse 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 the key point about Patellar resurfacing in TKA?
AnswerPatellar resurfacing in TKA is controversial. n The 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
Treatment principles#
QuestionWhat is the key point about Spontaneous osteonecrosis?
AnswerSpontaneous osteonecrosis involves a single condyle (medial femoral condyle). n Pathology is mechanical overload. n Classic radiographic appearance is the “sclerotic halo” with a central radiolucent zone.
Source: PDF 1, p. 16
QuestionWhat is the key point about Secondary osteonecrosis?
AnswerSecondary osteonecrosis has diffuse involvement. n Pathology is metabolic. n Classic appearance is sclerotic white areas of bone infarction throughout the knee. n The “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 secondary (e.g., trauma, surgery) causes.?
AnswerPrimary and secondary (e.g., trauma, surgery) causes.
Source: PDF 1, p. 16
QuestionWhat should you know about Primary OA?
AnswerPrimary OA: joint space narrowing, inferior humeral osteophyte, posterior wear.
Source: PDF 1, p. 16
QuestionWhat should you know about Inflammatory OA?
AnswerInflammatory OA: rotator cuff tears, central glenoid wear.
Source: PDF 1, p. 16
QuestionWhat should you know about Rotator cuff tear arthropathy (CTA)?
AnswerRotator cuff tear arthropathy (CTA): superior migration of humeral head, superior glenoid wear.
Source: PDF 1, p. 16
QuestionWhat should you know about Clinical exam is important?
AnswerClinical exam is important: focus on rotator cuff function, particularly the subscapularis.
Source: PDF 1, p. 16
QuestionWhat should you know about 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 pr-operative 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 the key point about Incidence?
AnswerIncidence is declining, very narrow indications.
Source: PDF 1, p. 16
QuestionWhat should you know about 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 the key point about Late glenoid pain?
AnswerLate glenoid pain is a frequent complication when hemiarthroplasty performed for arthritis.
Source: PDF 1, p. 16
QuestionWhat is the key point about Reverse shoulder 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
QuestionIn SECTION 21 TOTAL SHOULDER ARTHROPLASTY, what should you remember about: Incidence of full-thickness cuff tears with primary glenohumeral?
AnswerIncidence of full-thickness cuff tears with primary glenohumeral OA is low (5%-10%).
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 is the key point about Complications of TSA?
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 bas-plate and glenosphere on the?
AnswerInvolves placing a bas-plate 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 the key point about 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 the key point about The 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 is the key point about 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
QuestionWhat is the key point about Periprosthetic fractures can?
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#
QuestionIn SECTION 23 INFECTION IN SHOULDER ARTHROPLASTY, what should you remember about: Periprosthetic shoulder infections manifest differently from periprosthetic hip?
AnswerPeriprosthetic shoulder infections manifest differently from periprosthetic hip and knee infections.
Source: PDF 1, p. 16
QuestionWhat is the key point about 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
QuestionIn SECTION 23 INFECTION IN SHOULDER ARTHROPLASTY, what should you remember about: Serum laboratory tests and aspiration with analysis of?
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 the key point about Tissue culture?
AnswerTissue culture is the gold standard for diagnosis.
Source: PDF 1, p. 16
QuestionWhat is the key point about Management options?
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 is the key point about Antibiotic choices?
AnswerAntibiotic choices are guided by culture results.
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 is the key point about Ankle dorsiflexion?
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
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: Can lead to avulsion injuries of distal tip?
AnswerCan lead to avulsion injuries of distal tip of fibula.
Source: PDF 1, p. 17
QuestionWhat is the key point about There?
AnswerThere are three parts to the Lisfranc ligamentddorsal, plantar, and interosseous; interosseous is strongest.
Source: PDF 1, p. 17
QuestionIn SECTION 1 BIOMECHANICS OF THE FOOT AND ANKLE, what should you remember about: In hammer toes/crossover toes, the plantar plate is?
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 the key point about 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 is the key point about There?
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 is the key point about There?
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#
QuestionIn SECTION 2 PHYSICAL EXAMINATION OF THE FOOT AND ANKLE, what should you remember about: Inability to sense a Semmes-Weinstein 5.07 monofilament (10?
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 the key point about Peroneus brevis?
AnswerPeroneus brevis is dorsal to the peroneus longus at level of peroneal tubercle.
Source: PDF 1, p. 17
QuestionWhat is the key point about 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 is the key point about Pronation?
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) arthrodesis.
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, arthrodesis of the first TMT should be considered. Soft tissue release should be done in all scenarios.
Source: PDF 1, p. 17
QuestionWhat is the key point about 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 the key point about There?
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#
QuestionIn SECTION 4 JUVENILE AND ADOLESCENT HALLUX VALGUS, what should you remember about: In treatment of juvenile/adolescent hallux valgus, recurrence is?
AnswerIn treatment of juvenile/adolescent hallux valgus, recurrence is most common postoperative complication.
Source: PDF 1, p. 17
QuestionWhat is the key point about 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.
Source: PDF 1, p. 17
source p. 18
SECTION 5 HALLUX VARUS#
QuestionWhat is the key point about Hallux varus can?
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 the key point about 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 arthrodesis.
Source: PDF 1, p. 18
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: Flexor-to-extensor tendon transfer can lead to stiffness of?
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 is the key point about Claw toes?
AnswerClaw toes are often neurogenic in etiology (i.e., Charcot-Marie-Tooth [CMT]); are a noted complication of compartment syndrome involving the deep compartments of the foot.
Source: PDF 1, p. 18
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: For hammer-toe/claw-toe deformities, if there is skin breakdown?
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 the key point about 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
QuestionIn SECTION 6 LESSER-TOE DEFORMITIES, what should you remember about: In high-level athletes, repair of the plantar plate?
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 the key point about 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 the key point about 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 7-8 degrees or less).
Source: PDF 1, p. 18
QuestionWhat should you know about 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 the key point about 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 extremity.
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#
QuestionIn Turf toe comes in three grades (grade 1: capsular strain; grade 2, what should you remember about: For persistent sesamoid issues refractory to nonoperative measures?
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 should you know about 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 the key point about Interdigital neuromas?
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
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: Neuromas often demonstrate perineural fibrosis.?
AnswerNeuromas often demonstrate perineural fibrosis.
Source: PDF 1, p. 18
QuestionWhat is the key point about Lateral plantar nerve?
AnswerLateral plantar nerve may be injured during surgical approaches that require a plantar incision, such as a tibiotalocalcaneal arthrodesis 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
QuestionWhat is the key point about Wasting of the abductor hallucis (ABH) or abductor digiti quinti?
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 should you know about 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
QuestionIn SECTION 9 NEUROLOGIC DISORDERS, what should you remember about: Patients with anterior tarsal tunnel syndrome present with?
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 anterolateral portal following ankle arthroscopic procedures.
Source: PDF 1, p. 18
source p. 19
QuestionWhat is the key point about Popliteal nerve blocks do not typically?
AnswerPopliteal nerve blocks do not typically include the saphenous nerve.
Source: PDF 1, p. 19
QuestionWhat is the key point about 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 is the key point about 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 this topic, 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
QuestionWhat is the key point about First branch of the lateral plantar nerve (Baxter nerve)?
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#
QuestionWhat is the key point about Gout?
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 the key point about 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 is the key point about Infected joint?
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 is the key point about 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 is the key point about Nonoperative treatment of osteoarthritis of the foot/ankle should?
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 is the key point about Osteophytes at dorsal talonavicular (TN) joint?
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 arthrodesis with structural grafting.
Source: PDF 1, p. 19
QuestionWhat should you know about Fusion of the great toe?
AnswerFusion of the great toe: position neutral rotation, 10 to 15 degrees dorsiflexion, and 5 degrees valgus.
Source: PDF 1, p. 19
QuestionWhat is the key point about Best way to check sagittal alignment?
AnswerBest way to check sagittal alignment is to simulate weight bearing.
Source: PDF 1, p. 19
QuestionWhat is the key point about Toe?
AnswerToe is slightly elevated (4-6 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
QuestionIn SECTION 10 ARTHRITIC DISEASE, what should you remember about: Placement of plate too proximal (6 mm) can?
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 arthrodesis often indicated in patients with peripheral?
AnswerAnkle arthrodesis often indicated in patients with peripheral neuropathy and insensate foot.
Source: PDF 1, p. 19
QuestionWhat is the key point about Open arthrodesis?
AnswerOpen arthrodesis is ideal for severe deformity.
Source: PDF 1, p. 19
QuestionWhat is the key point about Ankle arthrodesis malunion?
AnswerAnkle arthrodesis malunion may lead to anterior talar translation of the talus. This can elongate the lever arm of the foot and needs a revision arthrodesis of the ankle. If excessive plantar flexion, will develop excessive hyperextension of the knee.
Source: PDF 1, p. 19
QuestionWhat is the key point about 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 arthrodesis), Charcot arthropathy, young age, and history of infection. Ipsilateral hindfoot arthritis is an indication for TAR.
Source: PDF 1, p. 19
QuestionWhat is the key point about Syndesmotic fusion when the Agility ankle replacement system?
AnswerSyndesmotic 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 the key point about 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 arthrodesis (femoral head) with or without additional subtalar fusion.
Source: PDF 1, p. 19
QuestionWhat is the key point about Wound breakdown in the acute period (3 weeks) after TAR?
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 the key point about 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 is the key point about 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).
Source: PDF 1, p. 19
source p. 20
QuestionWhat is the key point about The 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 anteromedial sustentaculum.
Source: PDF 1, p. 20
QuestionWhat is the key point about Patients?
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 key point about 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 arthrodesis.
Source: PDF 1, p. 20
QuestionWhat is the key point about If subtalar arthrodesis (alone or as part of triple)?
AnswerIf subtalar arthrodesis (alone or as part of triple) has been malunited in valgus, with tenderness in the lateral subfibular region, arthrodesis takedown and revision arthrodesis 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
QuestionWhat is the key point about Patients with pes cavus?
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 this topic, 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 is the key point about Nonoperative modalities?
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 is the key point about 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 the key point about 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 anterolateral 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 is the key point about If conservative management (immobilization/physical therapy)?
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 regar less 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 is the key point about Stenosis?
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#
QuestionIn SECTION 13 HEEL PAIN, what should you remember about: In evaluation of plantar fasciitis, weight-bearing x-rays are?
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 key point about 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, 90% to 95% of cases improve within a year regar less of the specific treatment offered.
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 the key point about Sever disease?
AnswerSever disease is a calcaneal apophysitis seen in young males (10-14 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
QuestionIn SECTION 13 HEEL PAIN, what should you remember about: Patients with noninsertional Achilles tendinopathy often present with?
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 intermediate 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 is the key point about Plantaris rupture?
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 should you know about 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 extremity 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
QuestionIn SECTION 14 ANKLE PAIN AND SPORTS INJURIES, what should you remember about: In lateral ankle sprain, physical therapy is important?
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 key point about 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 is the key point about Ankle instability can?
AnswerAnkle instability can occur without ligamentous issues (peroneal tendinopathy, osteochondral defects, fracture nonunion, anterior ankle impingement).
Source: PDF 1, p. 21
QuestionWhat is the key point about 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 is the key point about 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 , operative management has an 80% to 85% success rate. Débridement of the lesion back to a stable border is important.
Source: PDF 1, p. 21
QuestionIn SECTION 14 ANKLE PAIN AND SPORTS INJURIES, what should you remember about: Large lesions need alternative treatment; autologous osteochondral grafting?
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 is the key point about Larger lesions with cystic component?
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 is the key point about Chronic exertional compartment syndrome?
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 is the key point about The 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 should you know about 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 the key point about 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 SemmesWeinstein 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
QuestionIn SECTION 15 THE DIABETIC FOOT, what should you remember about: Peripheral vascular disease can lead to falsely elevated?
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 the key point about 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 Classifying ulcers can help guide management. Depth grade 0, 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 Classifying ulcers can help guide management. Depth grade 0, 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 is the key point about Treatment often?
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
QuestionWhat is the key point about Presence of infection?
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 the key point about 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 key point about Initial treatment of Charcot arthropathy?
AnswerInitial treatment of Charcot arthropathy is non-weight-bearing status with a TCC.
Source: PDF 1, p. 21
QuestionIn Classifying ulcers can help guide management. Depth grade 0, what should you remember about: Unstable/unbraceable deformities should be addressed with a tibiotalocalcaneal?
AnswerUnstable/unbraceable deformities should be addressed with a tibiotalocalcaneal arthrodesis 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.
Source: PDF 1, p. 21
source p. 22
QuestionWhat is the key point about Infections in the diabetic foot or ankle?
AnswerInfections in the diabetic foot or ankle are either isolated soft tissue infections (cellulitis or abscess) or osteomyelitis. If abscess is suspected, completed needle aspiration or MRI (renal issues may preclude MRI) is needed.
Source: PDF 1, p. 22
QuestionWhat is the key point about 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 osteomyelitis than isolated Tc scan.
Source: PDF 1, p. 22
QuestionIn this topic, what should you remember about: Contiguous osteomyelitis present in 67% of foot ulcerations?
AnswerContiguous osteomyelitis present in 67% of foot ulcerations that reach bone.
Source: PDF 1, p. 22
QuestionWhat is the key point about Osteomyelitis?
AnswerOsteomyelitis is treated with antibiotics and surgical débridement.
Source: PDF 1, p. 22
QuestionIn this topic, 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 is the key point about Syme amputation?
AnswerSyme amputation requires intact heel pad.
Source: PDF 1, p. 22
QuestionIn this topic, what should you remember about: Transtibial amputations.?
AnswerTranstibial amputations.
Source: PDF 1, p. 22
QuestionIn this topic, 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 this topic, 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 this topic, what should you remember about: Transfemoral.?
AnswerTransfemoral.
Source: PDF 1, p. 22
QuestionIn this topic, what should you remember about: Increased rates of oxygen consumption, metabolic rate, h-art?
AnswerIncreased rates of oxygen consumption, metabolic rate, h-art rate and perceived exertion.
Source: PDF 1, p. 22
QuestionWhat should you know about Traumatic?
AnswerTraumatic: 68% more energy.
Source: PDF 1, p. 22
QuestionWhat should you know about Vascular?
AnswerVascular: 100% more energy.
Source: PDF 1, p. 22
QuestionIn this topic, 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 this topic, 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 this topic, 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 , and albumin levels less than 2.5 g/dL result in poor healing potential.
Source: PDF 1, p. 22
SECTION 16 TRAUMA#
QuestionIn SECTION 16 TRAUMA, what should you remember about: 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 the key point about 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 the key point about 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 the key point about 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 the key point about The 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: Anteroposterior (AP), lateral, and oblique radiographs should be?
AnswerAnteroposterior (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 is the key point about 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 the key point about 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 the key point about Anatomic reduction?
AnswerAnatomic reduction is most predictive of good clinical results.
Source: PDF 1, p. 22
QuestionWhat is the key point about 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 the key point about Primary arthrodesis?
AnswerPrimary arthrodesis 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 Musculoskeletal Functional Assessment or Short Form 36 between arthrodesis 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 is the key point about Missed diagnosis or improper treatment?
AnswerMissed diagnosis or improper treatment may lead to traumatic planovalgus deformity or posttraumatic arthritis. Open reduction and midfoot arthrodesis 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 secondary 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 non-weight-bearing status and a cast for 6 to 8 weeks. For displaced injuries, operative fixation with screw placement is necessary. Initial operative treatment may be considered in elite athletes, although controversy remains, and the current treatment recommendation is that surgery be considered if nonoperative intervention has failed and not as a primary treatment.
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 secondary to the posterior tibial tendon.
Source: PDF 1, p. 22
source p. 23
QuestionIn this topic, 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 this topic, 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 is the key point about The 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 this topic, 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 secondary to maintenance of posterior vessels).
Source: PDF 1, p. 23
QuestionWhat is the key point about Early fixation?
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 is the key point about Failure to restore alignment?
AnswerFailure to restore alignment leads to varus malunion and hindfoot stiffness.
Source: PDF 1, p. 23
QuestionIn this topic, 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 arthrodesis, because distraction arthroplasty has not been shown to have good results; TAR is not an option.
Source: PDF 1, p. 23
QuestionIn this topic, what should you remember about: Lateral transfibular approach to a tibiotalocalcaneal arthrodesis to?
AnswerLateral transfibular approach to a tibiotalocalcaneal arthrodesis 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 this topic, 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 is the key point about Most frequent complication?
AnswerMost frequent complication is AVN. Majority do not have collapse but do revascularize.
Source: PDF 1, p. 23
QuestionIn this topic, 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 arthrodesis; best way to evaluate lateral process injuries, CT scan.
Source: PDF 1, p. 23
QuestionWhat is the key point about Avulsion fractures of the calcaneal tuberosity?
AnswerAvulsion fractures of the calcaneal tuberosity are caused by forceful Achilles contraction. Endangers 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 this topic, 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 this topic, 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 is the key point about 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 29 years, and injury not involved in workers’ compensation process. posttraumatic subtalar arthritis is common; may require arthrodesis.
Source: PDF 1, p. 23
QuestionWhat is the key point about The lateral wall?
AnswerThe lateral wall is “blown out,” causing subfibular impingement and peroneal tendon impingement or dislocation.
Source: PDF 1, p. 23
QuestionIn this topic, what should you remember about: 20% of patients may have peroneal tendon dislocation.?
Answer20% of patients may have peroneal tendon dislocation.
Source: PDF 1, p. 23
QuestionIn this topic, what should you remember about: Best seen on axial CT sequences.?
AnswerBest seen on axial CT sequences.
Source: PDF 1, p. 23
QuestionWhat is the key point about Extensile lateral exposure?
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 is the key point about Delayed wound healing can?
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 this topic, 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 this topic, 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 arthrodesis 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 this topic, 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
QuestionWhat is the key point about Diagnosis of ankle fractures?
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 is the key point about Measurements for syndesmotic issues?
AnswerMeasurements for syndesmotic 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 syndesmotic 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 the key point about 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
QuestionIn this topic, what should you remember about: Multiple classifications systems of ankle fractures. LaugeHansen and?
AnswerMultiple classifications systems of ankle fractures. LaugeHansen and Danis-Weber are commonly used. Lauge-Hansen system describes position of foot/d-forming mechanism. DanisWeber system describes fibular fracture line in relation to the syndesmosis.
Source: PDF 1, p. 23
QuestionWhat should you know about Log splitter injury?
AnswerLog splitter injury: Ankle fracture dislocation resulting with talus is displaced into syndesmotic space. High risk of posttraumatic arthritis: 54% to 85%.
Source: PDF 1, p. 23
QuestionIn this topic, 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
QuestionWhat is the key point about External rotation?
AnswerExternal rotation may be helpful to indicate evidence of medial ankle instability.
Source: PDF 1, p. 23
QuestionWhat is the key point about 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 this topic, 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 this topic, 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 this topic, 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 is the key point about Supination-adduction injuries?
AnswerSupination-adduction injuries are associated with second orthopaedic injuries.
Source: PDF 1, p. 23
QuestionWhat is the key point about Malreduction of the syndesmosis?
AnswerMalreduction of the syndesmosis is the most common complication after syndesmotic fixation. Although many studies report 0% to 16% risk of malreduction, it may be as high as 52%.
Source: PDF 1, p. 23
source p. 24
ANATOMY#
QuestionWhat should you know about Central slip?
AnswerCentral slip: terminal extension of extensor digitorum communis (EDC), aids in PIP extension.
Source: PDF 1, p. 24
QuestionWhat should you know about Lateral bands?
AnswerLateral bands: convergence of intrinsics and EDC, extends DIP joint.
Source: PDF 1, p. 24
QuestionWhat should you know about Transverse retinacular ligament?
AnswerTransverse retinacular ligament: prevents dorsal subluxation of lateral bands.
Source: PDF 1, p. 24
QuestionWhat should you know about Injury?
AnswerInjury: swan-neck deformity.
Source: PDF 1, p. 24
QuestionWhat should you know about Triangular ligament?
AnswerTriangular ligament: prevents volar subluxation of lateral bands.
Source: PDF 1, p. 24
QuestionWhat should you know about Injury?
AnswerInjury: boutonnière deformity.
Source: PDF 1, p. 24
QuestionWhat should you know about 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 should you know about 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 the key point about 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 should you know about 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 should you know about 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 should you know about Bunnell test?
AnswerBunnell test: extended MCP leads to limited PIP flexion, while flexed MCP enables PIP flexion.
Source: PDF 1, p. 24
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: therapy to stretch intrinsics or surgical intrinsic release.
Source: PDF 1, p. 24
QuestionWhat should you know about 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 the treatment or management for this concept?
AnswerTreatment: therapy to stretch extrinsics or tenolysis.
Source: PDF 1, p. 24
QuestionWhat should you know about Median nerve?
AnswerMedian nerve: innervates pronator teres, FDS, flexor carpi radialis (FCR), palmaris longus (PL), radial two lumbricals.
Source: PDF 1, p. 24
QuestionWhat should you know about 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 should you know about 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 should you know about Posterior interosseous nerve (PIN)?
AnswerPosterior interosseous nerve (PIN): innervates all remaining extensors.
Source: PDF 1, p. 24
QuestionWhat should you know about Anastomoses?
AnswerAnastomoses: Martin-Gruber (median-ulnar in forearm ), RicheCannieu (median-ulnar in palm).
Source: PDF 1, p. 24
DISTAL RADIUS FRACTURES#
QuestionWhat should you know about Concomitant injuries?
AnswerConcomitant injuries: scaphoid fracture, scapholunate (SL) injury, ulnar styloid fracture.
Source: PDF 1, p. 24
QuestionWhat should you know about Acute carpal tunnel syndrome (CTS)?
AnswerAcute carpal tunnel syndrome (CTS): evolving paresthesias/pain requires emergent release.
Source: PDF 1, p. 24
QuestionWhat should you know about Normal anatomy (11?
AnswerNormal anatomy (11:22:11).
Source: PDF 1, p. 24
QuestionIn DISTAL RADIUS FRACTURES, 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 DISTAL RADIUS FRACTURES, what should you remember about: Acceptable reduction.?
AnswerAcceptable reduction.
Source: PDF 1, p. 24
QuestionIn DISTAL RADIUS FRACTURES, 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 should you know about Nonoperative treatment?
AnswerNonoperative treatment: minimally displaced fracture.
Source: PDF 1, p. 24
QuestionWhat are the complications?
AnswerComplications: stiffness and disuse osteopenia.
Source: PDF 1, p. 24
QuestionWhat is the treatment or management for this concept?
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 should you know about 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 should you know about 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 Extensor pollicis longus (EPL) tendon rupture, 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 Extensor pollicis longus (EPL) tendon rupture, 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 the key point about FPL rupture?
AnswerFPL rupture is the most common flexor injury after volar plating (watershed line).
Source: PDF 1, p. 24
QuestionWhat should you know about Associated distal ulnar styloid fracture?
AnswerAssociated distal ulnar styloid fracture: treated nonoperatively if distal radioulnar joint (DRUJ) stable.
Source: PDF 1, p. 24
QuestionIn Extensor pollicis longus (EPL) tendon rupture, 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 Extensor pollicis longus (EPL) tendon rupture, 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 should you know about DRUJ instability?
AnswerDRUJ instability: increased risk if open fracture, coronal shift of the distal fragment, or >6 mm of prereduction positive ulnar variation.
Source: PDF 1, p. 24
CARPAL FRACTURES AND INSTABILITY#
QuestionWhat should you know about Scaphoid fracture?
AnswerScaphoid fracture: most common carpal bone fracture; retrograde blood supply from dorsal branch of radial artery.
Source: PDF 1, p. 24
QuestionWhat should you know about 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 should you know about 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 CARPAL FRACTURES AND INSTABILITY, 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 should you know about Approach?
AnswerApproach: dorsal for proximal pole; volar for distal fracture (less disruptive to vascularity).
Source: PDF 1, p. 24
QuestionWhat should you know about Scaphoid fracture complications?
AnswerScaphoid fracture complications: scaphoid nonunion advanced collapse (SNAC), nonunion, avascular proximal pole.
Source: PDF 1, p. 24
SNAC#
QuestionWhat should you know about Stage 1?
AnswerStage 1: radial styloid.
Source: PDF 1, p. 24
QuestionWhat should you know about Stage 2?
AnswerStage 2: radioscaphoid joint.
Source: PDF 1, p. 24
QuestionWhat should you know about Stage 3?
AnswerStage 3: scaphocapitate and lunocapitate.
Source: PDF 1, p. 24
QuestionWhat is the key point about Radiolunate joint?
AnswerRadiolunate joint is least affected (proximal row carpectomy [PRC] vs. scaphoid excision with four-corner fusion).
Source: PDF 1, p. 24
QuestionWhat should you know about 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 should you know about Lunate fracture?
AnswerLunate fracture: Kienböck disease or perilunate dislocation should be considered.
Source: PDF 1, p. 24
QuestionWhat should you know about Triquetrum fracture?
AnswerTriquetrum fracture: dorsal capsular avulsion (wrist sprain) or lunotriquetral (LT) injury should be considered.
Source: PDF 1, p. 24
QuestionWhat should you know about Capitate neck fracture?
AnswerCapitate neck fracture: often occurs in combination with perilunate dislocation or scaphoid fracture.
Source: PDF 1, p. 24
QuestionWhat should you know about Pisiform fracture?
AnswerPisiform fracture: rare, treated with cast immobilization; excision for painful nonunion.
Source: PDF 1, p. 24
QuestionWhat should you know about Hook of hamate fracture?
AnswerHook of hamate fracture: frequently associated with racket sports or baseball.
Source: PDF 1, p. 24
QuestionHow is this condition diagnosed or investigated?
AnswerDiagnosis: carpal tunnel radiographic view or computed tomography.
Source: PDF 1, p. 24
source p. 25
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: cast (nonoperative), excision (quickest recovery), or
Source: PDF 1, p. 25
ORIF.#
QuestionWhat should you know about 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 ORIF., 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 the key point about DISI?
AnswerDISI is the most common form of carpal instability (increased SL angle).
Source: PDF 1, p. 25
QuestionIn ORIF., what should you remember about: SL ligament (dorsal portion strongest).?
AnswerSL ligament (dorsal portion strongest).
Source: PDF 1, p. 25
QuestionWhat should you know about 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 the key point about VISI?
AnswerVISI is the second most common (decreased SL angle or increased LT angle).
Source: PDF 1, p. 25
QuestionIn ORIF., what should you remember about: LT ligament (volar portion strongest).?
AnswerLT ligament (volar portion strongest).
Source: PDF 1, p. 25
QuestionWhat is the key point about Perilunate dislocations?
AnswerPerilunate dislocations are an example of CIC.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 ORIF., 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 ORIF., 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 the key point about 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.
Source: PDF 1, p. 25
METACARPAL AND PHALANGEAL INJURIES#
QuestionWhat is the key point about Most metacarpal and phalangeal fractures?
AnswerMost metacarpal and phalangeal fractures are treated nonoperatively.
Source: PDF 1, p. 25
QuestionWhat should you know about Operative indications?
AnswerOperative indications: displacement, intraarticular fracture, malrotation, open or multiple fracture.
Source: PDF 1, p. 25
QuestionWhat is the key point about Volar PIP joint dislocation?
AnswerVolar PIP joint dislocation requires central slip repair with splint in full extension to prevent a boutonnière deformity.
Source: PDF 1, p. 25
QuestionWhat should you know about Rotatory dislocation?
AnswerRotatory dislocation: condyle is buttonholed between central slip and lateral band.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 should you know about Less than 30% involvement?
AnswerLess than 30% involvement: treated nonoperatively with dorsal block splint/pin.
Source: PDF 1, p. 25
QuestionIn METACARPAL AND PHALANGEAL INJURIES, 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 the key point about 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 METACARPAL AND PHALANGEAL INJURIES, 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 should you know about MCP head fracture?
AnswerMCP head fracture: fight bite; ORIF if more than 1 mm articular step-off.
Source: PDF 1, p. 25
QuestionWhat should you know about MCP neck fracture?
AnswerMCP neck fracture: boxer’s fracture; Jahss maneuver for reduction.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 should you know about MCP shaft fracture?
AnswerMCP shaft fracture: high risk of malrotation.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 the key point about 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 the key point about Bennett fracture?
AnswerBennett fracture is a fracture-dislocation of thumb CMC joint.
Source: PDF 1, p. 25
QuestionIn METACARPAL AND PHALANGEAL INJURIES, what should you remember about: Abductor pollicis longus (APL) and extensors cause proximal?
AnswerAbductor pollicis longus (APL) and extensors cause proximal, dorsal, and radial displacement of metacarpal shaft.
Source: PDF 1, p. 25
QuestionIn METACARPAL AND PHALANGEAL INJURIES, 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 METACARPAL AND PHALANGEAL INJURIES, 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 METACARPAL AND PHALANGEAL INJURIES, 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 is the key point about Stener lesion?
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 the key point about RCL instability?
AnswerRCL instability is due to overpull of adductor, which causes proximal phalanx to pronate around intact UCL.
Source: PDF 1, p. 25
TENDON INJURIES AND OVERUSE SYNDROMES#
QuestionWhat should you know about 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 should you know about Controversial indication for surgery?
AnswerControversial indication for surgery: displaced bony injury with volar subluxation of P3.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 TENDON INJURIES AND OVERUSE SYNDROMES, what should you remember about: Boutonnière deformity (PIP flexion, DIP extension).?
AnswerBoutonnière deformity (PIP flexion, DIP extension).
Source: PDF 1, p. 25
QuestionWhat is the key point about Central slip injury?
AnswerCentral slip injury causes lateral bands to sublux volarly.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, 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 should you know about Chronic boutonnière deformity?
AnswerChronic boutonnière deformity: central slip reconstruction if flexible.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 TENDON INJURIES AND OVERUSE SYNDROMES, what should you remember about: Principles of partial laceration treatment.?
AnswerPrinciples of partial laceration treatment.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, 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 TENDON INJURIES AND OVERUSE SYNDROMES, 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 TENDON INJURIES AND OVERUSE SYNDROMES, what should you remember about: Principles of flexor tendon repair.?
AnswerPrinciples of flexor tendon repair.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, 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 is the key point about Dorsally placed core sutures?
AnswerDorsally placed core sutures are stronger than volarly placed sutures.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, 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 TENDON INJURIES AND OVERUSE SYNDROMES, what should you remember about: Overall strength increased (w10%-50%) with epitendinous repair.?
AnswerOverall strength increased (w10%-50%) with epitendinous repair.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, 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 TENDON INJURIES AND OVERUSE SYNDROMES, 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 TENDON INJURIES AND OVERUSE SYNDROMES, 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 is the key point about Active flexion to reduce adhesions?
AnswerActive flexion to reduce adhesions requires minimum four-strand core suture repair.
Source: PDF 1, p. 25
QuestionIn TENDON INJURIES AND OVERUSE SYNDROMES, what should you remember about: 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 should you know about Rugger jersey finger (zone I)?
AnswerRugger jersey finger (zone I): forced DIP extension causes closed FDP avulsion.
Source: PDF 1, p. 25
QuestionWhat should you know about 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 should you know about 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
QuestionWhat is the key point about Tendon lacerations?
AnswerTendon lacerations may be at different level from skin laceration.
Source: PDF 1, p. 25
source p. 26
QuestionWhat should you know about 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 should you know about Key pulleys?
AnswerKey pulleys: A2 pulley (digits), oblique pulley (thumb).
Source: PDF 1, p. 26
QuestionWhat should you know about Comorbidities?
AnswerComorbidities: diabetes, inflammatory arthritis (e.g., rheumatoid arthritis [RA]).
Source: PDF 1, p. 26
QuestionIn this topic, what should you remember about: Failure of injection higher with diabetes.?
AnswerFailure of injection higher with diabetes.
Source: PDF 1, p. 26
QuestionWhat should you know about Pediatric trigger thumb?
AnswerPediatric trigger thumb: fixed flexion deformity of thumb interphalangeal (IP) joint; Notta node pathognomonic.
Source: PDF 1, p. 26
QuestionWhat is the key point about Treatment?
AnswerTreatment involves A1 release at 2 to 4 years of age.
Source: PDF 1, p. 26
QuestionWhat is the key point about Radial digital nerve?
AnswerRadial digital nerve is in danger during release.
Source: PDF 1, p. 26
QuestionWhat should you know about Pediatric trigger finger (less common than trigger thumb)?
AnswerPediatric trigger finger (less common than trigger thumb): aberrant anatomy.
Source: PDF 1, p. 26
QuestionIn this topic, 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 should you know about de Quervain tenosynovitis?
Answerde Quervain tenosynovitis: first extensor compartment; middle-aged women, new mothers, and golfers.
Source: PDF 1, p. 26
QuestionWhat should you know about Nonoperative treatment for most?
AnswerNonoperative treatment for most: corticosteroid injection has more than 80% success.
Source: PDF 1, p. 26
QuestionWhat should you know about Surgical release?
AnswerSurgical release: often multiple slips of APL and/or separate dorsal extensor pollicis brevis compartment.
Source: PDF 1, p. 26
QuestionWhat should you know about Intersection syndrome?
AnswerIntersection syndrome: at junction of first and second extensor compartments; rowers.
Source: PDF 1, p. 26
QuestionIn this topic, what should you remember about: Treatment nonoperative in vast majority.?
AnswerTreatment nonoperative in vast majority.
Source: PDF 1, p. 26
QuestionWhat should you know about 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 should you know about ECU subluxation?
AnswerECU subluxation: forceful hypersupination plus ulnar deviation leads to ECU subsheath injury.
Source: PDF 1, p. 26
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: immobilization in pronation and wrist radial deviation in acute cases.
Source: PDF 1, p. 26
QuestionIn this topic, what should you remember about: Subsheath reconstruction if immobilization fails.?
AnswerSubsheath reconstruction if immobilization fails.
Source: PDF 1, p. 26
DRUJ, TFCC, WRIST ARTHROSCOPY#
QuestionWhat should you know about 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 should you know about Neutral variance?
AnswerNeutral variance: 80% compressive loads through radius and 20% through ulna.
Source: PDF 1, p. 26
QuestionWhat should you know about þ2 mm variance?
Answerþ2 mm variance: 60% through radius and 40% through ulna.
Source: PDF 1, p. 26
QuestionWhat is the key point about 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 should you know about Arthroscopy?
AnswerArthroscopy: gold standard for diagnosis.
Source: PDF 1, p. 26
QuestionIn DRUJ, TFCC, WRIST ARTHROSCOPY, 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 the treatment or management for this concept?
AnswerSurgical treatment: peripheral (repair) or central (débridement).
Source: PDF 1, p. 26
QuestionWhat is the key point about 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 the treatment or management for this concept?
AnswerTreatment: ulnar shortening osteotomy (no arthrosis) or wafer resection (arthrosis).
Source: PDF 1, p. 26
QuestionIn DRUJ, TFCC, WRIST ARTHROSCOPY, 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 should you know about DRUJ osteoarthritis (OA) treatment?
AnswerDRUJ osteoarthritis (OA) treatment: hemiresection interposition arthroplasty, Darrach resection (low-demand patient), SauvéKapandji arthrodesis (e.g., RA) or prosthetic arthroplasty.
Source: PDF 1, p. 26
QuestionWhat should you know about Wrist arthroscopy?
AnswerWrist arthroscopy: gold standard for diagnosis of ulnar-sided wrist pain.
Source: PDF 1, p. 26
QuestionWhat should you know about Most common complication?
AnswerMost common complication: injury to superficial sensory nerves.
Source: PDF 1, p. 26
NAIL AND FINGERTIP INJURIES#
QuestionWhat should you know about Nail bed injuries?
AnswerNail bed injuries: in all cases, tetanus prophylaxis and antibiotic coverage.
Source: PDF 1, p. 26
QuestionWhat should you know about 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 should you know about 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 should you know about 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 are the complications?
AnswerComplications: nail ridging (crush injury), hook nail (distal matrix advancement), hypersensitivity (resolves in up to 1 year).
Source: PDF 1, p. 26
QuestionWhat should you know about 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 NAIL AND FINGERTIP INJURIES, 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 should you know about Less than 1 cm2 exposed bone?
AnswerLess than 1 cm2 exposed bone: healing by secondary intention.
Source: PDF 1, p. 26
QuestionWhat should you know about Larger wounds without exposed bone?
AnswerLarger wounds without exposed bone: skin graft.
Source: PDF 1, p. 26
QuestionWhat should you know about 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 should you know about Volar oblique injury?
AnswerVolar oblique injury: cross-finger or thenar flap.
Source: PDF 1, p. 26
QuestionWhat should you know about 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 should you know about Alternative?
AnswerAlternative: skeletal shortening and closure at level with available skin.
Source: PDF 1, p. 26
QuestionWhat should you know about Dorsal thumb injury?
AnswerDorsal thumb injury: kite flap from the index (first dorsal metacarpal artery).
Source: PDF 1, p. 26
QuestionWhat should you know about Lumbrical-plus finger?
AnswerLumbrical-plus finger: surgical shortening of an injury that acutely violates the FDP insertion.
Source: PDF 1, p. 26
QuestionIn NAIL AND FINGERTIP INJURIES, 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 NAIL AND FINGERTIP INJURIES, 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 should you know about 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 NAIL AND FINGERTIP INJURIES, what should you remember about: Complete finger amputations.?
AnswerComplete finger amputations.
Source: PDF 1, p. 26
QuestionWhat should you know about Index?
AnswerIndex: ray resection preserves palmar width (improved hand function).
Source: PDF 1, p. 26
QuestionWhat should you know about Middle/ring?
AnswerMiddle/ring: ray resection to prevent gap between fingers.
Source: PDF 1, p. 26
SOFT TISSUE COVERAGE AND MICROSURGERY#
QuestionWhat should you know about Reconstruction priorities?
AnswerReconstruction priorities: provide coverage of deep structures, provide barrier to bacteria, restore dynamic function of limb, and achieve cosmetic appearance (secondary).
Source: PDF 1, p. 26
QuestionWhat should you know about Primary closure?
AnswerPrimary closure: indicated only with minimal contamination and less than 6 hours from injury.
Source: PDF 1, p. 26
QuestionWhat should you know about 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 should you know about 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 should you know about Split-thickness skin grafts?
AnswerSplit-thickness skin grafts: dorsal hand wounds.
Source: PDF 1, p. 26
QuestionWhat should you know about Flap failure?
AnswerFlap failure: caused by inadequate arterial flow, vasospasm, seroma/hematoma.
Source: PDF 1, p. 26
QuestionIn SOFT TISSUE COVERAGE AND MICROSURGERY, what should you remember about: Primary indications for replantation.?
AnswerPrimary indications for replantation.
Source: PDF 1, p. 26
source p. 27
QuestionIn this topic, 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 this topic, 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 this topic, what should you remember about: Primary contraindications to replantation.?
AnswerPrimary contraindications to replantation.
Source: PDF 1, p. 27
QuestionIn this topic, 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 should you know about 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 should you know about Replantation sequence?
AnswerReplantation sequence: BEFAVNS (bone, extensor tendon, flexor tendon, artery, vein, nerve, skin).
Source: PDF 1, p. 27
QuestionIn this topic, 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 the key point about 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 this topic, 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 this topic, 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 the key point about Tenolysis?
AnswerTenolysis is the most commonly performed secondary procedure following successful replantation.
Source: PDF 1, p. 27
QuestionWhat should you know about Forearm replantation?
AnswerForearm replantation: arterial inflow is established before skeletal stabilization.
Source: PDF 1, p. 27
QuestionWhat should you know about Ring avulsion injury?
AnswerRing avulsion injury: forceful avulsion of soft tissues; salvage outcomes often poor.
Source: PDF 1, p. 27
QuestionWhat is the key point about Thumb reconstruction?
AnswerThumb reconstruction is performed whenever possible because thumb provides 40% of hand function.
Source: PDF 1, p. 27
VASCULAR DISORDERS#
QuestionWhat is the key point about 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
QuestionIn VASCULAR DISORDERS, what should you remember about: Approximately 20% of hands have an incomplete arch.?
AnswerApproximately 20% of hands have an incomplete arch.
Source: PDF 1, p. 27
QuestionIn VASCULAR DISORDERS, 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 should you know about Other tests?
AnswerOther tests: cold stimulation test, digital-brachial index, three-phase bone scan, arteriography.
Source: PDF 1, p. 27
QuestionWhat should you know about Hypothenar hammer syndrome?
AnswerHypothenar hammer syndrome: most common posttraumatic vascular occlusive condition of the upper extremity; involves the ulnar artery in the proximal palm.
Source: PDF 1, p. 27
QuestionHow is this condition diagnosed or investigated?
AnswerDiagnosis: noninvasive vascular studies or arteriography.
Source: PDF 1, p. 27
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: resection of the thrombosed segment, interposition vein graft or arterial conduit (better patency rate).
Source: PDF 1, p. 27
QuestionWhat should you know about Raynaud phenomenon?
AnswerRaynaud phenomenon: vasospastic disease with a known underlying cause.
Source: PDF 1, p. 27
QuestionIn VASCULAR DISORDERS, what should you remember about: Treatment focused on underlying cause.?
AnswerTreatment focused on underlying cause.
Source: PDF 1, p. 27
QuestionWhat should you know about Raynaud disease?
AnswerRaynaud disease: vasospastic disease without a known underlying cause.
Source: PDF 1, p. 27
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: calcium channel blockers, biofeedback, digital sympathectomy.
Source: PDF 1, p. 27
QuestionIn VASCULAR DISORDERS, 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 should you know about Compartment syndrome?
AnswerCompartment syndrome: from crush injury, supracondylar humerus fracture (children).
Source: PDF 1, p. 27
QuestionWhat should you know about Ten hand compartments?
AnswerTen hand compartments: thenar, hypothenar, adductor pollicis, four dorsal interosseous, and three volar interosseous (carpal tunnel is not a compartment).
Source: PDF 1, p. 27
QuestionHow is this condition diagnosed or investigated?
AnswerDiagnosis: increased pain with passive stretch of affected compartment is most sensitive indicator.
Source: PDF 1, p. 27
QuestionWhat should you know about Volkmann ischemic contracture?
AnswerVolkmann ischemic contracture: FDP and FPL muscles are most vulnerable.
Source: PDF 1, p. 27
QuestionIn VASCULAR DISORDERS, what should you remember about: Claw hand or intrinsic-minus posture.?
AnswerClaw hand or intrinsic-minus posture.
Source: PDF 1, p. 27
QuestionWhat should you know about Frostbite treatment?
AnswerFrostbite treatment: initial rapid rewarming, analgesia, local wound management.
Source: PDF 1, p. 27
COMPRESSION NEUROPATHY#
QuestionWhat should you know about Sequence of sensory losses?
AnswerSequence of sensory losses: light touch / pressure/vibration / pain/temperature.
Source: PDF 1, p. 27
QuestionWhat should you know about Electrodiagnostics?
AnswerElectrodiagnostics: electromyography (EMG; muscle innervation) or nerve conduction study (conduction along nerve).
Source: PDF 1, p. 27
QuestionWhat should you know about Double-crush phenomenon?
AnswerDouble-crush phenomenon: blockage of axonal transport at one point makes entire axon more susceptible to compression distally.
Source: PDF 1, p. 27
Median Nerve#
QuestionWhat should you know about CTS?
AnswerCTS: idiopathic (adults); due to mucopolysaccharidosis (children).
Source: PDF 1, p. 27
QuestionIn Median Nerve, 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 should you know about Clinical diagnosis?
AnswerClinical diagnosis: 80% probability of CTS with all six features: symptoms along median nerve-innervated 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 Median Nerve, what should you remember about: Treatment?
AnswerTreatment
Source: PDF 1, p. 27
QuestionIn Median Nerve, 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 should you know about Carpal tunnel release (CTR)?
AnswerCarpal tunnel release (CTR): division of TCL.
Source: PDF 1, p. 27
QuestionIn Median Nerve, 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 should you know about At risk?
AnswerAt risk: recurrent motor branch of median nerve (radial) or ulnar nerve (ulnar)
Source: PDF 1, p. 27
QuestionWhat should you know about 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 is the key point about Adults with chronic severe CTS?
AnswerAdults with chronic severe CTS may have incomplete neurologic recovery after surgery.
Source: PDF 1, p. 27
QuestionWhat should you know about Pronator syndrome?
AnswerPronator syndrome: compression of the median nerve in the arm/ forearm.
Source: PDF 1, p. 27
QuestionWhat should you know about 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 Median Nerve, 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 should you know about 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 Median Nerve, 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 Median Nerve, what should you remember about: No sensory loss.?
AnswerNo sensory loss.
Source: PDF 1, p. 27
Signs of motor weakness#
QuestionWhat should you know about Froment?
AnswerFroment: thumb IP flexion during key pinch due to a weak adductor muscle.
Source: PDF 1, p. 27
QuestionWhat should you know about Jeanne?
AnswerJeanne: thumb MCP hyperextension during key pinch due to a weak adductor muscle.
Source: PDF 1, p. 27
QuestionWhat should you know about 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 should you know about Cubital tunnel syndrome?
AnswerCubital tunnel syndrome: pain, numbness, weakness.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 this topic, 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 this topic, 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 should you know about Ulnar tunnel syndrome (compression in Guyon canal)?
AnswerUlnar tunnel syndrome (compression in Guyon canal): secondary to an extrinsic mass (e.g., ganglion, lipoma, aneurysm).
Source: PDF 1, p. 28
QuestionIn this topic, 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 should you know about Concurrent CTS?
AnswerConcurrent CTS: Guyon canal decompressed by release of TCL.
Source: PDF 1, p. 28
Radial Nerve#
QuestionWhat is the key point about 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 should you know about PIN compression syndrome?
AnswerPIN compression syndrome: distal muscle weakness.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 the key point about 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 should you know about Sites of compression?
AnswerSites of compression: same as in PIN syndrome.
Source: PDF 1, p. 28
QuestionIn Radial Nerve, 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 should you know about Cheiralgia paresthetica (Wartenberg syndrome)?
AnswerCheiralgia paresthetica (Wartenberg syndrome): compressive neuropathy of SBRN.
Source: PDF 1, p. 28
QuestionIn Radial Nerve, what should you remember about: Inability to wear wristwatch; pain and paresthesias over?
AnswerInability to wear wristwatch; pain and paresthesias over dorsoradial hand (SBRN).
Source: PDF 1, p. 28
Thoracic Outlet Syndrome#
QuestionWhat should you know about Vascular?
AnswerVascular: subclavian vein compression.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 should you know about Neurogenic?
AnswerNeurogenic: entrapment of the lower brachial plexus.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 should you know about Nonspecific?
AnswerNonspecific: paresthesias, fatigue.
Source: PDF 1, p. 28
QuestionIn Thoracic Outlet Syndrome, 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 Thoracic Outlet Syndrome, what should you remember about: Nonoperative management should be maximized, including shoulder and?
AnswerNonoperative management should be maximized, including shoulder and scapular strengthening exercises, injections, activity modification.
Source: PDF 1, p. 28
QuestionIn Thoracic Outlet Syndrome, what should you remember about: If present cervical rib should be resected.?
AnswerIf present cervical rib should be resected.
Source: PDF 1, p. 28
NERVE INJURIES AND TENDON TRANSFERS#
QuestionWhat should you know about Good prognosis?
AnswerGood prognosis: stretch injuries, clean wounds, direct surgical repair.
Source: PDF 1, p. 28
QuestionWhat should you know about Poor prognosis?
AnswerPoor prognosis: crush injuries, scarring or infection, delayed repair.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: Seddon classification divides nerve injury into neurapraxia (stretch)?
AnswerSeddon classification divides nerve injury into neurapraxia (stretch), axonotmesis (incomplete), and neurotmesis (complete) (in order of increasing severity).
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: Wallerian degeneration for axonotmesis and neurotmesis.?
AnswerWallerian degeneration for axonotmesis and neurotmesis.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: No technique deemed superior.?
AnswerNo technique deemed superior.
Source: PDF 1, p. 28
QuestionWhat is the key point about Gaps?
AnswerGaps may be addressed with nerve conduit, d-cellularized nerve allograft, or autograft.
Source: PDF 1, p. 28
QuestionWhat should you know about Brachial plexus injury?
AnswerBrachial plexus injury: usually observed for 3 months to allow recovery before intervention
Source: PDF 1, p. 28
QuestionWhat should you know about 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 NERVE INJURIES AND TENDON TRANSFERS, 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 NERVE INJURIES AND TENDON TRANSFERS, 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 the key point about Advantage?
AnswerAdvantage is providing shorter innervation distance to end-target muscle.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, 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 should you know about Oberlin?
AnswerOberlin: ulnar motor branch to FCU coapted to musculocutaneous nerve (elbow flexion).
Source: PDF 1, p. 28
QuestionWhat should you know about Leechavengvong?
AnswerLeechavengvong: radial nerve motor branch to triceps coapted to axillary nerve (shoulder abduction).
Source: PDF 1, p. 28
QuestionWhat should you know about 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 should you know about Priorities?
AnswerPriorities: elbow flexion > shoulder function > finger function.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: Basic tenets of tendon transfers.?
AnswerBasic tenets of tendon transfers.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: Donor must be expendable.?
AnswerDonor must be expendable.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, 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 NERVE INJURIES AND TENDON TRANSFERS, what should you remember about: One transfer should perform one function.?
AnswerOne transfer should perform one function.
Source: PDF 1, p. 28
QuestionWhat is the key point about Synergistic transfers?
AnswerSynergistic transfers are easier to rehabilitate.
Source: PDF 1, p. 28
QuestionWhat is the key point about A straight line of pull?
AnswerA straight line of pull is optimal.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, 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 NERVE INJURIES AND TENDON TRANSFERS, 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 should you know about Wrist extension?
AnswerWrist extension: pronator teres to ECRB.
Source: PDF 1, p. 28
QuestionWhat should you know about Finger extension?
AnswerFinger extension: FCU or FCR to EDC.
Source: PDF 1, p. 28
QuestionWhat should you know about Thumb extension?
AnswerThumb extension: PL to EPL.
Source: PDF 1, p. 28
QuestionIn NERVE INJURIES AND TENDON TRANSFERS, 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 NERVE INJURIES AND TENDON TRANSFERS, 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 the key point about Voluntary muscle control?
AnswerVoluntary muscle control is most important predictor of success in patients with cerebral palsy undergoing surgery to augment upper extremity function.
Source: PDF 1, p. 28
ARTHRITIS#
QuestionWhat should you know about Hand OA?
AnswerHand OA: affects joints in following order: DIP, thumb CMC, PIP, MCP.
Source: PDF 1, p. 28
QuestionIn ARTHRITIS, 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 the treatment or management for this concept?
AnswerSurgical treatment: DIP joint, arthrodesis; PIP joint index finger, arthrodesis; PIP joint other fingers, arthroplasty; MCP joint, arthroplasty.
Source: PDF 1, p. 28
QuestionWhat should you know about PIP fusion position?
AnswerPIP fusion position: index, 40 degrees; long, 45 degrees; ring, 50 degrees; small, 55 degrees.
Source: PDF 1, p. 28
QuestionWhat should you know about 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 should you know about Nonoperative treatment?
AnswerNonoperative treatment: injections, activity modification.
Source: PDF 1, p. 28
QuestionWhat is the treatment or management for this concept?
AnswerSurgical treatment: trapeziectomy with LRTI or suspensionplasty.
Source: PDF 1, p. 28
QuestionWhat should you know about Arthrodesis (young laborers)?
AnswerArthrodesis (young laborers): 20 degrees of radial abduction and 40 degrees of palmar abduction.
Source: PDF 1, p. 28
QuestionWhat should you know about MCP hyperextension?
AnswerMCP hyperextension: can consider volar capsulodesis (e.g., 20-40 degrees) or MCP arthrodesis (if arthritis or >40 degrees hyperextension).
Source: PDF 1, p. 28
QuestionWhat should you know about RA?
AnswerRA: systemic autoimmune disease that often affects the synovium surrounding small joints of the hand and wrist.
Source: PDF 1, p. 28
QuestionWhat should you know about Manifestations?
AnswerManifestations: rheumatoid nodules, tenosynovitis, tendon rupture, ulnar drift at MCP joint, swan neck/ boutonnière deformities, caput ulnae syndrome, carpal subluxation, and SLAC wrist.
Source: PDF 1, p. 28
source p. 29
QuestionWhat should you know about 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 should you know about Mannerfelt syndrome?
AnswerMannerfelt syndrome: rupture of FPL and/or index FDP secondary to attrition over a volar scaphotrapeziotrapezoid (STT) osteophyte.
Source: PDF 1, p. 29
QuestionWhat should you know about Caput ulnae syndrome?
AnswerCaput ulnae syndrome: DRUJ instability from ECU tendon subluxation.
Source: PDF 1, p. 29
QuestionWhat should you know about Rheumatoid wrist?
AnswerRheumatoid wrist: carpus subluxes in volar and ulnar direction.
Source: PDF 1, p. 29
QuestionIn this topic, what should you remember about: Total wrist arthroplasty versus total wrist arthrodesis for?
AnswerTotal wrist arthroplasty versus total wrist arthrodesis for late disease.
Source: PDF 1, p. 29
QuestionWhat should you know about Z deformity?
AnswerZ deformity: ulnar translocation and radial deviation of wrist, ulnar deviation of digits.
Source: PDF 1, p. 29
QuestionWhat should you know about Common procedures?
AnswerCommon procedures: synovectomy/tenosynovectomy, tendon transfers, extensor centralization at MCP joints, silicone arthroplasty, and wrist arthrodesis versus wrist arthroplasty.
Source: PDF 1, p. 29
IDIOPATHIC OSTEONECROSIS OF THE CARPUS#
QuestionWhat should you know about 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 IDIOPATHIC OSTEONECROSIS OF THE CARPUS, 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 should you know about Risks?
AnswerRisks: ulnar negative variance, decreased radial inclination, repetitive trauma, vascular patterns of the lunate.
Source: PDF 1, p. 29
QuestionIn IDIOPATHIC OSTEONECROSIS OF THE CARPUS, what should you remember about: Lichtman classification directs treatment.?
AnswerLichtman classification directs treatment.
Source: PDF 1, p. 29
QuestionIn IDIOPATHIC OSTEONECROSIS OF THE CARPUS, 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 IDIOPATHIC OSTEONECROSIS OF THE CARPUS, 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 should you know about First-line surgical treatment?
AnswerFirst-line surgical treatment: joint-leveling procedure or core decompression of radius.
Source: PDF 1, p. 29
QuestionWhat should you know about Ulnar-negative variance?
AnswerUlnar-negative variance: radial shortening osteotomy.
Source: PDF 1, p. 29
QuestionIn IDIOPATHIC OSTEONECROSIS OF THE CARPUS, what should you remember about: Supplemental vascularized bone grafting described.?
AnswerSupplemental vascularized bone grafting described.
Source: PDF 1, p. 29
QuestionWhat should you know about Stage IIIB?
AnswerStage IIIB: salvage procedure for associated carpal instability and/or degenerative OA: PRC.
Source: PDF 1, p. 29
QuestionIn IDIOPATHIC OSTEONECROSIS OF THE CARPUS, what should you remember about: Preiser disease (idiopathic osteonecrosis of scaphoid).?
AnswerPreiser disease (idiopathic osteonecrosis of scaphoid).
Source: PDF 1, p. 29
QuestionIn IDIOPATHIC OSTEONECROSIS OF THE CARPUS, what should you remember about: Initial treatment nonoperative; surgical procedures include core decompression?
AnswerInitial treatment nonoperative; surgical procedures include core decompression, vascularize graft, PRC, and partial wrist fusion.
Source: PDF 1, p. 29
DUPUYTREN DISEASE#
QuestionWhat is the key point about Benign fibroproliferative disorder that?
AnswerBenign fibroproliferative disorder that is sometimes inherited and sometimes sporadic.
Source: PDF 1, p. 29
QuestionWhat should you know about Myofibroblasts?
AnswerMyofibroblasts: predominant cell type found on histologic analysis of fascia in Dupuytren disease.
Source: PDF 1, p. 29
QuestionIn DUPUYTREN DISEASE, 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 is the key point about Cleland (dorsal) ligaments?
AnswerCleland (dorsal) ligaments are not involved; Grayson (volar) ligaments are involved.
Source: PDF 1, p. 29
QuestionWhat should you know about PIP contracture?
AnswerPIP contracture: associated with spiral cord.
Source: PDF 1, p. 29
QuestionIn DUPUYTREN DISEASE, 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 should you know about 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 the key point about Open limited fasciectomy?
AnswerOpen limited fasciectomy is preferred technique.
Source: PDF 1, p. 29
QuestionWhat are the complications?
AnswerComplications: recurrence (most common), digital nerve injury, wound breakdown.
Source: PDF 1, p. 29
QuestionWhat is the key point about Use of collagenase injection or needle aponeurotomy?
AnswerUse of collagenase injection or needle aponeurotomy is increasing.
Source: PDF 1, p. 29
QuestionWhat is the key point about Pooled study?
AnswerPooled study results show average MCP correction up to 85% and PIP correction up to 60%.
Source: PDF 1, p. 29
QuestionIn DUPUYTREN DISEASE, what should you remember about: Pain, swelling, and bruising are likely temporary adverse?
AnswerPain, swelling, and bruising are likely temporary adverse effects of injection.
Source: PDF 1, p. 29
QuestionWhat is the key point about Skin tears?
AnswerSkin tears are more common complication than flexor tendon rupture.
Source: PDF 1, p. 29
HAND TUMORS#
QuestionWhat is the key point about Ganglions?
AnswerGanglions are the most common soft tissue mass of the hand and wrist.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, what should you remember about: Dorsal wristdSL articulation.?
AnswerDorsal wristdSL articulation.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, what should you remember about: Volar wristdradioscaphoid or STT joint.?
AnswerVolar wristdradioscaphoid or STT joint.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, what should you remember about: IP jointdosteophyte.?
AnswerIP jointdosteophyte.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, what should you remember about: Distal palmdflexor tendon sheath.?
AnswerDistal palmdflexor tendon sheath.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, 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 key point about Treatment?
AnswerTreatment is marginal excision, but recurrence rate is relatively high.
Source: PDF 1, p. 29
QuestionWhat should you know about Other soft tissue tumors in the differential diagnosis?
AnswerOther soft tissue tumors in the differential diagnosis: epidermal inclusion cyst, lipoma, schwannoma, glomus tumor, hemangioma, pyogenic granuloma.
Source: PDF 1, p. 29
QuestionIn HAND TUMORS, 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 extremity.
Source: PDF 1, p. 29
HAND INFECTIONS#
QuestionWhat is the key point about Staphylococcus aureus?
AnswerStaphylococcus aureus is the most common pathogen.
Source: PDF 1, p. 29
QuestionIn HAND INFECTIONS, what should you remember about: MRSA more common in urban areas.?
AnswerMRSA more common in urban areas.
Source: PDF 1, p. 29
QuestionIn HAND INFECTIONS, 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 should you know about 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 should you know about Paronychia (nail fold)?
AnswerParonychia (nail fold): S. aureus; incision and drainage (I&D), nail plate removal, oral antibiotics.
Source: PDF 1, p. 29
QuestionWhat should you know about Felon (fingertip pulp)?
AnswerFelon (fingertip pulp): S. aureus; I&D, second intention, oral antibiotics.
Source: PDF 1, p. 29
QuestionWhat should you know about 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 is the key point about 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 is the key point about Dog bites?
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 the key point about Pyogenic flexor tenosynovitis?
AnswerPyogenic flexor tenosynovitis is a suppurative infection of the flexor tendon sheath.
Source: PDF 1, p. 29
QuestionWhat should you know about 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 Early (<24e48 hours) with less than four Kanavel signs, 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 should you know about 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 should you know about Deep potential-space infections?
AnswerDeep potential-space infections: collar-button abscess (digit webspace), midpalmar, thenar or hypothenar infection; all require I&D and antibiotics.
Source: PDF 1, p. 29
QuestionWhat should you know about Necrotizing fasciitis?
AnswerNecrotizing fasciitis: mortality correlates with time to initiation of treatment.
Source: PDF 1, p. 29
QuestionIn Early (<24e48 hours) with less than four Kanavel signs, what should you remember about: Most commonly b-hemolytic Streptococcus.?
AnswerMost commonly b-hemolytic Streptococcus.
Source: PDF 1, p. 29
QuestionWhat should you know about 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 should you know about Gas gangrene?
AnswerGas gangrene: Clostridium perfringens and other Clostridium spp. (gram-positive rods).
Source: PDF 1, p. 30
QuestionWhat should you know about Herpetic whitlow?
AnswerHerpetic whitlow: most common in toddlers, dental hygienists, other health care workers; treated nonoperatively.
Source: PDF 1, p. 30
QuestionIn this topic, what should you remember about: Atypical mycobacterial infections (e.g., Mycobacterium marinum) commonly involve?
AnswerAtypical mycobacterial infections (e.g., Mycobacterium marinum) commonly involve the hand.
Source: PDF 1, p. 30
QuestionWhat is the key point about Treatment generally?
AnswerTreatment generally requires surgical débridement and oral antibiotics such as ethambutol, trimethoprim-sulfamethoxazole, clarithromycin, azithromycin, or tetracycline.
Source: PDF 1, p. 30
QuestionIn this topic, 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 this topic, 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 this topic, what should you remember about: Treated urgently with I&D.?
AnswerTreated urgently with I&D.
Source: PDF 1, p. 30
The three signaling centers that control limb development#
QuestionIn The three signaling centers that control limb development, 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 The three signaling centers that control limb development, 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 The three signaling centers that control limb development, 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 The three signaling centers that control limb development, what should you remember about: Radial clubhand.?
AnswerRadial clubhand.
Source: PDF 1, p. 30
QuestionWhat should you know about 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 The three signaling centers that control limb development, 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 should you know about Ulnar clubhand?
AnswerUlnar clubhand: often associated with digit absence or syndactyly.
Source: PDF 1, p. 30
QuestionWhat should you know about Cleft hand?
AnswerCleft hand: often bilateral and familial; also involves feet.
Source: PDF 1, p. 30
QuestionWhat should you know about Radioulnar synostosis?
AnswerRadioulnar synostosis: associated with duplication of sex chromosomes.
Source: PDF 1, p. 30
QuestionWhat should you know about Camptodactyly?
AnswerCamptodactyly: usually small finger PIP flexion deformity.
Source: PDF 1, p. 30
QuestionWhat should you know about Clinodactyly?
AnswerClinodactyly: congenital curvature of digit in radioulnar plane.
Source: PDF 1, p. 30
QuestionWhat should you know about Flexed thumb?
AnswerFlexed thumb: due to pediatric trigger finger or congenital clasped thumb.
Source: PDF 1, p. 30
QuestionWhat should you know about Arthrogryposis?
AnswerArthrogryposis: congenital curved joints (contractures); neurogenic (90%) or myogenic (10%).
Source: PDF 1, p. 30
QuestionIn The three signaling centers that control limb development, 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 should you know about Preaxial polydactyly (thumb duplication)?
AnswerPreaxial polydactyly (thumb duplication): most commonly Wassel type IV with duplicate proximal phalanx.
Source: PDF 1, p. 30
QuestionWhat should you know about 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 should you know about Syndactyly?
AnswerSyndactyly: failure of apoptosis to separate digits.
Source: PDF 1, p. 30
QuestionIn The three signaling centers that control limb development, 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 incomplete.
Source: PDF 1, p. 30
QuestionIn The three signaling centers that control limb development, what should you remember about: Long-ring most common.?
AnswerLong-ring most common.
Source: PDF 1, p. 30
QuestionIn The three signaling centers that control limb development, what should you remember about: Border digit syndactyly released earlier.?
AnswerBorder digit syndactyly released earlier.
Source: PDF 1, p. 30
QuestionWhat is the key point about Web creep?
AnswerWeb creep is a frequent delayed complication following surgical separation.
Source: PDF 1, p. 30
QuestionIn The three signaling centers that control limb development, 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 (acrosyndactyly, mental retardation) are commonly associated with syndactyly.
Source: PDF 1, p. 30
QuestionWhat should you know about Macrodactyly?
AnswerMacrodactyly: if single digit, most favorable outcome is associated with amputation.
Source: PDF 1, p. 30
QuestionWhat should you know about 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 should you know about Madelung deformity?
AnswerMadelung deformity: disruption of volar ulnar physis of distal radius by tethering of Vickers ligament; treated by release of ligament.
Source: PDF 1, p. 30
ELBOW#
QuestionWhat is the key point about 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 the key point about 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 should you know about Lateral epicondylitis (tennis elbow)?
AnswerLateral epicondylitis (tennis elbow): degenerative tendinopathy of the ECRB origin.
Source: PDF 1, p. 30
QuestionWhat is the key point about Histologic examination?
AnswerHistologic examination demonstrates angiofibroblastic hyperplasia.
Source: PDF 1, p. 30
QuestionIn ELBOW, what should you remember about: No clear benefit from corticosteroid injection.?
AnswerNo clear benefit from corticosteroid injection.
Source: PDF 1, p. 30
QuestionIn ELBOW, 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 should you know about Medial epicondylitis (golfer’s elbow)?
AnswerMedial epicondylitis (golfer’s elbow): pain with resisted pronation and wrist flexion.
Source: PDF 1, p. 30
QuestionWhat should you know about Distal biceps tendon rupture?
AnswerDistal biceps tendon rupture: supination strength diminished more than flexion strength.
Source: PDF 1, p. 30
QuestionHow is this condition diagnosed or investigated?
AnswerDiagnosis: abnormal hook test result.
Source: PDF 1, p. 30
QuestionWhat is the key point about Partial ruptures?
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 should you know about Untreated?
AnswerUntreated: approximately 50% supination and approximately 70% flexion strength regained by 1 year.
Source: PDF 1, p. 30
QuestionIn ELBOW, what should you remember about: Complete tears with retraction treated expediently.?
AnswerComplete tears with retraction treated expediently.
Source: PDF 1, p. 30
QuestionIn ELBOW, 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 is the key point about Two-incision technique?
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 ELBOW, 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 is the key point about Titanium fixation button (Endobutton)?
AnswerTitanium fixation button (Endobutton) has been shown to have superior fixation strength.
Source: PDF 1, p. 30
QuestionWhat is the key point about Chronic untreated tears?
AnswerChronic untreated tears may require autograft or allograft reconstruction.
Source: PDF 1, p. 30
QuestionWhat should you know about Distal triceps injury?
AnswerDistal triceps injury: Elbow extension still intact due to intact anconeus
Source: PDF 1, p. 30
QuestionWhat should you know about Risks?
AnswerRisks: Anabolic steroids, multiple corticosteroid injections, olecranon bursitis
Source: PDF 1, p. 30
QuestionWhat should you know about “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 ELBOW, what should you remember about: Distal humerus fracture?
AnswerDistal humerus fracture
Source: PDF 1, p. 30
QuestionIn ELBOW, 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 ELBOW, what should you remember about: Surgical treatment?
AnswerSurgical treatment
Source: PDF 1, p. 30
QuestionWhat should you know about ORIF?
AnswerORIF: Plate orientation 90-90 or parallel equivalent
Source: PDF 1, p. 30
QuestionWhat should you know about 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 should you know about Radial head fracture?
AnswerRadial head fracture: Mechanical block in forearm rotation should be assessed.
Source: PDF 1, p. 30
QuestionWhat should you know about Associated injuries?
AnswerAssociated injuries: Forearm fracture, Essex-Lopresti (DRUJ injury)
Source: PDF 1, p. 30
QuestionWhat should you know about 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 ELBOW, 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 the treatment or management for this concept?
AnswerTreatment: ORIF of coronoid process, ORIF or arthroplasty of radial head, and lateral MCL repair
Source: PDF 1, p. 30
source p. 31
SECTION 1 INTRODUCTION#
QuestionWhat is the key point about Careful history?
AnswerCareful history is vital to accurate diagnosis and management of spinal pathology.
Source: PDF 1, p. 31
QuestionWhat is the key point about Physical examination should?
AnswerPhysical examination should include motor, sensory, and reflex assessment and, when appropriate, rectal examination.
Source: PDF 1, p. 31
QuestionIn SECTION 1 INTRODUCTION, what should you remember about: In absence of trauma and red-flag signs, plain?
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 the key point about 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 is the key point about Cervical spondylosis most commonly?
AnswerCervical spondylosis most commonly occurs at C5 to C6, followed
Source: PDF 1, p. 31
by C6 to C7.#
QuestionIn by C6 to C7., 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 the key point about 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 is the key point about 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 is the key point about Operative indications?
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 is the key point about Complications of anterior cervical discectomy and fusion?
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 the key point about 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 by C6 to C7., 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 intraoperatively are contraindications to cervical total disc replacement placement, and anterior cervical discectomy and fusion should be considered instead.
Source: PDF 1, p. 31
QuestionWhat is the key point about Surgical options for discogenic neck pain?
AnswerSurgical options for discogenic neck pain are limited and should be avoided.
Source: PDF 1, p. 31
QuestionIn by C6 to C7., what should you remember about: Cervical stenosis.?
AnswerCervical stenosis.
Source: PDF 1, p. 31
QuestionIn by C6 to C7., 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 the key point about Absolute stenosis?
AnswerAbsolute stenosis is defined as anterior-posterior canal diameter of less than 10 mm.
Source: PDF 1, p. 31
QuestionIn by C6 to C7., what should you remember about: Rheumatoid spondylitis.?
AnswerRheumatoid spondylitis.
Source: PDF 1, p. 31
QuestionIn by C6 to C7., what should you remember about: In the cervical spine can commonly be asymptomatic?
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 by C6 to C7., what should you remember about: Progressive cervical instability secondary to pannus formation and?
AnswerProgressive cervical instability secondary to pannus formation and erosion of the joint sand capsular structures occurs in up to 90% of patients. This can manifest as atlantoaxial subluxation (AAS), atlantoaxial invagination, or subaxial subluxation.
Source: PDF 1, p. 31
QuestionWhat is the key point about AAS?
AnswerAAS is most common. A posterior atlantodens interval less than 14 mm is associated with an increased risk of neurologic injury and usually requires surgical treatment. C1eC2 fixation is most commonly performed with C1 lateral mass screws and C2 pedicle/pars screws and is biomechanically the strongest construct of C1eC2 fixation techniques.
Source: PDF 1, p. 31
QuestionWhat is the key point about Surgery?
AnswerSurgery is less successful in Ranawat grade IIIB patients but should still be considered.
Source: PDF 1, p. 31
QuestionIn by C6 to C7., 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
QuestionIn by C6 to C7., what should you remember about: Ankylosing spondylitis (AS) patients who present with neck?
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 by C6 to C7., 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 the key point about Spinal shock?
AnswerSpinal shock is over with return of the bulbocavernosus reflex.
Source: PDF 1, p. 31
QuestionWhat is the key point about Neurogenic shock?
AnswerNeurogenic shock is hypotension secondary to loss of sympathetic tone with bradycardia.
Source: PDF 1, p. 31
QuestionWhat is the key point about Incomplete spinal cord syndromes?
AnswerIncomplete spinal cord syndromes are anatomically classified, and all involve some sparing of distal function.
Source: PDF 1, p. 31
QuestionWhat is the key point about 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. Independent ambulation is regained in approximately half of elderly patients and almost all young patients.
Source: PDF 1, p. 31
QuestionWhat is the key point about 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
QuestionIn by C6 to C7., what should you remember about: Brown-Séquard syndrome presents as ipsilateral motor weakness on?
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 the key point about 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 the key point about 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 is the key point about Most thoracic herniated discs?
AnswerMost thoracic herniated discs are treated symptomatically and nonoperatively.
Source: PDF 1, p. 31
QuestionWhat is the key point about Indications for surgery?
AnswerIndications for surgery include progressive thoracic myelopathy and persistent unremitting radicular pain.
Source: PDF 1, p. 31
QuestionIn SECTION 3 THORACIC SPINE, what should you remember about: Anterior transthoracic approaches allow direct access to the?
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 the key point about 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 the key point about Lumbar disc?
AnswerLumbar disc is innervated by the sinuvertebral nerve.
Source: PDF 1, p. 31
QuestionWhat is the key point about Most herniations?
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.
Source: PDF 1, p. 31
source p. 32
QuestionWhat is the key point about Far lateral herniation or foraminal stenosis?
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 this topic, 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
QuestionIn this topic, what should you remember about: Failure to improve after 6 weeks warrants further?
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 the key point about Surgery?
AnswerSurgery is indicated in the presence of persistent symptoms despite 12 weeks of conservative measures, progressive weakness, or evidence of bowel or bladder dysfunction. Partial discectomy with or without laminectomy is the most common procedure performed.
Source: PDF 1, p. 32
QuestionIn this topic, 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 this topic, 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 this topic, 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 this topic, what should you remember about: Statistically significant improvement in secondary outcome measures for?
AnswerStatistically significant improvement in secondary outcome measures for surgical intervention, sciatica bothersomeness, and self-rated improvement.
Source: PDF 1, p. 32
QuestionWhat is the key point about 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 is the key point about Complications?
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 is the key point about Treatment of dural tear?
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 the key point about 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 the key point about Lateral stenosis?
AnswerLateral stenosis is narrowing of the subarticular recess, bounded by the tak-off of the nerve root from the common dural sac to the medial border of the pedicle.
Source: PDF 1, p. 32
QuestionWhat is the key point about 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 the key point about 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 the key point about 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
QuestionIn III. Spondylolysis And Spondylolisthesis, what should you remember about: Isthmic spondylolisthesis can present in childhood or in?
AnswerIsthmic spondylolisthesis can present in childhood or in adults.
Source: PDF 1, p. 32
Pediatric#
QuestionIn Pediatric, 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
QuestionIn Pediatric, what should you remember about: High-grade (>50%) slips are typically more symptomatic and?
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 Adult, what should you remember about: Associated with increased pelvic incidence.?
AnswerAssociated with increased pelvic incidence.
Source: PDF 1, p. 32
QuestionWhat is the key point about Operative treatment frequently?
AnswerOperative treatment frequently requires associated decompression for neurologic compression, stabilization, and posterolateral fusion.
Source: PDF 1, p. 32
QuestionWhat is the key point about Degenerative spondylolisthesis?
AnswerDegenerative spondylolisthesis is more common in women.
Source: PDF 1, p. 32
QuestionIn Adult, what should you remember about: Can present with symptoms of both central and?
AnswerCan present with symptoms of both central and lateral recess spinal stenosis
Source: PDF 1, p. 32
QuestionWhat is the key point about Operative treatment for degenerative spondylolisthesis?
AnswerOperative treatment for degenerative spondylolisthesis involves decompression of nerve roots and stabilization with posterolateral fusion.
Source: PDF 1, p. 32
QuestionIn Adult, 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 secondary to large extruded disc, surgical trauma?
AnswerTypically secondary 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 extremity 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 the key point about Adult scoliosis?
AnswerAdult scoliosis is typically lumbar/thoracolumbar and more symptomatic than its childhood counterpart.
Source: PDF 1, p. 32
QuestionWhat is the key point about 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 the key point about 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 the key point about 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 the key point about 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 is the key point about Can?
AnswerCan occur secondary 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 is the key point about 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 is the key point about Sacral insufficiency fractures can?
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 the key point about 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 is the key point about Red flags for metastatic disease?
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 the key point about Multispecialty involvement?
AnswerMultispecialty involvement is important.
Source: PDF 1, p. 33
QuestionWhat is the key point about 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 the key point about 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 Decompressive surgery techniques, 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 Decompressive surgery techniques, 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 Decompressive surgery techniques, 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 Decompressive surgery techniques, what should you remember about: Multilevel involvement.?
AnswerMultilevel involvement.
Source: PDF 1, p. 33
I. Osteodiscitis#
QuestionWhat is the key point about Most commonly?
AnswerMost commonly presents as pain and elevated erythrocyte sedimentation rate and C-reactive protein levels.
Source: PDF 1, p. 33
QuestionWhat is the key point about 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 key point about Treatment?
AnswerTreatment is with IV antibiotics, and C-reactive protein should be used to monitor the response.
Source: PDF 1, p. 33
QuestionIn I. Osteodiscitis, what should you remember about: Surgical irrigation and débridement and bone grafting are?
AnswerSurgical irrigation and débridement and bone grafting are reserved for cases refractory to medical management.
Source: PDF 1, p. 33
QuestionWhat is the key point about Pyogenic vertebral osteomyelitis?
AnswerPyogenic vertebral osteomyelitis is usually from hematogenous spread and involves Staphylococcus aureus in 50% to 75% of cases.
Source: PDF 1, p. 33
II. Epidural Abscess#
QuestionWhat is the key point about Typically?
AnswerTypically presents with patients being more systemically ill than osteodiscitis and osteomyelitis patients.
Source: PDF 1, p. 33
QuestionWhat is the key point about Management?
AnswerManagement is typically surgical, with irrigation and débridement of infected tissue and drainage of abscess.
Source: PDF 1, p. 33
Differs from pyogenic infections in several ways#
QuestionIn Differs from pyogenic infections in several ways, 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 Differs from pyogenic infections in several ways, 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 Differs from pyogenic infections in several ways, 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 Differs from pyogenic infections in several ways, 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#
QuestionIn IV. Ankylosing Spondylitis, what should you remember about: Associated with HLA-B27, but only 2% of patients?
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
QuestionIn V. Diffuse Idiopathic Skeletal Hyperostosis, what should you remember about: Radiographs typically demonstrate undulating “nonmarginal syndesmophytes.”?
AnswerRadiographs typically demonstrate undulating “nonmarginal syndesmophytes.”
Source: PDF 1, p. 33
I. Upper Cervical Spine Injuries (C1eC2)#
QuestionIn I. Upper Cervical Spine Injuries (C1eC2), what should you remember about: American Spine Injury Association classification of spinal cord?
AnswerAmerican Spine Injury Association classification of spinal cord injury is based on motor strength and complete versus incomplete sensory deficit.
Source: PDF 1, p. 33
QuestionWhat is the key point about C1 ring fractures?
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 key point about Odontoid fracture treatment?
AnswerOdontoid fracture treatment is based on their risk of developing nonunion.
Source: PDF 1, p. 33
QuestionWhat should you know about Type I?
AnswerType I: avulsion of tip of dens; treated in rigid orthosis.
Source: PDF 1, p. 33
QuestionWhat should you know about Type 2?
AnswerType 2: through waist of dens; highest risk of nonunion.
Source: PDF 1, p. 33
QuestionWhat is the key point about Risk factors for nonunion?
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 key point about 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 should you know about 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 Traumatic spondylolisthesis of C2 (hangman’s fracture), what should you remember about: Fracture through pars of C2.?
AnswerFracture through pars of C2.
Source: PDF 1, p. 33
QuestionWhat is the key point about 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 is the key point about 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)#
QuestionIn II. Lower Cervical Spine (C3eC7), what should you remember about: Bilateral facet joint dislocations demonstrate greater than 50%?
AnswerBilateral facet joint dislocations demonstrate greater than 50% translation and are more often associated with spinal cord injury.
Source: PDF 1, p. 33
QuestionWhat is the key point about 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.
Source: PDF 1, p. 33
source p. 34
QuestionWhat is the key point about The 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 the key point about 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 key point about 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 this topic, what should you remember about: External beam irradiation (most common) can be delivered?
AnswerExternal beam irradiation (most common) can be delivered pr-operatively or postoperatively with the same oncologic outcome.
Source: PDF 1, p. 34
QuestionWhat is the key point about Radiation?
AnswerRadiation may be delivered pr-operatively (5000 cGy/50 Gy), followed by resection of the lesion with increased risk of wound healing.
Source: PDF 1, p. 34
QuestionIn this topic, 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
QuestionWhat is the key point about Residual tumor?
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 should you know about STS metastasis?
AnswerSTS metastasis: lung is the most common site of STS metastases.
Source: PDF 1, p. 34
QuestionIn this topic, 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
QuestionIn this topic, what should you remember about: 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 the key point about Synovial sarcoma?
AnswerSynovial sarcoma is the most common sarcoma in the foot.
Source: PDF 1, p. 34
QuestionIn this topic, what should you remember about: Translocation between chromosome 18 and the X chromosomedt(X;18)dis?
AnswerTranslocation between chromosome 18 and the X chromosomedt(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 is the key point about The balanced translocation?
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 key point about 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 the key point about Synovial sarcoma?
AnswerSynovial sarcoma is an unusual STS in which chemotherapy has shown a clinical benefit.
Source: PDF 1, p. 34
QuestionWhat is the key point about Lymph nodes?
AnswerLymph nodes may be involved (ESARC).
Source: PDF 1, p. 34
QuestionWhat is the key point about Epithelioid sarcoma?
AnswerEpithelioid sarcoma is the most common sarcoma of the hand.
Source: PDF 1, p. 34
QuestionWhat should you know about IHC?
AnswerIHC: loss of INI1 expression.
Source: PDF 1, p. 34
QuestionWhat should you know about Differential diagnosis?
AnswerDifferential diagnosis: Granuloma, rheumatoid nodule, or inclusion cyst. Often misdiagnosed as benign process.
Source: PDF 1, p. 34
QuestionWhat should you know about Desmoid fibromatosis IHC?
AnswerDesmoid fibromatosis IHC: positivity for estrogen receptor b and b-catenin (nuclear).
Source: PDF 1, p. 34
QuestionWhat should you know about Neurofibromatosis (von Recklinghausen disease)dgenes?
AnswerNeurofibromatosis (von Recklinghausen disease)dgenes: NF1 and NF2.
Source: PDF 1, p. 34
QuestionWhat is the key point about The colony-stimulating factor-1 pathway that?
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
QuestionIn this topic, what should you remember about: Bone sarcomas metastasize primarily via the hematogenous route?
AnswerBone sarcomas metastasize primarily via the hematogenous route; the lungs are the most common site.
Source: PDF 1, p. 34
QuestionWhat is the key point about Osteosarcoma and Ewing sarcoma?
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 is the key point about Osteoid osteoma?
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 the key point about The 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 the key point about Computed tomographyeguided radiofrequency ablation?
AnswerComputed tomographyeguided radiofrequency ablation is the standard of care.
Source: PDF 1, p. 34
QuestionWhat should you know about Osteoblastoma?
AnswerOsteoblastoma: pain that is NOT diurnal, rather persistent and chronic.
Source: PDF 1, p. 34
QuestionWhat is the key point about Size?
AnswerSize is greater than 2 cm.
Source: PDF 1, p. 34
QuestionWhat should you know about Osteosarcoma?
AnswerOsteosarcoma: Osteosarcoma metastasizes most commonly to the lung and next most commonly to bone.
Source: PDF 1, p. 34
QuestionWhat should you know about IHC?
AnswerIHC: SATB2 and MDM2.
Source: PDF 1, p. 34
QuestionWhat is the key point about 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 this topic, what should you remember about: Parosteal osteosarcoma (low-grade surface).?
AnswerParosteal osteosarcoma (low-grade surface).
Source: PDF 1, p. 34
QuestionWhat is the key point about Resection with a wide margin?
AnswerResection with a wide margin is curative.
Source: PDF 1, p. 34
QuestionWhat should you know about Low-grade lesion?
AnswerLow-grade lesion: chemotherapy NOT required.
Source: PDF 1, p. 34
QuestionIn this topic, what should you remember about: Ollier and Maffuci.?
AnswerOllier and Maffuci.
Source: PDF 1, p. 34
QuestionWhat is the key point about Patients with multiple enchondromatosis?
AnswerPatients with multiple enchondromatosis are at increased risk of malignancy (in Ollier disease, 30%; in Maffucci syndrome, 100%).
Source: PDF 1, p. 34
QuestionWhat is the key point about Patients with Maffucci syndrome also?
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 this topic, what should you remember about: Osteochondroma?
AnswerOsteochondroma
Source: PDF 1, p. 34
QuestionWhat is the key point about 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 this topic, what should you remember about: Multiple hereditary exostoses?
AnswerMultiple hereditary exostoses
Source: PDF 1, p. 34
QuestionWhat is the key point about 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 secondary chondrosarcoma develops. EXT1 mutation is associated with a greater burden of disease and higher risk of malignancy.
Source: PDF 1, p. 34
QuestionWhat should you know about Chondroblastoma treatment?
AnswerChondroblastoma treatment: intralesional resection with curettage and reconstruction.
Source: PDF 1, p. 34
QuestionIn this topic, 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 syndromedand periosteal chondromas may have atypical histopathologic features.
Source: PDF 1, p. 34
QuestionWhat should you know about Chondrosarcoma IHC?
AnswerChondrosarcoma IHC: IDH1 and IDH2.
Source: PDF 1, p. 34
QuestionIn this topic, what should you remember about: Treatment.?
AnswerTreatment.
Source: PDF 1, p. 34
QuestionIn this topic, what should you remember about: Wide surgical resection.?
AnswerWide surgical resection.
Source: PDF 1, p. 34
QuestionWhat is the key point about Chemotherapy?
AnswerChemotherapy has not been shown to improve survival.
Source: PDF 1, p. 34
QuestionIn this topic, what should you remember about: Lymphoma of bone (non-Hodgkin lymphoma).?
AnswerLymphoma of bone (non-Hodgkin lymphoma).
Source: PDF 1, p. 34
QuestionIn this topic, 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 should you know about IHC?
AnswerIHC: CD45- and leukocyte common antigenepositive.
Source: PDF 1, p. 34
Treatment#
QuestionIn Treatment, what should you remember about: Multiagent chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) is?
AnswerMultiagent chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) is curative.
Source: PDF 1, p. 34
QuestionWhat is the key point about Surgery?
AnswerSurgery is used only to stabilize fractures.
Source: PDF 1, p. 34
QuestionIn Treatment, what should you remember about: Giant cell tumor of bone.?
AnswerGiant cell tumor of bone.
Source: PDF 1, p. 34
QuestionIn Treatment, what should you remember about: Stromal malignant cells produce receptor activator for nuclear?
AnswerStromal malignant cells produce receptor activator for nuclear factor kB ligand (RANKL).
Source: PDF 1, p. 34
QuestionIn Treatment, 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 Treatment, 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
QuestionIn Treatment, what should you remember about: Denosumab (Prolia), a human monoclonal antibody that binds?
AnswerDenosumab (Prolia), a human monoclonal antibody that binds RANKL, inhibits the maturation of osteoclasts.
Source: PDF 1, p. 34
source p. 35
QuestionIn this topic, 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
QuestionWhat is the key point about Chemical cauterization?
AnswerChemical cauterization may be used (phenol, peroxide).
Source: PDF 1, p. 35
QuestionWhat is the key point about Area of defect?
AnswerArea of defect is usually reconstructed with subchondral bone grafts, methylmethacrylate, or both.
Source: PDF 1, p. 35
QuestionIn this topic, what should you remember about: Ewing sarcoma?
AnswerEwing sarcoma
Source: PDF 1, p. 35
QuestionWhat is the key point about The 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 should you know about ICH?
AnswerICH: CD99 and FLI-1 positivity.
Source: PDF 1, p. 35
QuestionWhat should you know about A classic t(11?
AnswerA classic t(11:22) chromosomal translocation produces the EWSFLI1 fusion gene.
Source: PDF 1, p. 35
QuestionWhat is the key point about Bone marrow biopsy?
AnswerBone marrow biopsy is performed for staging purposes.
Source: PDF 1, p. 35
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: a multimodal approach with multiagent chemotherapy, irradiation, and surgical resection.
Source: PDF 1, p. 35
QuestionWhat is the key point about Standard treatment?
AnswerStandard treatment includes chemotherapy.
Source: PDF 1, p. 35
QuestionWhat is the key point about Standard for local tumor control?
AnswerStandard for local tumor control is surgery.
Source: PDF 1, p. 35
QuestionWhat is the key point about Radiation therapy?
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
QuestionWhat is the key point about Metastatic disease?
AnswerMetastatic disease involves the lungs (50%), bone (25%), and bone marrow (20%).
Source: PDF 1, p. 35
Poor prognostic factors include the following#
QuestionIn Poor prognostic factors include the following, what should you remember about: Spine and pelvic tumors.?
AnswerSpine and pelvic tumors.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, 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 Poor prognostic factors include the following, 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 Poor prognostic factors include the following, 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 the treatment or management for this concept?
AnswerTreatment: wide-margin surgical resection.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, what should you remember about: Aneurysmal bone cyst?
AnswerAneurysmal bone cyst
Source: PDF 1, p. 35
QuestionWhat should you know about IHC?
AnswerIHC: USP6-positive (chromosome 17p13).
Source: PDF 1, p. 35
QuestionWhat is the treatment or management for this concept?
AnswerTreatment: curettage and reconstruction, which may include bone grafting or fixation in the setting of a fracture.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, what should you remember about: Fibrous dysplasia?
AnswerFibrous dysplasia
Source: PDF 1, p. 35
QuestionWhat is the key point about Genetic mutation?
AnswerGenetic mutation is an activating mutation of the GSa surface protein.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, what should you remember about: Increased production of cAMP.?
AnswerIncreased production of cAMP.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, 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 Poor prognostic factors include the following, what should you remember about: Metastatic bone disease?
AnswerMetastatic bone disease
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, 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 is the key point about The 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
QuestionIn Poor prognostic factors include the following, what should you remember about: Tumor cells secrete parathyroid hormoneerelated peptide (PTHrP), which?
AnswerTumor cells secrete parathyroid hormoneerelated peptide (PTHrP), which stimulates the release of RANKL from the osteoblasts and marrow stromal cells.
Source: PDF 1, p. 35
QuestionIn Poor prognostic factors include the following, 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 Poor prognostic factors include the following, 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 Poor prognostic factors include the following, 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 is the key point about 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 the key point about Lung primary?
AnswerLung primary is the most common for occult metastatic disease.
Source: PDF 1, p. 35
QuestionWhat is the key point about Cortical metastases?
AnswerCortical metastases are common in lung cancer.
Source: PDF 1, p. 35
source p. 36
QuestionWhat is the key point about The 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 the key point about 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 is the key point about Loss of gluteus medius function?
AnswerLoss of gluteus medius function leads to pelvic tilt and midstance instability.
Source: PDF 1, p. 36
QuestionIn this topic, 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 should you know about 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 is the key point about Common complications of amputation?
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 the key point about 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 the key point about 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 the key point about 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 this topic, 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 is the key point about Medicare functional classification level?
AnswerMedicare functional classification level provides recommendations on prosthesis prescription for lower limb amputations.
Source: PDF 1, p. 36
QuestionWhat is the key point about 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 this topic, what should you remember about: Orthopedic surgery can be considered for spasticity if?
AnswerOrthopedic 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.
Source: PDF 1, p. 36
source p. 37
Polytrauma Management#
QuestionIn Polytrauma Management, what should you remember about: Damage control orthopaedic principles involve staging the definitive?
AnswerDamage control orthopaedic 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
QuestionIn Polytrauma Management, what should you remember about: Early appropriate care can lead to reduced risk?
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 Polytrauma Management, what should you remember about: Lactate to <4.0 mmol/L.?
AnswerLactate to <4.0 mmol/L.
Source: PDF 1, p. 37
QuestionIn Polytrauma Management, what should you remember about: pH >7.25.?
AnswerpH >7.25.
Source: PDF 1, p. 37
QuestionIn Polytrauma Management, what should you remember about: Base excess >5.5 mmol/L.?
AnswerBase excess >5.5 mmol/L.
Source: PDF 1, p. 37
QuestionWhat is the key point about Post-traumatic stress disorder (PTSD)?
AnswerPost-traumatic stress disorder (PTSD) is common.
Source: PDF 1, p. 37
QuestionIn Polytrauma Management, 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 is the key point about Women?
AnswerWomen are more affected than men, and the symptoms often last longer in women.
Source: PDF 1, p. 37
Open Fracture Management#
QuestionIn Open Fracture Management, what should you remember about: Antibiotics administer within 3 hours of injury. This?
AnswerAntibiotics administer within 3 hours of injury. This is the most effective way to decrease infection risk.
Source: PDF 1, p. 37
QuestionIn Open Fracture Management, 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 Open Fracture Management, 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.
Source: PDF 1, p. 37
Basics of Fracture Healing and Fixation#
QuestionIn Basics of Fracture Healing and Fixation, 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.
Source: PDF 1, p. 37
Specific Trauma Scenarios#
QuestionIn Specific Trauma Scenarios, what should you remember about: Compartment syndrome diagnosisdintracompartmental pressure within 30 mm Hg?
AnswerCompartment syndrome diagnosisdintracompartmental pressure within 30 mm Hg of the diastolic pressure (DP) is diagnostic.
Source: PDF 1, p. 37
Proximal Humerus Fractures#
QuestionWhat is the key point about Tuberosity healing?
AnswerTuberosity healing is important for function/outcomes.
Source: PDF 1, p. 37
QuestionWhat is the key point about Low-demand/elderly patients most often?
AnswerLow-demand/elderly patients most often are indicated for nonoperative treatment.
Source: PDF 1, p. 37
QuestionIn Proximal Humerus Fractures, what should you remember about: Medial metadiaphyseal extension less than 8 mm (calcar?
AnswerMedial metadiaphyseal extension less than 8 mm (calcar <8 mm) is associated with humeral head ischemia.
Source: PDF 1, p. 37
Indications for open reduction and internal fixation (ORIF)#
QuestionIn Indications for open reduction and internal fixation (ORIF), 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 Indications for open reduction and internal fixation (ORIF), 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.
Source: PDF 1, p. 37
Elbow Injuries#
QuestionWhat is the key point about Elbow instability?
AnswerElbow instability is most commonly posterolateral rotatory instability (80%).
Source: PDF 1, p. 37
QuestionIn Elbow Injuries, what should you remember about: Terrible triad of the elbowdelbow dislocation with lateral?
AnswerTerrible triad of the elbowdelbow dislocation with lateral collateral ligament injury, radial head fracture, and coronoid fracture.
Source: PDF 1, p. 37
Pelvic Ring Injuries and Sacral Fractures#
QuestionIn Pelvic Ring Injuries and Sacral Fractures, what should you remember about: Anteroposterior (AP) pelvis during the initial trauma evaluationdcritical?
AnswerAnteroposterior (AP) pelvis during the initial trauma evaluationdcritical to be able to immediately recognize an injury with increased pelvic volume.
Source: PDF 1, p. 37
QuestionWhat is the key point about If there?
AnswerIf there is an injury with increased pelvic volume, apply a sheet or binder immediately.
Source: PDF 1, p. 37
QuestionWhat is the key point about If there?
AnswerIf there is concern for arterial bleeding on computed tomography (CT) scan, proceed to angiographic embolization.
Source: PDF 1, p. 37
QuestionIn Pelvic Ring Injuries and Sacral Fractures, 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 Pelvic Ring Injuries and Sacral Fractures, 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 Pelvic Ring Injuries and Sacral Fractures, 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.
Source: PDF 1, p. 37
Acetabulum Fractures#
QuestionIn Acetabulum Fractures, 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 Acetabulum Fractures, 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 the key point about 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 Acetabulum Fractures, 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 Acetabulum Fractures, 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 the key point about Transverse posterior wall?
AnswerTransverse posterior wall is the pattern associated with the highest rate of nerve injury.
Source: PDF 1, p. 37
QuestionIn Acetabulum Fractures, 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.
Source: PDF 1, p. 37
Geriatric Hip Fractures#
QuestionIn Geriatric Hip Fractures, 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 key point about 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 the key point about Multimodal analgesia incorporating pr-operative nerve block?
AnswerMultimodal analgesia incorporating pr-operative nerve block is recommended.
Source: PDF 1, p. 37
QuestionIn Geriatric Hip Fractures, 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 Geriatric Hip Fractures, 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 the key point about 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 the key point about Cemented femoral component?
AnswerCemented femoral component is recommended when treating femoral neck fractures .
Source: PDF 1, p. 37
QuestionWhat is the key point about 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 Geriatric Hip Fractures, 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 the key point about Sliding hip screw (SHS)?
AnswerSliding hip screw (SHS) is indicated for stable intertrochanteric fractures.
Source: PDF 1, p. 37
QuestionIn Geriatric Hip Fractures, 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 Geriatric Hip Fractures, 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
QuestionIn Geriatric Hip Fractures, what should you remember about: SHS cheaper than short CMN, which is cheaper?
AnswerSHS cheaper than short CMN, which is cheaper than long CMN.
Source: PDF 1, p. 37
QuestionIn Geriatric Hip Fractures, 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.
Source: PDF 1, p. 37
Young Adult Proximal Femur Injuries#
QuestionIn Young Adult Proximal Femur Injuries, what should you remember about: Hip dislocationdemergent open reduction if irreducible after closed?
AnswerHip dislocationdemergent open reduction if irreducible after closed reduction.
Source: PDF 1, p. 37
QuestionIn Young Adult Proximal Femur Injuries, 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.
Source: PDF 1, p. 37
source p. 38
QuestionIn this topic, what should you remember about: Femoral head fracturesdPipkin type III; associated femoral neck?
AnswerFemoral head fracturesdPipkin type III; associated femoral neck fracture has the worst outcomes.
Source: PDF 1, p. 38
QuestionIn this topic, 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 this topic, 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 the key point about Femoral neck nonuniondin young patients this?
AnswerFemoral neck nonuniondin young patients this is traditionally treated with a valgus-producing osteotomy.
Source: PDF 1, p. 38
Femur Fractures#
QuestionIn Femur Fractures, what should you remember about: Femur shaft.?
AnswerFemur shaft.
Source: PDF 1, p. 38
QuestionIn Femur Fractures, 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 is the key point about High incidence of malrotationduse of a fracture table?
AnswerHigh incidence of malrotationduse of a fracture table has a higher incidence of rotational malunion than manual traction.
Source: PDF 1, p. 38
QuestionWhat is the key point about 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 Femur Fractures, 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 Femur Fractures, 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 Femur Fractures, what should you remember about: Distal femur fractures.?
AnswerDistal femur fractures.
Source: PDF 1, p. 38
QuestionIn Femur Fractures, 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 is the key point about Geriatric patients?
AnswerGeriatric patients have a high 1-year mortality; decreased mortality in patients who undergo ORIF within 48 hours.
Source: PDF 1, p. 38
Knee Injuries#
QuestionWhat should you know about Knee dislocationdif concern for vascular injury?
AnswerKnee dislocationdif concern for vascular injury: reduce knee, re-evaluate.
Source: PDF 1, p. 38
QuestionIn Knee Injuries, 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 Knee Injuries, what should you remember about: Patella fractures.?
AnswerPatella fractures.
Source: PDF 1, p. 38
QuestionWhat should you know about 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 should you know about 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 is the key point about Quad tendondsuture anchor fixation shown to?
AnswerQuad tendondsuture anchor fixation shown to have less gap formation during cadaveric cyclic loading and higher strength than transosseous suture fixation.
Source: PDF 1, p. 38
Tibia Plateau/Shaft Fractures#
QuestionIn Tibia Plateau/Shaft Fractures, what should you remember about: Tibia plateau fracture.?
AnswerTibia plateau fracture.
Source: PDF 1, p. 38
QuestionIn Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, what should you remember about: Tibia shaft fracture.?
AnswerTibia shaft fracture.
Source: PDF 1, p. 38
QuestionIn Tibia Plateau/Shaft Fractures, what should you remember about: High rate of compartment syndromedhigher in younger age?
AnswerHigh rate of compartment syndromedhigher in younger age, treat with emergent fasciotomies.
Source: PDF 1, p. 38
QuestionIn Tibia Plateau/Shaft Fractures, what should you remember about: Semiextende nailingdimproved ease of intraoperative imaging; improved reduction?
AnswerSemiextende nailingdimproved ease of intraoperative imaging; improved reduction of distal fractures.
Source: PDF 1, p. 38
QuestionWhat is the key point about Suprapatellar?
AnswerSuprapatellar has equivalent or improved knee pain compared to infrapatellar.
Source: PDF 1, p. 38
QuestionIn Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, 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 Tibia Plateau/Shaft Fractures, what should you remember about: Tibia shaft nonunion.?
AnswerTibia shaft nonunion.
Source: PDF 1, p. 38
QuestionIn Tibia Plateau/Shaft Fractures, what should you remember about: Infection must be ruled out.?
AnswerInfection must be ruled out.
Source: PDF 1, p. 38
QuestionWhat is the key point about Reamed-exchange nailing?
AnswerReamed-exchange nailing is preferred treatment for middiaphyseal tibial nonunions.
Source: PDF 1, p. 38
Pediatric Trauma General Topics#
QuestionIn Pediatric Trauma General Topics, 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
QuestionIn Pediatric Trauma General Topics, what should you remember about: In pediatric patients, multiorgan failure from polytrauma is?
AnswerIn pediatric patients, multiorgan failure from polytrauma is often immediately after admission during the resuscitation phase.
Source: PDF 1, p. 38
Pediatric Elbow#
QuestionIn Pediatric Elbow, what should you remember about: Supracondylar humerus fracture.?
AnswerSupracondylar humerus fracture.
Source: PDF 1, p. 38
QuestionIn Pediatric Elbow, 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 Pediatric Elbow, 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 Pediatric Elbow, 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 Pediatric Elbow, 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 extremity.
Source: PDF 1, p. 38
QuestionIn Pediatric Elbow, 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 Pediatric Elbow, what should you remember about: Medial epicondyle.?
AnswerMedial epicondyle.
Source: PDF 1, p. 38
QuestionWhat is the key point about If apophysis?
AnswerIf apophysis is missing from an AP view, lateral and oblique views should be carefully evaluated for possible incarceration.
Source: PDF 1, p. 38
QuestionWhat is the key point about Incarceration of the fragment?
AnswerIncarceration of the fragment is an indication for surgical treatment.
Source: PDF 1, p. 38
Pediatric Femur Fractures#
QuestionIn Pediatric Femur Fractures, what should you remember about: Femur shaft fracture.?
AnswerFemur shaft fracture.
Source: PDF 1, p. 38
QuestionIn Pediatric Femur Fractures, 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 the key point about Compartment syndrome?
AnswerCompartment syndrome is a risk with spica casting and should be monitored.
Source: PDF 1, p. 38
QuestionIn Pediatric Femur Fractures, what should you remember about: Rigi nailingdtrochanteric or lateral entry nailing required.?
AnswerRigi nailingdtrochanteric or lateral entry nailing required.
Source: PDF 1, p. 38
QuestionIn Pediatric Femur Fractures, 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 Pediatric Femur Fractures, what should you remember about: Distal femur.?
AnswerDistal femur.
Source: PDF 1, p. 38
QuestionIn Pediatric Femur Fractures, 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 Pediatric Femur Fractures, 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 Pediatric Femur Fractures, what should you remember about: Growth arrestdvery common (30%-50%); patients and families should?
AnswerGrowth arrestdvery common (30%-50%); 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 Pediatric Femur Fractures, 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 should you know about 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.
Source: PDF 1, p. 39
QuestionWhat is the key point about Conflicts of interest?
AnswerConflicts of interest are common and must be resolved in the patient’s best interest.
Source: PDF 1, p. 39
QuestionWhat should you know about Most common conflicts?
AnswerMost common conflicts: facility ownership and relationships with industry where physicians should disclose payment to patients.
Source: PDF 1, p. 39
QuestionIn this topic, what should you remember about: American Academy of Orthopaedic Surgeons Standards of Professionalism?
AnswerAmerican Academy of Orthopaedic Surgeons Standards 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,
Source: PDF 1, p. 39
and the American Board of Orthopaedic Surgery.#
QuestionIn and the American Board of Orthopaedic Surgery., what should you remember about: Child abuse laws require reporting all suspected cases?
AnswerChild abuse laws require reporting all suspected cases of child abuse to local authorities.
Source: PDF 1, p. 39
QuestionWhat should you know about 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.
Source: PDF 1, p. 39
QuestionWhat is the key point about Physician-patient communication?
AnswerPhysician-patient communication is the most common factor cited in malpractice cases.
Source: PDF 1, p. 39
QuestionWhat is the key point about Supervisors?
AnswerSupervisors are responsible for their trainees (vicarious liability).
Source: PDF 1, p. 39
QuestionWhat is the key point about Residents/fellows?
AnswerResidents/fellows are held to the same standard as board-certified surgeons.
Source: PDF 1, p. 39
source p. 40
Clinical Research Designs#
QuestionIn Clinical Research Designs, 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.
Source: PDF 1, p. 40
QuestionWhat is the key point about 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.
Source: PDF 1, p. 40
QuestionWhat is the key point about The gold standard and highest level of evidence in clinical trials?
AnswerThe gold standard and highest level of evidence in clinical trials is the randomized controlled trial.
Source: PDF 1, p. 40
QuestionIn Clinical Research Designs, what should you remember about: 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.
Source: PDF 1, p. 40
Common Flaws in Research Designs#
QuestionWhat is the key point about Confounding variables?
AnswerConfounding variables are factors extraneous to a research design that potentially influence the outcome.
Source: PDF 1, p. 40
QuestionWhat is the key point about 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.
Source: PDF 1, p. 40
QuestionIn Common Flaws in Research Designs, 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.
Source: PDF 1, p. 40
How Many Subjects Are Needed to Complete a Research Study?#
QuestionWhat is the key point about Studies that?
AnswerStudies that have adequate statistical “power” are capable of finding hypothesized relationships if they exist.
Source: PDF 1, p. 40
QuestionWhat is the key point about More subjects/samples/observations?
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.
Source: PDF 1, p. 40
QuestionWhat is the key point about Studies with low statistical power?
AnswerStudies with low statistical power have higher likelihood of missing statistical differences (or relationships) when they actually exist (i.e., type II error).
Source: PDF 1, p. 40
Describing Your Data With Simple Statistics#
QuestionIn Describing Your Data With Simple Statistics, what should you remember about: Mean, median, mode, range, and standard deviation are?
AnswerMean, median, mode, range, and standard deviation are commonly used measures to describe fundamental characteristics of a dataset.
Source: PDF 1, p. 40
QuestionIn Describing Your Data With Simple Statistics, 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.
Source: PDF 1, p. 40
QuestionWhat is the key point about Outliers?
AnswerOutliers are data points that are considerably different from the rest of the dataset. Outliers can cause data distributions to be skewed.
Source: PDF 1, p. 40
Concepts in Epidemiologic Research Studies#
QuestionWhat is the key point about Prevalence?
AnswerPrevalence is the proportion of existing injuries/ disease cases conditions within a particular population.
Source: PDF 1, p. 40
QuestionWhat is the key point about Incidence (absolute risk)?
AnswerIncidence (absolute risk) is the proportion of new injuries/ disease cases within a specified time interval (requires a follow-up period).
Source: PDF 1, p. 40
QuestionIn Concepts in Epidemiologic Research Studies, 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.
Source: PDF 1, p. 40
QuestionIn Concepts in Epidemiologic Research Studies, 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.
Source: PDF 1, p. 40
QuestionWhat should you know about 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).
Source: PDF 1, p. 40
QuestionWhat should you know about 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).
Source: PDF 1, p. 40
QuestionWhat is the key point about 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).
Source: PDF 1, p. 40
What Statistical Test to Use for Different Analyses in Research#
QuestionWhat is the key point about 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.
Source: PDF 1, p. 40
QuestionIn What Statistical Test to Use for Different Analyses in Research, what should you remember about: In general, t-tests are used to compare two?
AnswerIn general, t-tests are used to compare two sample means, while analysis of variance (ANOVA) tests are used to compare three or more.
Source: PDF 1, p. 40
QuestionWhat is the key point about Post hoc testing?
AnswerPost hoc testing is necessary after any ANOVA test to determine the exact locations of differences among the compared groups.
Source: PDF 1, p. 40
QuestionIn What Statistical Test to Use for Different Analyses in Research, 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.
Source: PDF 1, p. 40
QuestionWhat is the key point about 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).
Source: PDF 1, p. 40
QuestionWhat is the key point about Logistic regression?
AnswerLogistic regression is used when the outcome is categorical and the predictor variables can be either categorical or nonenormally distributed continuous data.
Source: PDF 1, p. 40
QuestionWhat should you know about Chi-square (c2 ) test?
AnswerChi-square (c2 ) test: used for two or more groups of categorical data. Fisher exact test is similar to the c2 test but better for small sample sizes.
Source: PDF 1, p. 40
Validity and Reliability#
QuestionIn Validity and Reliability, what should you remember about: Accuracy/validity describes alignment with grounded truth/reality.?
AnswerAccuracy/validity describes alignment with grounded truth/reality.
Source: PDF 1, p. 40
QuestionIn Validity and Reliability, 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.
Source: PDF 1, p. 40
QuestionIn Validity and Reliability, 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.
Source: PDF 1, p. 40
Interpretation of Statistical Test Results#
QuestionIn Interpretation of Statistical Test Results, what should you remember about: P values less than 0.05 mean there is?
AnswerP values less than 0.05 mean there is less than 5% chance of a type I error and commonly defined as “statistically significant.”
Source: PDF 1, p. 40
QuestionIn Interpretation of Statistical Test Results, what should you remember about: However, statistical significance does not imply clinical importance.?
AnswerHowever, statistical significance does not imply clinical importance.
Source: PDF 1, p. 40
QuestionWhat is the key point about Minimal clinically important differences?
AnswerMinimal clinically important differences is a method to describe the importance of an observed difference during a statistical test.
Source: PDF 1, p. 40
QuestionWhat is the key point about 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).
Source: PDF 1, p. 40
source p. 41
QuestionWhat should you know about 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).
Source: PDF 1, p. 41
QuestionWhat should you know about 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).
Source: PDF 1, p. 41